Malvina Gualandi

Acute myelomonocytic leukemia terminating in histiocytic medullary reticulosis.Cytochemical, cytogenetic and electron microscopic studies

A case of acute myelomonocytic leukemia terminating in histiocytic medullary reticulosis is reported. The evolution of a single cellular clone presenting with progressive change of the morphological features of the leukemic cells towards more anaplastic elements endowed with prominent phagocytic properties is suggested on the basis of both cytochemical and chromosomal data. The histiocytic nature of the malignant proliferating cells and platelet phagocytosis has been confirmed by electron microscopic investigation. The main pathogenetic explanations of the evolutionary patterns of the disease are discussed with relation to: a) involvement of a common stem cell giving rise to different proliferative patterns of cells in a multiphasic sequence; b) release of dysplastic platelets and defective erythrocytes with massive sequestration by histioid phagocytic cells; and c) coexistence of two different disorders.

Pulmonary infections in lung cancer patients at diagnosis

We carried out a prospective study involving 96 consecutive lung cancer patients at diagnosis, in order to determine through quantitative cultures of the bronchoalveolar lavage (BAL) fluid, the prevalence of pulmonary infections; we also evaluated the relationship between a patients performance status, immunocompetence, lung cancer stage, histotype and the occurrence of respiratory infections. The patients (81 males, 15 females) had a mean age of 64 +/- 9 years. Of these, 62 were smokers, 30 were ex-smokers and four had never smoked. Sixty-seven patients had a prior history of chronic bronchitis. A total of 42 micro-organisms were cultured from the BAL fluids of 33 patients (34.3%). Fifty percent of these micro-organisms were gram-negative, 33.3% were gram-positive and the remaining 16.7% were other micro-organisms. The bacilli most often isolated were the Haemophilus species, accounting for 38.8% of all gram-negative bacilli. The most frequently isolated gram-positive pathogen was the Staphylococcus aureus. We have not found a significant relationship between the presence of a respiratory infection and the different cell types separately analyzed, nor with SCLC and NSCLC patient groups, nor with the stage of the disease. The performance status, the immunoregulatory ratio and the lymphocyte subsets were not significantly different in patients with or without a pulmonary infection. We think that the identification of a definite etiologic agent is of great importance for a rational anti-microbial treatment of pulmonary infections.

Sonographically Guided Biopsy and Sonographic Monitoring in the Diagnosis and Follow-up of 2 Cases of Sarcoidosis With Hepatic Nodules and Inconclusive Thoracic Findings

Objective. To report 2 cases in which abdominal sonography played a useful role in diagnosing sarcoidosis with early nodular hepatosplenic manifestations. Methods. In the first case, an asymptomatic woman with increased liver enzyme values underwent sonography, which showed multiple hypoechoic nodules in the liver and spleen. Computed tomography confirmed the hepatosplenic findings and showed micronodular infiltrates of both lung fields, without hilar and mediastinal lymph‐adenopathy. In the second case, in a woman with a cough, dyspnea, and increased liver enzyme levels, thoracic computed tomography showed right pleural effusion causing partial atelectasis of the lower and middle lobes and mediastinal lymphadenopathy. Results. Sonography and computed tomography showed multiple nodules of the liver and spleen and retroperitoneal lymphadenopathy. In both cases, bronchoscopy, bronchial and bronchioloalveolar lavages, and transbronchial and mediastinal biopsies had negative results. Sonographically guided biopsy of the hepatic nodules was carried out, and sarcoid granulomas were detected in the portal areas. After 3 months of steroid therapy, liver enzyme values nearly normalized, and sonography showed the disappearance of all abdominal lesions. The first patient underwent control computed tomography, which confirmed the regression of the disease; the second patient refused control computed tomography. Conclusions. Sarcoidosis can occur with atypical onset, and in selected cases sonography may play a useful role in its diagnosis and follow‐up.

Pregnancy in Severe Anorexia Nervosa

OBJECTIVE Anorexia nervosa among Arabian girls seems to be rare and pregnancy in condition of extreme underweight seems to be rare as well. METHOD We report the case of a 19-year-old Arabian girl living in Italy who referred to an Eating Disorder Unit for her anorexic condition. RESULTS She arrived for a consultation when she was at her 33rd week of pregnancy at a Body Mass Index lower than 14. CONCLUSION The present case aims to underline the need of medical and psychological attention to pregnancy in anorexia nervosa cases.

Chromosomal abnormalities in angio-immunoblastic lymphadenopathy

SummaryChromosomal studies have been performed in 2 patients with angio-immunoblastic lymphadenopathy. In both the cases the presence of abnormal cell lines characterized by marker chromosomes has been detected. Application of banding techniques allowed to detect the structural composition of the marker chromosome in 1 of the cases and to show a clonal evolutive pattern of the rearranged chromosomal set. In the same patient a consistent Y loss observed in the major fraction of the investigated metaphases did not appear to be related to any defined rearrangement of the karyotype. Longitudinal chromosomal studies are stressed in order to better correlate the cytogenetic abnormalities and the immunoreactive picture of the lymph nodes along the course of the disease.

Young man with anorexia nervosa.

Anorexia nervosa is rare among men; it seems to be more severe than in women, due to diagnostic delay, higher prevalence of excessive exercise, vegetarianism, more severe bone deficiency and higher risk of fracture.1–5

Anorexia nervosa: from purgative behaviour to nephropathy. a case report

BackgroundIndividuals who suffer from Anorexia Nervosa refuse to maintain a minimally normal body weight, are intensely afraid of gaining weight and exhibit a significant disturbance in the perception of the shape and size of their body. Postmenarchal females with this disorder are amenorrohic. In the Binge-Eating/Purging subtype individuals regularly engage in binge eating and purging behaviour (i.e self-induced vomiting or misuse of laxatives, diuretics, or enemas).Hypokalaemia is often seen in chronic Anorexia Nervosa, especially that of the purging type (ANp), and, as well as electrocardiographic anomalies, this can lead to tubulointerstitial nephritis (hypokalaemic nephropathy) with typical histological characteristics. The physiopathological mechanisms behind this damage are linked to altered stimulation of vasoactive mediators, and to the ammonium-mediated activation of the alternative complement pathway. However, it has not yet been ascertained whether a variant of the pathway specific for ANp [1], exists.Case presentationWe describe herein a case of hypokalaemic nephropathy in a patient affected by chronic ANp who presented to our Centre for Eating Disorders.ConclusionHypokalaemia can provoke cardiovascular alterations as well as muscular and renal complications, and thus potential renal damage needs to be investigated in patients suffering from long-term purgative anorexia.

Multiple chromosomal associations and paracentromeric region instability in a case of acute leukemia

SummaryA case of acute myelomonocytic leukemia is described, which was characterized cytogenetically by the presence of centromeric elongations, somatic crossovers, selective endoreduplication figures, and multiple chromosomal clusters. The demonstration of these phenomena by selective staining techniques for the chromosome bands (Q, C, G and S) and the nucleolar areas (acridine-orange, amido black B 10) raises some biological aspects involved in the proliferation of leukemic cells, such as nucleolar persistence during the metaphase and the non-separation of chromatids in the clusters during the anaphase. These structural abnormalities may represent the background for the explanation of the appearance of subclones in neoplastic disorders.

Nuclear projections in tumour cells and large chromosome markers

The application of banding techniques on cytological smears from pleural effusion in a case of histiocytic sarcoma has provided direct evidence for correspondence between nuclear projections in tumor cells and extra large chromosome markers observed in the neoplastic karyotype obtained by direct preparations.