Racial and other characteristics of human T cell leukemia/lymphoma (HTLV-I) and AIDS (HTLV-III) in Trinidad

Adult T cell leukaemia/lymphoma was first recognised as a clinical entity in southwest Japan. Subsequently the Caribbean has been found to be another area where the disease is endemic, and sporadic cases have been identified in different parts of the world. The human T cell leukaemia/lymphoma virus (HTLV-I) is causally related to adult T cell leukaemia/lymphoma. A subgroup of HTLV, designated HTLV-III, has recently been isolated from many patients with the acquired immunodeficiency syndrome (AIDS) and preAIDS, and there is now evidence that this variant is the primary cause of AIDS. This is the first report from Trinidad to describe 12 cases of adult T cell leukaemia/lymphoma and 14 of AIDS. All were in patients of African descent. No cases were seen in subjects of East Indian descent, who, like those of African descent, comprise as much as 40% of the population. West Indians of African descent may have increased susceptibility to infection with both HTLV-I and HTLV-III.     

AIDS complicated with intestinal lymphoma: X-ray radiology, CT scan and pathological findings

Background  The non-Hodgkin’s lymphoma is the AIDS symbol of tumor, with high incidence and poor prognosis. The purpose of this study was to investigate the radiological demonstrations of AIDS complicated by intestinal lymphoma and its pathological mechanism.

Methods  CT scan and pathological data of 3 cases of AIDS complicated by intestinal lymphoma were retrospectively analyzed. All the 3 cases received CT diagnostic scanning, including 2 receiving barium enema radiography after lower gastrointestinal tract cleansing, 1 receiving laporotomy to obtain partial thickened intestinal canal for histopathology and 1 with autopsy for histopathological analysis.

Results  Intestinal canal lymphoma occurred at the left intestinal canal in 2 cases and at the right intestinal canal in the other case, with manifestations of unevenly thickened intestinal canal wall, narrowed canal lumen and filling defect. It was pathologically classified as B cell lymphoma.

Conclusions  AIDS complicated by B cell lymphoma has manifestations of unevenly thickened intestinal canal wall and narrowed canal lumen, which are non-specific. It should be differentiated from other tumors of intestinal canal in its diagnosis.

     

Mortality among HIV-infected paediatric patients in Barbados

Since the onset of the HIV epidemic, AIDS has become the leading cause of mortality in the paediatric age group in many developing countries. The main objective of this study was to review the mortality in HIV-infected paediatric patients in Barbados. It is a retrospective analysis of the hospitalization course of HIV-infected paediatric patients aged < 16 years who died during a 15-year period of surveillance. Using a specific database, information pertaining to number and duration of hospitalizations, and cause of death were analyzed. There were 39 (65%) deaths among 60 HIV-infected patients diagnosed during the period of study. Twenty-one (54%) were male and 18 (46%) were female. Twenty-seven (69%) case records were retrieved for analysis. The highest mortality (56%) was among patients aged < 1 year and between 1989 and 1995. Hospitalizations averaged three per patient. No patient received anti-retroviral therapy. Nineteen (70%) patients died during hospitalization on the paediatric ward. Lower respiratory tract infections suspected to be Pneumocystis carinii, gastroenteritis and septicaemia were the most frequent diagnoses at the time of death. The annual mortality ranged between 0 and 1.7 (mean 0.7) per 1000 live births. The overall mortality rate was high among HIV-infected paediatric patients, with lower respiratory tract infections being implicated as a major contributing cause of death. Results of this study definitely indicate a need for improved resources in the management of paediatric HIV/AIDS cases, especially focussing on the availability and administration of anti-retroviral therapy.     

Acquired immunodeficiency syndrome, opportunistic infections, and malignancies in male homosexuals. A hypothesis of etiologic factors in pathogenesis

