Primary diagnosis and REAL/WHO classification of non-Hodgkin's lymphoma by fine-needle aspiration: cytomorphologic and immunophenotypic approach

The Revised European American lymphoma (REAL) and World Health Organization (WHO) classification of non-Hodgkin's lymphoma (NHL) relies on the constellation of cytologic, phenotypic, genotypic, and clinical characteristics of NHL. For the most part, the classification does not rely on architectural pattern for classification of neoplasms. This classification makes it possible to diagnose and classify lymphomas by fine-needle aspiration (FNA). In this study, we attempted to evaluate the accuracy of FNA in diagnosing and classifying NHL within the context of the REAL/WHO classifications. Cases included only those in which FNA was the primary diagnosis, followed by a surgical biopsy for confirmation. Flow cytometry (FCM) for phenotyping was carried out whenever material was available. Two groups of pathologists were identified. Group A consisted of pathologists with background training in cytopathology and/or hematopathology (three pathologists). Group B consisted of experienced surgical pathologists with no training in cytopathology and/or hematopathology (four pathologists). Seventy-four cases were included in the study. FCM phenotyping was performed in 53 cases (71%). Large cell lymphoma constituted 63% of the cases. The remaining lymphomas included Burkitt's, small lymphocytic, lymphoblastic, follicle center cell, Ki-1, mantle cell, marginal zone, and natural killer cell lymphoma. The diagnosis of lymphoma was rendered for all cases. The correct classification was seen in 63% of the cases. Classification was more accurate in immunophenotyped than in nonimmunophenotyped cases (84% vs 33%; P = 0.00004). Group A pathologists showed higher incidence of proper classification than group B (80% vs 56%; P = 0.046). The diagnosis and classification of NHL can be achieved in a large number of cases on FNA material. This accuracy can be increased if cytomorphologic criteria are established for different entities of NHL aided by FCM for phenotyping.

The role of coxsackieviruses infection in the children of insulin dependent diabetes mellitus

In the present study, there were two groups of diabetic patients. The first group was newly diagnosed diabetic patients of less than one year duration of disease. They were 40 patients. The second group was diabetic patients with more than one year duration of disease. They were 30 patients. The control group was 30 normal healthy children. Evidence of virus infection was detected by tissue culture isolation, neutralization test, RT-PCR, IgM, and IgG specific antibodies for coxsackie B viruses. There was significant increase in percent of tissue culture isolation of EV in group I more than group II while the percent in the two groups were significantly increased than the control group. Identification of the type of EV by neutralization test revealed that most of the type cases were Coxsackie B4 virus and one case was Coxsackie B6 virus (the most important diabetogenic strain). Viral RNA detection by PCR was done and revealed that most of cases in group I diabetic patients were positive for enterovirus while one case in group II of diabetic patients was positive. As regards Coxsackie virus B IgM antibodies positivity, there was increase in the percent in group I than group II, as it is a marker of acute infection. As regards Coxsackie virus B IgG antibodies positivity, there was no significant difference between group I and group II of diabetic patients, as it is a marker of past infection and it persists for years after the first episode.

Incidence and prognostic significance of right bundle branch block complicating acute myocardial infarction

The incidence and hospital courseofacute myocardial infarction wereobserved among randomly selected 560 patients. The mean age of the patients was 53 +/- 6.67 years with male-female ratio 2.6:1. The incidence of right bundle branch block (RBBB) was 15% (84 out of 560 patients). New RBBB, old RBBB and RBBB of indeterminate age were observed in 33 (39.25%), 23 (27.40%) and 28 (33.25%) cases respectively. RBBB was isolated in 50 (60%) cases and bi-fascicular in remaining 34 (40%) cases. The rate of use of thrombolytic was greater in RBBB group than non-RBBB group (52% vs 30.67%, P < 0.05). The complications were more frequently observed in patients with RBBB: in-hospital mortality, 27.40% vs 10.90% (P < 0.01); use of temporary pacemaker, 15% vs 9% (P < 0.05); and heart failure, 50% vs 35% (P < 0.05). In sub-group analysis, in-hospital mortality rate was higher among bi-fascicular group than isolated RBBB group (P < 0.05). Thus it appeared from the results that the incidence of RBBB is relatively common i.e. 15% over all (84 out of 560) and 5.90% new (33 out of 560) and despite greater use of thrombolytics, some specific in-hospital complications were significantly higher in patients with RBBB than without, RBBB.

