Organomegaly in chronic alcoholics

We compared the weights of the brain, heart, spleen, lungs, liver, and kidneys, uncorrected and corrected for body surface area (BSA) and body mass index (BMI), of 50 alcoholics with 50 forensic controls matched for sex, age, and body weight. With the exception of combined renal weight corrected for BSA and BMI, no significant differences were found in organ weights between the two groups. Glomerular diameter corrected for BSA was significantly greater in alcoholics than controls. It appears that nephromegaly and glomerulomegaly are both population markers for alcoholism. In alcoholics, there was no correlation between the microscopic degree of steatosis and glomerulomegaly. In controls, renal glomerular diameter was greater with increasing severity of hepatic steatosis, probably as a reflection of obesity.

Recombinant alpha-2b-interferon in therapy of previously untreated hairy cell leukemia: long-term follow-up results of study by Cancer and Leukemia Group B

In 1985, Cancer and Leukemia Group B initiated a multi-institutional study to define the role of interferon alpha in therapy of previously untreated active hairy cell leukemia (HCL). This is a long-term follow-up report of the study. Fifty-five evaluable patients were treated with recombinant interferon-2b 2 million units/m2 subcutaneously three times a week for 1 year. Treatment was well tolerated; toxicity mainly consisted of flu-like syndrome and pancytopenia, both of a transient nature. Seventy-three percent of patients had objective beneficial responses with 8.3 months median time to achieve at least a partial response (PR). After 1 year of therapy, the patients have been observed for a median of 5 years. There was a continual trend towards relapse throughout this period but 28% have remained in remission beyond 6 years. Forty-six patients (83%) are alive at 6 years. Among the 40 patients who achieved at least a PR, there were 28 with splenomegaly at the beginning of study: the spleen size was reduced in all with interferon alpha therapy and none required splenectomy. This study confirms the results of other investigators, and demonstrates that recombinant alpha interferon-2b is an effective agent for treatment of hairy cell leukemia.

Fine needle aspiration of the spleen in hairy cell leukemia. A case report

Hairy cell leukemia (HCL), or leukemic reticuloendotheliosis, first described by Bouroncle in 1958, is a chronic lymphoproliferative disorder of B-cell origin that is manifest primarily in the blood, marrow and spleen. The hairy cells often contain a tartrate-resistant acid phosphatase (TRAP) isoenzyme and show prominent cytoplasmic projections. We report a rare case of hairy cell leukemia wherein the total white blood cell count in the peripheral blood was 20 x 10(9)/L, there were hairy cells in the peripheral blood, and the bone marrow aspirate was a dry tap. Fine needle aspiration of the spleen was performed. The splenic smears showed a monotonous population of abnormal lymphoid cells, some with the hairlike cytoplasmic projections. TRAP staining was positive. HCL must be differentiated from splenic B-cell lymphoma with circulating villous lymphocytes.

Interleukin-2-induced splenic enlargement

BACKGROUND

Splenomegaly in patients with cancer raises the suspicion of tumor involvement. Splenic enlargement in the absence of splenic metastases, however, has been reported in patients treated with interleukin-2 (IL-2) immunotherapy. This study characterizes the change in spleen size that occurred in 42 patients treated with IL-2 between 1989 and 1993 for nonhematologic malignancies.

METHODS

Computed tomography (CT) scans before and during immunotherapy were available for review on all 42 patients and after immunotherapy on 16 of these patients. The splenic index was measured for each CT by a single reader blinded to the time course of IL-2 therapy.

RESULTS

Mean splenic index increased 64.1% from 646 cm3 (standard deviation [SD], 387) pre-IL-2 to 1059 cm3 (SD, 534) during therapy with IL-2 (P < 0.0001). The splenic index remained elevated at 1112 cm3 (SD, 633) after completion of IL-2 therapy.

CONCLUSIONS

Splenomegaly, temporally associated with IL-2 therapy for nonhematologic malignancies, is likely to represent a sequela of therapy and not tumor progression.

