Underpinning the use of indium as a neutron absorbing additive in zirconolite by X-ray absorption spectroscopy

Indium (In) is a neutron absorbing additive that could feasibly be used to mitigate criticality in ceramic wasteforms containing Pu in the immobilised form, for which zirconolite (nominally CaZrTi₂O₇) is a candidate host phase. Herein, the solid solutions Ca_1-xZr_1-xIn_2xTi₂O₇ (0.10 ≤ x ≤ 1.00; air synthesis) and Ca_1-xU_xZrTi_2-2xIn_2xO₇ (x = 0.05, 0.10; air and argon synthesis) were investigated by conventional solid state sintering at a temperature of 1350 °C maintained for 20 h, with a view to characterise In³⁺ substitution behaviour in the zirconolite phase across the Ca²⁺, Zr⁴⁺ and Ti⁴⁺ sites. When targeting Ca_1-xZr_1-xIn_2xTi₂O₇, single phase zirconolite-2M was formed at In concentrations of 0.10 ≤ x ≤ 0.20; beyond x ≥ 0.20, a number of secondary In-containing phases were stabilised. Zirconolite-2M remained a constituent of the phase assemblage up to a concentration of x = 0.80, albeit at relatively low concentration beyond x ≥ 0.40. It was not possible to synthesise the In₂Ti₂O₇ end member compound using a solid state route. Analysis of the In K-edge XANES spectra in the single phase zirconolite-2M compounds confirmed that the In inventory was speciated as trivalent In³⁺, consistent with targeted oxidation state. However, fitting of the EXAFS region using the zirconolite-2M structural model was consistent with In³⁺ cations accommodated within the Ti⁴⁺ site, contrary to the targeted substitution scheme. When deploying U as a surrogate for immobilised Pu in the Ca_1-xU_xZrTi_2-2xIn_2xO₇ solid solution, it was demonstrated that, for both x = 0.05 and 0.10, In³⁺ was successfully able to stabilise zirconolite-2M when U was distributed predominantly as both U⁴⁺ and average U⁵⁺, when synthesised under argon and air, respectively, determined by U L₃-edge XANES analysis.

Optimization of Magnesium Potassium Phosphate Cements Using Ultrafine Fly Ash and Fly Ash

The effect of ultrafine fly ash (UFA) and fly ash (FA) on the physical properties, phase assemblage, and microstructure of magnesium potassium phosphate cement (MKPC) was investigated. This study revealed that the UFA addition does not affect the calorimetry hydration peak associated with MKPC formation when normalized to the reactive components (MgO and KH₂PO₄). However, there is an indication that greater UFA additions lead to an increased reaction duration, suggesting the potential formation of secondary reaction products. The addition of a UFA:FA blend can delay the hydration and the setting time of MKPC, enhancing workability. MgKPO₄·6H₂O was the main crystalline phase observed in all systems; however, at low replacement levels in the UFA-only system (<30 wt %), Mg₂KH(PO₄)₂·15H₂O was also observed by XRD, SEM/EDS, TGA, and NMR (³¹P MAS, ¹H-³¹P CP MAS). Detailed SEM/EDS and MAS NMR investigations (²⁷Al, ²⁹Si, ³¹P) demonstrated that the role of UFA and UFA:FA was mainly as a filler and diluent. Overall, the optimized formulation was determined to contain 40 wt % fly ash (10 wt % UFA and 30 wt % FA (U10F30)), which achieved the highest compressive strength and fluidity and produced a dense microstructure.

Phase Evolution in the CaZrTi2O7-Dy2Ti2O7 System: A Potential Host Phase for Minor Actinide Immobilization

