Nucleolar size in benign and malignant plasma cell proliferation;

Diagnostic value of the concentration of M-component in initial classification of monoclonal gammopathy

The diagnostic value of the concentration of a serum M-component in initial classification of monoclonal gammopathy into malignant monoclonal gammopathy (MMG) and monoclonal gammopathy of undetermined significance (MGUS) was evaluated in 315 consecutive individuals with IgG, IgA or IgM type M-components. The final diagnosis was MMG in 84 and MGUS in 231 patients. Serum concentration was significantly highest in MMG, but for all 3 kinds of M-components, overlapping serum concentrations between MMG and MGUS were found. Highest efficiency was reached with a serum concentration of 30.2 g/l for IgG, 26.6 g/l for IgA and 22.7 g/l for IgM. Using these values, an initial correct classification was achieved in 0.90 of IgG M-components, in 0.91 of IgA M-components and in 0.79 of IgM M-components. Normal levels of uninvolved immunoglobulins were found to point strongly to MGUS.

Age-related change of distribution of immunoglobulin containing cells in human bone marrow. Changes in patients with benign monoclonal gammopathy and multiple myeloma

The number and mode of distribution of immunoglobulin containing cells in human bone marrow were investigated immunohistochemically using paraffin sections of bone marrow aspirates. In individuals without specific diseases, the number of immunoglobulin containing cells per unit field in bone marrow increased with advancing age until the 3rd decade and leveled off thereafter. The magnitude of the increase was great for Ig-G and Ig-A, but very slight for Ig-M. Such age-related change in the number of Ig-G and Ig-M containing cells in bone marrow was almost comparable to the age-related change of serum level of Ig-G and Ig-M. However, the magnitude of age-related increase of Ig-A containing cells in bone marrow was apparently higher than that of the serum level of Ig-A. Cluster formation of immunoglobulin containing cells increased with age in terms of both incidence and size. Three points were suggested for differentiation of benign monoclonal gammopathy (BMG) from multiple myeloma (MM). First, the ratio of serum level of M-component divided by the average number of immunoglobulin containing cells per unit field was higher in BMG than in MM; second, the number of cells per cluster of immunoglobulin containing cells was more than 50 in MM, but that in BMG less than 20; third, the small immunoglobulin containing cells with narrow cytoplasm were more prominent in MM than in BMG.

Computerized histopathologic assessment of malignant potential. II. A practical method for predicting survival following enucleation for uveal melanoma

To assess the malignant potential of uveal melanomas from standard histopathologic material, a single microslide from each of 100 cases underwent computer-assisted measurement of nucleolar cross-sectional area. The standard deviation of 200 measurements per slide correlated well with survival of patients following enucleation for their ocular tumor. Furthermore, a statistical model calculated from these measurements effectively predicted survival for 50 additional cases. Additional investigation demonstrated the following features of this method: (1) a high level of reproducibility; (2) acceptable constancy among different levels of the same tumor; (3) a practical expenditure of resources (assessment of each case required less than 40 minutes of a technician's time and an apparatus costing approximately $20,00). This method--computerized histopathologic assessment of malignant potential (CHAMP)--thus provides the pathologist with a practical method for extracting prognostic information from standard H & E-stained microslides of uveal melanomas. Previous studies by other researchers suggests that a similar method might be effective in assessing the malignant potential of more common neoplasms.

"Idiopathic" Bence Jones proteinuria: long-term follow-up in seven patients

We studied seven patients with idiopathic Bence Jones proteinuria (excretion greater than 1.0 g per 24 hours) who did not have acquired Fanconi's syndrome or an intact monoclonal immunoglobulin in the serum. None had evidence of overt multiple myeloma, of its variants, of systemic amyloidosis, or of malignant lymphoproliferative diseases when the proteinuria was recognized. In three of the seven patients, symptomatic multiple myeloma (associated with systemic amyloidosis in one) developed 8.8 to 21.1 years later. A fourth patient has asymptomatic myeloma and has not been treated. A fifth patient had an evolving myeloma at nine years but died of an unrelated cause. The remaining two patients still have apparently benign Bence Jones proteinuria after 7.7 and 12 years. Plasma-cell labeling indexes were low in all cases tested. This experience shows that although idiopathic Bence Jones proteinuria may remain stable for years, multiple myeloma or amyloidosis often develops, and consequently these patients must be kept under observation indefinitely.