Effect of IFN-gamma administration in virgin and pregnant mice: distribution of lymphoid and myeloid cells in the spleen

Administration of Interferon-gamma (IFN gamma) is used in the therapeutic approach for mainly cancer treatment and viral infections in vivo. Recently we observed some important pathologic dysfunctions caused by IFN-gamma administration to pregnant mice. This treatment affected not only the growth and development of the feto-placental unit, but also, among other hematologic disorders, caused splenomegaly to the mother. In an effort to explain the observed hypersplenism, we have analysed the behaviour of macrophages, B and T lymphocytes in the spleen of virgin and pregnant mice after intraperitoneal administration of low IFN-gamma doses. Although the percentage of myeloid Mac-1 and F4/80 positive cells in spleen cell suspensions of virgin and pregnant mice do not change with the IFN-gamma treatment, immunoperoxidase staining of frozen spleen sections shows that in pregnant mice the monocytic cells accumulate at the central white pulp area of the organ, whereas in non-pregnant mice these cells are mainly found at the peripheral red pulp area. In contrast, the same treatment was shown to increase the numbers of Ly5 positive B cells in both virgin and pregnant mice, whereas B cells were found to form clusters only in the case of pregnant animals. We also show that IFN-gamma increases the numbers of Tcyt/sup (Ly2 positive cells) and TH (L3T4 positive cells) in the spleen of virgin mice but not in pregnant mice. Both populations display a physiologic distribution in the white pulp of the organ as assessed by immunoperoxidase staining of frozen spleen sections. Interestingly, the distribution pattern of IL-2- and IL-4-producing cells, which reflects the presence of Th1 and Th2 subpopulations was different in pregnant and virgin mice. Gestating females had IL-2 producing cells dispersed in the white pulp area, whereas IL-4 producing cells formed clusters mainly at the periphery of the organ. Virgin females had almost undetectable levels of IL-4 producing cells, whereas IL-2 producing cells were found at the periphery. Our results indicate that IFN-gamma alters the equilibrium between Th1 and Th2 cells, which in turn is responsible for the redistribution of myeloid and lymphoid cells in the spleen of pregnant mice thereby explaining the development of an active immune/inflammatory reaction.

Immune parameters of mice bearing human head and neck cancer

A xenogeneic human head and neck squamous cell carcinoma (HNSCC) model in immunocompetent mice was evaluated for its requirement of cyclosporine for progressive tumor growth. Tumor growth and T cell functions were assessed in mice receiving cyclosporine treatment for various lengths of time. Tumor cells were injected s.c. on day 1 and cyclosporine was injected i.p. daily on days 1, 1-7, 1-14, 1-21, or for the entire 28 days of tumor growth. All mice developed tumors. These tumors were confirmed to be squamous carcinomas of human origin histologically and by positive staining for human MHC class I antigen expression. Tumors were largest in mice that received cyclosporine for days 1-21 or days 1-28. Increased tumor size was associated with increased serum levels of tumor-reactive antibodies, an increased intratumoral frequency of CD4+ and CD8+ cells, but a diminished production of interleukin-2 (IL-2) by the tumor infiltrate. Also correlating with increasing tumor size was splenomegaly, a decline in the frequency, but not the absolute levels, of splenic CD4+ and CD8+ cells, and a diminished capacity to proliferate in response to concanavalin A and to be stimulated to secrete IL-2. The HNSCC tumors contributed to the immune decline since T cell functions were more depressed in the tumor bearers than in control mice receiving only cyclosporine treatment. These results demonstrate that human HNSCC tumor xenografts can grow in mice even with limited cyclosporine treatment, and that the survival of these xenografts may, in part, be due to a tumor-induced decline in select T cell functions.

Anerythremic form of acute erythremic myelosis (Di Guglielmo's syndrome) causing hepatosplenomegaly due to the infiltration of hemoglobin-bearing blast cells: an autopsy case

An autopsy case of a 42 year old man with the anerythremic form of acute erythremic myelosis (Di Guglielmo's syndrome) is reported. The patient was admitted because of a 1 month history of fatigue and fever. Physical examination showed hepatosplenomegaly. Laboratory data showed leukopenia, mild normocytic anemia, and high levels of serum lactate dehydrogenase and vitamin B12. Bone marrow aspirate revealed an elevated number of erythroblasts, with dyserythropoiesis (E/M = 3.7). After admission, thrombocytopenia progressed rapidly, but blast cells were not seen in the peripheral blood throughout the clinical course. On the 56th hospital day, the patient died of pneumonia. At autopsy, the spleen weighed 550 g and the liver 1800 g. Histologically, the white and red pulps of the spleen and the portal region and sinusoid of the liver were diffusely infiltrated by blast cells that were positive for anti-hemoglobin (Hb) antibody on immunoperoxidase staining. The bone marrow, the lymph nodes, the adrenal glands, the pancreas, and the heart were also infiltrated by the blast cells. This was thus considered to be a rare case of the anerythremic form of acute erythremic myelosis (Di Guglielmo's syndrome), the findings showing that Hb immunoperoxidase staining is useful for the diagnosis of this condition.

