Myelodysplastic syndrome that progressed to acute myelomonocytic leukemia with eosinophilia showing peculiar chromosomal abnormality: a case report

Myelodysplastic syndrome is a closely related group of acquired bone marrow disorders characterized by ineffective and dysplastic hematopoiesis. These clonal disorders frequently progress to acute leukemia. Acute myelomonocytic leukemia with eosinophilia is characterized by an increase in abnormal eosinophils in the bone marrow, relatively good clinical course and inv (16) chromosomal abnormality. We experienced one case of refractory anemia with excess blasts which progressed to refractory anemia with excess blasts in transformation and finally to acute myelomonocytic leukemia with eosinophilia showing peculiar chromosomal abnormalities of der (1;7).

The Effectiveness and Safety of DA-3030 ( rhG-CSF ) for Chemotherapy - induced Neutropenia: A Randomized Controlled Trial / 대한암학회지

PURPOSE: We investigated the effectiveness and safety of DA-3030 for prophylatic use in patients receiving chemotherapy for malignant disease. MATERIALS AND METHODS: Seventy cancer patients were randomized to receive chemotherapy alone (36 patients) or with DA-3030 administered (34 patients) after stratified block randomization according to chemotherapeutic regimen. DA-3030 was subcutaneously administered at the dose of 100 pg/m/day for 10 days from 24 hours after the completion of chemotherapy. RESULTS: Of the 70 enrolled patients, 62 patients were evaluable. The neutropenia (absolute neutrophil count [ANC] <1,000/mm) occurred in 9 of 32 (28.1%) of the DA-3030 group and 21 of 30 (90.0%) of the control group, giving relative risk for control group of 0.154 (95% confidence interval [CI], 0.05 to 0.45; p-0.0001). Severe neutropenia (ANC 500/mm') occurred in 4 of 32 (12.5%) of the DA-3030 group and in 20 of 30 (66.7%) of the control group (relative risk for control group of 0.316 [95% CI, 0,18 to 0.55]; p=0.0001). The mean duration of neutropenic period (+/-standard error) was 1.13+/-0.34 days in the DA-3030 group and 6.73+/-0.69 days in the control group respectively, and was significantly shorter in the DA-3030 group (p<0.0001). And, there was higher nadir ANC in the OA-3030 group than that in the control group (p=0.0001); the mean nadir ANC was 2,547+/- 343/mm and 442+/-120/mm, respectively. The DA-3030 group had significantly higher incidence of myalgia in comparison to the control group (43.8% compared with 3.3%; p=0.001). However, it was tolerable and was easily managed by conservative therapy CONCLUSION: The use of DA-3030 was effective in preventing chemotherapy-induced neutropenia.

The Evaluation of Correlation between the Histologic Composition of BPH and TRUS Findings / 대한비뇨기과학회지

PURPOSE: It has been believed that o-blocker affects the stromal component of BPH, while 5 alpha -reductase inhibitor affects the glandular component. Information on the tissue composition of BPH might be helpful to choose an appropriate medical therapeutic agent. We evaluated whether transrectal ultrasonographic findings could reflect the histologic composition of BPH and the correlation of the composition of BPH and the clinical parameters such as patient's age, peak flow rate, IPSS symptom score, and prostate volume. MATERIALS AND METHODS: Fifty five patients with BPH treated by transurethral resection were studied. The proportions of stromal and glandular area in the resected prostate were determined by image analyzer. "Stromal hyperplasia"was defined when more than 75% of the resected prostate was composed of stromal tissue and microscopically, abundant stromal tissue with normal or atrophic glands were dominant. "Glandular hyperplasia" was defined when more than 25% of the prostate was composed of glandular tissue and microscopically, hyperplastic glandular cells and dilated lumen with occasional cystic changes were dominant. Ultrasonographically, it is classified as stromal hyperplasia when the echo of central gland is fine and lower echogenic than that of peripheral gland, and classlfied as glandular hyperplasia when the echo of central gland Is coarse and isoechogenic or hyperechogenic with focal echopenic areas. Statistical significance was judged by Student t-test and linear regression analysis. Concordance of ultrasonographic findings and histopathologic findings of BPH was determined by Kappa index. RESULTS: Sixty nine percent of resected prostate tissue were composed of stromal tissue. The proportion of stromal tissue in stromal hyperplasia and glandular hyperplasia was 85.8+/- 1.6% and 64.8+/- 1.0%, respectively(p<0.001). Ultrasonography accurately reflect histopathologlc type in 50 of 55 BPH. Two of 12 stromal hyperplasia and 3 of 43 glandular hyperplasia were falsely interpreted on ultrasonography. Three of 5 falsely interpreted cases showed marginal stromal tissue composition(60.9%, 72.9%, 73.3%, 76.4%, and 84.2%). Kappa index of ultrasonogrhaphic finding and histopathologic classification was 0.74(fair to good). In the meantime, clinical parameters including patient's age, peak flow rate, IPSS symptom scores did not correlate with tissue composition. Only prostate volume and resected prostate weight showed negative correlation with proportion of stromal tissue(p=0.0953 and p=0.0794, respectively). CONCLUSIONS: Using our sonographic criteria, transrectal ultrasonography could reflect histologic type of BPH so that choice of medical therapeutic agent may be possible. Larger prostates had less stromal tissue, however, the histologic composition of the prostate was not related to the severity of symptoms or peak flow rate.