Zirconolite is considered to be a suitable wasteform material for the immobilization of Pu and other minor actinide species produced through advanced nuclear separations. Here, we present a comprehensive investigation of Dy³⁺ incorporation within the self-charge balancing zirconolite Ca_1–xZr_1–xDy_2xTi₂O₇ solid solution, with the view to simulate trivalent minor actinide immobilization. Compositions in the substitution range 0.10 ≤ x ≤ 1.00 (Δx = 0.10) were fabricated by a conventional mixed oxide synthesis, with a two-step sintering regime at 1400 °C in air for 48 h. Three distinct coexisting phase fields were identified, with single-phase zirconolite-2M identified only for x = 0.10. A structural transformation from zirconolite-2M to zirconolite-4M occurred in the range 0.20 ≤ x ≤ 0.30, while a mixed-phase assemblage of zirconolite-4M and cubic pyrochlore was evident at Dy concentrations 0.40 ≤ x ≤ 0.50. Compositions for which x ≥ 0.60 were consistent with single-phase pyrochlore. The formation of zirconolite-4M and pyrochlore polytype phases, with increasing Dy content, was confirmed by high-resolution transmission electron microscopy, coupled with selected area electron diffraction. Analysis of the Dy L₃-edge XANES region confirmed that Dy was present uniformly as Dy³⁺, remaining analogous to Am³⁺. Fitting of the EXAFS region was consistent with Dy³⁺ cations distributed across both Ca²⁺ and Zr⁴⁺ sites in both zirconolite-2M and 4M, in agreement with the targeted self-compensating substitution scheme, whereas Dy³⁺ was 8-fold coordinated in the pyrochlore structure. The observed phase fields were contextualized within the existing literature, demonstrating that phase transitions in CaZrTi₂O₇–REE³⁺Ti₂O₇ binary solid solutions are fundamentally controlled by the ratio of ionic radius of REE³⁺ cations.

Zirconolite (CaZrTi₂O₇) ceramics are candidate wasteform materials for Pu and other minor actinides. Herein, the Ca_1−xZr_1−xDy_2xTi₂O₇ solid solution was fabricated by a conventional mixed oxide synthesis, with Dy³⁺ included as a structural simulant for Am³⁺. A phase transformation from zirconolite-2M to zirconolite-4M was observed at low Dy concentrations (0.20 ≤ x ≤ 0.30) after which cubic pyrochlore was stabilized as the dominant phase. Observations and interpretations were supported by electron diffraction and X-ray absorption spectroscopic methods.

Thermal treatment of Cs-exchanged chabazite by hot isostatic pressing to support decommissioning of Fukushima Daiichi Nuclear Power Plant

Ion exchange materials are used widely for the removal of radionuclides from contaminated water at nuclear licensed sites, during normal operating procedures, decommissioning and in accident clean-up, such as the ongoing recovery operation at the Fukushima Daiichi nuclear power plant. Framework silicate inorganic ion exchange materials, such as chabazite ((Na_0.14K_1.03Ca_1.00Mg_0.17)[Al_3.36Si_8.53O₂₄]•9.7H₂O), have shown particular selectivity towards ¹³⁷Cs uptake, but their safe storage poses a number challenges requiring conditioning into passively safe waste packages of minimal volume. We demonstrate the transformation of Cs-exchanged chabazite into a glass-ceramic wasteform by hot isostatic pressing to produce a durable consolidated monolith. The application of heat and pressure resulted in the collapse of the chabazite framework, forming crystalline Cs-substituted leucite (Cs_0.15(3)K_0.57(4)Al_0.90(4)Si_2.24(5)O₆) incorporated within a K₂O-CaO-MgO-Al₂O₃-SiO₂ glass. The Cs partitioned preferentially into the Cs/K-feldspar which incorporated ~77% of the Cs₂O inventory. Analysis of the chemical durability of the glass-ceramic wasteform revealed that the Cs release rates were comparable or lower than those reported for vitrified high level and intermediate level wastes. Overall, hot isostatic pressing was demonstrated to be an effective processing technology for conditioning spent inorganic ion exchange materials by yielding durable and passively safe wasteforms.

Characterisation and disposability assessment of multi-waste stream in-container vitrified products for higher activity radioactive waste

Materials from GeoMelt® In-Container Vitrification (ICV)™ of simulant UK nuclear wastes were characterised to understand the partitioning of elements, including inactive surrogates for radionuclide species of interest, within the heterogeneous products. Aqueous durability analysis was performed to assess the potential disposability of the resulting wasteforms. The vitrification trial aimed to immobilise a variety of simulant legacy waste streams representative of decommissioning operations in the UK, including plutonium contaminated material, Magnox sludges and ion-exchange materials, which were vitrified upon the addition of glass forming additives. Two trials with different wastes were characterised, with the resultant vitreous wasteforms comprising olivine and pyroxene crystalline minerals within glassy matrices. Plutonium surrogate elements were immobilised within the glassy fraction rather than partitioning into crystalline phases. All vitrified products exhibited comparable or improved durability to existing UK high level waste vitrified nuclear wasteforms over a 28 day period.

