Gerald A. Hanson

Occult thyroid pathology in the young adult: An autopsy study of 138 patients without clinical thyroid disease

Thyroid glands from autopsies on 138 adults, ages 20 to 40 years, with no known clinical or laboratory evidence of thyroid disease, were serially sectioned at 2 mm intervals and microscopically examined for occult thyroid disease and anatomic variations. Occult papillary carcinoma was found in 3% of the glands, along with a single case of medullary carcinoma. The prevalence of occult thyroid carcinoma in this group of young adults is significantly less than that reported in the literature in people over forty (P less than .001). The glands demonstrated a number of other morphologic changes of importance to surgical pathologists. The thyroid capsule was incomplete in 62% of the glands. Thyroid follicles were found in the capsule in 14% of cases and thyroid follicles or nodules were outside the gland in perithyroid connective tissue in 88% of cases. Thyroid follicles were identified in 7% of cases in perithyroid strap muscles attached to the pyramidal lobe. A number of other, less common anatomic variations were also seen.

T cell-depleted allogeneic bone marrow transplantation for high-risk non-Hodgkin's lymphoma : clinical and molecular follow-up

The use of allogeneic BMT in patients with relapsed non-Hodgkin lymphoma (NHL) offers the advantage of tumor-free bone marrow and possibly a ‘graft-versus-lymphoma effect’ which may decrease the risk of recurrence. However, allogeneic BMT also poses an increased risk of death due to graft-versus-host disease (GVHD) which can be ameliorated by T cell depletion. We performed a retrospective review of 37 patients who underwent T cell-depleted allogeneic BMT for aggressive and indolent NHL between 1988 and 1996. Polymerase chain reaction (PCR) was used to identify indolent NHL patients with the BCL2/IgH translocation which served as a marker of residual disease. Sixteen of 37 patients (44%) are alive and progression-free with a median follow-up of 4.4 years (range 1–10.3). The incidence of grade 2–4 acute GVHD was 36% and extensive chronic GVHD developed in 12%. Patients with aggressive NHL have an overall PFS of 33% (12–54%); those with chemotherapy-resistant and sensitive disease have PFS of 17% (0–47%), and 40% (15–65%) respectively at 5 years. Patients with indolent histologies have overall PFS of 62% (37–86%); those with chemotherapy-resistant and sensitive disease have PFS of 55% (25–85%) and 80% (45–100%) respectively at 5 years. Eight patients with indolent disease had a BCL2/IgH translocation detectable by PCR. Five of these eight patients remain alive and progression free at a median of 6.5 years after BMT (range 2.1–7.4 years), four of whom remain PCR positive from 1.7 to 2.9 years after transplantation. We conclude that T cell-depleted allogeneic BMT poses a low risk for death due to GVHD, and should be considered for patients with relapsed and refractory indolent NHL.

Lithium-Induced Granulocytosis

Excerpt The administration of lithium has been associated with granulocytosis in psychiatric patients and those with Feltys syndrome. Lithium can attenuate neutropenia in patients receiving cancer...

Primary ocular Epstein-Barr virus-associated non-Hodgkin's lymphoma in a patient with AIDS: a clinicopathologic report.

OBJECTIVE To report an unusual case of chronic multifocal chorioretinitis with vitritis in a patient with acquired immunodeficiency syndrome (AIDS) that was resistant to antiviral and antitoxoplasmic medication and required a retinal biopsy for definitive diagnosis. METHODS Vitreous biopsy, pars plana vitrectomy, and retinal biopsy were performed. The vitreous biopsy material was sent for bacterial, fungal, and viral culture, and the vitreous cassette was sent for cytology. The retinal biopsy material was divided and sent for polymerase chain reaction testing for toxoplasmosis and virology and pathologic tissue analysis. RESULTS Vitreous cytology showed a mixed population of lymphocytes and histiocytes, but all other microbiologic and virologic studies were negative. Tissue analysis revealed an infiltrate of atypical mononuclear cells extending from the inner limiting membrane through the outer plexiform layer characteristic of a B cell, non-Hodgkins lymphoma of the central nervous system (NHL-CNS). In situ hybridization for the Epstein-Barr virus (EBV) was positive. An extensive systemic evaluation did not show evidence of extraocular tumor. CONCLUSION Although rare, primary ocular NHL-CNS can be seen in patients with AIDS, and its clinical presentation often closely resembles other disorders. To our knowledge, this case represents the first ocular NHL in which EBV is shown to be associated.

Chronic granulocytic leukemia following radiation therapy for Hodgkin's disease

A 33‐year‐old white man was treated with irradiation for Hodgkins disease involving the mediastinum; four years later he developed typical Philadelphia chromosome‐positive chronic granulocytic leukemia. The patient has been treated with chronic low‐dose busulfan to maintain peripheral blood counts in the normal range and he continues to remain well 27 years after the initial diagnosis of Hodgkins disease and 23 years following the onset of leukemia.

Hodgkin's disease with leptomeningeal involvement: Report of a case with long survival

A 30‐year‐old white man with Stage IV B Hodgkins disease, mixed cellularity type, developed leptomeningeal involvement shortly after relapsing on nitrogen mustard, Oncovin (vincristine), procarbazine, and prednisone (MOPP), and while receiving Adriamycin (doxorubicin), bleomycin, Velban (vinblastine), and dacarbazine (ABVD). Whole brain irradiation and intrathecal methotrexate were successfully incorporated into his treatment program. The patient has now been in complete remission for more than 40 months. A review of this rare complication of Hodgkins disease is presented.

Indolent diffuse histiocytic lymphoma with sclerosis and chylous effusions

A case of diffuse histiocytic lymphoma with sclerosis and chylous pleural and peritoneal effusions spanning four years from onset to diagnosis is presented. Treatment with combination chemotherapy and consolidative radiotherapy resulted in clinical improvement and the patient remains free of disease 14 months after stopping treatment. The problems of chylous effusions and the subgroup of diffuse histiocytic lymphoma with sclerosis are discussed.

To the Editor.-Reply

Dr Bessman and Drs Karnad and Poskitt make valid points about the utility of the RDW in the evaluation of microcytic anemias. Although it is now available in our hospital, this was not utilized at the time that we initiated our study. However, it seems unlikely that clinicians who fail to recognize an abnormally low MCV will know how to utilize an abnormal RDW. This further emphasizes the most important point of our study—that the diagnostic approach and evaluation of microcytic anemias needs to be improved for physicians in general. Dr Feeley makes an important point about the greater effectiveness of a written note over computer flagging of aberrant results in laboratory data. However, in spite of the volume of information provided, it is still up to the clinician to determine the relative importance of all abnormal laboratory data and to decide which, if any, additional diagnostic tests are indicated.