The acquired immunodeficiency syndrome (AIDS) occurs in a subgroup of male homosexuals having sexual contact with a large number of partners. Uncommonly, AIDS has also been diagnosed in Haitians, hemophiliacs, and intravenous drug users and their infants. Manifestations include autoimmune disturbances, opportunistic infections, Kaposi's sarcoma, chronic lymphadenomegaly, non-Hodgkin's lymphoma, or squamous cell carcinoma. The hypothesis receiving most consideration is that a yet-to-be-identified virus causes AIDS. An alternative view is that repeated sexual involvement with multiple partners, in a subgroup of male homosexuals, exposes the men to the immunosuppressive impact of cytomegalovirus (CMV) and allogeneic semen. Antibody to asialo-Gm1 and other antigens on sperm react with and impair lymphoid cells. We propose a biphasic process. First, a reversible acquisition phase of impaired T-cell immunoregulation permits reactivation of Epstein-Barr virus (EBV), and autoantibodies are produced by the activated B cells. If sexual activity continues at a high level, accumulating immune defects, including destruction of thymic epithelium, lead to a second, self-sustaining phase wherein cytotoxic lymphocytes fail to eliminate herpesvirus-infected cells. Evidence is mounting that Kaposi's sarcoma is caused by CMV and that EBV is responsible for the B-cell lymphomas in these patients. Multiple factors, rather than a novel virus, probably induce AIDS in male homosexuals. If this hypothesis is correct, then rational bases for prevention and intervention can be designed.     

Acquired immunodeficiency syndrome presenting as childhood non-Hodgkin's lymphoma

Two children with non-Hodgkin's lymphoma (NHL) as the presenting illness of acquired immunodeficiency syndrome (AIDS) are described. There was a delay in diagnosing the underlying AIDS in both cases. In the first case, an 18-month-old boy with stage IV, high-grade,T-cell NHL, the diagnosis of underlying AIDS was suspected only when he developed recurrent and profound opportunistic infection during chemotherapy. The second case, an eight-month-old female infant presented initially with hepatosplenomegaly and thrombocytopenia of undetermined cause. She had progressive abdominal distension and swelling of her right eye one year later due to high grade B-cell NHL. She was later found to be sero-positive for HIV during pre-chemotherapy screening. As the prevalence of HIV infection continues to increase, HIV infection should be considered in the differential diagnoses of childhood hepatosplenomegaly and thrombocytopenia, and as a possible underlying cause of childhood cancer, especially NHL.     

B细胞淋巴瘤免疫球蛋白重链基因重排的检测

目的 探讨免疫球蛋白重链(IgH)基因重排的检测在B细胞性淋巴瘤(B-NHL)中的诊断价值。方法 用聚合酶链式反应(PCR)方法检测B细胞淋巴瘤30例．淋巴结反应性增生(RH)10例及T细胞淋巴瘤(T-NHL)2例的IgH基因重排。结果 30例B-NHL中，22例(73．3％)出现IgH基因克隆性重排，而RH及T-NHL均未出现IgH基因重排。结论 B细胞淋巴瘤中存在B细胞单克隆增生，支持肿瘤单克隆起源学说；IgH基因克隆性重排检测对鉴别B细胞淋巴瘤和反应性增生以及T细胞和B细胞淋巴瘤有重要意义。     

原发性脑淋巴瘤的影像诊断

目的:分析颅内原发性淋巴瘤CT和MRI的影像学表现,旨在提高对该病的诊断与鉴别诊断率。方法:回顾性分析12例经病理证实的颅内原发性淋巴瘤的CT与MRI表现。结果:单发8例,多发4例,共计15个病灶,病理类型均为B细胞型非霍奇金淋巴瘤。CT表现等密度或稍高密度实质性肿块,无钙化,瘤周水肿相对较轻,占位效应轻,增强后瘤体呈均匀性中度强化,无囊变及环形强化。MRI显示为长T1、长T2信号,增强后病灶明显强化。结论:脑内原发淋巴瘤少见,影像学表现与颅内其他肿瘤互相重叠,CT和MRI平扫和增强扫描的应用有助于脑内淋巴瘤的诊断和鉴别诊断。     

Human parvo-virus B19 infection among children with sickle cell anaemia in Jos,North Central Nigeria

Objective:Human Parvovirus B19 is known to cause significant morbidity and mortality and among diverse patient population groups.Among patients with sickle all disease,who have high red cell turn over due to chronic haemolysis,infection with parvovirus B19 can cause severe life threatening transient aplastic crisis.This study was conducted to determine the Seroprevalence of parvovirus B19 infection and to provide basic epidemiological data on parvovirus B19 infection among children with sickle cell anaemia in Jos,north central Nigeria.Methods: In a hospital based cross sectional survey,200 children aged 1-18 years confirmed to have sickle cell anaemia attending the paediatric sickle cell clinic of Jos university teaching hospital were studied.A questionnaire was designed to obtain basic socio-demographic information,& other relevant aspect of patients′ history.Blood samples were taken for anti parvo-virus B19 serology.Results: The over all prevalence rates of parvo-virus B19 immunoglobulin(IgG) and immunoglobulin(IgM) antibodies were 39.5% and 3.5% respectively,Conclusion: This study confirms that parvo-virus B19 infection is prevalent among children with sickle cell anaemia in Jos,North Central Nigeria.There is a need for further studies to fully evaluate the clinical impact of the infection on our sickle cell anaemia patients.     