Characterization of and Structural Insight into Struvite-K, MgKPO4·6H2O, an Analogue of Struvite

Struvite-K (MgKPO₄·6H₂O) is a magnesium potassium phosphate mineral with naturally cementitious properties, which is finding increasing usage as an inorganic cement for niche applications including nuclear waste management and rapid road repair. Struvite-K is also of interest in sustainable phosphate recovery from wastewater and, as such, a detailed knowledge of the crystal chemistry and high-temperature behavior is required to support further laboratory investigations and industrial applications. In this study, the local chemical environments of synthetic struvite-K were investigated using high-field solid-state ²⁵Mg and ³⁹K MAS NMR techniques, alongside ³¹P MAS NMR and thermal analysis. A single resonance was present in each of the ²⁵Mg and ³⁹K MAS NMR spectra, reported here for the first time alongside the experimental and calculated isotropic chemical shifts, which were comparable to the available data for isostructural struvite (MgNH₄PO₄·6H₂O). An in situ high-temperature XRD analysis of struvite-K revealed the presence of a crystalline-amorphous-crystalline transition that occurred between 30 and 350 °C, following the single dehydration step of struvite-K. Between 50 and 300 °C, struvite-K dehydration yielded a transient disordered (amorphous) phase identified here for the first time, denoted δ-MgKPO₄. At 350 °C, recrystallization was observed, yielding β-MgKPO₄, commensurate with an endothermic DTA event. A subsequent phase transition to γ-MgKPO₄ was observed on further heating, which reversed on cooling, resulting in the α-MgKPO₄ structure stabilized at room temperature. This behavior was dissimilar from that of struvite exposed to high temperature, where NH₄ liberation occurs at temperatures >50 °C, indicating that struvite-K could potentially withstand high temperatures via a transition to MgKPO₄.

Thermal treatment for radioactive waste minimisation

Safe management of radioactive waste is challenging to waste producers and waste management organisations. Deployment of thermal treatment technologies can provide significant improvements: volume reduction, waste passivation, organics destruction, safety demonstration facilitation, etc. The EC-funded THERAMIN project enables an EU-wide strategic review and assessment of the value of thermal treatment technologies applicable to Low and Intermediate Level waste streams (ion exchange media, soft operational waste, sludges, organic waste, and liquids). THERAMIN compiles an EU-wide database of wastes, which could be treated by thermal technologies and documents available thermal technologies. Applicability and benefits of technologies to the identified waste streams will be evaluated through full-scale demonstration tests by project partners. Safety case implications will also be assessed through the study of the disposability of thermally treated waste products. This paper will communicate the strategic aims of the ongoing project and highlight some key findings and results achieved to date.

Exploiting in-situ solid-state NMR spectroscopy to probe the early stages of hydration of calcium aluminate cement

We report a high-field in-situ solid-state NMR study of the hydration of CaAl₂O₄ (the most important hydraulic phase in calcium aluminate cement), based on time-resolved measurements of solid-state ²⁷Al NMR spectra during the early stages of the reaction. A variant of the CLASSIC NMR methodology, involving alternate recording of direct-excitation and MQMAS ²⁷Al NMR spectra, was used to monitor the ²⁷Al species present in both the solid and liquid phases as a function of time. Our results provide quantitative information on the changes in the relative amounts of ²⁷Al sites with tetrahedral coordination (the anhydrous reactant phase) and octahedral coordination (the hydrated product phases) as a function of time, and reveal significantly different kinetic and mechanistic behaviour of the hydration reaction at the different temperatures (20 °C and 60 °C) studied.

Exploiting in-situ solid-state NMR spectroscopy to probe the early stages of hydration of calcium aluminate cement

We report a high-field in-situ solid-state NMR study of the hydration of CaAl₂O₄ (the most important hydraulic phase in calcium aluminate cement), based on time-resolved measurements of solid-state ²⁷Al NMR spectra during the early stages of the reaction. A variant of the CLASSIC NMR methodology, involving alternate recording of direct-excitation and MQMAS ²⁷Al NMR spectra, was used to monitor the ²⁷Al species present in both the solid and liquid phases as a function of time. Our results provide quantitative information on the changes in the relative amounts of ²⁷Al sites with tetrahedral coordination (the anhydrous reactant phase) and octahedral coordination (the hydrated product phases) as a function of time, and reveal significantly different kinetic and mechanistic behaviour of the hydration reaction at the different temperatures (20 °C and 60 °C) studied.

