Intestinal Amyloidosis in Common Variable Immunodeficiency and Rheumatoid Arthritis.

We present a case of reactive amyloidosis that developed secondary to common variable immunodeficiency and rheumatoid arthritis. A 66-year-old woman, with prior history of common variable immunodeficiency and rheumatoid arthritis, was referred to our clinic for chronic diarrhea investigation. The patient was submitted to colonoscopy with ileoscopy, which did not show relevant endoscopic alterations. However, undertaken biopsies revealed amyloid deposition. Since amyloidosis with GI involvement is a rare cause of chronic diarrhea, this pathology should be considered in etiologic investigation, especially when associated with chronic inflammatory diseases.

Correlation between molecular and histopathological diagnoses of B cell lymphomas in bone marrow biopsy and aspirates.

AIMS: PCR has been shown previously to be the most sensitive technique to detect a clonal population in marrow aspirates (MAs), and the clinical standard for evaluation of bone marrow lymphoma involvement today is bone marrow trephine biopsy (BMTB). The goal of this study was to compare morphological evaluation of B cell neoplasm in BMTB (histology and immunohistochemistry) and PCR analysis in MA, with both specimens obtained at the same time, in patients with a known molecular marker of the disease. METHODS: This was a retrospective evaluation of 98 consecutive BMTB specimens from 60 patients with a known B-cell neoplasm and a previous PCR marker of the disease (BCL2 and/or IGH). RESULTS: Considering the IGH PCR cases alone, a B cell clone was detected in 85% and 39% of the morphology (M) positive and negative groups, respectively. Five M(+), IGH(-) cases were found, including two cases of follicular lymphoma (FL), one case of diffuse large B cell lymphoma, and two cases of mantle cell lymphoma. The FLs had about 20% and 50% of BMTB involvement each. All other cases had minimal lymphoma localisation. The two FLs were also BCL2-MBR(+). Use of BCL2-MBR detected all M(+) cases and 66% of M(-) cases whenever it was an initial marker of disease. CONCLUSIONS: IGH PCR alone is not good enough for BMTB assessment, especially in FL. On the other hand, the PCR study for BCL2 is more sensitive than morphology, without any false negative results in this series, suggesting that BCL2-MBR PCR on MA can be used as an alternative and more sensitive examination for disease evaluation, providing that there is careful analysis of data, adequate knowledge of PCR pitfalls and absence of other haematological disorders.

Laparoscopic excision of a retroperitoneal cystic lymphangioma in an elderly patient.

A 68-year-old male patient was referred to our hospital due to protrusion and pain in the right iliac fossa. On physical examination a palpable oval tumor was found. Ultrasonography and computed tomography revealed a cystic mass in right iliac fossa. The tumor was successfully excised laparoscopically and histologically diagnosed as cystic lymphangioma. Retroperitoneal cystic lymphangiomas are rare lesions, most often seen in pediatric patients. Surgical excision is the treatment of choice because of its potential to grow and develop complications, especially due to mass effect. The laparoscopic approach is a safe and effective alternative for treatment of retroperitoneal cystic lymphangioma in the elderly.