The immunophenotype of 177 adults with acute myeloid leukemia: proposal of a prognostic score

In acute myeloid leukemia (AML) patients, a variety of clinical and biologic parameters, including phenotype, have been examined for potential value in predicting treatment response and survival. The European Group for the Immunological Classification of Leukaemias (EGIL) has proposed that AML be defined immunologically by the expression of 2 or more of the following myeloid markers: myeloperoxidase, CD13, CD33, CDw65, and CD117. With regard to this classification, the prognostic significance of 21 antigens taken separately and with immunophenotypic subgroups were evaluated and compared with other clinical and biological variables in 177 adult AML patients. None of the antigens tested were associated with treatment outcome. In contrast, patients with blasts disclosing a full expression of panmyeloid phenotype (defined by the expression of all 5 myeloid markers) had a higher complete remission rate (P <. 0001) and differed significantly in disease-free survival (P =.02) and overall survival (P =.008) than patients whose cells expressed fewer than 5 of these markers. In multivariate analysis, only age, panmyeloid phenotype, performance status, and permeability glycoprotein activity influence treatment outcome. Cytogenetics was significant in univariate analysis but not in multivariate analysis, most likely because of the redundancy with panmyeloid phenotype and a higher sensitivity of immunophenotyping. Patients whose cells exhibit the panmyeloid phenotype appear to define a relatively homogeneous biological subset of AML. The 4 independent prognostic factors were used to create a prognostic score, defined by the number of factors present. This score permitted a stratification of patients with AML, thereby allowing for the consideration of innovative therapies to improve outcome in the poorer outcome groups.

[Immunohistochemical studies of breast and extra-mammary Paget's disease indicate an apocrine differentiation]

Using the PAP technique, paraffin-embedded and formalin-fixed tissue sections taken from 11 patients suffering from Paget's disease (5 mammary, 6 extramammary cases) were stained with antibodies against keratin, actin, S 100 protein, CEA, HMFG 1, cytokeratin 6 and 18 (Dako-CK-1), as well as the lectin SBA. We did not find any differences between mammary and extramammary Paget's disease. In both forms of the disease, all tumor cells showed reaction to antibodies against HMFG 1 and CEA and, in 50 to 100%, to the lectin SBA. The other antibodies investigated did not react with Paget's cells. Since HMFG 1 and Dako-CK-1 are selective markers of apocrine and eccrine sweat gland structures, respectively, our results suggest apocrine differentiation of both mammary and extramammary Paget's disease. At the same time, our findings rule out a possible histogenesis of Paget's cells from melanocytes (positive for S 100 protein) or keratinocytes (positive for Dako-CK-1 and antikeratin).

An immunohistochemical study of dermatofibrosarcoma protuberans supports its fibroblastic character and contradicts neuroectodermal or histiocytic components

Paraffin-embedded material from 26 cases of dermatofibrosarcoma protuberans (DFSP) was investigated by the peroxidase-antiperoxidase technique. Antibodies to S-100 protein, Leu-7 antigen, and neuron-specific enolase (neural markers); to lysozyme, alpha-1-antitrypsin, and alpha-1-antichymotrypsin (histiocytic markers); and to cytokeratin, desmin, vimentin, and factor VIII were used. The tumor cells reacted only for vimentin. In addition, 12 cases showed positive reactions with histiocytic markers (1-3% of the cells; in two cases, up to 10%). These results support a fibroblastic and contradict a neural or histiocytic histogenesis of DFSP.

[Immunohistochemical studies of the histogenesis of dermatofibrosarcoma protuberans]

Paraffin-embedded tissue sections taken from 16 patients with dermatofibrosarcoma protuberans were stained by means of the peroxidase-antiperoxidase technique using antibodies against S 100 protein, NSE, Leu 7, lysozyme, alpha-1 antitrypsin, alpha-1 antichymotrypsin, cytokeratin, desmin, vimentin, and factor VIII. Most of the tumor cells showed positive reactions to vimentin. Only 1-3% of the cells within the tumor area answered to the histiocytic markers lysozyme, alpha-1 antitrypsin, and alpha-1 antichymotrypsin. The remaining antibodies investigated did not react with the tumor cells. Our results support a fibroblastic, and contradict a neural or histiocytic, histogenesis of dermatofibrosarcoma protuberans.

[Temporal arteritis with hypotension syndrome and necrosis of the scalp]

An 80-year-old male patient with histologically confirmed temporal arteritis presented with two very rare complications: ocular hypotony and bilateral scalp necrosis. The intraocular pressure gradually normalized on high-dose cortisone therapy. Scalp necrosis was surgically removed and covered with a split-skin graft with good incorporation of the transplant. Scalp necrosis as well as ocular hypotony are serious complications of temporal arteritis, indicating a poor prognosis. To date three similar cases have been reported in the literature.