Current controversies in early-stage melanoma: Questions on incidence, screening, and histologic regression

In the first article in this continuing medical education series we review controversies and uncertainties relating to the epidemiology and initial diagnosis of localized cutaneous melanoma (ie, stage 0, I, or II). Many of these issues are unsettled because of conflicting evidence. Melanoma incidence appears to be increasing, yet its basis has not been fully explained. Despite the advantages of early detection, the US Preventive Services Task Force does not recommend skin screening for the general population. Occasionally, biopsy specimens of melanoma will show histologic regression, but the prognostic importance of this phenomenon is uncertain. Some practitioners recommend obtaining a sentinel lymph node biopsy specimen for thin melanomas showing regression, although this histologic finding is not part of the staging system for thin melanomas. Our goal is to provide the clinician who cares for patients with (or at risk for) melanoma with up-to-date contextual knowledge to appreciate the multiple sides of each controversy so that they will be better informed to discuss these issues with their patients and their families.

Use of an Interdisciplinary Student Medical Innovation and Entrepreneurship Program to Create Affordable Global Health Care Solutions

BACKGROUND

Bench to Bedside is a 7-month-long medical innovation and entrepreneurship program at the University of Utah in which teams comprising students from various disciplines work together to identify health care problems and develop novel technology solutions. Student teams are provided a small prototyping budget, access to device development workshops, prototyping facilities, and expert faculty and industry mentors. Teams then compete for seed funding at the Bench to Bedside competition at the end of the program. In 2014, we created global health-specific resources, mentorship, guidance, and award incentives as a means to drive global health technology development in the program and then studied our impact after 6 years.

METHODS

We reviewed program data collected continuously between 2011 and 2018 to evaluate the impact of global health incentive initiatives on the development of global health-related technologies. We quantified the number of global health teams based on both team-declared data and objective evaluation of each competing technology.

RESULTS

The initiation of global health technology incentives was associated with an annual overall doubling of teams pursuing the development of global health-related technologies from an average of 11.4% to 24.8% ( P = .003).

CONCLUSIONS

A student medical technology innovation program designed to address global health needs is an effective means of generating new solutions to improve global health care. The use of global health-specific awards and mentors raised awareness of the need for affordable global solutions and incentivized teams to pursue development.

Blast furnace slag-Mg(OH)2 cements activated by sodium carbonate

Novel cements can contain up to 50 wt% Mg(OH)₂, offering a new route to immobilisation of this nuclear waste constituent.

Histiocytic sarcoma with secondary involvement of the skin and expression of CD1a: evidence of indeterminate cell differentiation?

BACKGROUND

Histiocytic sarcoma is an exceedingly rare malignant neoplasm composed of cells with a monocyte/macrophage phenotype. In the current nosology of histiocytic neoplasms, histiocytic sarcoma is separate from indeterminate cell histiocytosis, a generally benign disorder characterized by proliferation of a CD1a+ and S-100+ population of cells lacking Birbeck granules usually limited to the skin.

METHODS

We present a case of histiocytic sarcoma in a 64-year-old man presenting as a peritonsillar mass and secondarily involving the skin.

RESULTS

The malignant cells in the extracutaneous foci of disease expressed macrophage-associated antigens including S-100 but were CD1a-. The malignant cells in the skin coexpressed CD1a and S-100 but lacked ultrastructural features of Langerhans cells, findings indicative of indeterminate cells.

CONCLUSIONS

We discuss the clinical and histopathologic differential diagnosis in association with prior reported cases of histiocytic sarcoma, particularly in cases involving the skin and cases expressing the Langerhans cell-associated antigen CD1a.

