Biphenotypic Philadelphia positive, monosomy seven acute leukaemia: ultrastructural immunocytochemical study.

A case of Ph1 positive acute leukaemia is presented in which an additional chromosome change, monosomy 7 was found. There was no clinical evidence of a pre-existing chronic myeloid leukaemia. Cytochemistry and immunology showed a predominant HLA-DR+, TdT+, cALL- phenotype, with a small percentage of HLA-DR+, Leu-Ml+ and cALL- cells. The true biphenotypic nature of this case was clearly shown by transmission electron microscopy using the immunogold method combined with myeloperoxidase (MPO). Two distinct phenotypes, lymphoid (cALL+, MPO-) and myeloid (LeuMl+, MPO+) were identified with this technique. An immuno-scanning electron microscope technique was also used to study this case, which demonstrated the presence of two different surface morphologies.

Ultrastructural evaluation of periodate-reactive glycoconjugates in human leukaemia cells.

Periodate-reactive glycoconjugates in human leukaemic cells were examined electron microscopically by the periodic acid-thiocarbohydrazide-silver proteinate (PA-TCH-SP) method. Granules in ALL cells were classified into 4 types based on PA-TCH-SP staining features. Abnormal granules containing glycogen were observed only in children with treatment-resistant ALL. Cytoplasmic granules in leukaemic cells of patients with AML and acute monocytic leukaemia exhibited moderate reactivity. The distribution pattern of glycogen in the cytoplasm of leukaemic cells was classified into 3 types, one lacking glycogen, one containing small glycogen particles scattered throughout cytoplasm, and one showing clusters of glycogen particles. Cells with glycogen clusters were observed in ALL cells and in erythroblasts from patients with erythroleukaemia. PA-TCH-SP reactivity was detected in the rough endoplasmic reticulum in acute promyelocytic leukaemia but not in ALL or other types of AML. Megakaryoblasts in megakaryocytic crisis of chronic myelogenous leukaemia exhibited characteristic PA-TCH-SP reactivity similar to that of normal megakaryocytes.

Ultrastructural criteria in evaluating leukemic infiltration in prepubertal testicular biopsies.

The diagnosis of leukemic infiltration in the testis by routine histology is not always possible. During the past 5 years, 46 bilateral testicular biopsies from prepubertal boys were examined by electron microscopy for the purpose of establishing the presence or absence of leukemic infiltration. The ultrastructure of the cells of acute lymphoblastic leukemia is described from the positive cases and compared with cases from the literature. Variations in ultrastructure between the T-cell, B-cell, and "null cell" types are discussed. The ultrastructure of the normal prepubertal cellular elements, which include immature Leydig cells, primitive fibroblastic cells (intertubular), and attenuated peritubular fibroblasts, is described. Ultrastructural criteria are summarized that enable a definitive evaluation of cases that are equivocal by histologic examination.

Chronic lymphocytic leukemia with IgM lambda and IgG lambda cytoplasmic inclusions.

We studied a unique case of chronic lymphocytic leukemia with intracytoplasmic inclusions containing IgM lambda and IgG lambda. We postulated a neoplastic arrest in B-cell ontogeny at the point of the IgM-IgG switch and a secretory defect.

Chromosomal aberrations in a case of T-cell CLL with concomitant IgA myeloma.

Four consistent markers, involving chromosomes 8, 11, 14, 18, 21 and 22, were found in the majority of metaphases obtained after stimulation of peripheral blood and bone marrow from a patient with a T-cell chronic lymphocytic leukemia (CLL) and a concomitant IgA/lambda myeloma with phytohemagglutinin (PHA), lipopolysaccharide of E. coli (LPS) and S. aureus strain Cowan I bacteria (Cowan). A second malignant clone with three additional markers was observed after stimulation with Concanavalin A (Con A). A chromosome 14 aberration, inv(14) (q11-q32), may be of significance in the T-cell malignancy and may suggest a common clonal origin of the two tumors.

Utilization of monoclonal antibodies and immuno-scanning electron microscopy for the positive identification of human leukemic cells.

