Musleh S. Tarawneh

Primary testicular diffuse large B-cell lymphoma belongs to the nongerminal center B-cell-like subgroup: a study of 18 cases

The most common type of primary testicular lymphoma is diffuse large B-cell type, which has the potential for aggressive clinical behavior. Diffuse large B-cell lymphoma can be further subclassified into two major prognostic categories: germinal center B-cell-like and nongerminal center B-cell-like. Such distinction is made possible using the immunohistochemical expression of CD10, Bcl-6 and MUM1. The aim of this study was to stratify primary testicular lymphoma of the diffuse large B-cell type according to this scheme. Immunohistochemical stains for CD10, Bcl-6 and MUM1 were performed on 18 cases of primary testicular lymphoma of diffuse large B-cell type. Subclassification was carried out as previously described where CD10 and/or Bcl-6 positivity and negativity for MUM1 were considered indicative of germinal center B-cell-like type and the opposite expression as nongerminal center B-cell-like type. The proliferative activity was determined using immunostaining with the Ki-67 antibody. Of 18 cases, 16 (89%) were found to belong to the nongerminal center B-cell-like type. Two cases (11%) were classified as germinal center B-cell-like type; one had a CD10-positive, Bcl-6-positive and MUM1-negative profile, and the other was CD10 negative, Bcl-6 positive and MUM1 negative. The former occurred in a 38-year-old patient who was human immunodeficiency virus positive. All the cases expressed high proliferative activity (≥50% Ki-67 labeling). We conclude that most (89%) primary testicular lymphomas of the diffuse large B-cell type belong to the nongerminal center B-cell-like subgroup and have high proliferative activity.

Acute leukemia in pregnancy: Report of five cases treated with a combination which included a low dose of adriamycin

Five cases of acute leukemia which developed in the course of pregnancy are reported. All five cases received combination therapy which included adriamycin. Two cases were treated during the first half of pregnancy. One of them aborted 2 weeks after commencing therapy but had severe homeostatic failure. The second had a successful pregnancy and delivered a normal infant. Three cases were treated during the second half of pregnancy. All had normal pregnancies and delivered normal infants. The babies have been followed up for periods ranging from 1 month to 3 yr and have shown normal growth and development.

Rapid Progressive Glomerulonephritis in Patients With Familial Mediterranean Fever

Two patients with a long-standing history of familial Mediterranean fever (FMF) presented with gross hematuria, oliguria, and acute renal failure; both required dialysis support. Kidney biopsies from both patients revealed crescentic rapid progressive glomerulonephritis (RPGN) without amyloidosis. One patient recovered renal function with methylprednisolone pulse therapy and cyclophosamide. The second patient did not improve and required regular hemodialysis. He is asymptomatic on colchicine therapy. To our knowledge, these are the first cases documenting the presence of RPGN in patients with FMF.

IgA Nephropathy in Patients with Familial Mediterranean Fever

Two patients with a long-standing history of familial Mediterranean fever were found to have both microscopic hematuria and proteinuria during the acute attacks. Kidney biopsies from both patients revealed diffuse mesangial proliferative glomerulonephritis with intense mesangial IgA and C3 deposits and no evidence of amyloidosis. To our knowledge these are the first 2 cases documenting the presence of mesangial IgA nephropathy in patients with familial Mediterranean fever.

HLA Antigens, Blood Groups and Immunoglobulin Levels in Idiopathic Thrombocytopenic Purpura

Thirty-three patients with idiopathic thrombocytopenic purpura (ITP) were tested for HLA-A, B and C antigens, platelet antibodies, immunoglobulin levels and ABO blood groups. With one exception, ITP proved not to be significantly associated with the HLA antigens studied; an increased frequency of HLA-A28 was found in chronic ITP patients (50 vs. 18.7% in the control population). An increased incidence of blood group A was found in ITP patients (64 vs. 37.98% in the control population), especially in those with acute ITP (84.7%). A significant reduction of IgG levels was noted in patients with chronic ITP, while below-normal levels of IgA were found in both chronic and acute ITP patients. There was no difference in levels of IgM. Circulating platelet isoantibodies were demonstrated in 67.6% of the ITP patients. No correlation was demonstrated between the presence of platelet antibodies, immunoglobulin levels of HLA antigens.

Primary testicular and paratesticular lymphoma: a retrospective clinicopathologic study of 34 cases with emphasis on differential diagnosis.