Randomized comparison of pentostatin versus interferon alfa-2a in previously untreated patients with hairy cell leukemia: an intergroup study

PURPOSE

Therapy of hairy cell leukemia has markedly improved. Interferon alfa-2a and pentostatin are active agents. The National Cancer Institute organized an intergroup trial to compare these agents prospectively in untreated patients.

METHODS

Patients were randomized to receive either interferon alfa-2a (3 x 10(6) U subcutaneously three times per week) or pentostatin (4 mg/m2 intravenously every 2 weeks). Patients who did not respond to initial treatment were crossed over.

RESULTS

Of 356 patients on study, 313 were eligible. Among interferon patients, 17 of 159 (11%) achieved a confirmed complete remission and 60 of 159 (38%) had a confirmed complete or partial remission. Among pentostatin patients, 117 of 154 (76%) achieved a confirmed complete remission and 121 of 154 (79%) had a confirmed complete or partial remission. Additional patients achieved criteria for complete remission, but lacked confirmatory follow-up evaluation. Response rates were significantly higher (P < .0001) and relapse-free survival was significantly longer with pentostatin than interferon (P < .0001). The median follow-up duration is 57 months (range, 19 to 82). Myelosuppression was more frequent with pentostatin (P = .013). A multivariate logistic regression analysis of the confirmed complete remissions on pentostatin showed the following factors to be important for achieving a complete remission: high hemoglobin level (two-tailed P = .024), young age (P = .0085), and no or little splenomegaly (P = .0029).

CONCLUSION

Both agents were well tolerated. Pentostatin produced higher response rates, and the responses were durable. Patient age and clinical status had an impact on outcome with pentostatin. Pentostatin is effective therapy for hairy cell leukemia.

Griscelli syndrome: report of three cases

The clinical features of three children with Griscelli syndrome and autopsy findings of two are presented. The patients were 5 years, 9 months, and 3 months old, respectively. Clinical features included partial albinism, hepatosplenomegaly, and various neurological symptoms. Light and electron microscopic studies of the skin were compatible with Griscelli syndrome. Postmortem examination of the viscera and central nervous system revealed lymphohistiocytic infiltration with erythrophagocytosis. Bilateral diffuse involvement of the central nervous system, cranial nerve, and spinal cord was detected in both cases.

Laparoscopic splenectomy for congenital spherocytosis with splenomegaly: a case report

The traditional method of splenectomy involves a 7- to 10-cm abdominal incision, with its attendant morbidity that includes sepsis. Recently, the laparoscopic technique has been adopted for splenectomy. Many surgeons still believe that laparoscopic splenectomy should be carried out only for idiopathic thrombocytopenia purpura and Hodgkin's disease with a normal-sized spleen. A 16-year-old girl with marked splenomegaly (spleen size for times normal and weighing 600 g) due to congenital spherocytosis underwent laparoscopic splenectomy and retrieval of the spleen through the umbilical trocar site. Preoperative arterial embolization was not used, and the operative blood loss was estimated to be only 250 mL. Her postoperative course was uncomplicated, and she was discharged on the 4th postoperative day. The operative technique is described and the advantages of laparoscopic splenectomy are discussed.

Refractory anemia with an excess of blasts developed into overt leukemia with leukothrombocytosis

A 72-year-old man with refractory anemia with an excess of blasts developed overt leukemia with leukothrombocytosis. Hematological and physical findings closely resembled those of an accelerated or blastic phase of chronic myelocytic leukemia. The cytogenetic anomaly of i(17q) was observed during the course. The present case is suggestive of the diversities of myelodysplastic syndromes (MDS), including relationships between MDS and myeloproliferative disorders (MPD) and acute leukemia.

