Frequency of t(14;18) in follicular lymphoma patients: geographical or technical variation.

The t(14;18) translocation is the most distinguishing molecular finding in follicular lymphoma (FL). However, the reported frequencies of t(14;18) in FL show significant variation, which is often attributed to geographical and/or methodological factors. The methods used to detect t(14;18) include Southern blotting, conventional cytogenetics, fluorescent in situ hybridization, and polymerized chain reaction (PCR). Because of its practicality and superior sensitivity, PCR is becoming the more commonly used method in clinical laboratories. The identification of the main breakpoint regions on chromosome 18, including the major breakpoint region (MBR), the minor cluster region (mcr), and the newly defined intermediate cluster region (icr), increased the detection frequency of PCR. In our study, using a highly sensitive nested PCR strategy with primers for MBR, mcr and icr regions, we were able to detect t(14;18) in 95% of FL patients, which is one of the highest reported frequencies using PCR. We screened 58 FL patient samples collected retrospectively from different hospitals in Jordan. DNA was extracted from archival paraffin-embedded samples, some of which were >10 years old. The respective breakpoint distributions were, 47 for MBR (81%), two for mcr (3.5%) and six for icr (10.3%). In this report, we analyze this high frequency of t(14;18) detection in a general review of the recent literature, in an attempt to assess the geographical vs. methodological influences on the reported frequencies.

Primary gastrointestinal lymphomas in Jordan are similar to those in Western countries.

It has been a common practice to divide gastrointestinal (GI) lymphomas into Western and Middle Eastern types; the former predominantly involves the stomach, whereas the latter are mostly intestinal. Recent studies suggested that these lymphomas are biologically different from their nodal counterpart and hence should be classified separately. In this retrospective study, we examined all of the primary GI lymphomas seen at Jordan University Hospital, Amman, Jordan, between 1983 and 1992 in an attempt to reclassify and immunophenotype these cases. We studied 53 cases of primary GI lymphomas for which available material was found. Lymphomas were morphologically reclassified according to current classification schemes. Immunoperoxidase stains were performed using the streptavidin biotin method using antibodies against leukocyte common antigen, B, and T-cells. The stomach was the most common site of involvement, accounting for 62% of the cases. The male-to-female ratio was 2.8:1. The three most common histologic types were, in order, diffuse large cell lymphoma, Burkitt's lymphoma, and lymphoma of mucosa-associated lymphoid tissue. Immunoproliferative small intestinal disease was seen in only one patient. The B-cell phenotype predominated in our cases; it was seen in 85% of the gastric and 100% of the intestinal cases. Unlike other series from the region, the stomach was the most commonly involved site by GI lymphoma. Immunoproliferative small intestinal disease seems to be a rare entity in Jordan, and the majority of intestinal and gastric lymphomas were diffuse large cell lymphomas. Histopathologic evidence of mucosa-associated lymphoid tissue origin was seen in at least 18% of the gastric cases. B-cell lymphomas were by far the most common type seen, and T-cell lymphomas were rare.

Diagnostic value of cervical lymph node biopsy: a pathological study of 596 cases.

During a 10-year period (1976-1985), a total of 596 cervical lymph node biopsies for diagnostic purposes were performed at our institution. Thirty-five percent of these nodes were involved with malignant lymphoma, and 20.5% showed metastatic deposits. Nondiagnostic reactive hyperplastic changes were noted in 23% of the cases. Several other inflammatory and neoplastic conditions were encountered. Comparison of our data with several series from different countries with review of relevant literature are presented.

The epidemiology and clinical outcome of hepatitis D virus (delta) infection in Jordan.

The epidemiology and clinical outcome of hepatitis D viral infection in HBsAg-positive acute hepatitis, chronic liver disease, primary hepatocellular carcinoma and the symptomless carrier state was studied in Jordan. The prevalence of hepatitis D viral infection was significantly higher in patients with chronic liver disease (18/79, 23%) and acute hepatitis (17/108, 16%) than in symptomless HBsAg carriers (2/136, 2%). The highest prevalence of hepatitis D viral infection was found in patients with primary hepatocellular carcinoma (10/15, 67%) who were also significantly older than such patients without hepatitis D viral infection. Antihepatitis D virus IgM was detected persistently in 83% of patients with antihepatitis D virus-positive chronic liver disease and transiently in 41% of patients with acute hepatitis. A trend to increased mortality was observed in acute hepatitis D viral superinfection (25%) compared to hepatitis D viral coinfection (0%) and to antihepatitis D virus-negative HBsAg-positive acute hepatitis (4%). In patients with established chronic liver disease, however, neither survival nor histological parameters of disease activity were significantly different in the antihepatitis D virus-positive and antihepatitis D virus-negative groups. While the early stage of hepatitis D viral superinfection is associated with increased mortality, it appears that in patients with late-stage chronic liver disease, severe histological activity subsides, and survival is no longer influenced by the factor of hepatitis D viral infection. However, primary hepatocellular carcinoma appears to complicate the course of those antihepatitis D virus-positive patients surviving beyond this stage.