Monoclonal antibodies generated against normal and leukemic human leukocytes were tested for their differential reactivity with leukemia and lymphoma cell lines as well as with circulating lymphoid and myeloid leukemic cells by means of immuno-scanning electron microscopy (immuno-SEM). Anti-T (OKT3), anti-mu-chain, anti-CALLA (J5), anti-BA-1, anti-BA-2, and anti-nonlymphoid (Mol) monoclonal antibodies were covalently conjugated to polystyrene latex microspheres (immunolatex), using a two-step glutaraldehyde reaction, and subsequently incubated with the various cell types. Cultured B-type Burkitt lymphoma cells (Daudi) and chronic lymphocytic leukemia (CLL) cells displayed extensive labeling with monoclonal anti-mu, anti-B1, and anti-BA-1 immunolatex conjugates, while cultured malignant T cells (HD-Mar) showed positive labeling with OKT3 immunolatex alone. Cultured myelomonocytic cells (GDM-1) and cells obtained from patients with acute myeloblastic (AML) and monoblastic leukemia (AMoL) labeled only with anti-Mol immunolatex, while cultured promyelocytic cells (HL-60) displayed far less labeling with this conjugate. Common-type acute lymphoblastic leukemia (C/ALL) cells were labeled predominantly with the J5 (anti-CALLA) and anti-BA-2 immunolatex conjugates. Evidence is presented indicating that immuno-SEM employing monoclonal antibodies is a reproducible technique which may be used in the study of leukocyte maturation and may provide additional information in the classification of poorly differentiated leukemias.

Ultrastructural cytochemistry of chronic T-cell leukaemias. A study with four acid hydrolases.

The ultrastructural localization of four acid hydrolases (acid phosphatase, beta-glucuronidase, beta-glucosaminidase and alpha-naphthylacetate esterase) has been studied in lymphocytes from 16 patients with three types of chronic T-cell leukaemia, namely, T-prolymphocytic leukaemia (T-PLL), T-chronic lymphocytic leukaemia (T-CLL) and adult T-cell lymphoma leukaemia (ATLL). Different patterns of enzyme distribution were observed in the leukaemic T-cells from these disorders. In T-PLL, reactivity for the four acid hydrolases was confined to single or a few large granules. Gall bodies were reactive for beta-glucuronidase, b-glucosaminidase and alpha-naphthylacetate esterase but apparently unreactive for acid phosphatase. In T-CLL, scattered small- to medium-size cytoplasmic granules and many parallel tubular arrays were strongly reactive for acid phosphatase, beta-glucuronidase and beta-glucosidase but showed no reactivity for alpha-naphthylacetate esterase. Intermediate features were observed in ATLL. The observed differences in enzyme reactivity reflect a different content of lysosomal granules in the various types of leukaemic T-cells. They also suggest that similar differences may be found in normal T-lymphocyte subsets.

Glucocorticoid-resistant human acute lymphoblastic leukemic cell line with functional receptor.

A receptor-containing, steroid-resistant clone of CEM cells, CEM-C1, was isolated without selective pressure from the wild-type population. The biological and physicochemical properties of glucocorticoid receptors in CEM-C1 cells were compared to those from a clone (CEM-C7) sensitive to glucocorticoid-mediated lysis. In a whole-cell binding assay, CEM-C1 cells exhibited high affinity for [3H]dexamethasone (Kd, 22 nM), nuclear translocation of steroid:receptor complex (nt, 43%) and were found to contain, on the average, 12,000 receptor sites/cell (R0). These steroid-binding parameters were similar to those displayed by wild-type CEM-C7 cells: Kd, 19 nM; nt, 47%; and R0, approximately 14,000 sites/cell. The ion-exchange and gel permeation profiles were indistinguishable from those of identically treated CEM-C7 cytosols. Thus, diethylaminoethyl cellulose chromatography of CEM-C1 cytosol showed that [3H]triamcinolone acetonide:receptor complex was eluted at 50 mM phosphate and 220 mM phosphate under "activating" and "nonactivating" conditions, respectively. Receptor complex of activated CEM-C1 cytosol bound to DNA-cellulose and was eluted at 100 mM salt. Filtration of unactivated CEM-C1 cytosol over Sephacryl S-300 generated a single peak of radioactivity for receptor complex with a calculated Stokes' radius of 55 to 59 A. Dexamethasone induced glutamine synthetase in CEM-C1. The dose dependence (50% effective dose, approximately 20 nM) and maximal fold increase (1.9, 1 microM dexamethasone) were comparable to those observed in CEM-C7. Since CEM-C1 cells contain apparently normal, functional cytosolic receptor, the results suggest that resistance to glucocorticoid in these cells involves a defect(s) at another locus.

