Unusual biclonal plasma cell dyscrasia with crystallike inclusions producing colonic tumors (plasma cell polyposis) and terminating in T-cell lymphoma.

A 62-year-old man underwent a partial colectomy for persistent rectal bleeding. Multiple submucosal lesions up to 7 cm in diameter were identified and were composed of plasmacytoid and histiocytoid cells with crystallike inclusions. Ultrastructurally, inclusions were bounded by rough endoplasmic reticulum. Immunohistochemical studies demonstrated a monoclonal population of IgA kappa-positive plasma cells. Immunofixation using a saline extract of the tumor revealed two distinct bands: one for IgG kappa and another for IgA kappa. Southern blotting revealed a germline configuration for the immunoglobulin heavy-chain gene and the T-cell antigen receptor beta-chain gene. A bone marrow aspirate contained 12% plasma cells, some of which had cytoplasmic inclusions. Eight months after surgery, the patient developed a large mediastinal mass. Histologic and immunohistochemical studies indicated that this mass was an undifferentiated neoplasm. However, gene rearrangement studies indicated a T-cell lymphoma. This patient illustrates a rare association between a plasma cell neoplasm and a T-cell lymphoma.

Small lymphocytic pulmonary lymphoma. Diagnosis by transthoracic fine needle aspiration.

A 77-year-old woman was found to have multiple densities on chest roentgenogram. Exfoliative cytology, bronchoscopy with brushings and washings, and transbronchial biopsy revealed a monomorphic population of small lymphocytes suggestive of lymphoma. Transthoracic fine-needle aspiration was performed to provide additional material for immunologic marker study. Immunocytochemistry revealed a monoclonal population of B-cells, which confirmed a diagnosis of small lymphocytic lymphoma. Chemotherapy resulted in significant clinical and roentgenographic improvement.

Computed tomography of benign mesenchymoma of the neck.

Mesenchymoma is a tumor composed of two or more mesenchymal components along with fibrous tissue. We describe the CT findings in a case of benign mesenchymoma that presented as an unusual neck mass in an elderly woman.

Hemispherical spondylosclerosis: MR appearance.

We present a case of hemispherical spondylosclerosis (HSS) in a middle-aged woman with low back pain. The plain radiographic findings, CT and MR appearance, and pathological examination are described, and the difficulties encountered in differentiating HSS from malignancy and infection are discussed.

Cardiorespiratory and cellular changes with interleukin 2 infusion in sheep.

Recombinant interleukin 2 (rIL-2) administration, a new form of therapy for patients with far-advanced cancer, is associated with a "third space" syndrome, i.e., pulmonary edema, respiratory distress, and hypoxemia, which limits the dose and duration of treatment. To extend our knowledge regarding this toxicity, we established a sheep chronic lung lymph fistula model and measured hemodynamics, arterial blood gases, caudal mediastinal (lung) lymph flow (QL), and blood and lung lymph cellular changes before, during, and after (recovery) a 3-day continuous rIL-2 infusion (9 x 10(5) U/kg). Moderate systemic hypotension, mild pulmonary hypertension, and an increase in alveolar-arterial PO2 gradient was present on day 3 of rIL-2 infusion. QL increased from a base line of 1.9 +/- 0.2 to a maximum of 4.3 +/- 1.1 ml/15 min on day 3 of rIL-2 infusion. At no time was there a change in lymph-to-plasma protein ratio. The leukocyte count increased significantly to 16.1 +/- 4.5 x 10(3) cells/mm3 at recovery day 1. The percentage of blood lymphocytes decreased significantly by day 1 of rIL-2 infusion, returned to base-line levels on day 3, and significantly increased on day 2 of recovery. Lung lymph lymphocytes decreased significantly on days 1 and 2 of rIL-2 infusion. There was a shift in their size; i.e., their area increased from 32 +/- 7 to 57 +/- 19 micron 2 (P less than 0.05) by day 2 of rIL-2 infusion. By day 1 of recovery, lung lymph lymphocyte counts increased significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of the cardiopulmonary effects of continuous versus bolus infusion of recombinant interleukin-2 in sheep.

The systemic administration of recombinant interleukin-2 (rIL-2) is used for the treatment of patients with far advanced cancer. However, treatment may be limited by a so-called "third space" syndrome. Whether these side effects are due to the total dose used or the method of administration is unclear. To define whether the continuous (Group 2) or bolus (Group 3) i.v. infusion of 9 x 10(5) units/kg rIL-2 over 72 h is associated with similar toxicities, we established a chronic sheep model and monitored changes in systemic and pulmonary vascular pressures, cardiac function, and gas exchange. At 72 h lung lymph flow, lymph/plasma protein ratios, lung histology, and extravascular lung water/dry lung weight were obtained. In both groups the infusion of rIL-2 resulted in an increase in high protein lung lymph flow, an increase in cardiac output, and a decrease in systemic vascular resistance. Large lymphoid cells were found by histology to be infiltrating the lung interstitium. In Group 2, in addition, there were mild pulmonary hypertension [pulmonary artery pressures increased from 14 +/- 5 to 22 +/- 6 mmHg (P less than 0.05)], systemic hypotension [81 +/- 7 compared to a baseline of 95 +/- 9 mmHg (P less than 0.01)], and worsening gas exchange. We conclude that a 72-h continuous or bolus infusion of equivalent doses of rIL-2 are associated with cardiopulmonary toxicity; however, pulmonary hypertension, systemic hypotension, and gas exchange are worse in animals receiving the continuous infusion.