Ewing sarcoma/peripheral primitive neuroectodermal tumor: adult abdominal tumors with an Ewing sarcoma gene rearrangement demonstrated by fluorescence in situ hybridization in paraffin sections

The differential diagnosis of small round cell tumors is exhaustive and requires ancillary studies. Relatively recently, fluorescence in situ hybridization (FISH) using probes for specific gene rearrangements has gained wide acceptance. This technique is particularly useful in the differential diagnosis of Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) and desmoplastic small round-cell tumor (DSRCT). In ES/PNET, the EWS gene is juxtaposed to the FLI-1 gene in 85% of cases and to the ERG gene in another 7% of cases; the EWS gene is juxtaposed to the WTI gene in DSRCT. Documentation of the EWS gene rearrangements in EWS/PNET has previously been demonstrated in frozen tissue. We report 2 unusual cases of EWS/PNET diagnosed in abdominal tumors in adults. Although the immunohistochemical results supported a diagnosis of ES/PNET, 1 case morphologically resembled DSRCT. The diagnosis in these 2 cases was confirmed by the FISH demonstration of EWS/FLI-1 gene fusion in paraffin-embedded tissue. Thus, the usefulness of FISH demonstration of an EWS gene rearrangement with these specific probes in such unusual cases is supported and is demonstrated in paraffin-embedded tissue.

Extranodal posttransplant plasmacytic hyperplasia with subsequent posttransplant plasmacytic malignancy: six-year interval case report and review of the literature

Posttransplant lymphoproliferative disorders (PTLDs) represent a morphologic, immunophenotypic, and genotypic spectrum of disease. Most recently, Knowles et al divided PTLDs into 3 distinct categories: (1) plasmacytic hyperplasia, (2) polymorphic B-cell hyperplasia and polymorphic B-cell lymphoma, and (3) immunoblastic lymphoma and multiple myeloma. Although one form of PTLD may progress to another form, only 1 previous case has been reported in which multiple myeloma developed 14 months after an original diagnosis of plasmacytic hyperplasia. The type of solid organ transplant was not specified in that case. We report a post--cardiac transplant plasmacytic hyperplasia developing 7 years posttransplant. Six years subsequent to the plasmacytic hyperplasia, the patient developed a posttransplant plasmacytic malignancy, supported by morphology, flow cytometric immunophenotyping, and genotypic studies. Since we have no data to support disseminated bony disease or an abnormal serum protein, we have not used the term "multiple myeloma" for this case.

Flow cytometric immunophenotyping in posttransplant lymphoproliferative disorders

We studied the flow cytometric immunophenotyping (FCI) and genotypic data of 11 specimens from 10 transplant recipients and categorized them based on a scheme for posttransplant lymphoproliferative disorders (PTLDs). Specimens had been analyzed by polymerase chain reaction and/or Southern blot for T-cell and B-cell (immunoglobulin heavy chain and light chain genes) gene rearrangements (BGR). The categories for PTLDs were as follows: 1, 1; 2, 6; and 3, 4. The plasmacytic and polymorphic B-cell hyperplasias (PBCHs) revealed no monoclonal/aberrant cells by FCI or genotypic studies (GS). Three of 4 polymorphic B-cell lymphomas (PBCLs) revealed monoclonal or aberrant (no surface light chain) B cells by FCI; 1 of 3 revealed a BGR. However, the 1 case with no monoclonal/aberrant B cells by FCI revealed a BGR. Both immunoblastic lymphomas revealed monoclonal or aberrant B cells by FCI; 1 revealed a BGR. Both multiple myelomas revealed monoclonal plasma cells by FCI; 1 revealed a BGR. In the 4 PTLDs with monoclonal/aberrant B cells by FCI and no clonality detected by GS, the GS were performed on fresh and paraffin-embedded tissue samples. FCI of the plasmacytic and PBCHs supported no clonal process by GS. FCI defined a clonal process in 2 PBCLs, I immunoblastic lymphoma, and 1 multiple myeloma that were negative by GS. However, 1 PBCL that was polyclonal by FCI was monoclonal by GS. Thus, FCI is useful for identifying a clonal process in PTLDs with negative results by GS; FCI and GS should be performed routinely in PTLDs to detect a clonal process.

