["Umbilicate" aspect of some lateral cervical adenomegalies. A possible sign of benign characterization?]

Fifty-one patients were examined by sonography for suspicious cervical adenopathies. In 11 the adenopathies, histologically benign, showed typical "umbilicate" aspect. We present this aspect as a possible benign sign and we advance a pathological interpretation.

DNA image cytometry in acquired immune deficiency syndrome (AIDS)

In nine cases with the acquired immune deficiency syndrome (AIDS), including four stage I cases, three stage II cases and two stage III cases, DNA image cytometry was performed on Feulgen-stained lymph node imprint smears. Diploidy was found in three cases, tetraploidy in three cases and octoploidy in two cases. Aneuploid DNA distribution patterns were not seen. The lymphoid cells showed an enormously increased proliferation rate. Two cases in stage I revealed characteristic intranuclear DNA inclusions in lymphoid cells. These results indicate that DNA image cytometry may be useful as an adjunct to surgical pathology in certain cases to assist in the differential diagnosis between AIDS and benign conditions of the lymphoid system as well as between AIDS and malignant lymphomas, which usually have aneuploid DNA patterns.

The spectrum of Leu-M1 staining in lymphoid and hematopoietic proliferations

Leu-M1, or MMA, originally was proposed as a differentiation antigen on myelomonocytic cells and was said to be useful as an aid in distinguishing lymphoid from myeloid leukemias. Subsequently, it was proposed by Hsu and Jaffe as a useful marker of Reed-Sternberg cells and their variants in paraffin-embedded sections in Hodgkin's disease and as an aid in the differential diagnosis among Hodgkin's disease, non-Hodgkin's lymphomas, and reactive lymphoid proliferations. In order to test the usefulness of this antibody in classifying acute leukemias and to investigate the spectrum of its positivity on B5 and/or formalin-fixed, paraffin-embedded tissue sections, a variety of benign and neoplastic hematopoietic and lymphoid disorders were studied, using Leu-M1 and the ABC immunoperoxidase technic. Definite positivity in neoplastic cells was present in 4 of 16 patients with acute nonlymphocytic leukemias, 0 of 9 patients with acute lymphocytic leukemias/lymphoblastic lymphoma, 11 of 13 patients with Hodgkin's disease, and 0 of 18 patients with non-Hodgkin's lymphomas. Granulocyte staining could be identified in many cases. Although not identified in tonsillar sections from three patients, variable numbers of sometimes large mononuclear and rare binucleate cells were identified in some of the 14 reactive lymph nodes studied as well. These data, together with other data recently reported, suggest that in routinely processed tissue sections, Leu-M1 is a relatively sensitive marker for Hodgkin's disease, but it does not appear to be specific for that diagnosis. Although marking some acute nonlymphocytic leukemias in tissue sections, its lack of sensitivity and possible lack of specificity severely limits its usefulness in classifying the acute leukemias.

Lymphocele after retroperitoneal node dissection for testis tumor

A patient is presented in whom a lymphocele developed after a retroperitoneal lymph node dissection for Stage II embryonal carcinoma of the testicle. The benign nature of this lymphocele has been confirmed not only by the diagnostic procedures outlined, but by its stability over a 42-month follow-up period with no further antitumor therapy. We conclude from reviewing the literature that while aggressive measures are necessary to confirm the diagnosis of a lymphocele, its management should be expectant. If significant obstruction of neighboring structures occurs, an attempt at percutaneous drainage (and possibly sclerosis) seems appropriate despite potential risks of interventional treatment such as hemorrhage and introduction of infection. Open procedures for marsupialization and drainage should be reserved for cases in which more conservative measures fail.

[Magnetic resonance imaging in the study of pulmonary hilar involvement]

A retrospective analysis of results of magnetic resonance imaging (MRI) was conducted in 28 patients with uni- or bilateral pulmonary hilum lesions and findings compared with those of computed tomography (CT). All abnormal hilar masses examined were between 1 and 5 cm in diameter and were easily detected by transverse axial imaging. Contrast of their images was very high in relation to hilar bronchovascular elements in the two types of spin echo sequence with a short TR (0.5-0.7 s) and a long TR (1.5-2 s). Differentiation between tumoral or adenopathies and vessels was simpler than with CT with intravenous contrast. For screening of possible extension of hilar tumors. MRI appears to be superior to CT for providing data on vascular relations of lesions but inferior to CT for determining bronchial relations. Mediastinal extension of hilar tumors is easily defined by the short TR sequence but MRI supplies data of greater value than CT only in a low proportion of cases and then partly as a result of complementary coronal and sagittal imaging.