Cardiopulmonary effects of recombinant interleukin-2 infusion in sheep.

The systemic administration of recombinant interleukin-2 (rIL-2) with or without lymphokine-activated killer (LAK) cells, a new treatment for patients with advanced cancer, is associated with a presumed "third-space" syndrome. To further define the extent and time course of this toxicity, we established a chronic sheep model and monitored changes in systemic and central vascular pressures, cardiac function, and gas exchange during a 72-h continuous intravenous infusion of rIL-2 at a total dose of 5 (group 3) or 9 x 10(5) U/kg (group 4). At 72 h, caudal mediastinal lymph flow, histology, and extravascular lung water-to-dry lung weight ratio (EVLW/DLW) were obtained. During the rIL-2 infusion there was a dose-dependent significant decrease in systemic blood pressure and arterial Po2 and an increase in core temperature. In group 4, pulmonary arterial pressure increased from a base line of 13 +/- 5 to 21 +/- 6 mmHg (P less than 0.05). Lung lymph flow was significantly increased in groups 3 and 4 compared with animals receiving 0.9% NaCl or excipient infusions (groups 1 and 2). EVLW/DLW values were elevated in groups 3 and 4 (P less than 0.01). In animals receiving rIL-2, histological evaluation revealed a dose-dependent infiltration of lung tissue by lymphoblastoid cells that stained esterase negative. We conclude that rIL-2 infusion in doses comparable to those given to humans results in alterations in systemic and central hemodynamics, gas exchange, high-protein lung lymph flow, and infiltration of lymphoblastoid cells into the lung parenchyma.

Effects of protamine, heparinase, and hyaluronidase on endothelial permeability and surface charge.

We undertook studies in the isolated perfused rat lung to determine 1) the effects of endothelial charge neutralization with the polycation protamine sulfate on microvascular permeability, lung water, and anionic ferritin binding to the endothelium and 2) the role of heparan sulfate and hyaluronate, negatively charged cell surface glycosaminoglycans, on permeability. Capillary permeability was determined by tissue 125I-albumin accumulation in isolated perfused rat lungs. In control lungs the 5-min albumin uptake was 0.50 +/- 0.05 cm3.s-1.g dry tissue-1 X 10(-3). It was increased by 132 +/- 7.8% (P less than 0.001) by protamine (0.08 mg/ml) and 65 +/- 12% (P less than 0.01) by heparinase (5 U/ml), whereas hyaluronidase (25 NFU/ml) was without effect. In control lungs total water was 4.83 +/- 0.15 ml g/dry tissue. Protamine increased lung water 12 +/- 2% (P less than 0.05). Heparinase caused a 9 +/- 3% increase (P less than 0.05), and hyaluronidase had no effect. Electron microscopy demonstrated that protamine increased anionic ferritin binding to the surface of endothelial cells. We conclude that protamine sulfate neutralization of negative charge in the pulmonary microcirculation leads to increased microvascular permeability. Heparin sulfate may be responsible for this charge effect.

Fatal pulmonary fibrosis from low-dose bleomycin therapy.

Six weeks after receiving a total dose of 20 units of bleomycin sulfate as part of BACOP therapy for non-Hodgkin's lymphoma, our patient had dyspnea and cough with marked hypoxemia. Open lung biopsy established the diagnosis of "bleomycin lung," confirmed by postmortem examination. Fatal bleomycin pulmonary toxicity can develop with any dosage, and routine tests are incapable of detecting early, reversible toxicity.

Adrenal myelolipoma diagnosis by computed-tomography-guided fine-needle aspiration. A case report.

A case of adrenal myelolipoma, to the authors' knowledge, the first diagnosed by fine-needle aspiration, is reported. Adrenal myelolipoma is an unusual, benign lesion with a distinctive cytologic appearance. Computed tomography (CT)-guided fine-needle aspiration of the adrenal gland involves minimal morbidity and provides rapid, reliable differentiation of this entity from a malignant neoplasm.

Cerebral fat embolism following cardiac surgery.

We describe 3 cases of cerebral fat embolism associated with cardiac surgery. The autopsy findings suggested that in 2 cases, the embolic fat globules entered the systemic circulation directly as a result of protrusion of epicardial fat into the left atrial chamber along the suture line in one case, and through an atrial septal defect in the other. The characteristic latent interval between surgical trauma and onset of neurologic manifestations was lacking in both cases. The evolution of neurologic manifestations and the pathologic findings in the third case were similar to those usually seen in posttraumatic fat embolism. This study suggests that the pathogenetic mechanisms of cerebral fat embolism following cardiac surgery may vary in different cases. Also, it emphasizes the importance of autopsy in the investigation of this serious but preventable complication.