10例HIV/AIDS相关Burkitt淋巴瘤(BL)临床病理和免疫表型分析

 目的  探讨HIV/AIDS相关Burkitt淋巴瘤(Burkitt lymphoma,BL)的临床病理学形态、免疫表型特点、诊断及其鉴别诊断。方法  按照WHO(2008)造血与淋巴组织肿瘤病理学分类,应用HE染色、免疫组化EnVision法染色、荧光原位杂交(fluorescence in situ hybridization,FISH)及原位杂交并结合临床资料对2010年8月至2013年3月收集的10例HIV/AIDS相关BL进行综合分析。结果  10例患者中活检腋下肿块4例、颈部肿块3例、腹股沟肿块1例、腹部手术切除肿物2例。免疫组化染色瘤细胞均显示IgM、CD20、CD19、CD79a、CD10、Bcl 6阳性,CD5、CD21、CD30、EMA、Bcl 2、CD3、ALK-1、TdT阴性,Ki67增殖指数均＞90%,1例表达CD38及MUM-1,3例c-myc阳性,1例LMP-1阳性,突变型p53阳性表达5例。原位杂交EBER 示3例阳性;FISH示C-MYC基因断裂重组8例t(8;14)(q24;q32)。病理诊断:经典型BL 9例,浆细胞样分化BL 1例。结论  HIV-BL为高度恶性淋巴瘤,预后较差,光镜下易与弥漫大B细胞淋巴瘤和淋巴母细胞性淋巴瘤/白血病等相混淆,结合典型病理表现、免疫组化和FISH技术有助于临床病理诊断及其鉴别诊断。     

Successful autologous stem cell transplantation in a severely immunocompromised patient with relapsed AIDS-related B-cell lymphoma

There is now evidence that the tolerability and response to systemic chemotherapy in HIV-infected patients with AIDS-related lymphoma (ARL) is significantly improved by highly active antiretroviral therapy. Here we report an severely immunocompromised AIDS patient with recurrent ARL who was successfully treated with autologous stem cell transplantation (ASCT). We also review the current literature of ASCT in HIV-infected patients.     

沈阳地区76例非何杰金淋巴瘤的分类及其免疫表型病理分析

目的：探讨我国沈阳地区非何杰金淋巴瘤（NHL）的病理特点及免疫组化表型分析。方法：对76例NHL按照WHO新分类进行病理观察和10种抗体免疫表型测定。结果：B系占78．9％,其中弥漫性大B细胞淋巴瘤（DLBL）最多;其次为MALT型（＋／－单核细胞样B细胞）及淋巴浆细胞性淋巴瘤（LPL）。T系占21．1％,以外周T非特殊型最多。CD79a对B－NHL染色阳性率达100％,未见与T细胞的交叉反应。CD3对T－NHL染色阳性率为88％,与B细胞仅有5％的交叉反应。结论：我国沈阳地区NHL以DLBL和外周T非特殊型为最多见,结内单核B和淋巴浆细胞性比例较高。CD79a和CD3分别是具有高度敏感性和特异性的B、T细胞标志抗体。     

自身免疫性疾病转为恶性淋巴瘤12例临床分析

目的 探讨自身免疫性疾病与恶性淋巴瘤的关系.方法 回顾性分析20年来先发生自身免疫性疾病后被诊断为恶性淋巴瘤的12例患者的临床资料并复习相关文献.结果 12例中,原发干燥综合征(pSS)6例,其中4例有反复腮腺肿大、浅表淋巴结及肝脾肿大,4例炎症指标持续升高,发生淋巴瘤时以非霍奇金淋巴瘤(NHL)B细胞型为主;类风湿关节炎(RA)2例,均有严重的关节病变和炎性指标增高,淋巴瘤均为NHL弥漫大B细胞型;系统性红斑狼疮(SLE)2例,抗SSA、抗SSB均呈阳性,分别转为T和B细胞型NHL;皮肌炎和银屑病关节炎各1例,后均诊断为NHL B细胞型.结论 自身免疫性疾病患者恶性淋巴瘤的发病率较高,尤以原发干燥综合征、类风湿关节炎、系统性红斑狼疮为多.这些患者具有一定的特征性表现,转化的恶性淋巴瘤以B细胞型为主.     