Systemic babesiosis. Another cause of the hemophagocytic syndrome

Hemophagocytosis is a pathologic finding in a variety of infectious diseases associated with peripheral pancytopenia. In addition, hemophagocytosis is a prominent finding in malignant histiocytosis, a primary disorder of the monocyte-macrophage system. Systemic babesiosis is a rare parasitic disorder associated with intraerythrocytic parasites in the peripheral blood. There has been no description of the marrow findings in this disorder. A patient is described who had systemic babesiosis and prominent hemophagocytosis that disappeared after appropriate antiparasitic therapy. Systemic babesiosis should be considered in the differential diagnosis of hemophagocytosis.

Fine-needle aspiration cytology of lymphadenopathy in homosexual males

We report five patients who illustrate the usefulness of fine-needle aspiration cytology (FNAC) in the differential diagnosis of lymphadenopathy in homosexual males. This differential includes hyperplasia, disseminated Kaposi's sarcoma, mycobacterial infections, and non-Hodgkin's lymphoma.

Acute myelocytic leukemia manifested by prominent generalized lymphadenopathy: report of two cases with immunological, ultrastructural, and cytochemical studies

Although it is well recognized that granulocytic sarcoma can cause localized lymphadenopathy, widespread nodal involvement by acute myelocytic leukemia (AML), clinically mimicking non-Hodgkin's lymphoma, has only been previously described twice. We report the clinicopathological, immunological, and cytochemical features of two patients who had widespread, prominent lymphadenopathy secondary to AML as well as concurrent marrow leukemia (M1 and M2). For one patient the lymphadenopathy was the predominant abnormality prompting him to seek medical attention, while the second patient had symptoms of infection following a 9-month history of myelodysplasia. The disease in both patients was aggressive; one patient survived only 1 week and the other survived only 5 weeks after diagnosis. In both cases the granulocytic sarcoma was confirmed by cytochemistry studies (naphthol ASD-chloroacetate esterase on tissue sections and myeloperoxidase on imprint smears), and electron microscopy, including morphology (both cases) or ultrastructural localization of myeloperoxidase (case 2). Non-specific esterase activity was not detected in either patient's blasts, although serum lysozyme was elevated in both cases. Immunological studies revealed reactivity of both patients' cells with panleukocyte, MY4, MY7, OKM-1, and Leu-M1 monoclonal antibodies and with alpha-1-antitrypsin and muramidase antibodies. The cells of one of these patients also reacted with anti-S-100 protein. Although the cytochemical studies indicated that both cases exhibited only myeloid differentiation, the immunological markers suggested that the tumor cells possessed some features of monocytes, perhaps explaining their propensity for widespread tumor formation. Morphological, immunological, cytochemical, and ultrastructural methods of diagnosing granulocytic sarcoma are presented.

Intrathoracic amyloid lymphadenopathy

2 patients with intrathoracic lymph node enlargement as their presenting symptom, were found to have amyloid lymphadenopathy. Both also had peripheral involved lymph nodes. The demonstration of amyloid deposits in the peripheral lymph nodes did not suffice to deduce that the intrathoracic nodes were of the same nature. A biopsy of the intrathoracic nodes was needed for final diagnosis. An additional 11 cases of intrathoracic amyloid lymphadenopathy from the literature are reviewed.

Ultrasound study of adenopathies within the hepatoduodenal ligament: the "rosebud" pattern

In about 10% of lymphopathies with extensive retroperitoneal adenopathies, adenopathies are also encountered within the hepatoduodenal ligament. When large, such adenopathies, which surround the portal vein, hepatic artery, and bile duct, give rise to a particular ultrasound pattern: the "rosebud pattern."

Frequent immunoglobulin and T-cell receptor gene rearrangements in "histiocytic" neoplasms

The authors have analyzed the DNA of immunoglobulin and T-cell receptor genes in a series of 6 malignancies which were judged to be of histiocytic derivation on the basis of morphologic criteria. They found that 4 of these cases showed rearrangements of the beta T-cell receptor genes in spite of the lack of any specific immunohistochemical markers for B or T cells. One case showed rearrangements of both heavy and light chain immunoglobulin genes and probably represents either a sinusoidal large cell lymphoma or a B-cell lymphoma with activation of histiocytes simulating malignant histiocytosis. A single case lacked both immunoglobulin and T-cell receptor rearrangements consistent with immunologic analyses that suggested its origin from an interdigitating reticulum cell. The result of this study in conjunction with the authors' previous immunologic observations suggests that many presumed histiocytic malignancies actually represent T-cell lymphomas. Alternatively, beta T-cell receptor rearrangement may be a common feature of tumors that show monocyte/histiocytic differentiation.