CD15(+) acute lymphoblastic leukemia and subsequent monoblastic leukemia: persistence of t(4;11) abnormality and B-cell gene rearrangement

The abnormality in the translocation of chromosomes 4 and 11 (t[4;11]) has been characteristically associated with calla-negative CD15(+) acute lymphoblastic leukemia (ALL) of early pre-B-cell origin. Transformation of a lymphoblastoid to a monoblastoid morphologic structure has rarely been described at relapse in these cases; however, these cases have lacked flow cytometric immunophenotyping (FCI) and genotypic studies (GS) to define the immunophenotype of and the presence of a B-cell gene rearrangement in the monoblastoid component. We report a case of CD15(+), CD10(-) ALL of early pre-B-cell origin defined by morphologic testing and FCI with the t(4;11) abnormality. At relapse, the morphologic testing, enzyme cytochemistry, and FCI data were characteristic of monoblastic leukemia. The t(4;11) abnormality persisted with associated additional chromosomal abnormalities, and the monoblasts contained a B-cell gene rearrangement by GS. These findings support the concept that both processes arose from a multipotential progenitor cell.

Evaluation of bone marrow specimens with acute myelogenous leukemia for CD34, CD15, CD117, and myeloperoxidase

CONTEXT

Immunophenotyping of bone marrow (BM) specimens with acute myelogenous leukemia (AML) may be performed by flow cytometric (FC) or immunohistochemical (IH) techniques. Some markers (CD34, CD15, and CD117) are available for both techniques. Myeloperoxidase (MPO) analysis may be performed by enzyme cytochemical (EC) or IH techniques.

OBJECTIVE

To determine the reliability of these markers and MPO by these techniques, we designed a study to compare the results of analyses of these markers and MPO by FC (CD34, CD15, and CD117), EC (MPO), and IH (CD34, CD15, CD117, and MPO) techniques.

MATERIALS AND METHODS

Twenty-nine AMLs formed the basis of the study. These AMLs all had been immunophenotyped previously by FC analysis; 27 also had had EC analysis performed. Of the AMLs, 29 had BM core biopsies and 26 had BM clots that could be evaluated. The paraffin blocks of the 29 BM core biopsies and 26 BM clots were stained for CD34, CD117, MPO, and CD15. These results were compared with results by FC analysis (CD34, CD15, and CD117) and EC analysis (MPO).

RESULTS

Immunodetection of CD34 expression in AML had a similar sensitivity by FC and IH techniques. Immunodetection of CD15 and CD117 had a higher sensitivity by FC analysis than by IH analysis. Detection of MPO by IH analysis was more sensitive than by EC analysis. There was no correlation of French-American-British (FAB) subtype of AML with CD34 or CD117 expression. Expression of CD15 was associated with AMLs with a monocytic component. Myeloperoxidase reactivity by IH analysis was observed in AMLs originally FAB subtyped as M0.

CONCLUSIONS

CD34 can be equally detected by FC and IH techniques. CD15 and CD117 are better detected by FC analysis and MPO is better detected by IH analysis.

CD30 expression in follicular lymphoma

CONTEXT

CD30(+) anaplastic large cell lymphomas were originally described as being of T-cell, null cell, and B-cell origin. CD30, however, is not a specific marker of anaplastic large cell lymphoma and has been found to be expressed in reactive as well as neoplastic populations as a probable activation marker. In addition, CD30(+) cells have also been described in both diffuse large B-cell and follicular lymphomas (FLs), resembling the pattern seen in reactive tonsils and lymph nodes.

OBJECTIVE

We report an index case of FL with CD30 expression, which on initial touch preparations and flow cytometric immunophenotyping revealed a prominent population of CD30(+) cells with marked cellular pleomorphism (anaplasia) in a background of typical FL. Immunohistochemistry of the paraffin section for CD30 in our index case confirmed unequivocal CD30(+) pleomorphic cells in the malignant nodules in occasional clusters. This case prompted a study of additional cases of FL for pattern of immunoreactivity with CD30 on paraffin sections.

DESIGN

Twenty-two additional cases of FL (grades 1-3) were retrieved for CD30 immunoperoxidase staining as in the index case.

RESULTS

This study demonstrated 32% of the additional cases of FL had definitive CD30(+), large, pleomorphic malignant cells by paraffin immunohistochemistry. In 2 cases (9%), the pattern of immunoreactivity with CD30 showed clustering and variable staining of large cells, as our index case.

CONCLUSION

This study underscores the morphologic and immunophenotypic spectrum of FL that includes CD30 staining and cellular pleomorphism.

