[Association of CD34 cell surface antigen expression with cytomorphological characteristics of acute promyelocytic leukemia blasts and clinical characteristics of patients: one center experience]. / Povezanost izrazaja biljega CD34 s morfoloskim znacajkama blasta u akutnoj promijelocitnoj leukemiji i klinickim znacajkama oboljelih: iskustvo jednog centra.

The aims of the study were to investigate the association between cytomorphology and immunophenotypic expression of CD34 cell surface antigen of blasts and their relationship with clinical and laboratory characteristics of patients with acute promyelocytic leukemia (APL). Sixteen consecutive patients (male 69% and female 31%) diagnosed with APL at Department of Hematology, Merkur University Hospital between August 1998 and December 2010 were included in the study. The mean age of patients was 43.9 (range: 18-78, SD 14.9). The patients' clinical and laboratory features, cytomorphological characteristics of APL-blasts and their immunophenotype determined by flow cytometry were analyzed. Patients were divided into two groups, CD34- and CD34+, and were then compared according to clinical and laboratory characteristics. There was no difference according to age, sex or white blood cell count between two groups. The mean value of hypogranular/agranular APL-blasts was markedly higher in CD34+ group than CD34- group (34%, range 9-60, SD 24.4 vs. 11.5%, range 0-38, SD 13.7), with borderline statistical significance (P=0.055). CD34- patients had significantly better overall survival than CD34+ ones (P=0.02). Patients without Auer rods detected in APL-blasts had higher CD34 expression (69.4% +/- 33.8) compared to patients with detected Auer rods (7.3% +/- 24.8), but statistical significance was not reached (p=0.053). Our results are consistent with the results of other published studies and point to the fact that higher CD34 expression and lower cytoplasmic granularity of APL-blasts are factors that seem to define a specific subgroup of APL patients. Together with other diagnostic tools currently available, they could be of value in planning treatment of APL patients.

[Erythrocyte morphology in urine determined by light microscopy in patients with bladder cancer]. / Podrijetlo eritrocita u urinu odredivano svjetlosnim mikroskopom kod bolesnika s karcinomom mokracnog mjehura.

A finding of 80% or more of dysmorphic erythrocytes is assumed to point to kidney glomeruli, and of 80% or more of isomorphic erythrocytes to lower urinary tract as the origin of bleeding. In urine samples without significant origin of bleeding, there were 20%-80% of mixed results with both dysmorphic and isomorphic erythrocytes. The aim of the study was to show the origin of erythrocytes in malignant urine samples. Samples were fresh native urine sediment contrast stained with 0.1% safranin solution and analyzed under light microscope (X40). Out of 72 patients with malignant cells detected in urine, the origin of erythrocytes was identified in 25 patients (nine female and 16 male) through 90 samples (approximately 3-4 samples per patient); 26 (28.9%) samples did not have enough erythrocytes to define their origin, a mixed origin of erythrocytes was identified in 33 (36.7%) samples, dysmorphic erythrocytes were found in 25 (27.9%) samples, and isomorphic erythrocytes in 6 (6.3%) samples. In conclusion, there was no specific connection between malignant cell findings in urine and origin of erythrocytes. However, the high presence of mixed erythrocyte origin in malignant samples may suggest that the existence of a malignant process and renal disease should be taken in consideration.

[Isolated myeloid sarcoma involving the mediastinum]. / Izolirani mijeloidni sarkom medijastinuma.

Myeloid sarcoma is a rare extramedullary solid tumor consisting of immature myeloid cells and most commonly involving the bone, skin, lymph nodes, soft tissue, gastrointestinal tract and testis. Mediastinal myeloid sarcoma is very rare. There are two major types of myeloid sarcoma: granulocytic sarcoma and monoblastic sarcoma, according to immature cell type. Myeloid sarcoma is found in 2%-8% of patients with acute myeloid leukemia (AML). Myeloid sarcoma may develop before or concurrently with AML, or may be the initial manifestation of AML relapse in previously treated patients. Blast transformation of some form of myeloproliferative neoplasm or myelodysplastic syndrome may also manifest as myeloid sarcoma. A major differential diagnostic problem is isolated primary myeloid sarcoma without bone marrow and peripheral blood involvement, which may precede leukemic stage for months or years, and which is frequently misdiagnosed, mostly as malignant lymphoma. A case is presented of a 56-year-old female patient complaining of weakness, vertigo, dry cough and breathing difficulties. Clinical examination revealed enhanced vascular pattern on the right chest and right arm edema. Computed tomography (CT) of the thorax showed an expansive growth measuring 11 cm craniocaudally in the anterior mediastinum. Fine needle aspiration cytology of tumor mass yielded a scarcely cellular sample with individual atypical immature cells, fine chromatin structure and scarce cytoplasm with occasional granules and Auer rods. Considering the morphological, cytochemical and immunocytochemical characteristics of immature cells, the diagnosis of myeloid sarcoma was made and verified by histopathology of tumor biopsy sample. Immature cells were not found by analysis of bone marrow puncture sample, immunophenotyping of bone marrow cells and bone biopsy analysis. As immature cell proliferation was not detected in bone marrow and peripheral blood, while spread of the disease beyond the mediastinum was ruled out by imaging methods (CT, ultrasonography), it was decided to be a primary non-leukemic form of mediastinal myeloid sarcoma. Myeloid sarcoma should be taken in consideration on differential diagnosis of solid tumors because making an accurate diagnosis is necessary for timely initiation of appropriate therapy. Weakly expressed or lacking clear signs of myeloid differentiation may hamper morphological diagnosis. As isolated myeloid sarcoma is a very rare entity frequently resembling lymphoma in clinical presentation, it poses a major diagnostic challenge for both morphologists and clinicians.