Malignant neoplasms in Jordanian children.

Three hundred and seventy-three cases of malignant disease in children were diagnosed in Jordan during the 5-year period 1975-79. Lymphomas (28.7%) were the most frequently encountered tumours, followed by leukaemias (19.6%) and brain tumours (16.1%). One third of the children with lymphoma had Hodgkin's disease. Burkitt's lymphoma accounted for another one third, and lymphocytic lymphoma the remaining third. Abdominal involvement was frequently encountered in children with non-Hodgkin's lymphoma. Our data are similar to those reported from the neighbouring Arab countries, Iraq, Saudi Arabia, Kuwait and Egypt, and contrast with the data available from developed countries in which leukaemias and brain tumours are more frequent than lymphomas.

Burkitt's lymphoma in Jordanian children: epidemiological and clinical study.

Twenty-four children with a diagnosis of Burkitt's lymphoma were seen at Jordan University Hospital during a 6 year period (1978-1983). Their median age was 4 years and the male to female ratio was 3:1. A space clustering of cases was evident. Abdominal mass was the commonest presentation being observed in 21 patients, while only two patients presented with jaw masses. Sixteen patients had advanced disease (stages C and D). Chemotherapy was the basic form of therapy given. Twelve children (50%) survived. Advanced stage and poor nutritional status at diagnosis correlated with poor outcome. Our data indicate that Burkitt's lymphoma in Jordanian children presents an intermediate type that shares some similarities with both the endemic (African) and non-endemic types.

Idiopathic subcutaneous and laryngeal fibrosis.

A 40-year-old totally deaf male presented with submucosal masses in the subglottic space and multiple subcutaneous nodules in the eyelids, scrotum and thighs. Biopsies of these masses revealed dense fibrosis associated with non-specific chronic inflammation. Although the findings were clinically similar to those of neurofibromatosis, amyloidosis, multifocal fibrosclerosis with cutaneous nodules, and familial multicentric fibromatosis, they did not fit completely with any of the above-mentioned conditions. It is possible that this case represents a peculiar entity of its own.

Two new glucose-6 phosphate dehydrogenase (G6PD) variants associated with hemolytic anemia: G6PD Amman-1 and G6PD Amman-2.

Two glucose-6-phosphate dehydrogenase (G6PD) variants were investigated. G6PD Amman-1 was partially purified from the red cells of a patient suffering from recurrent jaundice and spontaneous episodic attacks of severe hemolysis in the absence of oxidant drugs, infection, or fava beans. The enzymatic characteristics of G6PD Amman-1 were markedly reduced activity, fast eletrophoretic mobility, slightly increased km for NADP, normal km for G-6-P, normal heat stability, normal utilization of substrate analogues 2-deoxy G-6-P and deamino-NADP, and a monophasic pH curve with a peak at 8.5 to 9.3. The second variant, G6PD Amman-2, was partially purified from the red cells of a patient suffering from recurrent jaundice with episodic mild hemolysis caused by infection or unknown factors. G6PD Amman-2 characteristics were severely reduced activity, slow electrophoretic mobility, normal km for NADP, decreased km for G-6-P, decreased heat stability, increased utilization of substrate analogues, and a monophasic pH curve with a narrow peak at pH 9.5. The red cell level of reduced glutathione was markedly decreased with twofold increase in the activity of glutathione reductase in the patient with G6PD Amman-2.

HLA antigens, blood groups and immunoglobulin levels in idiopathic thrombocytopenic purpura.

Thirty-three patients with idiopathic thrombocytopenic purpura (ITP) were tested for HLA-A, B and C antigens, platelet antibodies, immunoglobulin levels and ABO blood groups. With one exception, ITP proved not to be significantly associated with the HLA antigens studied; an increased frequency of HLA-A28 was found in chronic ITP patients (50 vs. 18.7% in the control population). An increased incidence of blood group A was found in ITP patients (64 vs. 37.98% in the control population), especially in those with acute ITP (84.7%). A significant reduction of IgG levels was noted in patients with chronic ITP, while below-normal levels of IgA were found in both chronic and acute ITP patients. There was no difference in levels of IgM. Circulating platelet isoantibodies were demonstrated in 67.6% of the ITP patients. No correlation was demonstrated between the presence of platelet antibodies, immunoglobulin levels of HLA antigens.

