A Patient with IgA Monoclonal Gammopathy Presenting as Myelomatous Pleural Effusion with Axillary Node Involvement

Multiple myeloma is a cancer of plasma cells that produce monoclonal immunoglobulin, and the neoplastic plasma cells typically accumulate in the bone marrow with occasional involvement of other organs. Pleural effusion that is associated with multiple myeloma has been infrequently reported (<6%) and myelomatous pleural effusion is extremely rare (<1%). A 73-year-old woman was admitted to the department of dermatology for skin lesions on both arms and both ankles. A chest radiograph taken on admission showed a nodular lesion in the right upper lung and pleural effusion. Analysis of the pleural fluid revealed many atypical plasma cells, elevated levels of IgA (27.95g/L) and lambda light chain (9.16g/L), and monoclonal IgA-lambda paraprotein on immunofixation. The serum concentrations of IgA were elevated (33.08g/L) while the concentrations of IgG and IgM were decreased. Bone marrow aspirate smears contained increased levels of immature-appearing atypical plasma cells. This is only the third case of myelomatous pleural effusion that has been reported in Korea.

Clinical Usefulness of Circulating Hepatocyte Growth Factor (HGF) in Breast Cancer / 대한진단검사의학회지

BACKGROUND: The hepatocyte growth factor (HGF) is a cytokine modulating epithelial cell proliferation and motility. A circulating HGF level is frequently increased in a variety of tumors including advanced breast cancer. The clinical usefulness of measuring circulating HGF in breast cancerwas evaluated in this study. MATERIALS AND METHODS: The plasma HGF levels in patients with primary (n=58) and recurrent breast cancer (n=13) were measured by the ELISA method using Quantikine (R&D, Minneapolis, MN, USA) kit. The results were compared with those of age-matched healthy controls (n=53). The mean (+/-SD) levels of HGF were also compared between primary and recurrent breast cancerpatients. The correlation of the circulating HGF level and the conventional prognostic factors such as tumor size, lymph node involvement, Her-2/neu over-expression, DNA aneuploidy was studied to evaluate the clinical usefulness of HGF as a new prognostic indicator in breast cancer. RESULTS: Plasma HGF levels (mean+/-SD) increased in breast cancer patients (788+/-853 pg/mL), compared with those of age-matched healthy control women (426+/-120 pg/mL) (P<0.05). Patients with recurrent breast cancer (1, 945+/-1, 544 pg/mL) showed increased HGF levels compared with primary breast cancer (592+/-132 pg/mL) (P<0.001). No significant correlations between plasmaHGF levels and conventional prognostic indicators of breast cancer including tumor size, lymphnode involvement, Her-2/neu over-expression, DNA aneuploidy, and histologic grade were found. CONCLUSIONS: The above findings suggest that the measurement of plasma HGF levels in breast cancer patients may be useful for early detection of recurrence.

A Case of Gray Platelet Syndrome / 대한혈액학회지

The gray platelet syndrome (GPS) is a rare platelet storage pool deficiency with variable degrees of reduction in the numbers and contents of alpha granules. We report a case of GPS in a two month-old male patient who was admitted to the hospital because of congenital biliary atresia and hip dislocation under the impression of ARC (arthroglyposis, renal tubular dysfunction, and cholestasis) syndrome. Bleeding time was not prolonged and platelet count was normal. The peripheral smear demonstrated abnormal platelet morphology with many agranular and large forms. A platelet aggregation study was abnormal in response to adenosine diphosphate and collagen. Electron microscopy of platelets revealed marked decrease in alpha granules and increase in vacuoles. The patient underwent Kasai operation with mild complication of postoperative bleeding.

Red Cell Depletion from the Bone Marrow Aspirates for the ABO Incompatible Transplantation by Apheresis Separations / 대한혈액학회지

BACKGROUND: Allogeneic bone marrow transplantation across ABO incompatibility barriers may result in immune mediated hemolysis. Hemolysis may be avoided by RBC depletion from the graft. In vitro graft manipulations carry the risk of hematopoietic stem cell loss, a factor that may be most important in graft failure. We report 16 major ABO blood group incompatible allogeneic bone marrow transplants using erythrocyte depletion of marrow prior to infusion. METHODS: From March 1997 to July 2001 in Yonsei University College of Medicine, 16 patients underwent ABO blood group incompatible allogeneic BMT: 5 for acute myelocytic leukemia, 5 for severe aplastic anemia, 3 for acute lymphocytic leukemia, 2 for chronic myelocytic leukemia, and 1 for myelodysplastic syndrome. RBC depletions were done with automatic cell separator, COBE Spectra (COBEBCT Inc., Lakewood, USA). RBC removal rates and mononuclear cell recovery rates were calculated. And the evidence of successful engraftment and intravascular hemolysis were also evaluated. RESULTS: The RBC removal rate was 99.1+/-0.0% and a mean of 1% of the original red cell volume was contained in the final infusate. The mononuclear cell recovery rate was 70.0+/-16.3% from the original MNCs. Fourteen patients tolerated the infusion of the marrow concentrates without any adverse effects. Two patients experienced hemoglobinuria, but disappeared within 2 days by continued observation. After transplantation, absolute neutrophil counts exceeded 500/nL by 10.8+/-1.9 days, platelet counts exceeded 50,000/nL by 30.5+/-8.5 days, and reticulocytosis sustained at >1% was by 25.8+/-13.9 days. CONCLUSION: RBC depletion from ABO major mismatched bone marrow aspirates by the automatic cell separator is a safe and effective technique.