[Malignant lymphomas (non-Hodgkin's lymphomas and Hodgkin's disease) associated with infection by the human immunodeficiency virus. Study of 9 cases]. / Linfomas malignos (no hodgkinianos y enfermedad de Hodgkin) asociados a la infección por el virus de la immunodeficiencia humana. Estudio de nueve casos.

Six cases of non-Hodgkin's lymphoma and three of Hodgkin's disease in patients carrying antibodies against human immunodeficiency virus are reported. Mean age was 30.6 years (SD: 6). From the patients with non-Hodgkin's lymphoma, three were homosexual and three were parenteral drug users. The three patients with Hodgkin's disease were parenteral drug users. The primary features of the patients with non-Hodgkin's lymphoma were: degree of malignity intermediate (three patients) or high (three patients), initial extralymphatic involvement (five patients) and advanced stages (IIIA one patient, and IVB four patients). In turn, the patients with Hodgkin's disease presented the following histopathologic varieties: mixed cellularity (two cases) and lymphocytic depletion (one case); advanced stage (III two cases and IV one case) and B symptoms. We wish to emphasize the necessity of determining the existence of antibodies against human immunodeficiency virus in all patients with Hodgkin's disease or non-Hodgkin's lymphomas with high degree of malignity and extralymphatic involvement. In patients with antibodies against the human immunodeficiency virus who present a marked impairment of general condition and/or changes in the clinical features of their adenopathies, the development of a lymphoma must be ruled out.

Intestinal lymphoma in a patient with chronic lymphocytic leukemia of atypical phenotype: Richter's syndrome of unusual presentation.

A patient who developed an intestinal large-cell pleomorphic lymphoma during the course of untreated chronic lymphocytic leukemia (CLL) with an atypical phenotype (SIgG kappa) is reported. This is an unusual presentation of Richter's syndrome since RS with primary gastrointestinal involvement has only been described in two patients. In our case, immunological studies disclosed the same immunoglobulin (IgG kappa) in the large-cell pleomorphic lymphoma and on the surface of CLL cells, suggesting that both had arisen from the same clonal proliferation.

Non-Hodgkin's lymphoma of unfavourable histology: a multivariate analysis of factors predicting the response to CHOP.

Forty-eight patients with de novo non-Hodgkin's lymphoma (NHL) of unfavourable biology received CHOP as first-line chemotherapy. A complete remission (CR) was achieved in 64.5 per cent patients. Overall 4-year projected survival was 48 per cent with a median follow-up of 40.5 months. Two pretreatment characteristics, high LDH serum levels and bulky abdominal disease, were negatively associated with survival at the proportional hazards regression model and were used to calculate each patient's relative-risk. Such analysis allowed to identify two prognostic subgroups according to their outcome to CHOP. Firstly, a high-risk subgroup that showed an 8 per cent CR rate, most patients dying within the first year after diagnosis. Secondly, a low-risk subgroup that showed an 83.5 per cent CR rate and a 4-year project survival of 66 per cent. From the above results two major conclusions can be drawn: (1) the CHOP combination is an effective treatment for unfavourable NHL patients with a low relative-risk and (2) new therapeutic approaches should be explored for NHL patients with a high relative-risk at diagnosis.

Main autopsy findings in bone marrow transplant patients.

The autopsy findings in 24 cases (representing 17 males and seven females) that underwent bone marrow transplantation during the course of disease are reported. The mean age of the patients was 20.0 years, with individual ages ranging from 7 to 40 years. In 23 cases, serious infectious disease occurred. A patient frequently exhibited more than one type of infection. In total, there were seven mycotic, eight cytomegalovirus, and 15 bacterial infections. Twenty-three cases showed striking lung pathology, the most prevalent lesions being infectious diseases and those of diffuse alveolar damage, which was found in ten cases. Gastrointestinal tract pathology of differing types was observed in 13 cases. Necrotizing enterocolitis was observed in three of these cases. Three cases also displayed cholangiolar cholestasis, probably related to their terminal infectious disease. In only two cases could graft-vs-host disease be proved histologically.