[Longterm indolent course of pleomorphic mantle cell lymphoma with multiple chromosomal abnormalities]. / Dugogodisnji indolentni tijek pleomorfnog limfoma plastene zone s multiplim kromosomskim abnormalnostima.

Mantle cell lymphoma (MCL) is a B-cell neoplasm characterized by aggressive clinical course with an average 3- to 5-year patient survival. We present a patient whose illness turned from initial classical morphological variant to a more aggressive pleomorphic form of MCL in only a few months, but with unchanged long-term indolent clinical course. At the time when lymphoid cell pleomorphism was proven, the disease presented itself through recurrent peripheral lymphadenopathy without extranodal involvement or general symptoms. Other numerous abnormalities were found next to typical cytogenetic translocation t (11,14). Histopathology confirmed the diagnosis of MCL, pleomorphic type. After autologous stem cell transplantation, the disease remained morphologically the same, but the patient was in a good general condition for a long period of time. More than two years after the pleomorphic MCL had been diagnosed and one year after the transplantation, major lymphadenopathy occurred. Our case report points to a large spectrum of morphological and cytogenetic variability of MCL, which often does not correlate with the clinical course of the disease.

A case report of breast angiosarcoma.

Angiosarcoma is a rare disease of the breast with the reported incidence of only 0.04% of all breast malignancies. The etiology of angiosarcoma remains unknown. It occurs post-mastectomy, in association with chronic lymphedema (Stewart-Treves syndrome), or after radiotherapy. We present a patient with angiosarcoma which developed 12 years of the diagnosis of breast carcinoma and 8 years of the operative procedure and radiotherapy for disease recurrence. A small angiomatous lesion of a few mm in size, cytologically suspect of vascular tumor (hemangioma or hemangiopericytoma) and histopathologically verified to be an atypical vascular lesion, was detected two years before breast enlargement and cytologic and histologic diagnosis of angiosarcoma. The patient died 15 months of the diagnosis of angiosarcoma, after two tumor recurrences and intrathoracic cavity invasion.

T lymphoblastic leukaemia with an unusual Burkitt lymphoma morphology--a case report.

Precursor T-cell acute lymphoblastic leukaemia (T-ALL)/lymphoma (T-LBL) is a neoplasm with cytological features that include blast cells of medium size, high nuclear cytoplasmic ratio and inconspicuous nucleoli, which are usually TdT (Terminal Deoxynucleotidyl Transferase) positive and variably express T-cell markers. We report a case of T-ALL with atypical cytological presentation which showed lymphoblasts with homogenous nuclear pattern, larger amounts of cytoplasm with vacuoles and prominent nucleoli. A 56-year-old male was hospitalized due to high fever and kidney infection. Further examination confirmed anemia, thrombocytopenia, normal level of white blood cells and high level of lactat-dehydrogenase (LDH). Bone marrow aspiration revealed 87% and peripheral blood 41% of lymphoblasts with cytoplasmic vacuoles which suggested Burkitt lymphoma (BL) morphology. Patient's karyotype showed no chromosomal aberations. Identification of immunophenotype discovered cells which were CD2 and CD3 positive and CD20 negative with focal acid phosphatase activity in 67% of blasts. This excluded Burkitt lymphoma and led to diagnosis of T-ALL. The patient was submitted to two cycles of chemotherapy, autologous stem cell transplantation, and intrathecal chemotherapy, but he died after 10 months because of disease complications (lung aspergillosis and pleural effusion). Our case report showed how morphology alone can be misleading and sometimes is not enough in diagnosing ALL. Beside morphologic criteria, setting correct diagnosis depends on identification of immunophenotype by flow cytometry and cytogenetic-molecular abnormalities. Further improvements in the molecular definition of ALL subtypes, development of new and targeted drugs will improve patient's outcome and prognosis.