Lack of alloimmunization to D antigen in D-negative immunosuppressed liver transplant recipients.

BACKGROUND: Orthotopic liver transplantation (OLT) sometimes requires large amounts of blood. An adequate supply of Rh-negative blood for Rh-negative patients is not always available. STUDY DESIGN AND METHODS: Seventeen Rh-negative patients, out of 327 receiving OLT in this hospital, received from 5 to 41 units of Rh-positive red cells during surgery. Each of the 17 patients was followed for 7 weeks to 70 months after OLT for detection of unexpected antibodies. Cyclosporin A and prednisone, azathioprine, and adjunctive rabbit antilymphocyte globulin or monoclonal OKT3 antibody were used to prevent graft rejection. RESULTS: Evidence of immunization, either to D or to antigens in the rest of the red cell antigen systems, did not appear in any patients. CONCLUSION: It is hypothesized that cyclosporin A affects the immune humoral response, inhibiting lymphocyte activation and the primary immune response; consequently, Rh-positive blood may be transfused to Rh-negative OLT recipients so treated with little or no risk of alloimmunization.

The fine structural localization of endogenous and exogenous peroxidase activity in human bone marrow mast cells under pathological conditions.

We have examined the ultrastructural characteristics of peroxidase activity in human bone marrow mast cells. These studies were performed in three patients with systemic mast cell disease, and in another six patients showing bone marrow mast cell hyperplasia. Endogenous peroxidase activity was localized in the perinuclear cisternae and strands of endoplasmic reticulum, but never in the granules. We have also demonstrated the "in vivo" existence of exogenous peroxidase activity in two of the three cases of systemic mast cell disease. The peroxidase internalization involved its binding to the plasma membrane, followed by its incorporation into the cell by a general endocytic process comprising the uptake of dispersed peroxidase-positive material mainly by phagocytosis of granular structures containing peroxidase. The exogenous peroxidase appeared in non-membrane bound granules, vacuoles or aggregates, but we have never seen the enzyme linked to the mast cell granules.

Rhabdomyosarcoma presenting with diffuse bone marrow involvement, hypercalcemia and renal failure.

Rhabdomyosarcoma and other small round-cell neoplasms of infancy and childhood frequently involve the bone marrow. An unusual clinical presentation of diffuse bone marrow involvement as the sole manifestation of the disease represents a difficult diagnostic challenge. We report the case of an 18-year-old boy presenting with lower back pain, sternum tenderness, anemia, thrombocytopenia, leukoerythroblastic blood film, hypercalcemia, and renal failure. No solid tumor was found. A diagnosis of rhabdomyoblastic bone marrow metastatic involvement was initially suggested by the morphological picture, and later confirmed by the ultrastructural findings. Hypercalcemia and renal failure were controlled, initially, with furosemide and calcitonin. The patient was treated with intensive chemotherapy, including vincristine, actinomycin D, cyclophosphamide, and doxorubicin. A remission was achieved, lasting 5 months until relapse.

Ultrastructural study of blood cells in toxic oil syndrome.

The toxic oil syndrome is a new multisystemic disease, linked to the consumption of denatured rapeseed oil, which occurred in Spain in 1981. The hematological symptoms, present in about all the patients since the beginning of this disease have been dominated by leukocytosis and eosinophilia. The ultrastructural study of circulating blood cells has shown the presence of multiple abnormal lipid vacuoles in the eosinophil series and less frequently in neutrophils, monocytes and lymphocytes, associated to a high phagocytic activity. Bone marrow cells contrasted by the absence of lipid vacuoles in any hemopoietic series, while phagocytic activity and cytoplasmic processes were abundant. Even though patients entered the chronic phase of the disease, the hematological symptoms have spontaneously corrected themselves.

Six new cases of prolymphocytic leukemia with heterogeneous prognosis. Clinical and immunologic features, light microscopy, and ultrastructural findings.

The clinical features and diagnostic evaluation of six patients affected by prolymphocytic leukemia (PLL), are described. Some of the cases deviate from a relatively uniform and aggressive clinical course of the disease entity. An actuarial survival analysis of 60 cases gathered from the literature and the authors' experience indicate that the cases showing the most prolongated evolution may reach 30% of the total. The different aggressiveness in the clinical course of these patients does not depend on the efficiency of the therapies applied. The percentage of prolymphocytes (PL) in peripheral blood throughout the clinical course was variable and not depending on the treatments used. This fact, in conjunction with (1) the presence of cellular types deviated from the typical PL and detected both at optical and ultrastructural levels and (2) the existence of cases of PL with minimal splenomegaly and leukocyte counts of less than 50 X 10(9)/liter, could lead to an underdiagnosis of PLL and hinder the actual cognition of the natural medical history of the disease.

On the histogenesis of Ewing's sarcoma. An ultrastructural, immunohistochemical, and cytochemical study.