北京和香港地区鼻咽部B细胞淋巴瘤的比较研究

了解苯那普利（ｂｅｎａｚａｐｒｉｌ）的降低慢性肾小球肾炎原蛋白的作用。方法：对慢性肾炎病人６４例进行多中心自身对照观察。结果：经苯那普利治疗１２周后,大量蛋白尿组（３０例）尿蛋白下降４７．０％,小量蛋白尿组（３４例）尿蛋白下降 ４７．５％,平均起效时间分别为（ ５．１±３． ２）周（大量蛋白尿组）和（ ２． ７±２． １）周（小量蛋白尿组）,同时,其中１４例肾病综合征患者的低白蛋白血症也有明显改善。结论：苯那普利可部分地降低慢性肾小球肾炎患者的尿蛋白。     

189例恶性淋巴瘤病理类型分析

目的分析恶性淋巴瘤病理类型和部位分布特征。方法收集本院病理科1993～2001年间诊断的淋巴瘤病例189例，应用WHO新分类进行分类。结果189例患者中，霍奇金淋巴瘤11例(5．8％)，非霍奇金淋巴瘤(NHL)178例(94．2％)。免疫表型显示，B细胞淋巴瘤160例(89．9％)，T细胞淋巴瘤18例(10．1％)。以弥漫大B细胞淋巴瘤(DLBCL)为主要病理类型117例(65．7％)，但其组织细胞学呈明显异质性。胃部约有1／3的病例为MALT型边缘区B细胞淋巴瘤(粘膜相关淋巴瘤)，未见T细胞淋巴瘤；而肠道可见到25．0％的病例为T细胞淋巴瘤；鼻腔鼻窦则以T细胞淋巴瘤为多数。结论本地区霍奇金淋巴瘤少见；结外NHL多于淋巴结，且B细胞淋巴瘤占绝大多数；DLBCL为最常见的病理类型，其它类型有明显的部位分布特征。     

大肠原发性恶性淋巴瘤的临床特点及治疗

目的：探讨大肠原发性恶性淋巴瘤的临床与病理特点。方法：对14例大肠原发性恶性淋巴瘤患者的临床资料作回顾性分析,按1985年我国成都NHL分类和WHO新分类进行组织学分类。结果：14例均经手术治疗无并发症。随访5年生存率为42．8％,其中低度恶性淋巴瘤B细胞性3例(21．4%),中度恶性淋巴瘤B细胞性、高度恶性淋巴瘤T细胞性及分类不明的淋巴瘤各l例。结论：低度恶性淋巴瘤B细胞性预后较好。     

PCR技术在B细胞淋巴瘤诊断中的应用

应用聚合酶链反应（ＰＣＲ）技术从ＤＮＡ水平测定Ｂ细胞非霍奇金淋巴瘤的单克隆起源，以用于淋巴瘤的诊断。４０例标本检测的阳性结果为；Ｂ细胞淋巴瘤１３／１５例，Ｔ细胞淋巴瘤０／３例，霍奇金病０／３例，慢性淋巴结炎０／８例，非淋巴源性肿瘤０／１１。与组织学及免疫组化诊断符合率为８７％。本研究在把分子生物学的新方法用于Ｂ细胞淋巴瘤的临床诊断方面作出初步的探索。关键词     

36例恶性淋巴瘤临床病理学研究

对３６例淋巴瘤进行了临床病理学研究，结合形态不到及免疫组织化研究结果，Ｂ细胞林巴病２２例（６４．７％），Ｔ细胞性淋巴瘤１２例（３５．３％），ＨＤ２例。发生于鼻腔、鼻窦原诊断为恶性肉芽肿７例细胞性淋巴瘤，而发生于扁桃体的原诊断为未分化癌１例为Ｂ细胞淋巴瘤。本研究表明免疫组化在淋巴瘤诊断与鉴别诊断中有重要意义。     