Reticuloendoteliose com eosinofia: doença de Omenn / Reticuloendotheliosis with eosinophilia: Omenn's disease

É apresentado o primeiro caso espanhol publicado de reticuloendoteliose com eosinofilia (doença de Omenn). Este quadro é considerado, atualmente, como uma imunodeficiência mista, grave e mortal, que dá lugar a uma proliferaçäo histiocitária reativa generalizada. No plano clínico, caracteriza-se por apresentar-se em lactentes, em forma de infecçöes diversas, diarréias, eritrodermia, alopécia, deterioraçäo do estado geral, hepatoesplenomegalia, adenopatias generalizadas e eosinofilia persistente. Em alguns casos, tem-se observado um déficit de 5-nucleotidase linfocitária e um aumento de IgE. O diagnóstico diferencial deve ser feito, fundamentalmente, com as histiocitoses malígnas (histiocitose X e histiocitoses que cursam com autocitofagia) e com outras histiocitoses reativas secundárias a déficits imunitários congênitos

Characteristics and prognostic value of pleural effusions in non-Hodgkin's lymphomas.

The characteristics of 26 pleural effusions associated with non-Hodgkin's Lymphomas (NHL) have been analyzed (13% of the 200 NHL reviewed). Twenty-one of them were exudates and 5 chylous. Cytological examinations were positive in 18/21 of exudate effusions and so were 11 of the 15 pleural biopsies performed. Three of the chylous effusions were associated with chylous ascites, the pleural biopsy being positive in one case. In only 4 cases mediastinal adenopathies were found (3 exudates and one chylous). In half of the cases, the effusion disappeared as a response to chemotherapy. Intrapleural treatment with doxorubicin was performed in 6 patients with exudates, but the pleural effusion disappeared in only one case. The survival was shorter (estimated median survival, 6 months) in those patients in whom the pleural effusion did not disappear under systemic chemotherapy than in those in whom a response was achieved (estimated median survival greater than 40 months; p less than 0.01).

Sequential appearance of immunoblastic lymphoma and acute nonlymphocytic leukemia in a patient with angioimmunoblastic lymphadenopathy.

Immunoblastic lymphoma developed in a patient diagnosed as having angioimmunoblastic lymphadenopathy 5 years earlier. Chemotherapy schedules including alkylating agents were administered for 1 year, resulting in subsequent remission of the lymphoma. Thirty months after the start of chemotherapy, preleukemic changes were observed in peripheral blood and bone marrow, and acute nonlymphocytic leukaemia (M5 of the FAB classification) was diagnosed shortly afterwards. The possible role of both chemotherapy and the immunodeficiency associated to angioimmunoblastic lymphadenopathy in the pathogenesis of the leukemia is discussed.

[Incidence of cancer in a university hospital: analysis of 500 clinical autopsies]. / Incidencia del cáncer en un hospital universitario: análisis de 500 autopsias clínicas.

In a series of 500 autopsies cancer was found to be the first cause of death (24.6 por 100), followed by infectious diseases (23.8 per 100), and vascular diseases (22.2 per 100). The most frequent kind of malignant tumors found were lung neoplasms (17.8 per 100), followed by leukemias (17.0 per 100) and digestive tract tumors (11.3 per 100). Metastases were produced most frequently by tumors of the lungs (82.6 per 100), liver (81.8 per 100) and digestive tract (64.2 per 100). Metastases were found mainly in the lymph glands and liver.

Generalized Castleman's disease with urinary elimination of heavy chain fragments.

A generalized form of Castleman's disease of transitional type is reported in a 66-year-old male who was found in addition to have gamma heavy chain fragments in his urine. One portion of them was constituted by Fc fragments and the other ones by fragments which reacted with anti-Fab/IgG and anti-Fc/IgG antisera but not with anti-kappa and anti-lambda antisera. The findings of the present case support an immunological basis for Castleman's disease.