Diagnostic Efficacy of Biochemical Studies and MIBG Scan in Pheochromocytoma / 대한비뇨기과학회지

We evaluated the role of clinical symptoms, biochemical studies and metaiodobenzylguanidine (MIBG) scan in the diagnosis of pheochromocytoma. From August 1991 to June 1997, 42 patients with complaints of hypertension or adrenal mass were evaluated with MIBG scan, 24 hour urinary vanillylmandelic acid (VMA), serum and 24 hour urinary catecholamine and radiologic studies such as CT, MRI or ultrasonography. Initial 9 patients were evaluated with 131 I-MIBG scan and the rest 33 patients with 123 I-MIBG scan. Of 42 patients, histologic diagnosis was obtained in 32 patients including 23 patients with pheochromocytoma or paraganglioma and 9 patients with other adrenal or extra-adrenal tumors. Remaining 10 patients had no evidence of adrenal disease on radiologic studies. Paroxysmal symptoms or hypertension was noted in 14 patients with pheochromocytoma or paraganglioma, while it was also found in 12 out of 19 patients without pheochromocytoma or paraganglioma. Sensitivity, specificity and positive predictive value (PPV) of each diagnostic modality were 60.9%, 92.9% and 93.3% in 24 hour urinary VMA, 61.9%, 75.0%, and 81.3% in 24 hour urinary catecholamine, 82.6%, 94.7%, and 95.0% in MIBG scan, respectively. Sensitivity and specificity were improved to 86.9% and 100% when 24 hour urinary VMA and MIBG scan were combined. In conclusion, MIBG scan was the most useful single screening method for the diagnosis of pheochromocytoma, and combination of MIBG scan and 24 hour urinary VMA would enhance the diagnostic accuracy.

A Case of Primary B-cell Lymphoma of the Centrol Nervous System after Renal Transplantation: A Case Report / 대한내과학회지

Primary lymphoma of the central nervous system is a rare disease, occurring spontaneously and/or in conjunction with immunosuppressive state. Its incidence is increasing according to the increment of organ transplantation and AIDS. Recently we experienced a case of primary lymphoma occurred in central nervous system after renal transplantation in a 58-year-old women who had complained of persistent headache and left hemiparesis. CT scan of the brain showed two hyperdense mass lesions in right frontal and right basal ganglia areas. Immunohistochemical stain of the excised mass lesion revealed that tumor cells were derived from B cells. The patient was treated with discontinuance of immunosuppressive drug and irradiation, but expired due to pneumonia.

Role of Clinical Stage, PSA and Gleason`s Score in Predicting Pathologic Outcome in Prostate Cancer / 대한비뇨기과학회지