Primary histiocytic dermatoses

The physiology of the histiocyte (macrophage) in health and disease is reviewed briefly. An overview of the so-called primary malignant, pseudomalignant, and benign histiocytic disorders, excluding histiocytosis X, is presented. The malignant histiocytosis with erythrophagocytosis, the pseudomalignant histiocytic diseases (such as sinus histiocytosis with massive lymphadenopathy and regressing atypical histiocytosis), and the solitary lesions with histologic malignant and atypical storiform histiocytosis are described. Two groups of adult histiocytic diseases are reviewed; one is characterized by nonfamilial and familial histiocytic dermatoarthritis and the other by multiple widespread benign lesions, such as xanthoma disseminatum, generalized eruptive histiocytoma, nodular non-X histiocytosis, and various xanthomatous eruptions associated with paraproteinemia. Finally, multiple benign cutaneous histiocytic lesions of childhood, such as juvenile xanthogranuloma and congenital self-healing histiocytosis, are included.

Pulmonary microvascular cytology. A new diagnostic application of the pulmonary artery catheter

When pulmonary disorders involve primarily the microvasculature, definitive diagnosis is difficult and, in some cases, is not possible until autopsy. In patients with amniotic fluid embolism, fat embolism, and lymphangitic carcinomatosis, terminal pulmonary arterioles and capillaries contain abundant diagnostic material. We hypothesized that withdrawal of blood from a pulmonary artery catheter, particularly in the wedge position, should recover diagnostic cells and debris in patients with these disorders. We describe the technique of pulmonary microvascular cytology and show examples of the recovery of fetal squames in amniotic fluid embolism, fat globules in fat embolism, and malignant cells in lymphangitic carcinomatosis. Megakaryocytes, normal inhabitants of the pulmonary capillary bed, are readily seen in wedged blood and confirm the microvascular origin of a blood sample.

Granulocyte and HLA-D region specific monoclonal antibodies in the diagnosis of Hodgkin's disease

Tissue sections embedded in paraffin and fixed in formalin from 32 patients with Hodgkin's disease, representing the major histological subtypes, were studied using two granulocyte specific monoclonal antibodies (Leu-M1 and 3C4) and an HLA-D region specific monoclonal antibody (TAL-IB5). Reed-Sternberg cells were stained with one or other of the antigranulocyte antibodies in the nodular sclerosing and lymphocyte depleted subtypes. Reed-Sternberg cells in all but three cases of mixed cellularity Hodgkin's disease were positive with both Leu-M1 and 3C4. One case stained with only Leu-M1, and two cases were consistently negative with both antibodies. HLA-DR was widely expressed in the Reed-Sternberg cells of all three subtypes. In the four cases of lymphocyte predominant Hodgkin's disease the multinucleated Reed-Sternberg cells did not stain with either antigranulocyte antibody but were strongly positive with anti-HLA-DR. Twenty five cases of non-Hodgkin's lymphoma, in which there were multinucleated giant cells resembling Reed-Sternberg cells, were studied in a similar way. These cases included pleomorphic T cell and B cell lymphomas, histiocytic lymphomas, and malignant histiocytosis of the intestine. In none of these did the multinucleated cells stain with either antigranulocyte antibody, but in most cases the multinucleated cells stained with anti-HLA-DR. In two cases of the tumour stage of mycosis fungoides dot like intracytoplasmic staining was shown in the tumour cells with both antigranulocyte markers. The monoclonal antigranulocyte antibodies Leu-M1 and 3C4 are of considerable value in both the diagnosis and the differential diagnosis of Hodgkin's disease and are particularly valuable in that they can be applied to tissue fixed in formalin and embedded in paraffin. Antibody to HLA-DR, while useful, is of less value.

Inflammatory neuropathy in homosexual men with lymphadenopathy

Twelve homosexual men had peripheral neuropathy with fever, night sweats, and lymphadenopathy. Sensory symptoms predominated, but there was also weakness and cranial nerve dysfunction. Manifestations were multifocal in nine and distal and symmetric in three. CSF was abnormal in all eight patients examined. Sural nerve in five patients showed axonal degeneration, accompanied in two by segmental demyelination. Four patients had epineurial and endoneurial perivascular chronic inflammatory cells without evidence of vasculitis. Neuropathy remitted spontaneously in six patients. Four patients received steroids without clinical response, although one later responded to plasmapheresis-lymphocytapheresis. Four patients later progressed to AIDS.