A rare case of ventriculoperitoneal shunt co-infection with Brevibacterium and Corynebacterium minutissimum organisms

Ventriculoperitoneal (VP) shunt infections are associated with increased risk of morbidity and mortality from complications such as meningitis, ventriculitis, shunt malfunction and in some cases, recurrence of infection. Brevibacterium and Corynebacterium are gram positive organisms that are rarely implicated in VP shunt infections but are more commonly associated with colonization of dialysis and central venous catheters. Typical microbiological isolates in VP shunt infections include Staphylococcus aureus, Staphylococcus epidermidis and gram-negative rods. Here, we describe the case of a young woman who had VP shunt placement for over a decade without any history of infection, and now presented with new-onset VP shunt co-infection with Brevibacterium and Corynebacterium organisms.

Spectrophotometric detection of RT-PCR-amplified BCR/ABL fusion transcripts. A survey performed on archival hematologic slides

We describe a method of spectrophotometric detection of BCR/ABL chimeric sequences amplified by multiplex reverse transcriptase-polymerase chain reaction (RT-PCR), enabling the use of archival hematologic slides as RNA sources. Multiplex PCR amplified b3a2, b2a2, and e1a2 break points of the BCR/ABL translocation and the normal ABL gene product. Assessment of sensitivity, performed on K562 cells, showed that the threshold approximated radioactive methods of detection (i.e., 1 positive cell in 1 x 10(6) negative cells for single round PCR and lower than 1 positive cell in 1 x 10(7) negative cells for nested PCR). Then, we assayed 38 different archival hematologic slides from 18 patients, including 11 cases of chronic myelogenous leukemia or chronic myelogenous leukemia-like disease, such as a case of myelofibrosis and a case of chronic neutrophilic leukemia, 6 cases of acute lymphoblastic leukemia, and 1 case of acute myelogenous leukemia. Amplification and spectrophotometric detection of BCR/ABL fusion messenger RNAs gave an unambiguous positive result in 24 (89%) of 27 expected positive slides, among which 17 (63%) were positive after a single PCR round. Concordant unambiguous results were obtained from 35 (92%) of 38 slides, as verified through parallel analyses of corresponding cryopreserved cells. Retrospective analysis on archival hematologic slides yielded identification of the presence or absence of the t(9;22) translocation and break point in 14 previously uncharacterized cases. The application of this method can help define the diagnosis of cases lacking other appropriate material and assist in the retrospective analysis of large patient series for which only smears are available.

Immunophenotypic and molecular genetic characterization of a case of CD8+ B cell chronic lymphocytic leukemia

We report the case of a patient with chronic B lymphocytic leukemia, with stable clinical and hematological conditions in the absence of any treatment. The flow cytometry analysis of the patient's cells revealed a CD19+, CD5+, IgM+, IgD+, lambda chain-phenotype, along with an unusual expression of CD8 alpha/alpha homodimer. B cells did not stain with the anti CD8 beta monoclonal antibody T8/2T8 5H7. Molecular biology analyses confirmed the monoclonal rearrangements of immunoglobulin heavy and lambda light chain genes in the presence of a germline configuration of T cell receptor genes. Moreover, an abnormal configuration of the CD8A gene was found in the CD8+B lymphocytic clone. We suggest that the aberrant expression of the CD8 gene could be related to its abnormal configuration.

Report of an unusual small lymphocytic B-cell lymphoma selectively involving the B-zone of lymph node

Selective involvement of the B-cell compartment of lymph node by B-cell malignant lymphomas is an occasional finding related to early phases of lymph node infiltration. The authors have observed a unique case of diffuse small lymphocytic lymphoma that consisted of immunohistologically and genotypically proven B-clonal population exhibiting a repetitive pattern of infiltration in three lymph node samples obtained from the patient during a 9-year period. This pattern consisted of a selective and complete replacement of the B-areas with disappearance of follicles and widening of the medullary cords, an expanded T-zone showing features consistent with dermatopathic lymphadenitis and well-preserved sinuses. Clinically, multiple involved sites at presentation (lymph nodes, spleen, skin, bone marrow, and peripheral blood) and during the 9-year follow-up (testis) were detected, and the disease was associated with a relative indolent course like other low-grade lymphomas. The phenotypic profile of lymphoma cells studied by immunoperoxidase method, and by single-labeling and double-labeling flow cytometric analyses (SIg+, K+, LN2+, MB1+, MB2+, HLA-DR+, CD 9+, CD19+, CD 20+, CD 21+, CD 22+, CD 24+, Leu 8+, CD 5-, CD 10-, CD 11b-, CD 11c-, CD 25-, CD 38-, PCA-1-, FMC-7-, CD 23-) was consistent with a B-cell proliferation at an intermediate stage of differentiation but distinct from other well-defined B-cell neoplasms. Whether such unique B-zone pattern was due to an intrinsic property of this lymphoma or it is to be related to the coexisting reactive T-zone expansion remains controversial.