gamma/delta peripheral T-cell lymphoma of the breast diagnosed by fine-needle aspiration biopsy

Gamma/delta T-cell lymphoma is a rare neoplasm that is not well characterized and is associated with a poor prognosis. We report a case of gamma/delta peripheral T-cell lymphoma that appeared as a breast lump in a 35-yr-old woman. The patient was examined for a 2-mo history of a right-sided breast mass with associated hepatosplenomegaly 2 yr in duration. A fine-needle aspiration biopsy (FNAB) was performed, and the diagnosis of lymphoma was rendered. The patient received two cycles of CHOP and is alive with persistent disease. FNAB showed evidence of polymorphous lymphoma, consisting of medium-size to large cells with immature chromatin. Flow cytometric immunophenotyping showed expression of CD2, CD3, and CD7 with lack of expression of CD1a, CD4, CD5, CD8, and CD56. Flow cytometry also showed predominant expression of the gamma/delta T-cell receptor. Cytogenetic analysis showed 48XX+i7(q11.2),+7(3). Our case indicates that gamma/delta peripheral T-cell lymphoma can be diagnosed by FNAB. This rare entity requires further investigation.

Partial sequence at 2BC region of HAV isolated from stool of acute sporadic HAV patients

More than 20 hepatitis A virus (HAV) strains that can be distinguished from each other are known till now. In the present study, a cytopathic strain of HAV (HA-10) was isolated in Egypt from stool of acute sporadic cases. The isolated strain showed CPE in early stages of adaptation in cell culture. Accordingly, the first step in the work was to confirm the presence of HAV, the second step was to prove that no enteric virus is associated with the isolate and finally to try to know the reason for that rapid adaptation in cell culture. So, RT-PCR was carried out for different regions of the viral RNA (5'ntr, VP1, VP1/2A, 2B and 2B/2C) also, enterovirus primers (5'ntr) were used. Reference HAV strains such as HM-175, HAS-15, MBB and 18F were used for comparison. Segment of 2BC region of the viral RNA was sequenced and compared with the nucleotide sequence of the reference HAV strains at the same region. The results revealed that HA-10 isolate react with all HAV primers and similar in this behavior with 18F and HM-175 strains. The nucleotide sequencing showed that there are 16 mutations in HA-10, two of them in 2B and the others in 2C region which may explain the reason for the highly adaptation of HA-10 isolate than 18F. As a result of this study, HA-10 may give us a highlight on HAV replication and also, the isolated strain may be useful for vaccine development.

A phase II study of weekly alternating chemotherapy in extensive-stage small cell lung cancer

Despite the recent development of new chemotherapeutic agents with activity in small cell lung cancer (SCLC), the long-term prognosis of patients with extensive-stage disease remains poor and has not improved in the past 20 years. The present study was designed to evaluate the activity and toxicity of weekly, alternating-regimen chemotherapy in patients with extensive-stage SCLC. Patients with previously untreated extensive-stage SCLC and performance status 0-2 were treated with cyclophosphamide 250 mg/m2, etoposide 100 mg/m2, and cisplatin 50 mg/m2 on day 1; vincristine 1 mg/m2 on day 8; and ifosfamide 1.2 gm/m2 on days 8 and 9 with the entire treatment repeated every 14 days. Eighteen patients received chemotherapy for a median of 14 weeks (range, 1-35 weeks). Seventeen patients (94%) required dose delays and 16 patients (89%) required at least one dose reduction due to toxicity. Twelve patients (67%) exhibited an objective response (1 complete response, 11 partial response) with a median duration of response of 18 weeks (range, 8-32 weeks). Median survival was 33 weeks (range, 1-57 weeks) with a 1-year survival rate of 22%. Toxicity was primarily hematologic, including grade 3-4 leukopenia (82% of patients) and anemia (53% of patients). Only 2 patients developed grade 3 peripheral neuropathy and none exhibited grade 3-4 renal insufficiency. This regimen of weekly alternating combination chemotherapy resulted in tolerable toxicity as well as response and survival rates comparable to those achieved with standard chemotherapy in patients with extensive-stage SCLC. However, weekly chemotherapy regimens for the treatment of SCLC remain investigational.