Preoperative clinical staging in the prostate cancer does not always accurately predict the surgical-pathological outcome. We evaluated how the clinical staging, and other clinical parameters including preoperative PSA and Gleason`s score could reflect on the surgicopathological findings in 30 patients with prostate cancer, who underwent radical prostatectomy. Twelve of 24 patients with clinical T1 or T2 disease were understaged by clinical staging determined by digital rectal examination, bone scan, and radiologic studies including CT and MRI with endorectal coil. MRI with endorectal coil accurately reflected the extracapsular disease only in 59.1% of 22 patients studied. At the same time, it also showed low sensitivity (50%) with high specificity (100%) in detecting lymph node metastasis. Preoperative levels of PSA in patients with P2, P3, and N+ disease were 17.8 +/- 4.5, 47.9 +/- 11.3, 93.5 +/- 20.5ng/ml, respectively. The level of PSA was less than 20ng/ml in 9 of 12 patients with P2 disease, while they were greater than 20ng/ml in 9 of 12 patients with P3 disease. PSA may have a role to rule out lymph node metastasis when its level is less than 10ng/ml, although it did not reach the statistical significance because of small sample size. Gleason`s scores in patients with P2 disease were quite similar to those in patients with P3 disease (5.92 +/- 0.69 vs 5.67 +/- 0.56), whereas Gleason`s scores in all 6 patients with N+ disease were 9 or greater. Neoadjuvant hormonal therapy with LH-RH analogue and androgen receptor blocker for 1.5 to 3 months had no impact on the reduction of margin positivity or downstaging in 10 patients. PSA failure rate in patients with P2 and P3 disease was 25% at 1 year after operation. PSA is a good marker for differentiating between P2 and P3 disease (,p=0.0214) and can safely rule out N+ disease if its level is below 10ng/ml, while Gleason`s score may reflect the lymph node metastasis when it is 9 or greater (p=0.0012). Among the candidates for radical prostatectomy, selection of the patients on the basis of PSA and Gleason`s score might improve the surgical-pathological outcome.

Clinicohematologic Observations of Acute Leukemias with Hyperleukocytosis / 대한내과학회지

OBJECTIVES: It is well known that Acute Leukemic patients with Hyperleukocytosis (ALH, leukocyte count>or=100,000/micro L) have poor prognosis. This is indebted in fatal complications arising from cerebral and pulmonary leukostasis. To investigate the factors influence on the prognosis of these patients, we have analyzed age, sex, laboratory findings and complications and their relationship to remission rate. METHODS: Retrospective evaluation was done from January 1985 to March 1994 on fifty-four patients with ALH. We excluded secondary leukemias transformed from chronic myelogeneous leukemia, relapsed acute leukemia and myelodysplastic syndrome in this study. The prognostic factors associated with early death were also evaluated. RESULTS: 1) Hyperuricemia and incidence of central nervous system and respiratory symptoms were higher in acute myelogeneous leukemia (AML) with hyperleu-kocytosis than in acute lymphocytic leukemia (ALL), 2) Twenty-two of fifty-four patients had complete remission by remission induction chemotherapy. Remission rate was 41%, median duration of remission was 26 weeks and 1 year survival rate was 11%. 3) There were no differences in remission rate between male and female and higher WBC group (WBC>or=200,000/micro L) and lower WBC group (WBC 100,000~200,000/micro L). 4) The group with better performance status (ECOG score1-2), younger (age below 40) and higher hemoglobin level (Hb>or=10g/dL) had higher remission rate. The group of AML and with hepatomegaly had lower remission rate than the group of ALL and without hepatomegly. 5) Early death rate of AML was higher than that of All. Infection was the most common cause of early death in both AML and ALL. 6) Early death rate between the two groups managed with and without leukapheresis was not different. CONCLUSIONS: This result reveals that acute leukemia with hyperleukocytosis is grave disease, especially the patients with poor performance status (ECOG score: 3-4), older age above 40 and severe anemia (Hb<10g/dL) have poor prognosis, The group of AML and with hepatomegaly showed worse prognosis than the group of ALL and without hepatomegaly.

The analysis of cholescintigraphy in differentiating the causes of jaundice

As a adjuvant, 99m Tc-IDA complex cholescintigraphy has been used to differentiate the causes of jaundice,hepatocellular jaundice from the obstructive jaundice. So we conducted the retrospective study from the 41 casesof cholescintigraphy from the Mar, 83 to Sept. 84 at the Dept. of radiology in the Sonnchyunhyang university todetermine the etiology and differential points in the diagnosing the Jaundice. The following results wereobtainend; 1. As a 1st-ordered parameter, the leading edge hepatic parenchymal transit time was very significant in differentiating the causes of jaundice, among the hepatocellular jaundice, obstructive jaundice due to tumor,and obstructive jaundice due to cholelithiasis. (P0.01 by t-test) 3. The difference in hepatic clearance between the biliary obstruction dueto tumor and that of the cholelithiasis, was not significant. (P>0.05 by X2-test) 4. The difference in bile ductdilatation among the hepatocellular jaundice obstructive jaundice due to tumor, and obstructive jaundice due tocholelithiasis, was singnificant in differentiating the causes of jaundice. (P<0.05 by X2-test) 5. Intrahepaticstone showed scintigraphic pooling with partial stasis. 6. Cholescintigraphy was useful to differentiated the Rotor's syndrome from the Dubin-Johnson syndrome, supplying the additional criteria.