Forty-two cases of Ewing's sarcoma (ES) have been studied with light microscopy during the 9-year period 1974 to 1982. Thirty-three patients had ES of bone, and in 9 patients the tumor was located in the extraskeletal soft tissues. Cases which fulfilled all the morphologic criteria were accepted as typical ES (31 cases), and those with some architectural or cytologic peculiarities were considered atypical forms of ES (11 cases). An immunohistochemical study (PAP method) to evaluate the presence in the tumor cells of the following markers: myoglobin, F-VIII-related antigen, lysozyme, alpha-1-antitrypsin, alpha-1-antichymotrypsin, and immunoglobulins (IgG, IgA, IgM, kappa and lambda light chains), was performed with negative results in all cases (paraffin blocks were available in 38 cases). The cytochemical study on fresh tissue imprints from five patients (PAS, Sudan Black, alpha-naphthyl acetate esterase, acid phosphatase, beta glucuronidase, myeloperoxidases, naphthol-AS-D chloroacetate esterase and alkaline phosphatase) gave no pattern of histogenetic significance, PAS being the best morphologic marker in tissue sections and touch preparations. A detailed ultrastructural study was performed on 34 cases; the main findings may be summarized as follows: medium sized cells, polygonal shape, oval nuclei, smooth nuclear envelope, abundant euchromatin, well-developed nucleolonema, scant membranous organelles, abundant hyaloplasmic glycogen, occasional lipid vacuoles, straight cell membranes, and primitive intercellular junctions. No differences were found between bone and extraskeletal ES; moreover, typical and atypical forms showed moderate quantitative differences with no qualitative change. The histogenesis is discussed; no functional or morphologic markers have been found to suggest the cell of origin; however, some cell lines may be excluded. It is the impression of the authors that they are dealing with a primitive noncommitted mesenchymal cell.

Signet-ring cell lymphoma. Ultrastructural and immunohistochemical features of three varieties.

An ultrastructural and immunohistochemical study was performed on three malignant lymphomas of follicular center cell origin with signet-ring cells. The first case corresponded to a diffuse lymphoma with follicular center cells and plasmacytic features; the other two cases corresponded to the nodular centrocytic-centroblastic category. The neoplastic lymphocytes contained Russell bodylike inclusions, clear vacuoles, and ill-defined eosinophilic masses, respectively, which produced a displacement of the nuclei to the periphery. Ultrastructurally, there were three different morphologic types because of the following cytoplasmic changes: the accumulation of electron-dense granular material in the cisternae of the rough endoplasmic reticulum; the formation of clear vacuoles with a smooth limiting membrane; and, the presence of granular-fibrillar and crystalline material in the hyaloplasm without a limiting membrane. The first type of signet-ring cell contained monoclonal immunoglobulin (IgM-K). No immunoglobulins were found in the clear cytoplasmic vacuoles of the second type; however, the rim of cytoplasm stained for IgG, kappa and lambda. Finally, the third type showed IgG and kappa light chain in the hyaloplasmic inclusions. It is concluded that the signet-ring cell appearance is due to an abnormal production and secretion of immunoglobulins.

Lymphoblastic lymphoma/leukemia of T-cell origin: ultrastructural, cytochemical, and immunologic features of ten cases.

Ten cases of T-lymphoblastic lymphoma/leukemia were studied with light and electron microscopy. Cytochemical strains were performed on touch preparations, and mononuclear cell suspensions were tested for spontaneous rosette formation with sheep erythrocytes, C3 receptors, and surface immunoglobulins. The present investigation was performed to evaluate several ultrastructural parameters, mainly the nuclear shape, as diagnostic clues for this group of lymphomas. Characteristic convoluted nuclei were present in 7 to 47% of the lymphoblasts. This percentage correlated with the focal acid phosphatase reaction and E-rosette formation. Acid phosphatase was the best cytochemical marker (70-100% of the lymphoblasts showed focal reaction product). By ultrastructural cytochemistry, the reaction product was demonstrated in the Golgi cisternae and primary lysosomes. The cell suspensions obtained from different sources contained 14 to 95% E-rosette-forming cells. No specific morphologic, cytochemical, or immunologic differences were found between patients with or without mediastinal involvement.

Unusual inheritance in the ABO blood group system: a group O child from a group A2B mother.

A serologically typical group A2B mother with no unusual anti-A or anti-B agglutinins delivered a normal group O infant with no demonstrable A or B antigens. By the age of 1 year the child had developed anti-A and anti-B agglutinins. He had H antigen and secreted H substance in his saliva. A second group O child has since been born. Although family studies were inconclusive, the most likely explanation is that the mother is a cis-AB. If this is the case, she differs from other reported cis-ABs in her apparently normal B antigen and the lack of anti-B antibodies in her serum.