[Tuberous sclerosis and lymphangiomyomatosis syndrome. Problem of their relationship (author's transl)]

Discussion of a case relating to a patient affected by a typical tuberous sclerosis, and a lymphangiomyomatosis syndrome, proliferation of unstriated muscles of lymphatic system. These symptoms induce pulmonary injuries, ascites and renal angiomyolipomas. The closeness of these localizations with the visceral manifestations of tuberous sclerosis leads to debate connections among the two diseases.

Opportunistic pneumonia caused by a new acid-fast bacterium

An 80-year-old black woman with a clinical diagnosis of unclassified malignant lymphoproliferative disease experienced acute pneumonia four days after chemotherapy was begun. Open lung biopsy revealed acute suppurative pneumonia with dense neutrophilic alveolar infiltrates but without granulomas or caseous necrosis. Numerous intra- and extracellular gram-negative bacilli were present, some of which were acid-fast. Routine bacterial, fungal, and mycobacterial cultures were negative. The organism was successfully cultivated by embryonated egg inoculation with subsequent transfer to buffered charcoal yeast extract agar. Serologic studies using the indirect fluorescent antibody technic confirmed the presence of an organism recently described as the "Pittsburgh pneumonia agent," further suggesting that this particular organism is a significant cause of suppurative pneumonia in the immunocompromised host.

Myeloproliferative and lymphoproliferative disorders in the same patient

A 67-year-old man developed a Philadelphia-negative myeloproliferative disorder which initially manifested as marked thrombocytosis, followed two years later by marked leucocytosis. He subsequently developed an IgG lambda plasma cell dyscrasia together with a monoclonal proliferation of circulating lymphocytes with IgM kappa surface immunoglobulin. The lymphoid neoplasm was associated with a rapidly progressive and fatal course.

Retroperitioneal lymphangiomyomatosis with lymphedema of the legs

Retropertioneal tumor is demonstrated by lymphangiography in a 28 year old woman with lymphedema of both legs. Retroperitioneal tumor was subtotally extirpated, with subsequent subsidence of the swelling of both legs. According to the pathologic examination of the extirpated specimens, lymphangiomyomatosis was confirmed. This is the fisrt case reported in the literature of lymphangiomatosis presenting with lymphedema of the leg in the absence of pulmonary involvement, pleural or abdominal effusion.

Comparison of two direct assays for platelet-associated IgG (PAIgG) in assessement of immune and nonimmune thrombocytopenia

A number of methods have been developed to measure platelet-associated IgG (PAIgG). The antiglobulin consumption assay directly quantitates IgG on the platelet and is sensitive and specific. A fluorescent anti-IgG assay has recently been described and has the advantage of simplicity. We compared the results of these two PAIgG assays in immune and nonimmune thrombocytopenia and nonthrombocytopenic controls. The antiglobulin consumption assay was negative in 61 of 62 and the fluorescent negative in 54 of 62 assays in nonthrombocytopenic controls, and they were negative in 11 of 13 and 8 of 13 assays, respectively, in nonimmune thrombocytopenic patients. The antiglobulin consumption assay was positive in 54 of 58 and the fluorescent positive in 24 of 58 assays of patients with immune thrombocytopenia (ITP and SLE). The overall sensitivity and specificity of the antiglobulin consumption assay was 94% and 95% and of the fluorescent assay was 44% and 82%.

[Induced malignant hemopathies. 6 new cases with 1 patient surviving 45 months]

Among 246 patients (49 with Hodgkin's disease, 29 with multiple myeloma, 75 with other lympho- and immunoproliferative syndromes, 70 with carcinomas and 23 with non-malignant affections) treated by cytostatic or immunosuppressive chemotherapy, 6 developed malignant hemopathy (acute myeloblastic leukemia, erythroleukemia and erythremia) apparently induced during the last 7 1/2 years. In addition, 2 carcinomas have been noted. All have received melphalan or chlorambucil, alone or associated with other cytostatic drugs. 5 out of these 6 patients also underwent radiotherapy. The lenght of chemotherapy ranged between 7 and 110 months and the latency between 45 and 110 months. A "preleukemic" cytopenia phase was observed in 4 out of 6 cases. An exceptional 45-month survival was secured in case 1 (acute myeloblastic leukemia in a patient probably cured of Hodgkin's disease IIIB). Observation 2 is the 3rd case ever published of induced acute leukemia in disseminated lupus erythematosus. All these observations are compared with the latest findings in the literature. To the very extent that the utilization of cytostatic drugs produces improvement in the prognosis of very serious diseases, their leukemogenic potential becomes more dangerous and demands limitation of their use.

Immune thrombocytopenia in lymphoproliferative diseases

We have studied the thrombocytopenia of lymphoproliferative disorders using a measurement of membrane-bound IgG by an antiglobulin consumption assay. Nine patients with chronic lymphocytic leukemia (CLL) and thrombocytopenia had increased membrane-bound IgG. Two patients with non-Hodgkins lymphoma and 1 patient with Hodgkins disease also had thrombocytopenia and increased membrane-bound IgG. Five of the patients with CLL had positive direct antiglobulin (Coombs) tests on red cells; of these, 3 patients had hemolytic anemia. In eight of the 9 patients with CLL, thrombocytopenia, and increased platelet-bound-IgG, the platelet count increased with the administration of prednisone or an alkylating agent, with splenectomy, or with a combination of these.

Hairy cell leukemia-associated familial lymphoproliferative disorder: immunologic abnormalities in unaffected family members

Three generations of a family were affected by hematologic malignancies: the proband had hairy cell leukemia, his brother chronic lymphocytic leukemia, his nephew cutaneous and central nervous system lymphoma, and his father chronic granulocytic leukemia. There was no clinical evidence for immune deficiency in 17 unaffected family members. Most family members had normal serum immunoglobulins and peripheral B-cells, but some had decreased T cells. Lymphocyte responses to phytohemagglutinin and concanavalin A were markedly reduced, while pokeweed mitogen responses were essentially normal. Delayed hypersensitivity responses determined by response to a 23-antigen skin test panel were markedly diminished, as were viral antibody titers. The decreased immune function in these family members suggests a role for the immune system in the emergence of hairy cell leukemia and other lymphoid malignancies, though further follow-up will be needed to see if other family members develop malignancies.

[Splenic lympho-plasmocytic sarcomas discovered by exploratory laparotomy in 2 cases of cold agglutinin disease]

The 2 patients have cold agglutinin disease with lymphoid nodules in the bone marrow. A splenectomy was done because of the severity of the hemolytic anemia and because of the increasing splenomegaly. Tumoral nodules with the aspect of lymphoplasmocytic sarcoma or immunocytoma were discovered in the spleen. Those tumors can be considered either as a morphologic aspect of the cold agglutinin disease which is yet considered as a kind of chronic lymphoproliferative syndrom or as the proliferation of an other clone. In this hypothesis, the lymphoplasmocytic sarcoma habe the same signification that the Richter's syndrome in chronic lymphoid leukemia and that the sarcoma appearing in Waldenström's macroglobulinemia or in alpha heavy chain disease.

[Lymphoproliferative diseases with small molecular (monomere) IgM paraproteinemia (proceedings)]

Phytohemagglutinin P, when used like an antiserum in immunoelectrophoresis, precipitates with pentameric IgM but not with monomeric IgM subunits. In a retrospective study this simple screening method was applied to 180 sera containing monoclonal IgM. Five cases were found to be of the monomeric type of IgM paraproteinemia. Four of these patients had lymphoproliferative diseases with lymphocytic infiltration of the bone marrow. The last case was complicated by acute myelomonocytic leukemia.