T8 chronic lymphocytic leukemia. A distinctive disorder related to T8 lymphocytosis.

A case of T chronic lymphocytic leukemia (CLL) was first suspected on histologic and cytochemical examination of a splenectomy specimen. Later the patient became frankly leukemic with an E+/T3+/T8+/T4- phenotype. From our case and other reported cases of T-CLL studied with monoclonal antisera, the authors conclude that there are significant clinical and morphologic differences between T4 CLL and T8 CLL. In contrast to T4 CLL, T8 CLL characteristically presents with relatively low lymphocyte counts, little organ involvement, and often only discreet bone marrow involvement, and has a long clinical course. The leukemic cells are often large and have abundant cytoplasm with azurophilic granules. Similar features in cases reported as T8 lymphocytosis with neutropenia lead us to consider both entities part of a spectrum of the same disorder.

Peripheral T-cell lymphoma: a clinicopathologic study of nine cases.

The clinicopathologic features of nine cases of peripheral T-cell lymphoma were analyzed. Although the youngest patient was 18 years old, the median age was 59.8 years. They usually presented with widespread disease and had an aggressive course. Seven have died with a median survival of 10.9 months. Five cases were of mixed cell type, sharing certain histopathologic features that we believe are characteristic of peripheral T-cell lymphomas. Three cases were of large cell type; one was a small cell (PDL) type. This latter patient lived symptom-free without treatment for over 3 years, despite stage III disease. Another patient, whose tumor had nodular sclerosis-like fibrosis, is in complete remission two years after chemotherapy for stage III B disease. Because peripheral T-cell lymphoma is morphologically heterogeneous, it may be clinically heterogeneous as well. We believe that classification according to a modified Rappaport system may clarify possible variations in biologic behavior.

Solitary extramedullary plasmacytoma of the palpebral conjunctiva.

A 63-year-old man had a solitary extramedullary plasmacytoma of the conjunctiva for several years with no history of ocular inflammation or systemic abnormalities. Immunoperoxidase staining was consistent with a neoplastic lesion. This is the only well documented such case in the recent literature to the best of our knowledge. This rare condition is contrasted with reactive plasma cell granuloma, a benign inflammatory condition, which comprises most of the cases previously reported as plasmacytomas. Since extraskeletal plasmacytomas may be the first manifestation of multiple myeloma, these patients deserve appropriate diagnostic evaluation and close follow-up.

Malignant lymphoma presenting in the orbit: a clinicopathologic study of a rare immunoglobulin-producing variant.

Malignant lymphoma with orbital presentation and associated serum paraproteinemia has seldom been reported in the literature. We report two such cases of lymphoplasmacytic type, one of which was also associated with amyloidosis. Both cases were studied with immunohistologic and one with electron microscopic techniques with results that confirmed that the neoplastic cells were producing the abnormal serum immunoglobulin.

Pulmonary hypertension as a presentation of hepatocarcinoma. Report of a case and brief review of the literature.

A case, unique in the literature, is reported in which a primary carcinoma of the liver presented a right-sided heart failure and pulmonary hypertension. The diagnosis of hepatocarcinoma was established by needle biopsy of the liver. Later, postmortem examination demonstrated that the pulmonary arterial tree was severely compromised by multiple tumor microemboli, despite the persistent lack of characteristic roentgenographic abnormality in our patient. In reviewing the literature, we found rare cases of occult renal cell carcinoma, choriocarcinoma and one of occult hepatocarcinoma, which presented as pulmonary embolism. These were diagnosed by pulmonary embolectomy, human chorionic gonadotrophin levels or autopsy, respectively. In another small group of reported cases of known carcinoma (gastric, breast, colonic) the patients had a clinical picture of "idiopathic" pulmonary hypertension or of pulmonary hypertension with pulmonary metastases. Pulmonary hypertension in these cases resulted from carcinomatous lymphangitis and/or tumor microembolization, as in our case. We report this case to emphasize the necessity of including occult carcinoma in the differential diagnosis of pulmonary hypertension and right ventricular failure.