Prolymphocytic leukemia with IgM hypogammaglobulinemia.

A case of prolymphocytic leukemia with IgM hypogammaglobulinemia in a 47-year-old man was presented. The leukemic cells possessed Ia-like antigen and receptors for the third component of complement but lacked surface immunoglobulins, cytoplasmic IgM, receptors for sheep red blood cells, or terminal deoxynucleotidyl transferase activity. In vitro immunoglobulin production experiments demonstrated that the leukemic cells did not have the capacity to produce IgM, while patient's T cells were shown to possess helper function on normal B cells to produce immunoglobulins. By these findings, together with the presence of selective IgM hypogammaglobulinemia, it was suggested that the leukemic cells were derived from a B-cell clone of a stage in differentiation and maturation of IgM-forming B-cell spectrum.

Testicular biopsy and occult tumor in acute lymphocytic leukemia.

Testicular biopsy has become a routine procedure before discontinuing chemotherapy in male children being treated for acute lymphocytic leukemia (ALL). Before a decision can be made to discontinue multiple drug therapy, all possible sites of occult tumor such as the testis, cerebrospinal fluid, and bone marrow must be sampled. Between December, 1978, and November, 1981, 25 male children underwent testicular biopsies after two or more years of combination chemotherapy at the Babies Hospital, Columbia-Presbyterian Medical Center. Only 3 of the 25 patients (12%) were found to have leukemic infiltrates on histologic sections. Two of 3 patients, however, were noted preoperatively to have either irregular testicular contours or testicular enlargement and induration. Occult testicular infiltration discovered after two or more years of chemotherapy is rare. Most children with a histologically positive biopsy result were at least suspected preoperatively to have testicular involvement.

HNK-1 monoclonal antibody (Leu-7) in the identification of abnormal expansions of large granular lymphocytes.

Among 12 cases of chronic T lymphoproliferative disorders we observed, six patients showed an expansion of mononuclear cells with azurophilic granules usually referred to as large granular lymphocytes or LGL. Cells obtained from five patients with these abnormal LGL proliferations were studied with several surface markers including their reactivity with the HNK-1 monoclonal antibody reported to be specific for LGL. Cells in four out of five cases were HNK-1 positive. Whereas normal LGL have been reported to be unreactive with several T cell markers, three cases showed the co-existence of HNK-1 and surface markers expressed by T cells. Two cases were characterized by the proliferation of OKT8 cells. Cells from one patient were HNK-1 positive but did not express T or monocytic antigens. These cells were apparently not completely mature since alpha-naphthyl acetate acid esterase activity was negative. Cells from the remaining case were HNK-1 negative and positive for T and monocytic antigens. An increase of OKT-10 cells was observed in only one patient. Our data indicate that proliferations of LGL represent a remarkable proportion of the rare cases of sheep erythrocyte rosetting chronic lymphocytic leukaemias or lymphomas. Besides the morphology of LGL, the rosetting ability and the negativity for peroxidase, cells from these cases showed a vast heterogeneity of other structural and functional markers, possibly reflecting different stages in the maturation of these cells. The HNK-1 monoclonal antibody proved to be an important marker in the identification of these cases.

Development of a model of chronic lymphocytic leukemia in inbred strain 2 guinea pigs.

