Successful treatment of disseminated Fusarium infection after autologous bone marrow transplantation for acute myeloid leukemia.

Disseminated Fusarium is a rare but life-threatening infection of severely immunocompromised patients. A fatal outcome has been described in all reported cases of Fusarium infection occurring after bone marrow transplantation. We describe a patient who developed disseminated Fusarium infection with a secondary fungal endophthalmitis after an autologous bone marrow transplant for acute myeloid leukemia. This infection was successfully eradicated after neutrophil recovery by prolonged systemic administration of amphotericin B as well as aggressive local therapy including enucleation of the affected eye. The patient remains free of both leukemia and fungal disease more than 4 years after transplant.

Immunofluorescent characteristics of the diabetic cornea.

In view of the increasing awareness of corneal abnormalities in diabetes, five diabetic and five nondiabetic post-mortem corneas were investigated. Indirect fluorescent antibody techniques were used for the detection of immunoglobulin, complement components, fibrinogen, and fibronectin, as some of these had already been found in the kidney, pancreas, and skin of diabetic patients. There was no obvious difference in the deposition of IgG, IgA, IgM, fibrinogen, or fibronectin between diabetic and control corneal specimens. Five diabetic specimens versus three control specimens demonstrated positive staining at 1:50 dilution for complement components Clq, C3, and C4. This staining was primarily present in the epithelium. Of greater interest was the finding that complement components were present in the basement membrane of two diabetic patients, but were not found in nondiabetic patients. In conclusion, diabetic corneas demonstrate unusual staining for complement components in the epithelial basement membrane.

Electron microscopy and HLA expression of a new cell line of retinoblastoma.

A new continuous retinoblastoma cell line (Rb 355-7) derived from a nonfamilial unilaterally-affected child was studied morphologically and with regard to HLA expression. The tumor was compared with two older and widely studied cell lines, the Y-79 and WERI-Rb1 strains. The Rb 355-7 line grew in tissue culture in clusters and chains. Its doubling time was calculated to be 4.4 days. In contrast to the Y-79 and WERI-Rb1 cell lines, the Rb 355-7 showed a paucity of HLA expression.

Glial cell component in retinoblastoma.

The right eye of a 4-month-old girl with a large, unilateral, sporadic retinoblastoma was enucleated. The tumor was unusual because it contained Flexner-Wintersteiner rosettes with extremely large lumina. Smaller rosettes and undifferentiated tumor cells were observed within the lumina. Also of importance were cells resembling glial cells which were intermixed with more typical cuboidal retinoblastoma cells. These cells had electron microscopic features typical of glial cells and stained positively for glial fibrillary acidic protein in immunohistochemical studies. Rosettes and glial cells continued to be observed in the tumor carried in tissue culture through two passages over a 7-month period. This tumor is presented because of its unusual rosette structures and because it confirms recent reports describing a glial cell component in retinoblastoma.

Morphologic effect of hyperosmolarity on rabbit corneal epithelium.

The morphologic effect of hyperosmolarity, equivalent to that seen in the tear film of patients with keratoconjunctivitis sicca (KCS), on rabbit corneal epithelium in vitro and in vivo was studied. In the in vitro studies, corneal epithelium was grown in explant cultures. Control tissue was cultured in a 307 mOsm/L medium. Epithelium cultured in the 333, 361 and 363 mOsm/L media showed decreased intercellular connections, blunting and loss of microplicae, disruptions in cell membranes and cellular swelling with decreased cytoplasmic density. In in vivo studies, corneas bathed in balanced salt solutions (BSS) concentrated to 330, 360, or 407 mOsm/L showed increased cell desquamation, and the cell changes observed at similar osmolarities in the in vitro studies. The tear film osmolarities observed in KCS are sufficient to cause the corneal epithelial changes seen in patients with this disease.

Retinoblastoma. HLA expression induced by retinoic acid.

The full expression of Class 1 antigens of the major histocompatibility complex (HLA A,B,C,) on ocular cell surfaces appears to be developmentally regulated; HLA is undetectable in retina from 16-week-old fetal eyes but is present in adult retina. Cultured retinoblastoma (RB) may serve as a useful model of retinal cell development. SF81 is an undifferentiated subculture of in vitro retinoblastoma with little evidence of spontaneous differentiation and lack of expression of HLA, attesting to the "undifferentiated" character of this cell line. RB SF81 cells were treated with retinoic acid, a known stimulator of differentiation (optimal concentration 5 X 10(-8) M). HLA expression was evaluated with immunofluorescence, immunoperoxidase, and radioimmunoassay, using monoclonal antibodies. RB SF81 treated with retinoic acid showed a significant, persistent increase in HLA levels by 24 hours compared with controls. Thus, retinoic acid has been documented to induce the surface expression of HLA in undifferentiated retinoblastoma. Developmental parallels between embryonic retina and in vitro retinoblastoma treated with retinoic acid exist.

Vascular basophilia in ocular and orbital tumors.

The occurrence of vascular basophilia in ocular tumors has been a selective histologic feature of retinoblastomas. We recently observed a metastatic oat-cell carcinoma to the choroid which also demonstrated such a vascular hematoxyphilia. Histologic review of a variety of ocular and orbital metastatic carcinomas failed to yield a similar basophilic pattern. Examination of 100 consecutive retinoblastomas for vascular basophilia revealed an incidence of 6.0%. Similar material was not seen in any of 125 melanomas, including 10 with areas of necrosis. Histochemical studies showed the basophilic material to be DNA, and electron microscopy revealed the nuclear debris of pyknotic tumor cells to be continuous with identical material surrounding the adjacent blood vessels. The pathogenesis of vascular deposition of DNA in these two ocular tumors remains unclear. This finding most likely represents a form of tumor activity requiring comparatively healthy blood vessels to adequately precipitate liberated nucleic acids being filtered from the necrotic and degenerating tumor tissue.

Nevus of Ota with contralateral cerebral melanoma.

A case of unilateral nevus of Ota was associated with ipsilateral ocular melanocytosis and contralateral malignant melanoma of the CNS. The malignant neoplasm may have arisen from an area of bilateral leptomeningeal melanosis associated with unilateral nevus of Ota.

Retinal neoplasia and dysplasia. II. Retinoblastoma occurring with persistence and hyperplasia of the primary vitreous.

The occurrence of retinoblastoma in an eye with persistent hyperplastic primary vitreous (PHPV) is reported. These are both rare lesions. The absence of previous reports of their association has led to the clinical impression that the occurrence of PHPV in a microphthalmic eye precludes the presence of retinoblastoma. The coexistence of these lesions in the present case may represent a coincidence. Their occurrence in the same eye is felt to be noteworthy, nontheless, because of its clinical implications and the possibility of a common underlying etiology.

Retinal neoplasia and dysplasia. I. Induction by feline leukemia virus.

Feline leukemia virus, a naturally occurring C-type virus (oncorna virus), was injected systemically and intraocularly into fetal and newborn kittens. A light microscopy study of the resultant ocular tumor changes was carried out. One animal developed an intraocular tumor of apparent retinal origin. Eight animals showed intraocular neoplastic cell infiltration. The most common ocular change observed was retinal dysplasia. Sequential histologic examination of enucleated eyes showed diffuse intraocular inflammation after viral inoculation. In the developing retinas progressive disorganization and necrosis were documented, with subsequent reorganization into cell clumps and dysplastic rosette structures. The retinal pigment epithelium showed proliferation and intraretinal migration. The mature retina exhibited full-thickness folds and tubes associated with infoldings of the retinal pigment epithelium.