Angioimmunoblastic lymphadenopathy with dysproteinemia in Thailand.

Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) is a disease of unknown etiology and pathogenesis. It has the features of hyperimmunity and immune deficiency, and its behavior resembles malignant lymphoma. We report a review of 16 patients with AILD seen at Ramathibodi Hospital from 1982 to 1986. Thirteen patients had fever and seven had pruritus and rashes. Lymphadenopathy was found in all 16 cases; generalized in 14 and localized in 2. Hepatomegaly was present in 14 patients while only 7 had splenomegaly. Laboratory findings included autoimmune hemolytic anemia, lymphocytosis and polyclonal hypergammaglobulinemia. Pulmonary involvement was seen in 5 cases, and bone marrow showed the characteristic features of the disease in 9 cases. Two patients went on to develop diffuse lymphocytic, poorly differentiated lymphoma. Fourteen patients were treated with prednisolone initially. Five responded with complete recovery, eight responded with partial recovery, and one died with extensive involvement of the disease. Six of the patients that recovered partially were later treated with cyclophosphamide, vincristine and prednisolone. One patient recovered completely and two partially. Three died from extensive involvement. Two patients with malignant lymphoma were treated by combination chemotherapy. One case went to complete remission while the other died from infection. One patient was lost to follow up before any treatment was started.

Shrinkage of recurrent endometrioma, after danazol.

A 29-year-old woman presented with a history of primary infertility one year after excision of endometrioma of the left ovary. On the first pelvic examination at the Infertility Clinic, the uterus was of normal size, retroversion and rather fixed with 0.5 cm firm nodule at its posterior surface. There was a tense cystic mass about 4-5 cm at the right adnexa. Three months later this mass was noted to have increased in size and the ultrasound revealed a slight, thick wall cystic mass with the largest diameter of 7 cm. The impression was endometriotic cyst of the right ovary. The patient was put on danazol 200 mg daily. After 6 months of treatment, the right ovarian mass was found to be 3.3 cm in the largest diameter by ultrasound. So the medication was discontinued. The patient conceived on the third cycle after discontinuing danazol. A healthy male infant, birth weight 3,320 g was delivered by elective cesarean section at term.

Malignant pericardial tumor in childhood: a case report diagnosed by cross-sectional echocardiogram and magnetic resonance imaging.

Since primary malignant pericardial tumors are seldomly found in children, we reported a case with massive pericardial effusion. Pericardial tumor was diagnosed by cross-sectional echocardiogram. The extent of the tumor was well demonstrated by magnetic resonance imaging. The tumor was removed successfully and proved to be low grade fibrosarcoma. Modern technics can be very helpful in the diagnosis of pericardial tumor.

Ultrasonic findings in intramural exogastric lesions.

Four cases of intramural exogastric lesions studied by ultrasound are presented. In all four patients, a large mass was identified in the left mid- and upper abdomen with a strip of solid tissue extending toward the left hemidiaphragm anteriorly, adjacent to the left lobe of the liver. This finding, best demonstrated on longitudinal scanning, suggested that the mass originated in the stomach rather than in the spleen or splenic flexure of the colon, which are posterior in location. Two of the lesions were leiomyoblastomas and two leiomyosarcomas.