Acute promyelocytic leukemia, hypogranular variant, with uncharacteristic staining with chloroacetate esterase

A diagnosis of the hypogranular variant of acute promyelocytic leukemia (APLv) may be difficult to establish based on cytomorphology alone. However, the great majority of cases have a classical immunophenotype by flow cytometric immunophenotyping (FCI) (CD13+, CD33+, dim CD64+, HLA-DR-, and CD34-) and a classical enzyme cytochemical (EC) staining pattern. [intensely staining with myeloperoxidase, Sudan Black B, and chloroacetate esterase (CAE) and negative with alpha'-naphthyl acetate and butyrate esterases]. Although the immunophenotype of APLv by FCI has varied in the literature (HLA-DR +/- and CD34 +/-), the EC staining pattern has remained constant. We report a case of APLv with characteristic cytomorphology, compatible FCI data (CD13+, CD33+, dim CD64+, HLA-DR +/-, and CD34-), chromosomal detection of t(15; 17), and molecular detection of the PML/RAR alpha fusion gene; however, staining of the leukemic cells with CAE was quite uncharacteristic. We describe our findings.

Paraffin immunoreactivity of CD10, CDw75, and Bcl-6 in follicle center cell lymphoma

Follicle center cell lymphoma(FCCL) has the following immunophenotype(IP): sIg+, Pan B+, CD10+/-, CD5-, CD23-/+, CD43-, CD11c-, CD25-. In addition, reactivities of a malignant lymphoma with CDw75(LN-1) and bcl-6 are considered indicators of FCCL. Bcl-6 expression is common in Grade 1 FCCL (100%) and rare in other indolent B-cell lymphomas(BCL). In contrast, bcl-2 expression is common in FCCL (80%) and in other BCL subtypes. Since no previous study has correlated paraffin immunoreactivity(PIR) of CD10, CDw75, and bcl-6 in FCCL (Grades 1-3), this is this study's purpose. Twenty-nine FCCL's were identified and reviewed (6, Grade 1; 10, Grade 2; 13, Grade 3) from the Division of Hematopathology, St. Louis University. The diagnoses were based on morphology and immunohistochemistry(IH)(21 cases) +/- the flow cytometric IP(14 cases). The paraffin blocks were stained for CD10 (Novacastra, Vector Laboratories, Burlingame, CA), CDw75 and bcl-6 (DAKO Corporation, Carpinteria, CA). Results showed that, CD10 by paraffin IH(PIH) was positive in 23 [18(strong); 3(moderate); 2(weak)] and negative in 6(3, Grade 2; 3, Grade 3). All CD10-cases were CDw75+; 4, bcl-6+. The two CD10-, bcl-6-cases were Grade 2. CDw75 was positive in 28 cases [16(strong); 11(moderate); 1(weak)] and negative in 1 (Grade 3; CD10+, bcl-2+, bcl-6+). Bcl-6 was positive in 26 [16(strong); 6(moderate); 4(weak)] and negative in 3(Grade 2's). Thus, the sensitivity of CD10, CDw75, and bcl-6 by PIH for FCCL was 79%, 97%, and 90%, respectively. Of the three stains evaluated by PIH in FCCL, CDw75 was the most sensitive, closely followed by bcl-6. CD10 was least sensitive-79%. By combining these 3 stains, the sensitivity was 100%; thus, a combined approach is recommended.

CD30+ anaplastic large-cell lymphoma with aberrant expression of CD13: case report and review of the literature

CD13 is commonly expressed in hematopoietic malignancies of myelomonocytic origin and has less commonly been described in lymphoid neoplasms, including acute lymphoblastic leukemia, B-cell lymphoproliferative disorders, and plasma cell malignancies. Aberrant CD13 expression has rarely been described in KP-1 (CD68)-positive large-cell lymphomas. However, CD13 positivity has not previously been described in a case of CD30+ (ALK-1+) anaplastic large-cell lymphoma of presumed null-cell origin without histiocytic differentiation. The purpose of this case report is to describe a CD30+ anaplastic large-cell lymphoma of presumed null-cell origin with aberrant expression of CD13. The case illustrates the unique usefulness of immunophenotypic and molecular techniques in establishing the correct diagnosis. The case was referred with a diagnosis of "rule out granulocytic sarcoma versus megakaryocytic malignancy" due to the morphology and a limited flow cytometric immunophenotypic (FCI) panel that had been performed and revealed expression of CD45, HLA-DR, and CD13. Subsequent morphologic review at our institution combined with an expanded FCI panel established the diagnosis. The differential diagnosis of a CD13+ hematopoietic malignancy should include this entity. The prognostic significance of this finding has yet to be determined.

