Transformation of hairy cell leukemia to EBV genome-containing aggressive B cell lymphoma.

Hairy cell leukemia is a preplasmacytic B cell leukemia which is not EBV associated, although elevated titers of Epstein-Barr virus (EBV) antibodies have been seen in this leukemia and chronic lymphocytic leukemia. Hairy cells are not readily susceptible to EBV infection in vitro, even though they are EBV receptor-positive B cells. We have observed a 59-year-old patient who after 9 years of hairy cell leukemia developed a well-differentiated IgG-kappa monoclonal B cell lymphoma without further evidence of hairy cell leukemia. Pathologically, the lymphoma showed plasmacytic differentiation, and in the patient's serum, a 2 g/dl monoclonal IgG-kappa component was present. DNA extracted from the lymphomatous lymph node hybridized with DNA fragments of a reiterated sequence of EBV, IR1. The transformation, with no chemotherapy involved, from a preplasmacytic leukemia into a lymphoplasmacytic lymphoma with monoclonal gammopathy may be related to the entry of EBV into these cells. Studies at the molecular level may help understand mechanisms of malignant transformation or interconversion in lymphoproliferative disorders of the B cell type.

Managing the complications of plasma cell myeloma.

Management of some diverse complications of plasma cell myeloma is reviewed with respect to prevention when possible and prompt treatment when necessary. A series of 102 patients from the Duke University Medical Center was surveyed to ascertain the approximate frequency with which renal failure, hypercalcemia, infection, hyperviscosity syndrome, and neurologic disorders occur. Selected patient studies and additional data from the literature emphasize aspects of these complications amenable to therapy aside from that directed at plasma cell growth.

Chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is the commonest type of leukemia seen in Western countries. It affects an older group of individuals than most other varieties of leukemia, and men more often than women, in a ratio of 2:1. The incidence of CLL is significantly increased in some families. In most instances, CLL is due to the overgrowth or accumulation of immunoglobulin producing B lymphocytes. Hypogammaglobulinemia is a common feature, and anomalous immunoglobulin components occur in 3 to 5% of patients. The early symptoms and signs of CLL include fatigue, reduced exercise tolerance, enlarged lymph nodes, and splenomegaly. Fever, weight loss, and impairment of bone marrow function, with anemia, bleeding and susceptibility to infection are characteristic of severe or advanced disease. In the great majority of patients, the disease can be controlled for 6 to 10 or more years with simple regimens using chlorambucil or cyclophosphamide, often in combination with prednisone. Radiotherapy and splenectomy are useful in some instances. The terminal phase of the disease is characterized by exacerbation or increasing severity of the leukemia and the development of opportunistic infections associated with immunodeficiency.

Malignant effusions in recurrent breast cancer: steroid hormone receptor analysis of effusion fluid derived cells.

Estrogen and progesterone receptor determination in breast cancer is of significance in determining a patient's potential response to hormonal manipulation. One practical limitation to this procedure has been availability of material for receptor assay. We describe 12 patients in whom quantitative estrogen and/or progesterone receptor analysis was accomplished utilizing tumor cells obtained from malignant effusions. The ability to obtain quantitative steroid receptor data on material derived from malignant effusions provides an effective source for this important biochemical parameter in patients in whom no other tumor tissue is available for study.

Chloroma (granulocytic sarcoma) without evidence of leukemia: facilitated light microscopic diagnosis.

Localized tumors composed of immature cells of the myelogenous series have been recognized for many years as an uncommon manifestation of granulocytic leukemia. The histologic diagnosis of chloroma (granulocytic sarcoma) may be extremely difficult when the myeloblastic cells are poorly differentiated and the tumor lacks the characteristic green color. The diagnostic difficulty may be further compounded when the granulocytic sarcoma develops before there is peripheral blood or bone marrow evidence of leukemia. Previous criteria for the diagnosis of chloroma have been ambiguous because of the capricious nature of the hydroperoxidase activity and the lack of definitive histochemical criteria. In this case, a combination of Sudan black B and myeloperoxidase histochemical staining and ultrastructural evaluation was applied. The light microscopic histochemical studies suggested the presence of Phi bodies and rods both in the formalin-fixed tumor and in the cells derived from the subsequent pleural effusion; this was confirmed by electron microscopy, which demonstrated the peridicity of the crystalline rod substructure. These observations show that light microscopic histochemical studies can facilitate the diagnosis of granulocytic sarcoma or chloroma in the absence of peripheral blood or bone marrow manifestations of leukemia.

Estrogen receptor determination in percutaneous bone marrow biopsies of patients with metastatic breast cancer.

Estrogen receptor determination in metastatic breast cancer has been shown to be important in determining potential for response to endocrine therapy. One limitation to this procedure can be the availability of neoplastic material for receptor assay. This report describes patients in whom estrogen receptor status was determined using malignant cells obtained through routine posterior iliac crest bone marrow biopsy. The ability to obtain receptor data from percutaneous bone marrow biopsy specimens has proved to be of important in patients in whom other sites involved with tumor were not accessible.

PIP: Because material for biopsy among breast cancer patients is often scarce, a new procedure using material obtained from percutaneous bone marrow biopsy was developed and is presented. Bone marrow biopsy was the source of neoplastic material in 42 patients and was used to determine whether percutaneous bone marrow biopsy specimens could provide the necessary neoplastic tissue for estrogen receptor (ER) determination. Of the 42 patients, specimens from 11 (26%) were found to have insufficient tumor material for further evaluation; of the remaining 31 patients, 12 (39%) contained quantitatively ( 7 fmol) or qualitatively significant estrogen binding. All 12 patients were treated with endocrine therapy alone. Of the 12 patients, 8 (67%) responded to hormonal manipulation. The majority of patients evaluated were without other measureable signs of recurrent disease. All data obtained served to corroborate the usefulness of routine percutaneous bone marrow specimen for receptor analysis. This use of bone marrow represents an important application of improved technology to clinical practice.