[Severe mixed thrombopenia during interferon treatment for chronic viral hepatitis C]. / Thrombopénie mixte sévère au cours d'un traitement par interféron chez une femme atteinte d'une hépatite chronique virale C.

BACKGROUND: Thrombocytopenia occurred in a woman given alpha interferon for chronic hepatitis C without cirrhosis. Both central thrombocytopenia, clearly demonstrated, and peripheral thrombocytopenia, probably of autoimunne origin, were involved. CASE REPORT: A 55-year-old woman with active chronic hepatitis C (Metavir score A2, F2) was given alpha interferon. One month after treatment onset, she developed thrombocytopenia (32 G/L). A second bone marrow aspirate and osteomedullary biopsy evidenced megalokaryocytes and the platelet count responded to polyvalent immunoglobulins. Five months after discontinuing interferon, the platelet count progressively returned to normal. DISCUSSION: Central thrombocytopenia is classically described in patients given interferon and usually appears during the first weeks of treatment. In our case, the central mechanism was clearly demonstrated by the bone marrow aspirate and osteomedullary biopsy findings at a time when the platelet count was 32 G/L. A peripheral immunological participation was more difficult to prove but was strongly suggested by the persistence of thrombocytopenia despite the interruption of the interferon and the efficacy of immunoglobulins.

Two additional cases of isochromosome 21q or translocation 21q21q in hematological malignancies.

We report on 2 patients with isochromosome 21q [i(21q)] or translocation 21q21q [t(21q21q)] in myeloid disorders. Of 18 available cases of i(21q) or t(21q21q), 15 were found in myeloid malignancies, often secondary to a previous carcinogen exposure. Complex karyotypes were found in most cases. Four cases presented with i(21q) or t(21q21q) as the sole anomaly, and this might represent a specific entity.

Cytogenetic Findings and Survival in B-cell Chronic Lymphocytic Leukemia. Second IWCCLL Compilation of Data on 662 Patients.

Chromosome analysis on CLL-cells from 649 patients revealed clonal changes in 311 cases (48%). The most common abnormalities were trisomy 12 (n = 112), and structural changes on the long arm of chromosome 13 (n = 62), most of them interstitial deletions or translocations involving 13q14, the site of the retinoblastoma gene. Complex karyotypes were associated with poor prognosis, although karyotypic changes rarely develop during the course of the disease. Among patients with single chromosomal abnormalities those with trisomy 12 had a poor survival, whereas those with structural changes on chromosome 13 had as good a prognosis as patients with a normal karyotype.

INV(12) (p13q11) and dicentric chromosomes in a secondary leukaemia with basophilia.

We report on a case of secondary myelodysplasia with basophilia. A karyotype showed 1) the involvement of 12p, which should be related to the basophilia and/or to previous drug exposure, and 2) the unexpected presence of three different dicentric chromosomes.

Translocation (8;9)(q12;p21). A new non-random rearrangement in lymphoid malignancies.

We report two cases of t(8;9) with probable breakpoints in 8q12 and 9p21 in malignant lymphoma. In a review of the literature, we found two cases of acute lymphocytic leukemia and one case of malignant lymphoma which probably share the same breakpoints.

Chromosome 6p rearrangements appear to be secondary changes in various haematological malignancies.

We report on six cases of 6p rearrangement in various haematological malignancies. On reviewing the literature, we assume 6p rearrangements to be secondary anomalies in both myeloid and lymphoid malignancies, and confirm it to be strongly associated with -5/del (5q) in myelodysplastic syndromes.

Squamous cell carcinoma of the bladder.

Clinical and morphological features of 90 cases of squamous cell carcinoma of the bladder have been reviewed. The lesions were solitary in 90 per cent of the patients, developed without a history of vesical malignant disease in 82 per cent and were invasive at the time of diagnosis in all cases. Ureteral obstruction was demonstrated in 42 per cent of the group. The over-all survival rate at 5 years was only 10.6 per cent. There were 17 patients who received no therapy, all of whom were dead before 2 years. Unassisted supervoltage radiation therapy for patients with stages B2 and C lesions yielded a 5-year survival rate only 17.7 per cent. However, preoperative radiotherapy followed by simple total cystectomy and urinary diversion in a small number of patients with stages B2 and C lesions resulted in a 5-year survival rate in excess of 34 per cent. We are encouraged by this finding and believe that combination therapy warrants further clinical trial.

Rotational skin flaps to cover wound defect in groin.

A technique of a lower relaxing incision and use of a rotational skin flap from the anterolateral thigh to close an extensive defect in the inguinal area is described. Its use is especially applicable for palliation in patients with large fungating metastases in the inguinal region.