Malignant mesothelioma with CD30-positivity. A case report and review of the literature

The activation marker CD3O is useful in the diagnosis of Hodgkin and non-Hodgkin lymphomas. It has also been described in nonhematopoietic tumors, including pancreatic carcinomas, salivary gland tumors, and embryonal carcinomas. We report a case of malignant mesothelioma with intense CD30 positivity. This finding has not previously been described and is important in broadening the differential diagnosis of a CD30(+) cohesive large cell malignancy.

Correlation of fine needle aspiration biopsy and fluoride-18 fluorodeoxyglucose positron emission tomography in the assessment of locally recurrent and metastatic head and neck neoplasia

OBJECTIVE

Patients with primary head and neck neoplasia can present during follow-up with suspected recurrence, and both fine needle aspiration biopsy (FNAB) and fluoride-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scan are available methodologies for evaluating these patients. Our objective was to retrospectively correlate patients who underwent both FNAB and FDG-PET scan in order to assess the possibility of recurrent neoplasia.

STUDY DESIGN

The cytopathology files at Saint Louis University Health Sciences Center were retrospectively searched for patients with known primary head and neck malignancies beginning in 1995. Suspected recurrence and local metastases evaluated by both FNAB and FDG-PET scan were correlated.

RESULTS

Twenty-eight patients received a combined total of 37 FNABs with concurrent FDG-PET scans. The majority of patients had primary oropharyngeal squamous cell carcinoma with intermixed, single cases of other primary head and neck neoplasms. Thirty of the 32 aspirates with recurrent or locally metastatic disease had combined positive findings by both FNAB and FDG-PET scan, yielding a sensitivity of 94%. One nonspecific and one negative FDG-PET scan came from a patient who had disease confirmed by FNAB. Five patients had negative findings by both methods that were supported by the subsequent clinical course.

CONCLUSION

FNAB can provide confirmatory evidence of disease in a clinically suspicious abnormality with nonspecific FDG-PET results. FNAB and FDG-PET are highly sensitive for tumors in cases of clinically suspected recurrence and locally metastatic disease.

Identification of CD56 and CD57 by flow cytometry in Ewing's sarcoma or primitive neuroectodermal tumor

CD56 and CD57 are commonly considered as natural killer and neuroectodermal markers, but their expression has been identified in a wide spectrum of neoplasms including some cases of Ewing's sarcoma (ES) and primitive neuroectodermal tumor (PNET). We report two cases of small, round blue cell tumor (SRBCT), in which flow cytometry immunophenotyping (FCI) detected strong expression of CD56 and CD57 (one case). Immunohistochemical staining with Leu-19 and Leu-7 confirmed the FI results. Although CD56 and CD57 expression is consistent with ES/PNET, it can be potentially misleading if results of FCI are interpreted in the absence of other findings. These cases suggest the utility of FCI in undifferentiated SRBCT. The literature on CD56 and CD57 expression in ES/PNET is reviewed and discussed.

Initial interaction of human fibroblast and leukocyte interferons with FS-4 fibroblasts

Human FS-4 cells were exposed to human fibroblast interferon for various times and further incubated in the absence of interferon until challenged with vesicular stomatitis virus. Addition of antibody to fibroblast interferon at the time of removal of interferon did not alter the development of the antiviral state. If cells were exposed to interferon for 45 min at either 0 or 37 degrees C, they developed resistance upon subsequent incubation at 37 degrees C. However, less resistance developed if the cells were initially incubated at 0 degrees C. Our results indicate that a single interaction of fibroblast interferon with susceptible cells, either at 0 or 37 degrees C, is sufficient for the subsequent development of an antiviral state, at least in the short term experiment. The kinetics of development of the antiviral state were compared with fibroblast and leukocyte interferon. The rise in the degree of antiviral resistance was steeper and maximal levels of resistance were reached sooner when FS-4 cells were incubated with increasing concentrations of fibroblast interferon than with leukocyte interferon. This suggests a greater affinity of fibroblast interferon for these cells.