Prediction of adult stature for Japanese population: a stepwise regression approach

The longitudinal growth in stature for 509 males and 311 females was characterized from early childhood to adulthood. A triphasic generalized logistic (BTT) model (Bock et al. [1994] Chicago: SSI) was used through the AUXAL software program. Growth parameters were derived from the estimated distance and velocity curves for each individual. A set of estimated growth parameters, including adult stature, was selected to develop equations, through the forward stepwise regression method, for the prediction of adult stature for Japanese boys and girls.

Adolescent growth events in eight decades of Japanese cohort data: sex differences

The presence of secular trends in sex differences for the onset or takeoff of the adolescent growth spurt and subsequent (adolescent) growth of Japanese boys and girls were investigated using data published in "The Statistical Report of the School Health Survey" of the Ministry of Education, Science, Sports and Culture, Japan. An optimum kernel regression method was used to derive the biological parameters of the adolescent growth curve. The six parameters derived from the regression analysis were age at takeoff (ATO), height at takeoff (HTO), velocity at takeoff (VTO), peak height velocity (PHV), age at PHV (APHV), and height at PHV (HPHV). The sex difference in age at PHV is about 2.1 years. The sex difference in age at takeoff was about 2.1 years starting with the birth year of 1943, but has become almost insignificant with the birth year of 1980. After 1960, the sex difference in mean HPHV varied within 12-13 cm, but the difference in HTO showed a decreasing trend. After the birth year of 1911, the rate of growth at HTO for girls has become markedly greater than for boys. In contrast, the rate of growth at HPHV for girls has become significantly smaller than for boys (P < 0.05). Sex differences in ATO, HTO and VTO were significantly and negatively correlated with differences in APHV and HPHV, but positively correlated with the difference in PHV. The sex difference in PHV had no relationship with the differences in APHV and HPHV.

Spatial requirements of the antagonist binding site of the NK2 receptor

Computer-aided modelling has been used to identify a putative antagonist binding site in the tachykinin NK2 receptor. In order to validate the implied spatial requirements for this region, a series of compounds, based on the potent antagonist GR 149861 have been synthesised and their binding affinities established. Our findings suggest the presence of a large hydrophobic cavity in the putative binding crevice of GR 149861.

Waterborne viruses associated with repeated abortion

In this study we tried to find the role of some waterborne viruses in repeated abortion of women. The study includes maternal blood serum and fetal tissue. The serum of full-term delivered women was taken as a control. All collected samples were inoculated on BGM and Hep2G cells to detect entero and Hepatitis E viruses. Enzyme-linked immunosorbent assay was also carried out for IgM and IgG antibodies against HEV in all serum samples. HEV-Ag was determined by dot-ELISA, which used also for enterovirus typing. Reverse transcriptase polymerase chain reaction was used for detection of entero and HE virus RNAs in the collected serum samples. To follow up the source of virus transmission, the wastewater treatment plant which serves the area of samples population was studied at the intake and the final effluent for the presence of hepatitis E virus and enteroviruses with special reference to coxsackieviruses. Wastewater samples were collected for 1 year and for enterovirus concentration the adsorption-elution on nitrocellulose membrane was used and for HEV, two methods of virus concentration were used, urea arginine phosphate buffer (U-APB) and PEG8000. The results of HEV investigation of aborted women sera was 22% for IgG, 3% for IgM, 20% HEV-Ag, and 16% of HEV-RNA by RT-PCR. For fetal tissue, HEV-Ag was detected in 5% of the collected samples. The detected enteroviruses were coxsackieviruses types 2, 3,4 and 5 in all serum samples and wastewater samples. The results showed also, that virus concentration by U-APB is much better than PEG-8000 but not highly efficient.

