Small-cell lymphoma and Sjögren's syndrome. Lymphoplasmacytic subvariant of small-cell lymphoma with IgA/kappa immunoglobulin surface markers.

To our knowledge, the association of the plasmacytoid variety of small-cell lymphoma with primary Sjögren's syndrome has not been reported. We describe a patient with SS who developed plasmacytoid small-cell lymphoma. As opposed to the commonly detected IgM, the lymphocyte surface immunoglobulins contained monoclonal IgA/kappa light chains. In addition to the unique immunopathologic features, the impressive response to chemotherapy and the importance of surface immunoglobulin markers in the diagnosis of malignancy in Sjögren's syndrome are discussed.

Periorbital ecchymoses as the initial sign in multiple myeloma.

A 61-year-old man with bilateral recurrent periorbital ecchymoses was followed up for 36 months, at which time the diagnosis of multiple myeloma was established. However, in vitro tests of blood coagulation and platelet function gave normal findings. A biopsy specimen of the ecchymotic area showed no evidence of amyloid. Clinical and laboratory evaluation did not suggest another cause. The mechanism of the localized bleeding tendency could not be elucidated.

Antigranulocyte antibodies and deranged immune function associated with phenytoin-induced serum sickness.

A phenytoin-associated serum-sickness-like syndrome was followed by severe pancytopenia in a 17-year-old female. Serum obtained during the acute phase of her illness contained antibodies against homologous eosinophils and neutrophils, antibodies against autologous neutrophils, and antibodies to phenytoin. The serum also inhibited bone marrow granulocyte colon formation in vitro. Lymphocyte transformation by pokeweed mitogen was impaired and, after recovery, the patient's lymphocytes were transformed in vitro by the addition of phenytoin. These data demonstrate that profound derangements of immunity can be associated with a phenytoin-induced serum-sickness-like illness.

Advances in adult non-Hodgkin's lymphoma. Current concepts of classification, diagnosis, and management.

In recent years, major advances in the knowledge of immunobiology of the malignant cell, changes in systems of histologic classification and staging procedures, and the development of new therapeutic regimens have considerably changed the approach to, and treatment of, patients with non-Hodgkin's lymphoma. Along with these developments has come the realization that close collaboration among the hematologist-oncologist, the hematopathologist, the radiotherapist, and the surgeon is critical in the successful treatment of these patients. Today, the possibility of cure exists for selected patients with non-Hodgkin's lymphoma; such patients must be identified and given appropriate initial therapy. In all patients, the selection of therapy is guided by the histologic type and stage of disease.

Cytarabine-induced anaphylaxis. Demonstration of antibody and successful desensitization.

An anaphylactic episode occurred in a patient receiving cytarabine (Ara-C) for acute myeloid leukemia. Specific allergy of the patient to cytarabine was demonstrated in vivo by intradermal testing and in vitro by four-hour passive cutaneous anaphylaxis in guinea pigs. Desensitization to cytarabine was successfully performed. This case represents the first known report of both cytarabine anaphylaxis and densensitization, and provides immunologic evidence implicating an allergic reaction to cytarabine.