ABSTRACT
Hematogenous blasts in cytologic preparations of cerebrospinal fluid (CSF) have generally been thought to indicate leukemic involvement of the central nervous system (CNS). However, two leukemic patients who came to autopsy had no CNS involvement despite positive CSF preparations shortly before death. Both patients had over 10,000 blasts/cu mm in their peripheral blood. The CSF specimen from one patient was grossly bloody, but the specimen from the second patient was clear. An experiment was designed to test the hypothesis that membrane filter techniques are sufficiently sensitive to detect blasts in CSF contaminated by amounts of leukemic blood too small to be detected visually. Blood from a leukemic patient with 130,000 cells/cu mm was serially diluted in CSF from 1:20 to 1:1,600,000 and membrane filters from each dilution were examined. No blood could be detected visually at the 1:8,000 and further dilutions. Blasts forms were seen on membrane filter preparations down to the 1:1,600,000 dilution, which contained 0.000000125 ml of blood, equivalent to about 1/40,000th the volume of an 18-gauge spinal needle. These findings suggest that contamination of CSF specimens with minute amounts of blood, undetectable by visual inspection, may lead to erroneous interpretation of leukemic involvement of the CNS.
Subject(s)
Leukemia, Lymphoid/cerebrospinal fluid , Leukemia, Myeloid, Acute/cerebrospinal fluid , Adolescent , Aged , Humans , Leukemia, Lymphoid/blood , Leukemia, Lymphoid/pathology , Leukemia, Myeloid, Acute/blood , Leukemia, Myeloid, Acute/pathology , MaleSubject(s)
Endometriosis/pathology , Leiomyoma/pathology , Lymph Nodes/pathology , Adult , Female , Humans , Muscle, Smooth/pathologyABSTRACT
A patient who developed primary amyloidosis, pure red cell aplasia, and Kaposi's sarcoma is described. This is the second reported coincidence of Kaposi's sarcoma and pure red cell aplasia and the first coincidence of Kaposi's sarcoma and primary amyloid, thus enlarging the spectrum of plasma cell and immunoglobulin abnormalities seen in Kaposi's sarcoma. Because immunologic abnormalities have been described in all these diseases, it is felt that some primary immune dysfunction is the underlying cause of the three diseases in this patient.