Determinants of case fatality rates of meningococcal disease during outbreaks in Makkah, Saudi Arabia, 1987-97

We studied case-fatality rates (CFRs) among cases of meningococcal disease (MCD) admitted to Makkah (Saudi Arabia) hospitals during the period 1988-97. Of 483 cases, 431 (89.2%) were due to strains of serogroup A, 31 (6.4%) to serogroup W135, 16 (3.3%) to serogroup C, and 5 (10%) to serogroup B. Eighty-one patients died (case fatality rate (CFR)) 16.8%, 95% CI 13.5%, 20.4%). The CFR in infections due to serogroup A strains was 14.8%, and for other serogroups it was 32.7% (95% CI 20.3%, 47.1%). The CFR of MCD due to N. meningitidis serogroup A increased steadily with age (P<0.05). Seeking first medical help at a foreign Hajj medical mission and being treated in a non-specialized hospital were associated with a higher case fatality rate.

An algorithm to aid in the investigation of thalassemia trait in multicultural populations

CONTEXT

The differentiation between iron deficiency and a thalassemia syndrome is an important consideration in the investigation of microcytic anemia.

OBJECTIVE

An established statistical method was used to demonstrate the importance of considering ethnic background in combination with mean cell volume (MCV) in the investigation of beta-thalassemia trait in a multicultural urban population.

DESIGN

Posttest probabilities for beta-thalassemia trait were calculated using likelihood ratios for various microcytic MCV ranges in conjunction with published pretest probabilities for beta-thalassemia trait based on ethnic background.

SETTING

Regional hemoglobinopathy laboratory, St Joseph's Hospital, Hamilton, Ontario, Canada.

PATIENTS

Patient data were derived from a previously published study. The original study cohort consisted of 789 patients aged 18 years or older who had an MCV less than 80 fL and were referred for routine complete blood count during a 6-month period.

MAIN OUTCOME MEASURES

Posttest probabilities.

RESULTS

Simplified tables for the determination of posttest probabilities for beta-thalassemia trait in individual patients based on ethnic background and MCV are provided. An algorithm to assist in determining when thalassemia investigations are indicated is presented.

CONCLUSIONS

A high index of suspicion based on ethnic background and low MCV can provide increased sensitivity and specificity for the detection of thalassemia trait in centers with multicultural populations similar to the study population.

Trichodinid ectoparasites (Ciliophora: Peritrichida) of some River Nile fish, Egypt

Four species of trichodinid ectoparasites (Ciliophora: Peritrichida) were collected from the gills of the following River Nile fish in Egypt: Hydrocynus forskalii, Mormyrus kannume, Schilbe mystus. These species are: Trichodina heterodentata Duncan, 1977, Trichodina fahaka sp. n., Trichodinella epizootica Raabe, 1950, Tripartiella dactylodentata sp. n. Photomicrographs and morphometric data are presented for each species.

Incidence of spontaneous echocontrast in left atrium in mitral stenosis detected by transoesophageal echo cardiography and related factors

The incidence of left atrial (LA) spontaneous echo contrast (SEC) and the clinical and echocardiographic variables related to it were prospectively evaluated in a series of 60 patients with mitral stenosis (MS) undergoing transoesophageal echocardiography (TEE) with a 5 MHz multiplane transducer. LA-SEC was found in 39 patients (65%) employing TEE. Statistical analysis showed a significant relationship between the presence of SEC and MS without mitral regurgitation (MR) (P < 0.05), MS with < or = MR grade II (P < 0.05), atrial fibrillation (P < 0.001) and increased left atrial dimension (P < 0.05). Age, sex, mitral valve area and ejection fraction did not show any positive association (P > 0.05). Thus, it is concluded that LA-SEC is a common finding observed in approximately 65% of MS patients undergoing TEE and associated with conditions favouring stasis of left atrial blood.