Comparative study between different diagnostic techniques in huge splenomegaly cases in El-Minia Province

Fifty four patients presenting by huge splenomegaly were admitted to Tropical Medicine Department, El-Minia University Hospital. Tissue biopsy revealed pure bilharziasis due to S. hematobium in 10 (19%) cases, liver cirrhosis in 23 (42%), mixed schistosomiasis and cirrhosis in 8 (15%), hepatoma in 3 (6%), lymphoma in 6 (11%) and hematological diseases in the form of chronic myeloid leukemia in 2 (3.5%) and thalassemia major in 2 (3.5%) cases. The sensitivity and specificity of abdominal ultrasonography was 100% and 97% in cases of schistosomiasis, 100% and 100% in cases of hepatoma, 87% and 100% in cases of liver cirrhosis, 33% and 100% in cases of lymphoma respectively. There was a positive significant correlation between endoscopic variceal grading, portal vein diameter, splenic vein diameter, size of the spleen and the grading of the portal tract thickenings. The pathological and ultrasonographic diagnosis was the same in 38 (70%) cases. Splenogram was characteristic but not diagnostic in cases of schistosomiasis and liver cirrhosis. It was diagnostic and similar to peripheral blood picture in the 2 cases of chronic myeloid leukemia and was normal in cases of thalassemia major. Splenic aspiration was able to diagnose all cases of lymphomas. It can be considered as a useful adjunct to the usual diagnostic procedures, both in staging and follow up, especially in cases presenting only by splenomegaly.

Pathology of the spleen in primary biliary cirrhosis: an autopsy study

Pathologic changes of the spleen in primary biliary cirrhosis (PBC) were studied using autopsy cases. By analysis of the data complied in the Annual Registry of Autopsies of Japan (1977-92), it was found that the splenic weight of 184 cases of PBC (450 +/- 224 g) was significantly heavier than that of 41 control autopsy cases of non-biliary liver cirrhosis from the School of Medicine, Kanazawa University (341 +/- 189 g), and also of 210 control cases filed in the Annual Registry of Autopsies of Japan (1982; 334 +/- 174 g). Among the cases of PBC, the splenic weight was positively correlated with the liver weight. There was no significant difference in the splenic weight between the cases belonging to histologic stages 1-3 and those of stage 4. Fibrosis extending from the splenic trabecula, proliferation and dilatation of the splenic sinus, and congestion in the red pulp, all being compatible with chronic splenic congestion, were similarly observed in the spleen in PBC as well as in other non-biliary cirrhotic cases. The present study indicates that the PBC patients present splenomegaly in the non-cirrhotic histologic stage and splenomegaly persists thereafter. However, the histopathologic changes of the spleen peculiar to PBC were not specified in this autopsy study. Prolonged portal hypertension and other mechanisms, possibly related to immune disarrangement, may be responsible for the prominent splenomegaly in PBC.

Risks and benefits of splenectomy in myelofibrosis: an analysis of 39 cases

From 1980 to 1993, 39 splenectomies were performed in the Department of Visceral Surgery of Saint-Louis Hospital, in patients referred for myelofibrosis associated with myeloid splenomegaly. The short term morbidity was considerable: 33 serious haemorrhagic, infectious or thrombotic complications including 5 fatal accidents were observed in 18 patients. Severe thrombotic or infectious complications leading to 6 further deaths occurred in 8 patients over the two years following splenectomy, while six cases of acute leukaemia appeared between 6 months and 3 years after splenectomy. In 40% of cases with regular follow-up, the operation did not provide any haematological improvement and all these patients died. Only patients with minimally progressive or stable myelofibrosis and residual marrow activity in isotope studies showed an amelioration of general status with relief of pain and reduction of transfusional requirements. The indication for splenectomy should therefore probably be limited to such cases.

