ABSTRACT
Visceral leishmaniasis (VL) or Kala-azar is a common parasitic infection among children in Iran. The records of 249 children with VL were evaluated retrospectively. The clinical, hematologic, and bone marrow biopsy findings were studied. In particular, we assessed whether there was an association between bone marrow biopsy findings and prognosis. Five major groups were identified: (1) hypercellular marrow with many Leishman Donovan (LD) bodies, (2) multiple noncaseating granulomas with a few LD bodies, (3) diffuse fibrosis with rare LD bodies, (4) benign lymphoid nodules with many LD bodies, and (5) marrow necrosis with many LD bodies. The patients with hypercellular marrow and benign lymphoid nodules were alive and responded well to glucantime therapy. The patients with marrow fibrosis and marrow necrosis died and were resistant to any type of therapy. Patients with granulomas did not respond to glucantime therapy but responded to amphotericin B. However, less than half of the patients died owing to malnutrition and misdiagnosis. We correlated the bone marrow biopsy findings with the treatment outcomes and prognosis. The outcome was excellent in cases of hypercellular marrow, very poor in cases of fibrosis and necrosis, and intermediate in cases of granulomas. As a result, we believe that bone marrow biopsy findings can be helpful for assessing the prognosis of VL patients.
Subject(s)
Bone Marrow/pathology , Leishmaniasis, Visceral/pathology , Amphotericin B/therapeutic use , Antiprotozoal Agents/therapeutic use , Biopsy , Bone Marrow Examination , Child , Child, Preschool , Female , Fibrosis/pathology , Granuloma/pathology , Humans , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/mortality , Male , Meglumine/therapeutic use , Meglumine Antimoniate , Necrosis/pathology , Organometallic Compounds/therapeutic use , Prognosis , Retrospective StudiesABSTRACT
BACKGROUND: Fine needle aspiration (FNA) diagnosis of Langerhans cell histiocytosis (LCH) of the lymph nodes has been described rarely. CASES: LCH was confined to the lymph nodes in six children. The FNA smears showed high cellularity composed of many isolated Langerhans cells (LCs) with nuclear grooves and intranuclear inclusions. Also seen were numerous eosinophils, lymphocytes, giant cells, dendriticlike cells, macrophages and Charcot-Leyden crystals in a background of eosinophilic granules. Immunohistochemical study revealed a positive reaction with S-100 protein. CONCLUSION: The presence of LCs with nuclear grooves, eosinophils, giant cells and a positive reaction with S-100 protein aided the diagnosis of LCH of the lymph nodes. Charcot-Leyden crystals, intranuclear inclusions and dendriticlike cells were seen in this study. These findings have not been reported before in lymph node FNA smears of LCH.