Microscopic patterns in surgically removed spleens.

348 spleens surgically removed have been examined microscopically and classified into 3 groups: (I) 154 emergency splenectomies (86 traumatic ruptures, 44 enlarged supramesocolic exeresis, 44 cirrhosis), (II) 143 therapeutic splenectomies (135 cases of hypersplenism among which 10 apparently primitive, 7 myeloproliferative syndromes, 1 hairy cell leukemia), and (III) 51 diagnostic splenectomies (7 non specific inflammations, 2 tuberculosis, 1 mycosis, 6 echinococcosis, 12 leukemias, 9 non-Hodgkin's lymphomas, 13 Hodgkin's lymphomas, 1 primary splenic hemangioma). The study of the first group material, obtained especially of traumatic rupture, has been very valuable to follow the spleen microscopic structure in normal humans of different age. The latter two group cases have raised interesting problems of microscopic diagnosis, permitting at the same time a better understanding of the pathology of this organ.

Bone marrow biopsy (BMB). III. Bone marrow biopsy in Hodgkin's disease (HD).

Bone marrow biopsies have been investigated in 330 cases of Hodgkin's disease totalising 298 patients, out of which 32 with repeated biopsies. Positive biopsies with typical lesions were found in 32% of patients, the majority in stages III and IV (88.6%), rarely in stage I or II (11.4%). Nonspecific lesions were very frequent (75%), either isolated or accompanied by typical lesions. The majority of the positive biopsies were found in patients with lymphocytic predominance and lymphocytic depletion, or in polytreated patients in an advanced stage of the disease. The specific marrow involvement consisted in lymphocytic infiltrations either nodular or diffuse, Reed-Sternberg (R-St) or Hodgkin cells. The lymphocytic depletion is often accompanied by diffuse fibrosis, atypical histiocytes, fibroblasts and R-St cells. Hodgkin typical granulomas are rare. The positive biopsies were associated with nonspecific reactions including hyperplasia of granulopoiesis, megakaryocytes, territories with hyperplasia or aplasia, fibrosis, disruption of sinus walls, oedema, plasmocytosis, necrosis, myelomonoblastic cells, lymphocyte nodes, etc. The bone marrow histology has a prognostic significance.

Bone marrow biopsy (BMB). II. Bone marrow biopsy in myeloproliferative disorders.

The myeloproliferative disorders (MPD) are a domain in which the bone marrow biopsy (BMB) greatly proved its utility. We have studied the histology of the bone marrow (BM) in all the four entities of MPD: chronic myeloid leukemia (CML) with its subtype, chronic megakaryocytic granulocytic myelosis (CMGM), polycythemia vera (PV), hemorrhagic thrombocythemia (HT) and myeloid metaplasia with myelofibrosis (MMM). The work presents in short some of the clinical and hematologic characters of MPD with special stress upon the histologic modifications of BM, either specific or common to all MPD entities, underlying also the criteria for differential diagnosis.

Bone marrow biopsy (BMB). I. Generalities, material and method, normal structure of bone marrow, pathological conditions.

The authors presented in their first note generalities concerning the normal and pathological structure of bone marrow (BM), based on their personal experience (1,500 BMB) and on the literature. A short historical survey and the adopted research method are presented. The advantage of Burkhardt's myelotomy with its technical process by embedding in synthetic resins to avoid decalcification are discussed. The authors have used Jamshidi's cannula (or some other similar needle) with the subsequent embedding in paraffin after decalcification. Further papers will analyse the approach, by BMB, of the myeloproliferative disorders, myelodysplasia, lymphomas and Hodgkin's disease, cancer metastases and medullar aplasia.

[The simultaneous occurrence of chronic lymphatic leukemia with malignant tumors and the lymphatic reaction caused by malignant growths]. / Beitrag zum gemeinsamen Vorkommen von chronisch lymphatischer Leukämie mit malignen Tumoren und über die durch Malignome verursachte lymphozytäre Reaktion.

In 352 patients affected with chronic lymphatic leukemia (CLL) the authors simultaneously detected a solid second tumour 22 times (= 6.22%) (6 cancers of the prostrate, 5 cancers of the skin, 4 cancers of the uterus, 2 cancers of the stomach, 2 cancers of the lung, one case of rectal and mamma cancer each and one case of eye sarcoma). In one third of the cases the two malignomas were simultaneously detected, thus it was excluded that the second tumour was induced by the antimitotic treatment of the primary disease. In seven cases the solid tumour was identified after diagnosing CLL, without any cytostatic therapy having been made here before. In addition, a report is given on a patient showing symptoms of gastric cancer not radically removed and a lymphocytic reaction. Initially, the case was explained as gastric adenocancer with simultaneous CLL because even 5 years after surgical treatment there were 16-20 X 10(6)/l of leukocytes with 64% of lymphocytes in the peripheral blood and 85% of lympho-reticular cells in the bone marrow. Two years later, however, the blood picture was normal and remained to be unchanged further on. Thus, it seems that the healing of the gastric cancer has caused the lymphocytic reaction to have ceased. In addition, it should be noted that in 1974 the patient suffered from an epithelium after a scratch-mark on the nose tip, which was irradiated, however, without eliciting any lymphocytic reaction. The patient is still alive (June 1985).

Incidence and significance of micronuclei in pernicious anemia.

The incidence of micronuclei in bone marrow erythroblasts of patients with pernicious anemia ranged between 0.5-5.6% as compared with the value of 0-0.5% noted in hematologically healthy patients. The mechanism of formation and the possible significance of micronuclei in megaloblastic anemia are briefly discussed.

Different cell clones in bone marrow and spleen of a patient with chronic myelocytic leukemia (CML) in blastic phase.

The chromosome study of a patient with chronic myelocytic leukemia in blastic phase revealed a 46,XY,Ph1/47,XY,Ph1,+8 cytogenetic constitution in bone marrow cells and a 46,XY,Ph1/48,XY,2Ph1,+19 cytogenetic constitution in spleen cells. As the cell clones exhibiting chromosome abnormalities in addition to the Ph1 chromosome evolved apparently independently, it is suggested that the acute transformation had a bifocal, myeloid and splenic origin.

Missing X chromosome and ring chromosome 21 in a case of acute myelomonocytic leukemia.

The karyotypic picture of a female patient with acute myelomonocytic leukemia (A.M.M.L.) consisted in the loss of a sex chromosome and a ring chromosome 21. It is suggested that in A.M.M.L. the loss of sex chromosome may represent an early event, the monosomic cells being the object of further chromosome rearrangements, which involve more frequently a chromosome 21.

Angio-immunoblastic lymphadenitis: remarks about two cases.

Two patients with clinical and pathological symptoms of so-called angioimmunoblastic lymphadenitis are presented. Both patients were over 50, with multiple lymphadenopathies, fever, pruritus and hyperglobulinemia. The lymph node changes exhibited a characteristic histological triad consisting of diffuse lymphoid proliferation, small arborizing vessels proliferation and paraamyloid-like amorphous material deposition. As previous authors suggested, the disease seems to be the expression of a prolonged hyperimmune response induced by the hypersensitivity to certain factors.