Svetislava J. Vukelja

Angiofollicular lymph node hyperplasia (Castleman's disease)

This review provides a comprehensive assessment of angiofollicular lymph node hyperplasia (ALNH) or Castlemans disease including pathogenesis, clinical presentation, histomorphologic and immunophenotypic findings, laboratory results, treatment, and prognosis. A division of ALNH into clinically relevant subtypes provides a framework for the consideration of the disorder. A comprehensive search of the medical literature involving ALNH using Medline was performed. Reports judged to be significant for the understanding of the disorder were analyzed and their findings incorporated into this review. ALNH is divided into localized/unicentric ALNH and generalized/multicentric ALNH due to the profound clinical differences seen between these variants. Localized/unicentric ALNH is separated by clinical and histomorphologic criteria into hyaline-vascular (HV) and plasma-cell (PC) subtypes. Generalized/multicentric ALNH may be divided by clinical criteria into generalized/multicentric ALNH without neuropathy (non-neuropathic) and generalized/multicentric ALNH with neuropathy (POEMS-associated or neuropathic). The dichotomy between these two subtypes is not absolute, with considerable clinical overlap occurring among patients presenting with generalized disease. Immunophenotypic and molecular probe studies demonstrate clonal B-cell lymphocyte populations in some cases, particularly those with generalized/multicentric ALNH. However, the finding of clonal populations is of no value in predicting malignant clinical progression. We conclude that using this division of ALNH, patients presenting with symptoms and histomorphology consistent with ALNH can be subdivided into the appropriate category of ALNH. Localized or unicentric disease, either HV or PC subtype, has an excellent prognosis with surgery being curative in the majority of cases. Generalized or multicentric disease indicates a poor prognosis with short survival, with the neuropathic variant possessing resistance to steroids and chemotherapy and a corresponding worse prognosis.

Pyroxidine for the Palmar-Plantar Erythrodysesthesia Syndrome

Excerpt To the Editor:Reported cutaneous reactions associated with 5-fluorouracil seem to depend on dose and schedule (1). The palmar-plantar erythrodysesthesia syndrome (PPES) was initially descri...

Eosinophilia associated with adult t-cell leukemia/lymphoma

Eosinophilia is associated with a number of disorders including malignancies. A patient is described who had eosinophilia associated with adult T‐cell leukemia/lymphoma (ATL) induced by human T‐lymphotropic virus type I (HTLV‐I). Both tissue and peripheral blood eosinophilia and high titers of HTLV‐I antibody were present. The eosinophilia was most likely caused by the malignant cells producing one or more lymphokines. The patient has achieved a durable complete remission from combination chemotherapy. Because durable remissions in ATL are rare with any known therapy and eosinophilia has not previously been associated with ATL, it is possible that the tumor in this patient was derived from a T‐cell subset not usually transformed by HTLV‐I. ATL is another malignancy now known to cause eosinophilia.

Acute myeloid leukemia evolving from essential thrombocythemia in two patients treated with hydroxyurea.

Essential thrombocythemia (ET) is an uncommon myeloproliferative disorder, which is thought to develop from a multipotent stem cell. Like other myeloproliferative diseases, ET is associated with an increased risk of development of acute leukemia (AL). However, the large majority of cases of leukemic transformation in ET are thought to be related to prior therapy, usually radioactive phosphorous or alkylating chemotherapy, and the development of AL in ET is extremely rare in the untreated patient. In this report, two cases of ET which evolved into AL without prior exposure to radiation or alkylating agents, and which were treated with long‐term hydroxyurea therapy, are described. The first case had cytogenetic changes in the bone marrow suggestive of therapy‐associated leukemia, and the second developed myelodysplastic syndrome on therapy which was likely chemotherapy‐induced and led to acute leukemia. Prolonged used of hydroxyurea in patients with ET may lead to therapy‐associated acute leukemia.

Paclitaxel-induced radiation recall dermatitis.

The authors present a case of radiation recall dermatitis occurring in a patient receiving paclitaxel shortly after completion of radiation therapy. A brief review of previously reported taxane-induced radiation recall reactions is provided.