The use of monoclonal antibody R92F6 and polymerase chain reaction to confirm the presence of parvovirus B19 in bone marrow specimens of patients with acquired immunodeficiency syndrome

BACKGROUND

Parvovirus B19 infection is a cause of chronic anemia and red cell aplasia in patients with acquired immunodeficiency syndrome (AIDS) and in other immunocompromised hosts. Anemia in AIDS patients has a multifactorial etiology, with parvovirus B19 infection being an infrequent but nevertheless treatable cause. Therapy with intravenous immune globulin can result in rapid improvement of parvovirus-induced anemia. This treatment is expensive, therefore accurate and rapid confirmation of parvovirus infection is important in providing appropriate and cost-effective therapy.

METHODS

Bone marrow samples from 2 AIDS patients with severe anemia and reticulocytopenia were studied. Bone marrow morphology and serologic studies were evaluated for parvovirus B19 infection. An immunohistochemical method using a monoclonal antibody, R92F6, to B19 capsid proteins was utilized on decalcified, B5-fixed, paraffin-embedded bone marrow biopsies. Bone marrow aspirate cells were examined by electron microscopy for evidence of viral particles. In addition, polymerase chain reaction (PCR) studies using a nested PCR assay to the parvovirus B19 viral genome were performed in a case for which fresh cells were available.

RESULTS

Bone marrow findings included marked erythroid hypoplasia with characteristic giant pronormoblasts and intranuclear inclusions. Serologic studies were negative in one case, while the second case showed positive parvovirus B19 immunoglobulin M antibody. Immunohistochemical studies for parvovirus B19 were positive in both cases. The presence of intranuclear virions was demonstrated by electron microscopy and was confirmed by PCR analysis. Both patients were treated with intravenous immune globulin, and subsequent improvement was noted.

CONCLUSIONS

Both immunohistochemistry and PCR studies on bone marrow specimens from AIDS patients with anemia are rapid and sensitive methods for the confirmation of parvovirus B19 infection. They are valuable tools, particularly when serologic studies are negative. When PCR is not available, immunohistochemical methods can be useful. The rapid confirmation of parvovirus B19 infection will allow for early and cost-effective therapy.

Traumatic pseudoaneurysm: a possible early lesion in the spectrum of epithelioid hemangioma/angiolymphoid hyperplasia with eosinophilia

We describe a vascular lesion that develops secondary to trauma (pseudotraumatic aneurysm) and study its relation to epithelioid hemangioma (EH)/angiolymphoid hyperplasia with eosinophilia (ALHE). Four lesions are described, all with a distinct history of trauma to the site from which they arose. They presented with masses in the subcutaneous tissue of the head. They were studied by immunohistochemical methods to identify their component cells. The lesions all demonstrated marked thickening of the wall of small and medium-sized arteries, with capillary vascular proliferations. One lesion demonstrated increased eosinophils. Myxoid changes were noted in all lesions. We hypothesize that these lesions may represent an early form of EH/ALHE.

Gallstones implanting in the ovary. A complication of laparoscopic cholecystectomy

Laparoscopic cholecystectomy has become the treatment of choice for most patients with cholelithiasis. The spillage and loss of gallstones into the peritoneal cavity is a relatively common event occurring during these procedures and has generally been thought to be of little consequence. Although in many cases this does appear to be true, there are uncommon but nevertheless noteworthy sequelae being described. Complications reported have included intraperitoneal abscesses; foreign body granuloma formation; and, more rarely, cholelithiasis of the ovary. We present the case of a 30-year-old woman, who underwent diagnostic laparoscopy for infertility 20 months following a laparoscopic cholecystectomy. Gross findings showed tissue deposits that suggested a malignant tumor. Microscopic findings revealed gallstones embedded in the ovaries and the pelvic peritoneum. To our knowledge, this is the longest reported persistence of gallstones involving the ovary. A full case report is presented, and the possible complications of lost laparoscopic gallstones are reviewed.

Leukemic phase of mantle cell lymphoma two case reports and review of the literature

Two cases of mantle cell lymphoma are presented. Both patients were women, aged 68 and 56 years, who presented with lymph node enlargement. Each case was initially interpreted as a follicular small cleaved cell lymphoma. Both patients later presented with splenomegaly and recurrent lymphadenopathy. Morphologic and immunologic studies on a parotid swelling in one case and a splenectomy specimen in the other indicated a diagnosis of mantle cell lymphoma. Both women subsequently presented in leukemic phase associated with a poor prognosis, and both patients succumbed soon after. The characteristics, differential diagnosis, and leukemic phase of mantle cell lymphoma are discussed. The importance of appropriate immunohistochemical and flow cytometry analysis in distinguishing mantle cell lymphoma from morphologically similar follicular center cell lymphomas is demonstrated.