Scanning and transmission electron microscopy of clonal peripheral blood lymphocytes in low grade non-Hodgkin's B-cell lymphomas with predominant splenomegaly

Peripheral blood mononuclear cells (PBLs) from 14 patients with low grade non-Hodgkin's B-cell lymphomas with predominant splenomegaly were studied by means of scanning (SEM) and transmission electron microscopy (TEM). All patients had peripheral blood and bone marrow involvement, the absence of lymphoadenopathy, and, except in one case, immunophenotypic features of a malignant proliferation of mature spleen B-cells arising from outside the germinal center, but not consistent with CLL or HCL. Several distinctive cytological features were observed in PBLs of the different subgroups. The SEM surface features of PBLs in patients with intermediate differentiation lymphocytic lymphoma (IDL) (five cases), lymphoplasmacytoid immunocytoma (LP-IC) (two cases), and mixed small and large cells malignant lymphoma (one case) were characterized by the presence of numerous well-developed microvilli. Some distinctive TEM ultrastructural features were also seen in the different cases. In the two cases of splenic lymphoma with villous lymphocytes (SLVL), SEM revealed large and elongated surface microvilli generally arising from two or three poles of the cells. This surface morphology, confirmed by TEM analysis, may be pathognomonic of this disease. Four additional cases, tentatively classified as small lymphocytic lymphoma on the basis of immunophenotypic data, were extremely heterogeneous at both SEM and TEM analysis. The ultrastructural features revealed by SEM and TEM may be useful for the more precise characterization of this heterogeneous group of diseases, which is generally difficult to define even when immunophenotypic and molecular approaches are used.

[Wolman disease]

BACKGROUND

Wolman disease is a severe disease associated with hepatosplenomegaly and adrenal calcifications; it is nearly always fatal in the first year of life.

CASE REPORT

A boy was born to consanguineous parents. His weight was 3,500 g, height 53 cm. Hepatomegaly was observed at the age of 26 days; he also had vomiting and watery stools with failure to thrive. Diagnosis of Wolman disease was suspected due to family history. Two sisters had died at the age of 3 months without precise diagnosis; both had abdominal distension, hepatosplenomegaly, anemia and inanition; CT scan showed calcifications of adrenal glands in one of them that had been attributed to adrenal hemorrhage. Investigations in our patient showed no adrenal calcification, hepatomegaly without splenomegaly, anemia (Hb: 8 g/100 ml). Liver biopsy showed enlarged and vacuolated parenchymal and Kupffer cells but the marrow did not contain foam cells. Acid lipase deficiency was demonstrated in cultured skin fibroblasts, permitting prenatal diagnosis in a further sib.

CONCLUSION

This case of Wolman disease was the first seen in Tunisia; it was inherited as an autosomal recessive disorder; this patient, as two of his sisters, died during the first 6 months of life.

Immunopharmacological profile of SR 31747: in vitro and in vivo studies on humoral and cellular responses

In our preceding paper, we demonstrated that both human and rat lymphocytes possess saturable high-affinity binding sites for the new sigma ligand SR 31747. Here we investigate the potential activity of this ligand on immune responses. In vitro, our study shows that SR 31747 exerts a concentration- and time-dependent inhibition of proliferative response to mitogens on mouse and human lymphocytes without affecting cell viability. This suppressive effect elicited by SR 31747 occurs over a concentration range which correlates with the pharmacological profile of the molecule in binding assays, strongly suggesting that SR 31747 acts through a receptor-mediated process. We showed that the SR 31747 effect, which was observed on purified T lymphocytes, affects a late event in the activation process which occurs after the G1 during the S phase of the cell cycle. Interestingly, no anti-proliferative effect was observed in a variety of tumor cell lines, supporting a specific effect limited to normal immune cells. In vivo, in mice, treatment with SR 31747 prevented both graft-versus-host disease and delayed-type hypersensitivity granuloma formation, while antibody response to sheep red blood cells was not affected. These results strongly suggest that the sigma-related receptor recognized by SR 31747 is very likely coupled to a biological function of lymphocytes.

Sonographical morphometrical findings of the liver and spleen in Sudanese patients with Schistosoma mansoni induced periportal fibrosis

Sonographic measurements of the liver, spleen and related blood vessels were performed in 87 healthy controls and in 50 patients with periportal fibrosis (pF) as well as in 52 patients with pF and at least one episode of gastro-oesophageal bleeding due to chronic Schistosoma mansoni infection. There was a progressing shrinkage of the liver paralleled by an increasing rate of patients with a larger left than right liver lobe as involvement of pF due to S. mansoni infection progressed. This was accompanied by an increasing percentage of pathological gallbladder wall enlargement, splenomegaly and an increasing portal vein diameter. It is suggested that organomorphometrical parameters of the liver and spleen can be used for sonographical evaluation of patients with S. mansoni infection as these may be useful for their clinical assessment of the progression of disease.