Non-Hodgkin's lymphomas in Jordanians: a histopathological study of 231 cases.

Our hospital admitted 231 patients with non-Hodgkin's lymphomas between June 1976 and November 1984. Review of these cases revealed the following profile: ages ranged from 1 to 70 years (median: 30 years), 156 males, predominantly children and adolescents, and 75 females. Diffuse histiocytic lymphoma accounted for 40.6 per cent of all cases. Seventeen patients (7 per cent) had nodular lymphomas. Fifteen patients, predominantly male children and adolescents, had lymphoblastic lymphomas and showed high association with mediastinal mass (47 per cent). Extranodal lymphomas mostly of the diffuse histiocytic subtype were diagnosed in 100 cases (43.3 per cent) and most frequently situated in the small intestine (59 cases). Burkitt's lymphoma--32 patients (14 per cent)--presented most often in male patients during the first decade of life and as an abdominal intestinal disease (19 cases). There were four cases of Mediterranean abdominal lymphoma (IPSID). Non-Hodgkin's lymphomas in Jordanians are mostly of the diffuse histiocytic type, are rarely nodular, have a high frequency of extranodal involvement and tend to occur in younger age groups. Mediterranean abdominal lymphoma is less frequent than previously thought. The use of both of the Rappaport and Lukes-Collins classifications demonstrated a high degree of reproducibility.

Patterns of hepatomegaly in Jordanians: a prospective study of 800 cases.

Eight hundred Jordanians with liver enlargement were studied: 369 (46%) were males and 431 (54%) females. Ages ranged between 13 and 85 years, with a mean of 47.4%: 766 cases demonstrated a single pathological process while 34 cases showed two or more processes. The most significant findings were: congestion secondary to cardiac failure in 323 cases (38.5%); inflammatory and parasitic processes in 192 cases (22.9%), including acute hepatitis (81 cases), hydatid cyst (63 cases), chronic hepatitis (27 cases), liver abscess (19 cases), brucellosis (one case) and malaria (one case); malignancy in 164 cases (19.6%); liver cirrhosis in 80 cases (9.5%); fatty metamorphosis in 47 cases (5.6%); metabolic and genetic disease in 11 cases (1.3%); miscellaneous conditions in nine cases (1.1%); and 15 apparently normal individuals (1.8%). Cardiac failure was the most frequent cause of hepatomegaly in this sample of Jordanians. Inflammatory processes were the second major cause, followed by malignancy and cirrhosis of the liver.

Hodgkin's disease in Jordanian children: a study of 26 cases.

A retrospective review of Hodgkin's disease in 26 children of 14 years of age and below admitted to Jordan University Hospital during the period from 1976 through 1981 was conducted. This review showed a preponderance of males, particularly in the first decade of life, with prominence of the prognostically unfavourable histologic sub-types and advanced clinical stages.

Patterns of leukemias in Jordanians: a study of 378 cases.

378 patients of leukemias were admitted to Jordan University Hospital during the period from January 1976 through December 1983. Acute leukemias, acute lymphocytic leukemia in particular, were most frequent, and chronic lymphocytic leukemia was the least frequent type seen among Jordanians. In general the leukemias tend to occur in younger age groups among Jordanians.

Acute leukemia in pregnancy: report of five cases treated with a combination which included a low dose of adriamycin.

Five cases of acute leukemia which developed in the course of pregnancy are reported. All five cases received combination therapy which included adriamycin. Two cases were treated during the first half of pregnancy. One of them aborted 2 weeks after commencing therapy but had severe homeostatic failure. The second had a successful pregnancy and delivered a normal infant. Three cases were treated during the second half of pregnancy. All had normal pregnancies and delivered normal infants. The babies have been followed up for periods ranging from 1 month to 3 yr and have shown normal growth and development.

Therapeutic effect of vincristine, adriamycin and prednisolone (VAP) in angioimmunoblastic lymphadenopathy (AIL).

Five patients, three males and two females, with angioimmunoblastic lymphadenopathy (AIL) are described. The two who received steroids had no response and died 2 and 6 months later. The three patients who received vincristine, adriamycin and prednisolone (VAP) went into remission early and are still in remission with a follow-up of 22-35 months. It is concluded that VAP is effective therapy in AIL.