CONTEXT Recent reports indicate the rate of primary testicular lymphomas is on the rise and misdiagnosis can still occur. OBJECTIVE To review and investigate the clinicopathologic features of primary testicular lymphoma with emphasis on the differential diagnosis. Discussion about the issue of misdiagnosis is also presented. DESIGN Retrospective review of pathology archives in 3 medical centers for cases fulfilling criteria of primary testicular lymphoma or paratesticular lymphoma was carried out. Clinicopathologic and immunohistochemical features were studied and analyzed. RESULTS The search identified 34 cases. Patients ranged from 4 to 87 years of age (mean, 55 years). All presented with a testicular/paratesticular mass and were stage I. The masses ranged from 2.5 to 13 cm (mean, 5.6 cm). Microscopically, the tumors often had an intertubular growth pattern or diffuse arrangement of predominantly large cells with pleomorphic, twisted nuclei and small nucleoli. Mitotic activity was brisk and apoptotic bodies were abundant. Thirty-two tumors were classified as diffuse large cell lymphomas; immunophenotype was determined in 21 of these and all were of B-cell type. The median survival was 96 months. The rate of initial misdiagnosis was unexpectedly high (5 cases, 15%). CONCLUSIONS Most cases of primary testicular lymphoma fall into the broad category of diffuse large cell lymphoma and the majority are B-cell type with particularly high proliferative activity when characterized by appropriate immunophenotyping. Misdiagnosis can occur, especially in those cases in which presentation occurs at an age similar to that for germ cell tumors, showing the need for caution and appropriate immunostaining when a testicular neoplasm has an atypical appearance for a germ cell tumor.

Malignant neoplasms in Jordanian children

Three hundred and seventy-three cases of malignant disease in children were diagnosed in Jordan during the 5-year period 1975-79. Lymphomas (28.7%) were the most frequently encountered tumours, followed by leukaemias (19.6%) and brain tumours (16.1%). One third of the children with lymphoma had Hodgkins disease. Burkitts lymphoma accounted for another one third, and lymphocytic lymphoma the remaining third. Abdominal involvement was frequently encountered in children with non-Hodgkins lymphoma. Our data are similar to those reported from the neighbouring Arab countries, Iraq, Saudi Arabia, Kuwait and Egypt, and contrast with the data available from developed countries in which leukaemias and brain tumours are more frequent than lymphomas.

Therapeutic Effect of Vincristine, Adriamycin and Prednisolone (VAP) in Angioimmunoblastic Lymphadenopathy (AIL)

SummaryFive patients, three males and two females, with angioimmunoblastic lymphadenopathy (AIL) are described. The two who received steroids had no response and died 2 and 6 months later. The three patients who received vincristine, adriamycin and prednisolone (VAP) went into remission early and are still in remission with a follow-up of 22–35 months. It is concluded that VAP is effective therapy in AIL.

CONGENITAL MUSCULAR DYSTROPHY IN JORDANIAN CHILDREN

This is a consecutive study on 28 patients who have been diagnosed as having congenital muscular dystrophy at Jordan University Hospital in the period from January 1990 to February 1997. Of 75 patients diagnosed as having muscle disease, 55 (73.3%) had muscular dystrophy. Of 55 muscular dystrophy patients, 28 (50.9%) had congenital muscular dystrophy, 11 (20%) had Duchenne muscular dystrophy, 9 (16.4%) had Becker muscular dystrophy, 4 (7.3%) had myotonic dystrophy, 2 (3.6%) had limb-girdle dystrophy, and 1 (1.8%) patient had facioscapulohumeral dystrophy. Age of onset of symptoms of congenital muscular dystrophy (hypotonia and weakness) was documented antenatally or in the first few months in the majority (92.9%) of patients. Parental consanguinity was documented in 21 (75%) of congenital muscular dystrophy cases, and family history of possible similar cases in 15 (53.6%). Congenital muscular dystrophy patients with normal cognitive milestones (n = 16; 57.1%) were slightly more common than patients with cognitive delay. In contrast to previous reports, congenital muscular dystrophy is probably more common in communities with high rates of parental consanguinity than other dystrophies. Our study adds significant support to the most recent literature on this finding. (J Child Neurol 1998;13:383-386).

Seroimmunity to rubella virus in Jordanians

Abstract Sera of 985 Jordanians from 1 to 36 years of age and 115 cord blood specimens werescreened for rubella haemagglutination-inhibition antibodies. The percentage of seropositivity increased with age, 73–76% of the younger group were positive, while 80–91% of the older group and 95% of cord blood specimens were positive. Analysis of the results according to the age group and geographical distribution isdiscussed.