Excellent response to interferon therapy in a patient with hypereosinophilic syndrome and elevated serum immunoglobulin E levels

The hypereosinophilic syndrome (HES) is a heterogeneous disease characterized by sustained eosinophilia for a period of at least six months with evidence of organ involvement. Its manifestations range from a benign disorder not requiring any therapy to an aggressive, malignant variety refractory to common treatments. Diverse therapies have been used, including steroids, hydroxyurea, and chemotherapy, with variable responses. Recently alpha-interferon therapy has been shown effective in this disorder. Of the various prognostic factors, elevated serum immunoglobulin E (IgE) levels is considered among the most favorable, with most patients presenting with a [quot ]benign[quot ] disorder, not requiring therapy. We describe a patient presenting with an aggressive variant of HES despite having elevated IgE levels. The patient had a dramatic and lasting response to alpha-interferon

Simultaneous occurrence of Hodgkin's disease and chronic lymphocyte leukemia: a unique presentation

Chronic lymphocytic leukemia (CLL) is a chronic, low-grade hematologic malignancy that can transform to a large cell non-Hodgkin's lymphoma (Richter's syndrome), which is associated with an unfavorable prognosis. A distinct Hodgkin's disease subgroup of lymphomatous CLL transformation has been well characterized. We describe a patient presenting with simultaneous manifestations of CLL and Hodgkin's disease. This patient is unique, presenting with separate sites of involvement of each disease within the same organ, in this case the bone marrow. The morphologic and immunohistochemical findings at diagnosis are correlated with the findings of the postmortem examination

T-cell rich B-cell lymphoma masquerading as Hodgkin disease: excellent outcome to inadequate therapy

T-cell rich B-cell lymphomas (TCRBCL) are characterized as non-Hodgkin lymphomas with a minor population of malignant B-cells scattered among predominant, reactive T-lymphocytes. This entity can easily be confused with lymphocyte-predominant Hodgkin disease (HD-LP), resulting in inappropriate therapy and a poor outcome. Because of their similarity, the pathology of patients treated for HD-LP with an inadequate or short-lived response to therapy should always be reviewed by an expert hematopathologist. We describe the first reported patient in Puerto Rico with TCRBCL, originally diagnosed and treated as HD-LP. Although the patient received partial, substandard therapy for TCRBCL, an excellent prolonged complete response ensued, thus, giving further credence to the fact that malignant lymphomas and TCRBCL in particular, are a protean group of disorders which should be precisely and accurately classified before the proper therapeutic strategies can be outlined