Cytoplasmic inclusions in leukocytes. An unusual manifestation of cryoglobulinemia.

Cryoglobulins are circulating immunoglobulins characterized by reversible, cold-induced precipitation. A variety of laboratory abnormalities, including hypocomplementemia, elevated erythrocyte sedimentation rate, rheumatoid factor activity, pseudoleukocytosis, and pseudothrombocytosis, are associated with cryoglobulinemia. Extracellular, faintly basophilic, amorphous deposits of cryoglobulins occasionally have been described in blood smears. In the present study, smears prepared from blood collected at room temperature from 6 patients with cryoglobulinemia exhibited neutrophil and, occasionally, monocyte inclusions containing clear, light pink, or faintly basophilic amorphous material. The inclusions were absent in smears from blood collected and maintained at 37 degrees C. Ultrastructural examination revealed that the material within the leukocyte inclusions was consistent with phagocytosed immunoglobulins. The identification of characteristic cytoplasmic inclusions in leukocytes may be an important clue in the early recognition of cryoglobulinemia.

Acute myelogenous leukemia (FAB AML-M1) in the setting of HIV infection and G-CSF therapy: a case report and review of the literature.

Although hematologic dysplasia is common in HIV disease, evolution to AML is unusual. We report a case of AML in a patient with stage-C3 AIDS who had been previously treated with granulocyte colony-stimulating factor (G-CSF). This 41-year-old black man presented with pancytopenia (Hg 8.6 g/dl, Hct 24.3%, platelets 16,000/mm3, WBC 0.6 x 10(3)/mm3) and hemoptysis. His peripheral smear manifested 19% blasts. His bone marrow biopsy was hypocellular (20%) with greater than 90% blasts, which were positive for myeloperoxidase and Sudan black B. The blasts were negative for nonspecific esterase. Immunophenotypic analysis by flow cytometry showed the majority of cells to be of myeloid lineage, expressing CD13, and CD45 at low intensity. In addition, there was aberrant expression of CD2 and no expression of CD14 or CD4. The diagnosis of AML-FAB-M1 was made. The patient refused chemotherapy. Of the rare cases of AML in HIV patients previously reported in the literature, the majority were of the monocytic or myelomonocytic subtype. This case is of special interest because of prior G-CSF therapy. In this setting, the relationship between HIV, G-CSF, and subsequent AML is controversial.

CD5 negative diffuse mantle cell lymphoma with splenomegaly and bone marrow involvement.

We report the case of a 78-year-old man in whom routine physical examination revealed cervical adenopathy and splenomegaly. Peripheral blood showed a normal white blood cell count with an absolute lymphocytosis, which included a population with slightly indented nuclei. Lymph node biopsy showed morphology compatible with mantle cell lymphoma. Bone marrow biopsy showed replacement by a lymphoid proliferation composed of lymphocytes with features similar to those found in the peripheral blood. Immunophenotypic analysis of both peripheral blood and lymph node showed positivity for CD19, CD20 and CD22, with lambda light chain restriction. Tests for CD5 and CD10 were negative. Cytogenetic analysis and polymerase chain reaction studies confirmed the presence of t(11,14) supporting a diagnosis of mantle cell lymphoma. This unusual case of CD5-negative mantle cell lymphoma exemplifies the importance of combined molecular, cytogenetic, and morphologic evaluation when confronted with a lymphoma having an atypical phenotype.

Web-like malformation of the carotid artery and multicystic encephalomalacia.

Multicystic encephalomalacia and hydranencephaly lie within a spectrum of brain lesions linked to ischemic cerebral damage. Causes include vascular malformation, thrombosis, embolism, infection, and toxins. We describe an infant with multicystic encephalomalacia associated with a peculiar web-like malformation of the right common carotid and left subclavian arteries. We postulate that this luminal bridging is a congenital malformation resulting from defective canalization of the medium-sized blood vessels but could represent organized and recanalized thrombi, the etiology of which remains unknown.