Cryptosporidial enteritis and pneumocystis pneumonia in a homosexual man.

The case of a 44-year-old homosexual man with cryptosporidial enteritis associated with multiple opportunistic infections and increased T-suppressor cells is reported. This case calls attention to cryptosporidia as the cause of unremitting diarrhea in homosexual men with the syndrome of opportunistic infectious disease associated with acquired immunodeficiency.

Bone marrow involvement in histiocytosis X.

Twenty-eight patients with histiocytosis X (HX) who had bone marrow aspirates and/or trephine biopsies taken at diagnosis were studied. Five of the 28 patients (18%) had bone marrow specimens with clusters of benign histiocytes characteristic of histiocytosis X. Several statistically significant clinical and laboratory differences were found between those patients with positive marrows versus those with uninvolved bone marrows. Presence of HX in the bone marrow was more frequently associated with fever (P less than 0.01), splenomegaly (P less than 0.01), rash (P = 0.04), diabetes insipidus (P = 0.09), and platelet counts less than 175 X 10(9)/L(P = 0.01). Two of the five patients with bone marrow involvement died, whereas there were no deaths due to HX in the other 23 patients. From this review, it is suggested that bone marrow involvement at diagnosis may be associated with more extensive and potentially fatal disease. HX of the marrow was more easily diagnosed from trephine biopsy sections than aspiration smears.

Acute promyelocytic leukaemia: a study of 39 cases with identification of a hyperbasophilic microgranular variant.

Thirty-nine cases of acute promyelocytic leukaemia (APL) were divided into two morphological subgroups, typical hypergranular APL (31 cases) and microgranular APL (eight cases, 21%). The leukaemic cells in the microgranular APL cases were characterized by striking nuclear folding or lobulation; granulation was present in most of these cells but was less abundant and finer than in typical APL. In three microgranular APL cases a distinctive small leukaemic promyelocyte with unusual nuclear lobulation and deeply basophilic cytoplasm containing few or no visable granules was the predominant leukaemic cell. This small hyperbasophilic promyelocyte was also present as a minor population of cells in the other five microgranular APL case and in 28 of the 31 typical APL cases. Ultrastructurally the most abundant promyelocytes in microgranular APL had smaller and usually fewer granules than in typical APL; other characteristic ultrastructural features of APL were found with equal frequency. The median blood leucocyte count was significantly higher in microgranular APL, 83.0 x 10(9) x 10(9)/l, than in typical APL, 1.8 x 10(9)/l (P less than 0.01). The median duration of complete remission (CR) for microgranular APL, 6.5 months, was shorter than the 21 + month median CR for typical APL. The morphological characteristics of microgranular APL may mimic those of myelomonocytic leukaemia; however, the presence of cells with multiple Auer rods, large inclusions of Auer-like material and the small hyperbasophilic promyelocytes are important distinguishing features. In equivocal cases cytochemistry, electron microscopy and cytogenetic studies may verify the diagnosis.

Bone marrow aspiration and trephine biopsy. An approach to a thorough study.

Recent advances in the treatment of hematologic malignancies have been paralleled by renewed interest on the part of pathologists and hematologists in methods of obtaining and preparing bone marrow for diagnostic studies. A thorough bone marrow morphologic study involves examination of peripheral blood smears, direct, particle, and buffy coat bone marrow smears, trephine biopsy imprints, particle and trephine biopsy sections, and marrow volumetric data. The information obtained from the study of these various specimens is complementary. Frequently it is a combination of clues gathered from examination of several different preparations that leads to a correct diagnosis. Utilization of biopsy material by the methods described provides complete, accurate and reproducible information and minimizes the necessity for repeating a biopsy for morphologic diagnosis or ancillary studies.

Comparison of three procedures for isolating human ferritin, for use as a standard in an immunoradiometric assay.

We evaluated three methods for isolating ferritin for use as a standard, with respect to purity of the products, ease of preparation, and yield. Examination of the respective products by gel filitration on Sephadex G-200 and Sepharose 6B suggested that the preparations isolated by ammonium sulfate and cadmium sulfate precipitation (Method 1) and by ultracentrifugation (Method 2) were homogeneous, while the product of a procedure including precipitation with ammonium sulfate (Method 3) contained significant amounts of nonferritin protein. The ratios of ferritin as measured by immunoradiometric assay to the amount of protein in the product indicated the ferritin prepared by Method 1 to be the most highly purified. Methods 1 and 2 were both comparatively simple. Although the yield from Method 1 was lowest, it is probably the method of choice, on the basis of the ease of obtaining a highly purified product. The most appropriate method for estimating protein in the isolated preparations appears to be that of Lowry et al.

Morphology of chronic lymphocytic leukemia and its relationship to survival.

The morphology of lymphocytes in blood and bone marrow from patients with chronic lymphocytic leukemia was studied; blood lymphocyte morphology was related to survival. Three primary morphologic groups emerged. Group 1 was characterized by small to medium-sized lymphocytes with narrow rims of cytoplasm and coarsely clumped nuclear chromatin. In group II the predominant lymphocytes were large with abundant cytoplasm. Group III was characterized by a heterogeneous population of lymphocytes with characteristics of both groups I and II. Clinical features of the patients were studied, and B and T typing of the lymphocytes was done. The median survival in group I was 26+ months; in group II 46+ months; and in group III 50+ months. Our data are at variance with previous reports and suggest that survival in patients with large lymphocytes is longer than in those with small lymphocytes.