Microspore culture in Corchorus olitorius: effect of growth regulators, temperature and sucrose on callus formation

Culture of isolated microspores and of anthers on media containing IAA directed free microspore development to an embryogenic pathway in C. olitorius. The first division of microspores on transfer to culture media was symmetrical in contrast to the asymmetrical division seen in normal development in vivo. Initially, 10-30% microspores divided symmetrically, but only 0.2-1% of the dividing microspores continued dividing and produced multicellular microcalli. About 30% of these microcalli produced callus but only on medium with 2.0 mg/L zeatin and 0.1 mg/L IAA. Incubation in the dark at temperatures of 35 degrees C for 1 day and then 25 degrees C was found effective for induction of first embryonic division in Corchorus. The frequency of microspore callus formation was higher on medium containing either 3% or 5% sucrose. Addition of colchicine and addition of activated charcoal to the above medium did not enhance microspore division in Corchorus olitorius. On transfer to different media most calli produced roots but regeneration of shoots and embryos was not induced.

The lactate-dependent enhancement of hydroxyl radical generation by the Fenton reaction

The effect of lactic acid (lactate) on Fenton based hydroxyl radical (*OH) production was studied by spin trapping, ESR, and fluorescence methods using DMPO and coumarin-3-carboxylic acid (3-CCA) as the *OH traps respectively. The *OH adduct formation was inhibited by lactate up to 0.4 mM (lactate/iron stoichiometry = 2) in both experiments, but markedly enhanced with increasing concentrations of lactate above this critical concentration. When the H2O2 dependence was examined, the DMPO-OH signal was increased linearly with H2O2 concentration up to 1 mM and then saturated in the absence of lactate. In the presence of lactate, however, the DMPO-OH signal was increased further with higher H2O2 concentration than 1 mM, and the saturation level was also increased dependent on lactate concentration. Spectroscopic studies revealed that lactate forms a stable colored complex with Fe3+ at lactate/Fe3+ stoichiometry of 2, and the complex formation was strictly related to the DMPO-OH formation. The complex formation did not promote the H2O2 mediated Fe3+ reduction. When the Fe3+ -lactate (1:2) complex was reacted with H2O2, the initial rate of hydroxylated 3-CCA formation was linearly increased with H2O2 concentrations. All the data obtained in the present experiments suggested that the Fe3+-lactate (1:2) complex formed in the Fenton reaction system reacts directly with H2O2 to produce additional *OH in the Fenton reaction by other mechanisms than lactate or lactate/Fe3+ mediated promotion of Fe3+/Fe2+ redox cycling.

Blood pressure profile in Nigerian children

OBJECTIVE

To observe blood pressure (BP) pattern and its correlates in primary school children of northern Nigeria.

DESIGN

Sitting BP and pulse were measured in quadruplicate, then repeated after four weeks in 1,721 healthy children aged five to 16 years. Body weight and height were also measured in their school environment.

SETTING

Primary schools located in three communities in Zaria Local Government Area (LGA) of Kaduna State, Nigeria. The communities were Tudun Wada (University community of migrants with some indigenous Hausa settlers), Zaria City (traditional Hausa community) and Zaria Kewaye (a rural Hausa settlement).

RESULTS

BP rose with age. However, BP levels particularly systolic was highest in children from Tudun Wada (TW) (urban), followed by those from Zaria city (ZC) (semi urban), and Zaria Kewaye (ZK) (rural). The mean systolic/diastolic BP (mmHg) were: 99/61, 94/62 and 89/60 in children aged five to ten years; and 112/69, 109/68 and 107/68 in those older than 10 years respectively. The differences in BP levels were evident even as early as the age of five years and appears largely independent of physical stature and gender.

CONCLUSION

These observations suggest that place of residence and ethnicity may be important factors in the progression of BP with age in some children in northern Nigeria.

A phase II study of mitomycin C, etoposide, and cisplatin in advanced non-small cell lung cancer

