Carter R. Bishop

True histiocytic lymphoma. A report of four cases

Clinical, morphologic, cytochemical, immunologic, and ultrastructural features of four cases of true histiocytic lymphoma are described. The neoplastic cells were large, ranging from 20 to 45 μ in diameter with round, folded, or convoluted nuclei, and abundant eosinophilic cytoplasm. They exhibited diffuse nonspecific esterase activity. Diffuse acid phosphatase activity was present in two cases so tested. Muramidase activity was present in half of the cases. Finely granular PAS‐positive material was seen in the cytoplasm. Methyl green‐pyronin positivity was variable. An occasional neoplastic cell showed erythropagocytosis in one case. Malignant cells either contained no cytoplasmic immunoglobulins (three cases) or had immunoglobulins of multiple classes (one case). Surface markers were studied in two cases; they were absent in one case, and were of multiple classes in another case. Ultrastructurally the neoplastic cells had lysosomal granules in three cases so examined, and phagolysosomes, phagocytized material and residual bodies in one of three cases so studied. Patients ranged in age from 28 to 60 years. Two patients had extralymphatic tumors. Survival of more than 5 years was seen in one patient.

Serum copper levels in non‐Hodgkin's lymphoma

Levels of serum copper in 34 patients with adult non‐Hodgkins lymphoma at different phases of the disease have been studied. All of the patients were evaluated with complete blood counts, sedimentation rate, gallium scintigraphy, liver and bone marrow biopsies, lymph node biopsy, and laparoscopy. The level of serum copper was significantly elevated in non‐responding or relapsing patients (mean 191.06 μg/dl), and correlated with the estimated tumor burden. Serum copper levels within normal range were found in patients in complete remission (mean 114.76 μg/dl). Age‐ and sex‐matched normal controls also showed serum copper levels within normal range (mean 112.81 μg/dl). It is proposed that serial measurements of serum copper level may be of use in: (1) monitoring the remission status of patients with non‐Hodgkins lymphoma, (2) detecting early relapse of non‐Hodgkins lymphoma, and (3) contrary to previous reports by Hrgovcic et al.,5 the level of serum copper seems to be related to the disease activity of histiocytic lymphoma.

Hand mirror cell leukemia—immunologic and ultrastructural studies

Acute lymphoblastic leukemia (ALL) with hand mirror cell (HMC) variant was diagnosed in a 26‐year‐old black man in May 1978. Hemoglobin was 3.6 g/dl; the platelet count was 19.0 × 109/1; leukocyte count was 8.4 × 109/1 with 40% blasts, 66% of which had HMC appearance. Cytochemical studies, terminal deoxynucleotidyl transferase level, and immunologic marker studies indicated a non‐T/non‐B lymphoblastic origin of the leukemic population. Electron microscopic studies confirmed the hand mirror appearance. Mitochondria were more numerous in these cells compared with other lymphoid cells. Cytogenetic studies showed a 46XY karyotype. Our studies confirmed the previous studies reported by Stass, et al.22 of lymphoblastic origin of HMC leukemia. The patient responded to treatment with vincristine, prednisone and L‐asparaginase and went into complete remission. It appears that this morphologic variant of ALL does exist and is not an artifact.

Acute myelofibrosis terminating in an acute lymphoblastic leukemia. A case report

A patient with acute myelofibrosis developed acute leukemia during the course of her disease. Light microscopic examination showed that the cells were lymphoblasts. The presence of terminal deoxynucleotidyl transferase and T‐and B‐lymphocyte markers suggested that the malignancy was of immature lymphoid cell origin. Terminal leukemic transformation in some cases of acute myelofibrosis may be of a lymphoid nature and, thus, less toxic chemotherapy could be used with a better prognosis. Cancer 46:615–618, 1980.

Continuous infusion ABDIC therapy for relapsed or refractory Hodgkin's disease

Background. Patients whose Hodgkins disease is refractory to standard combination chemotherapy usually have a poor prognosis. These patients are generally considered for bone marrow transplantation if the disease is still sensitive to chemotherapy.

Waldenström's macroglobulinemia in young African‐American adults

We have identified five African‐American patients with Waldenströms macroglobulinemia (WM) diagnosed at a young age (ages 35, 38, 38, 40, 51; 4 males, 1 female). All had a history of intravenous heroin abuse and four also used cocaine. Their manner of presentation and clinical course were typical. Three of three patients tested for the hepatitis C virus (HCV) were positive and three of three patients tested were HIV negative. The potential relationship between intravenous drug abuse and/or HCV to development of WM in this group of young patients is provocative, especially since a polyclonal increase in serum IgM is commonly seen in chronic intravenous heroin addicts. More recently, the contribution of HCV is being evaluated in lymphoproliferative disorders. Although WM is typically a disease of older people, it should also be considered in the differential in a young patient with a suggestive clinical picture. Am. J. Hematol. 60:229–230, 1999.