非霍奇金淋巴瘤组织中bcl-6及细胞凋亡检测

目的:检测非霍奇金淋巴瘤组织中bcl-6的表达和肿瘤细胞凋亡情况.方法:应用免疫组化SP法观察50例非霍奇金淋巴瘤(B细胞淋巴瘤30例,T细胞淋巴瘤20例)和30例淋巴结炎组织中bcl-6的表达水平,并应用TUNEL法检测细胞凋亡.结果:淋巴结炎、B细胞淋巴瘤和T细胞淋巴瘤组织中bcl-6阳性表达率分别为40.0%、46.7%、35.0%,3组差异无统计学意义(P＞0.05),但B细胞淋巴瘤组织中bcl-6强表达率达36.7%,高于T细胞淋巴瘤的20.0%和淋巴结炎组织的6.7%(P＜0.05).bcl-6阳性表达的非霍奇金淋巴瘤组织细胞凋亡指数低于阴性表达组(P＜0.05).结论:B细胞淋巴瘤组织中bcl-6过表达可能与淋巴瘤的发生发展有关.     

肠道B细胞淋巴瘤Epstein-Barr病毒感染与癌基因

目的:研究肠道非霍奇金淋巴瘤B细胞型的Epstein-Barr(EB)病毒感染、p53、p21ras基因表达及其相关性.方法 :应用单克隆抗体、免疫组化方法对瘤细胞进行免疫表型研究,CD20、CD45RA、CD79a 鉴定瘤细胞的B细胞分化,CD45RO、CD3除外瘤细胞T细胞分化.同时用免疫组化方法,检测瘤细胞p53基因表达、p21ras基因表达.EB病毒寡核苷酸探针(EBER)原位杂交,观察瘤细胞EB病毒感染情况.结果:34例肠道B细胞淋巴瘤好发部位为回肠和结肠,以单发瘤结节多见,常伴有表面溃疡形成.34例中,弥漫性大B细胞淋巴瘤9例(26.5%),19例为惰性的边缘区B细胞淋巴瘤黏膜相关淋巴组织型(MZL-MALT型)(55.9%),6例为MZL-MALT型伴高度恶性转化(17.6%).EBV- EBER 原位杂交检测,全部病例为阴性.p53蛋白表达共有23例,占全部病例的67.6%(其中高度恶性占47.8%);16例有p21ras的表达,为47.1%(其中高度恶性占43.8%).有15例同时检出p53蛋白和p21ras的表达,占病例数的44.1%.结论 :34例肠道B细胞淋巴瘤以惰性为多见,但恶性转化明显.EBV的研究提示肠道B细胞淋巴瘤有别于T细胞淋巴瘤,与EBV感染无关.p53蛋白的表达高于p21ras,p53和p21ras的共同表达检出率较高,提示癌基因p53和p21ras在肠道B细胞淋巴瘤的发生中可能起一定作用.     

Childhood deaths from malignant neoplasms in accra

Summary BACKGROUND: Malignant neoplasms are set to become a leading cause of childhood death in sub-Saharan Africa as immunization programmes reduce deaths due to infectious diseases. Knowledge of the pattern of deaths from these neoplasms is therefore desirable. OBJECTIVE: To describe the pattern of deaths from paediatric malignancies, compare this to morbidity figures and provide baseline data for planning child care services. METHODS: A 10 year retrospective survey of autopsy cases of paediatric malignancies at the Korle-Bu Teaching Hospital Mortuary was carried out based on autopsy files form January 1, 1990 to December 31, 1999 RESULTS: A total of 252 cases of childhood malignant tumours were retrieved, 139 males and 113 females with a male to female ratio of 1.2:1. The most common malignancy was lymphoma forming 54% of cases and almost all of Non-Hodgkin's type. Non-Burkitts type (29%) was the commonest followed by Burkitts (24%) and Hodgkin's disease only one percent. The lymphomas were followed by central nervous system (CNS) tumours (13%), nephroblastomas(10.3%) leukemias (6.7%) hepatic tumours (4%) and sarcomas (2.6%). Less common tumours were Neuroblastomas (2.4%) and retinoblastomas (2%). CONCLUSION: Overall the pattern of deaths from paediatric malignancies followed the pattern of relative incidence in morbidity figures from Ghana and the subregion except for a relatively higher proportion of deaths from CNS tumours and a lower proportion from sarcomas. The pattern of cancer deaths seen in this study is similar to that seen in advanced countries except that lymphomas replace leukemia as the commonest cause of death.