Fine needle aspiration biopsy of the spleen. A useful procedure in the diagnosis of splenomegaly

This study analyzed a series of 140 consecutive fine needle aspiration biopsies of the spleen (sFNAB) collected over a period of nine years. sFNABs were performed by the authors using a 22-gauge spinal needle, and 23-gauge needle in pediatric patients, with a subdiaphragmatic approach. Ultrasound assistance was utilized in 35 cases. Four of the cytocentrifuge specimens were also prepared with part of the aspirated material and used for immunocytochemical staining. Study of these biopsy specimens revealed various benign conditions, such as white pulp hyperplasia, myeloid metaplasia, storage disease, and granulomatous processes and abscesses. Malignant neoplasms were represented by non-Hodgkin's and Hodgkin's lymphomas, leukemias, malignant histiocytoses and metastases. sFNAB was the only diagnostic procedure employed for the morphologic assessment of 60 benign and of 2 malignant cases. In all the other cases sFNAB gave the first diagnosis that was confirmed on surgical specimens. In 2 cases splenic bleeding occurred; one of them required splenectomy. Diagnostic and technical problems are discussed. The authors consider sFNAB a useful procedure, especially in the study of hematologic disorders and in all cases in which splenomegaly is not related or correlated with any clinical finding.

Amplification of the graft-versus-host reaction by cyclophosphamide: dependence on timing of drug administration

An experimental model, previously developed to study the combined effect of partial body irradiation and the graft-versus-host (GVH) reaction, has been adapted to assay the amplification of the GVH reaction by cyclophosphamide (CY). The system has proved sensitive enough to detect differences in the level of the GVH reaction produced by relatively small changes in pre-transplant conditioning. F1 hybrid mice treated with either CY 60 mg/kg or allogeneic (parental) lymphoid cells (ALC, 20 x 10(6)) had 100% survival. In contrast, ALC given 24 h after CY injection resulted in 84% GVHD-related mortality with a mean survival time of 18 days. Amplification of the GVH reaction by CY was also seen in terms of splenomegaly and immunosuppression. Separation of CY and ALC injection by an interval longer that 24 h reduced the severity of GVH reaction but some amplification was still observed. Based on several GVHD-related criteria, experimental groups with a 2 or 4 day interval between CY and ALC injection had approximately the same response, an effect was still detectable for an interval of 7 days between injections but was no longer apparent when the interval was extended to 12 days.

Acute leukaemia after hydroxyurea therapy in polycythaemia vera and allied disorders: prospective study of efficacy and leukaemogenicity with therapeutic implications

Fifty consecutive patients, 30 of whom had polycythaemia vera (PV), 10 essential thrombocythaemia (ET), and 10 myelofibrosis (MF), entered a long-term prospective study of hydroxyurea (HU) therapy. The indication for treatment was mainly thrombocytosis or symptomatic splenomegaly. Control of erythrocytosis and thrombocytosis was achieved in 70% of the patients. Continuous maintenance treatment was required. In 15% of responding patients with thrombocytosis, unexpected rises of the platelet count occurred during maintenance therapy. Severe thrombo-embolic events occurred in 6 patients. The size of the spleen decreased in all patients who did not develop thrombocytopenia and could absorb adequate HU doses. Acute leukaemia (AL) was diagnosed in 9 patients and a myelodysplastic syndrome in one. Seven of them had been treated with HU alone. Among the patients with PV and ET, 6 developed AL and 4 of them were treated with HU alone (3 PV and 1 ET), giving an incidence of 10.5%. In previously untreated patients with initially normal karyotypes (n = 19), chromosome abnormalities developed during HU therapy in 7 (37%). Our results indicate that HU should be regarded as leukaemogenic, at least when used for treatment of PV and allied diseases. Since myelosuppressive treatment of PV does not prolong survival, the use of HU should be restricted to patients in whom the treatment indication outweights the risk of leukaemia induction.

[Diagnosis of visceral leishmaniasis]

The differential diagnosis between visceral leishmaniasis and lymphoplasmacell polimorphocell lymphosarcoma may be difficult. One case is described in which electron microscopy allowed detection of Leishmania in the histiocytes of the spleen.