A new transplantable leukemia (KSL) of unknown etiology that arose in a female Sewall-Wright strain 2 guinea pig is described. KSL cells morphologically resembled medium to large lymphocytes, displayed surface Ia antigen and receptors for complement and for the Fc portion of immunoglobulin, and synthesized surface immunoglobulin (IgM). These characteristics suggest a leukemia of B-lymphocyte origin. KSL cells were shown to be sensitive in vivo to both cyclophosphamide and 1,3-bis(2-chloroethyl)-1-nitrosourea; however, neither drug effectively prevented eventual recurrence of the disease. KSL leukemia was also shown to be distinct from another guinea pig lymphatic leukemia (L2C) with respect to cell morphology, antigenicity, and in vivo growth rate. In this last respect, KSL appeared more closely related to the chronic lymphocytic leukemias. Thus KSL is the first chronic lymphocytic leukemia in the guinea pig to be characterized; it is also the only guinea pig model of lymphatic leukemia that is distinct from L2C leukemia currently available for study.

High incidence of human type-C retrovirus (HTLV) in family members of a HTLV-positive Japanese T-cell leukemia patient.

Sera and peripheral blood cells of an adult T-cell leukemia patient and several clinically normal members of his family from the northwest coast of Japan were examined for evidence of infection with human T-cell leukemia (lymphoma) virus (HTLV). The sera of the patient and his parents had antibodies to HTLV, whereas these antibodies were absent in the sera of the patient's brother and sister. T-cell lines were established from the peripheral blood lymphocytes of all of the family members, and all except the patient's sister expressed HTLV antigens (p19, p24, and reverse transcriptase) and type-C virus particles. Not only the fresh peripheral blood lymphocytes from the patient but also those from his clinically normal mother showed abnormal morphology of the kind characteristic of some patients with T-cell leukemia. These studies are consistent with previous evidence indicative of a high rate of HTLV infection within families, and they show that people whose sera are negative for antibodies may still be infected by HTLV. In addition, the results indicate that infection of T cells by HTLV can be associated with morphological transformation of the cells without other signs of leukemia.

Granular acute lymphoblastic leukemia.

Granules in blasts are most typical of acute myeloblastic leukemia. However, there have been scattered reports of patients with acute lymphoblastic leukemia (ALL) that have lymphoblasts with azurophilic cytoplasmic granules. These reports do not describe immunologic markers or cytogenetics. We report five additional cases with detailed cytologic, immunologic, and cytogenetic studies. At diagnosis one of these patients had central nervous system disease, while the others had no unusual features. Four of the five patients attained remission. The blasts of all five patients contained distinct cytoplasmic azurophilic granules. The granules were negative for peroxidase and chloroacetate esterase and positive for PAS, acid phosphatase, alpha-naphthyl acetate esterase incompletely fluoride inhibited, alpha-naphthyl butyrate esterase, and in one case, Sudan black B. In the one patient studied by electron microscopy, characteristic lymphoblasts contained membrane-bound electron lucent inclusions, which stained positively with non-specific esterase. Immunologic markers showed a common ALL phenotype. Different cytogenetic abnormalities were seen in all cases. It is important to recognize the characteristics of this morphologic subtype of ALL in order to avoid a misdiagnosis of acute nonlymphocytic leukemia.

Subtypes of T-cell chronic lymphatic leukemia.

Thirteen cases of T-cell chronic lymphatic leukemia (T-CLL) (including T-cell prolymphocytic leukemia) are presented. Five subtypes were distinguished according to morphologic and functional parameters of the leukemic cells: prolymphocytic; lymphocytic, small; lymphocytic, Sézary-like; lymphocytic, abundant cytoplasm; lymphocytic, abundant cytoplasm and granules. The subtype can be recognized by light and by electron microscopic investigation. Cytochemistry (APh and ANAE) may be helpful to delimit T-CLL from B-CLL, and acid phosphatase to recognize the subtype characterized by abundant cytoplasm and granules. Membrane marker investigations support the diagnosis of T-type CLL. When functional properties of the leukemic cells were tested, cells of one patient (T-PLL) were shown to help in B-lymphocyte differentiation and Ig-secretion, whilst the cells of a second patient (lymphocytic, abundant cytoplasm and granules) were proven to act as effectors in natural killing and antibody-dependent cytotoxicity. The T-helper lymphocyte nature of some of the leukemic cells was supported by demonstration of the Fc mu-receptor in three cases. In one of these patients, monoclonal IgM was detected in the serum. Response to therapy and prognosis were rather poor in this limited number of patients when compared with B-CLL.