Lymph nodes in incipient adult T-cell leukemia-lymphoma with Hodgkin's disease-like histologic features

Article Abstract:

Adult T-cell leukemia-lymphoma classically presents as a rapidly progressing disorder. However, there are some cases in which the condition is preceded by an extended prodromal syndrome prior to the actual onset of the leukemia-lymphoma. The authors present the cases of four patients who developed a prodromal syndrome during which lymph nodes showed a structure strongly reminiscent of Hodgkin's disease. The patients had mild lymphadenopathy (disease of the lymph nodes), fatigue and, at most, a few atypical lymphocytes (a type of white blood cell)in the blood. Examination of tissue from the lymph nodes revealed that their structure was essentially preserved and that Reed-Sternberg cells, which are characteristic of Hodgkin's disease, were present. However, using the polymerase chain reaction to detect (with high sensitivity) genes from the human T cell lymphotropic virus type I, it could be convincingly demonstrated that this was not Hodgkin's disease. This retrovirus is associated with human T cell leukemia and lymphoma, and not with Hodgkin's disease. Within two years of the removal of the lymph nodes, all four patients were dead; three of overt leukemia-lymphoma, and one of a pulmonary carcinoma (lung cancer) with mediastinal lymphadenopathy - disease of the lymph nodes in the chest. The authors suggest that it is important to distinguish between true Hodgkin's disease and the symptoms of incipient adult T-cell leukemia-lymphoma. Since the prognosis of Hodgkin's disease is good, in marked contrast to the poor prognosis of adult T-cell leukemia, the distinction has important clinical consequences. The possibility of HTLV-I infection should be considered by pathologists, especially in nations like Japan where adult T-cell leukemia-lymphoma is endemic. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, HTLV-I infections, Lymph nodes, HTLV (Viruses), HTLV viruses, HTLV-I (Virus), Adult T-cell leukemia-lymphoma, Preleukemia

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Cystic thymomas: a clinicopathologic study of ten cases

Article Abstract:

The development of cysts within thymus tumors is quite common. It is estimated that in perhaps 40 percent of thymomas, fluid-filled cystic spaces develop. In some cases, these cysts may be quite large and filled with blood or coarsely granular yellow-brown material. Sometimes, the cyst may become so large that the true nature of the tumor is obscured. Only a few clumps of tumor cells at the edge indicate that the lesion is not a non-tumorous thymic cyst. This poses a clinical problem, since the appearance of these cystic thymomas may cause an erroneous diagnosis. The authors provide a review of 10 cases in which the cystic thymoma was initially mistaken for a non-neoplastic lesion. The age of the patients ranged from 23 to 81; men and women were represented equally. Microscopic examination revealed that solid islands of tumor cells could be observed within the thymoma. Furthermore, the cysts were not lined with epithelial cells, another indication that they developed from tumors and not from non-neoplastic thymus. Infiltration of cells into the surrounding normal thymus could be observed. While such findings are often indications of malignancy or cancer, the authors emphasize that in the cystic thymoma, the infiltrating cells do not represent a malignant process. Rather, the infiltrating cells are inflammatory cells which are not part of the tumor but which have accumulated in response to it. After follow-up periods as long as 10 years, none of the 10 patients with cystic thymoma in the present study have experienced a recurrence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Endocrine gland tumors

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Thymomas associated with pure red cell aplasia: histologic and follow-up studies

Article Abstract:

Red cell aplasia, or the lack of red blood cell development, is commonly found in association with tumors of the thymus. Although the autoimmune disease myasthenia gravis is more commonly associated with thymoma than red cell aplasia, half of all patients with pure red cell aplasia (PRCA) have thymic tumors. To further clarify the relationship between these two entities, immunological data was obtained on seventeen patients with PRCA and thymoma. Histological data on the thymus was usually obtained after surgery, and in one case by biopsy only. The thymic tumors were all of the spindle type histologically, distinguishing them from the type seen in myasthenia gravis. In addition, the corticomedullary boundary of these thymuses had vanished. No remarkable immunological characteristics were observed in these patients, but it is tempting to speculate that, given the immune role of the thymus and the clear role of autoimmunity in myasthenia gravis, PRCA may result from an immune dysfunction. Antibodies or immune cells may in some way interfere with the normal maturation of red blood cells, or perhaps with the hormones that stimulate this process. A possible cause of thymoma may be unrelated to autoimmunity; whatever agent is responsible for PRCA may damage, or infect, the thymus, increasing its likelihood of developing tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Pure red cell aplasia

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