Standard chemotherapeutic regimens, such as cisplatin and etoposide, may improve quality of life and prolong survival in patients with incurable non-small cell lung cancer (NSCLC). This trial was designed to evaluate the activity and toxicity of a regimen combining three of the most active agents against advanced-stage NSCLC: mitomycin C, etoposide, and cisplatin (MEP). Sixty-eight patients with stage IIIB (pleural effusion) or IV NSCLC received cisplatin 80 mg/m2 i.v. on day 1 and etoposide 80 mg/m2 i.v. on days 1, 2, and 3 every 3 weeks along with mitomycin C 10 mg/m2 i.v. on day 1 of the first and third cycles for a median of four cycles (range, 1-11). Median age was 59 years, and nine patients were enrolled after relapse from previously treated early-stage NSCLC. Eighty-eight percent of patients had stage IV disease, and 14 (21%) had brain metastases at diagnosis. Palliative radiotherapy was given to 10 patients (15%) before MEP and to 17 (25%) concurrent with MEP. The major toxicity of MEP was myelosuppression, with grade 3-4 neutropenia in 74% of patients. Sixteen patients (24%) had documented infections, and there were eight (12%) treatment-related deaths. Partial response was observed in 24 patients (35%) with a median duration of 4.4 months, (range 1.4-13 months). Median survival was 8.1 months (range, 1-34 months), and 1-year survival was 32%. The addition of mitomycin C to cisplatin and etoposide resulted in response and survival rates comparable with those achieved with standard regimens in patients with advanced NSCLC but was associated with substantial hematologic toxicity and unacceptable treatment-related mortality.

Henneguya ghaffari sp. n. (Myxozoa: Myxosporea), infecting the Nile perch Lates niloticus (Teleostei: Centropomidae)

Light microscopical description is presented for a new myxozoan species, Henneguya ghaffari, which infects the Nile perch Lates niloticus (Linnaeus, 1758) in Lake Wadi El-Raiyan in Egypt. The spore is characterized by a triangular thickening at the base of the caudal processes. The relatively long caudal processes run adherent to each other for two-thirds of their length, then bifurcate to very fine processes. Prevalence of infection was 34.6% and peaked during winter and early spring. The infection was concentrated along the intestinal tract, and in severe cases gills and gill rakers were also infected. Histology revealed that, in contrast to findings of previously published works on related species, intralamellar plasmodia did not develop inside the blood capillaries of the gills. Intestinal plasmodia were very pathogenic due to their large number and size. These plasmodia caused atrophy of the muscularis layer, and replaced and distended the submucosal and mucosal layers. The validity of some Henneguya species in Africa is discussed.

Sinonasal T-Cell lymphomas: A clinicopathologic study of a possibly distinct entity

BACKGROUND

Most cases of sinonasal lymphomas reported in the literature which show positive expression for Epstein-Barr virus are CD2+, CD3-, CD43+ and CD56+, and also show a germ-line T-cell receptor genotype. Five-year survival is usually around 50%. We report a group of patients with T-cell sinonasal lymphoma that showed distinct immunophenotypic and molecular profiles and a more aggressive behavior.

PATIENTS AND METHODS

Nineteen cases representing approximately 75% of sinonasal lymphoma diagnosed and treated at our institution between 1988 and 1997 were studied. They comprised 12 males and 7 females, with an age range of 10 to 73 years (median 46 years). The remaining cases (about 25%) were B-cell lymphomas. The morphology of the cases was evaluated together with a limited immunophenotyping. In situ hybridization for EBV mRNA was performed in 18 cases. Polymerase chain reaction (PCR) for T-cell receptor (TCR) gene rearrangement was performed in 15 cases. Clinical follow-up information was available on 14 patients. All cases showed a pattern of large-cell lymphoma, and three exhibited an immunoblastic morphology. The tumors showed extensive soft tissue invasion, necrosis and ulceration. While perineural invasion was a prominent feature, perivascular invasion was not noticed.

RESULTS

Seventeen tumors (84%) were CD3 positive. PCR analysis showed TCR gene rearrangement in 7 of 15 cases (46%). Fifteen cases (79%) were positive for EBV. The 14 patients with available clinical information had extensive local diseases, with stages ranging from IE to IIIE, where none showed positive bone marrow involvement. The 14 patients received chemotherapy with or without radiation therapy. Ten of the 14 patients (71%) died of the disease after a median of seven months, including all seven patients with positive TCR gene rearrangement.

CONCLUSION

Our findings suggest that sinonasal T-cell lymphoma represents a heterogeneous group of diseases with different phenotypic, genotypic and biological characteristics. Cases that show TCR gene rearrangement may represent a more aggressive subtype of the disease.