Evaluation of Bone Marrow Infiltration in Non-Neuropathic Gaucher Disease Patients with Use of Whole-Body MRI--A Retrospective Data Analysis

PURPOSE

To evaluate whole-body magnetic resonance imaging (WB-MRI) for the assessment of bone marrow infiltration in patients with confirmed Gaucher disease type 1 under long-term enzyme replacement therapy (ERT).

MATERIALS AND METHODS

This retrospective data analysis included 38 patients in two subgroups. Group A: 10 females, 9 males, 15-29 years, mean age 22 years and Group B: 11 females, 8 males, 29-77 years, mean age 49 years, all treated with alglucerase or imiglucerase for at least 12.5 years. Whole-body MRI was carried out in all patients using a standard MRI protocol. Two radiologists assessed all MR images retrospectively with the use of three different MRI score systems: The bone marrow burden (BMB) score, the Düsseldorf-Gaucher score (DGS) and the vertebra disc ratio (VDR). As a clinical component, severity score index type 1 (GD-DS3) was determined.

RESULTS

In both groups the MR scores showed low to moderate pathologic levels but no statistically significant difference was found between both groups. The median scores in group A/group B were 7.00/9.00 for the BMB score (p=0.07), 4.00/3.00 for the DGS score (p=0.062) and 1.54/1.62 for the VDR score (p=0.267). The GD-DS3 score was statistically significantly different between both groups (1.6/3.9, p=0.000) and osseous Gaucher disease complications were only found in group B.

CONCLUSION

Bone marrow involvement and typical clinical manifestations are reduced to a minimum, when ERT starts immediately after the confirmed diagnosis of Gaucher disease type 1. The applied MR scores are useful markers to control bone marrow infiltration under enzyme replacement therapy in older patients. Pathologic MR scores in young patients may reflect postponed fat conversion of the juvenile bone marrow. This issue has to be examined in further studies.

KEY POINTS

Whole-body MRI is valuable for the staging of Gaucher disease type 1. Osseous complications are reduced to a minimum in early treated patients. MR score systems have to be adjusted in young Gaucher patients.

[Sarcomatoid carcinoma of the bladder in a 25-year-old man]

A 25-year-old patient with a rapidly growing sarcomatoid carcinoma of the urinary bladder is reported. The diagnosis was made on the basis of extended atypical proliferations of spindle or pleomorphic cells in the area of pelvic floor and the radix of the penis. The tumor showed invasion of the blood and a high Ki-67 growth fraction up to 40%. Immunohistochemically, the reactions with antibodies against cytokeratin, EMA, and vimentin were positive, while negative results were obtained in reactions with antibodies against desmin, actin, PSA, S 100, human epithelial antigen (Ber-EP4), and cytokeratin 13. The differential diagnosis against myosarcomas, pseudosarcomatous lesions, and inflammatory pseudotumours is discussed. After radical surgery a pelvic recurrence and pulmonary metastases developed, which led to the patient's death 3 months later. This case shows that sarcomatoid carcinomas of the urinary bladder can be found even in young people.

Arsenate ion reduction in non-living biological materials

The reduction of arsenate ion to arsenite ion by a variety of tissues was widely distributed, and not a property of any particular tissue. The nature of the reduction was investigated by using various chemical inducers and inhibitors and is believed to be chemical in nature.

The determination of arsenite and arsenate ions in fish and shellfish by selective extraction and polarography

Arsenite ion, as arsenic trichloride was extracted into benzene from strongly acidified tissue homogenates. Following this, arsenite was extracted from the benzene into water, made up in 1N HCl and analyzed polarographically. Arsenate ion, left in the homogenate after arsenite extraction is isolated in exactly the same way following treatment of the homogenate with cuprous ion to reduce arsenate to arsenite ion. Treatment of the acidified homogenate with cuprous ion prior to extraction gives a homogenate which is readily analyzed for total "inorganic" arsenic. The method was efficient to a maximum level of about 20 mug inorganic arsenic since at higher levels lower recoveries were found. Analysis of a variety of marine biological specimens, with levels of total arsenic up to 40.5 ppm, indicated little of this arsenic was present in an inorganic form. Post mortem reduction of arsenate to arsenite was found to occur rapidly in fish tissue.