Theophylline as a therapy for chronic lymphocytic leukemia: a case report and review of literature

We herein, report that theophylline which can induce apoptosis in chronic lymphocytic leukemia (CLL) cells both in vitro and in vivo, also appears to be effective when used clinically to treat an advanced CLL patient.     

Case report and literature review: a rare patient with chronic myeloid leukemia and chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML) are the most common leukemias of the elderly. However, the sequential occurrence of CML followed by CLL in the same patient is extremely rare. In the present report, a 71-yr-old man was diagnosed with Philadelphia (Ph) chromosome positive CML and treated with imatinib mesylate. He went into morphologic, cytogenetic, and molecular remission. Seven years after the diagnosis of CML, he developed CLL. We describe the morphologic, immunophenotypic, cytogenetic, and molecular findings in this patient.     

Genetic characterization of the paraimmunoblastic variant of small lymphocytic lymphoma/chronic lymphocytic leukemia: A case report and review of the literature

Paraimmunoblastic variant of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) is characterized by a diffuse proliferation of cells, called paraimmunoblasts, normally located on the pseudoproliferation centers. Patients usually present with multiple lymphadenopathies and a rapid and aggressive progression of the disease. We report a case with paraimmunoblastic variant of SLL/CLL genetically well-characterized by conventional cytogenetics, comparative genomic hybridization (CGH), IgH/BCL-1, IgH/BCL-2, and p53 fluorescent in situ hybridization (FISH) probes and polymerase chain reaction (PCR) for detection of IgH/BCL-2 translocation. A complex karyotype was found, with p53 deletion confirmed by CGH and FISH; however, no translocations involving either BCL-2 or BCL-1 and the immunoglobulin heavy chain gene were identified. A literature review shows only 20 previously reported cases, 6 of which involve genetic studies.     

Chronic lymphocytic leukemia mimicking recurrent carcinoma of the breast: case report and review of the literature

Secondary localization of chronic lymphocytic leukemia (CLL) in breast is rare, while concurrent invasive ductal carcinoma and CLL manifesting as a collision tumor in breast is extremely rare.The observation of a CLL infiltration closely associated with a distinct breast neoplasm with the absence of any other localization for the leukemia is an indisputable argument for a relationship between the two diseases. The presence of both tumors is not simply due to chance. This association (CLL and carcinoma) has also been described in other organs.Hereafter, we report a second case of an 80 year-old woman in whom a leukemic infiltrate was confined to the region immediately surrounding poorly differentiated primary breast carcinoma, and we will discuss the association between CLL and carcinoma.     

Mantle cell lymphoma concurrent with T-large granular lymphocytic leukemia: report of a case and review of literature

Mantle cell lymphoma is one of the B-cell lymphomas. The concurrent presentation of mantle cell lymphoma with large granular lymphocytic leukemia simultaneously has never been reported. In this case we present an old man with concomitant mantle cell lymphoma and large granular lymphocytic leukemia diagnosed by the morphology of the bone marrow aspiration, immunophenotyping of the peripheral blood by flow cytometry detecting the increased CD3+CD4-CD8+ cells, immunohistochemical studies of lymph node showed cyclinD1+, chromosome analysis by fluorescence in situ hybridization (FISH) showed t(11,14), positive results of IGH and TCR rearrangement studies. The patient discharged from the hospital voluntarily and lost the follow-up. A brief discussion is also presented.     

Hereditary chronic lymphocytic leukemia: an extended family study and literature review

Leukemia is manifested in about 1-2% of people in Western industrialized nations. The most common form of leukemia is B-cell chronic lymphocytic leukemia (B-CLL), which accounts for approximately 30% of all cases. While CLL's etiology remains elusive, there is increasing evidence that substantially supports the role of hereditary factors in a subset of cases of this disease. Our purpose is to describe an extremely well documented CLL family wherein the disease has been verified in a father and his four sons; two of the sons are identical twins. The family history, including available medical records and pathology reports, was gathered and reviewed. Peripheral blood lymphocytes were used for cytogenetic and fluorescence in situ hybridization analyses. The family reported herein shows classic findings in support of an autosomal dominant mode of genetic transmission of CLL. Given the explosive developments in molecular genetics during the past decade, it is certain that families of this type will provide important clues to the etiology, pathogenesis, and ultimate prevention of CLL.     

Acquired haemophilia B: a case report and literature review

Acquired haemophilia is a rare disease; it occurs most frequently in elderly patients. The majority of cases are due to autoantibodies to factor VIII, which deplete circulating factor VIII or acquired haemophilia A. Only few cases of acquired haemophilia B are reported until today. We report a case of a 7-year-old girl with no past medical history of bleeding disorder and who present an extensive haematoma in the left calf. The diagnosis was established by the demonstration of an isolated prolongation of the activated partial thromboplastin time (APTT) with a reduced factor IX level and evidence of factor IX inhibitor activity to 2 Bethesda Unit (2UB). Diagnosis of acquired haemophilia B confirmed, patient received recombinant factor VIIa and corticosteroid treatment. Bleeding symptoms had completely disappeared and coagulation tests become normal. In conclusion, if bleeding symptoms are associated with unexplained prolongation of APTT, an inhibitor against factor must be searched for not missing an acquired coagulation disease.     

混合型急性白血病临床病理探讨并文献复习

目的：探讨混合型急性白血病的临床病理特征、诊断和鉴别诊断、治疗及预后。方法：回顾性分析1例混合型急性白血病患者的临床资料、组织病理形态、免疫组织化学染色、流式细胞学、染色体核型分析、治疗及随访结果,并回顾相关文献。结果：光镜下,颈部淋巴结活检示淋巴结基本结构被破坏,不见明显的淋巴滤泡及套区,代之以小-中等大小的比较均匀一致的异型淋巴样细胞,其细胞质较少,细胞核圆形或卵圆形,染色质比较均匀细腻,核仁不明显或偶见,核分裂象可见。免疫组织化学染色结果显示异型淋巴样细胞LCA散在较多(+),CD7弥漫较多(+),TdT弥漫较多(+),CD10弥漫较多(+),MPO散在(+);外周血涂片和骨髓涂片可见原始幼稚细胞;第一次化疗前后流式细胞学检测分别提示急性髓系白血病和急性B淋巴母细胞白血病。第一次化疗前骨髓短期培养法染色体核型分析提示46、XY、del(11q)。上述淋巴结活检形态学、免疫组织化学染色结果、外周血及骨髓涂片、骨髓流式细胞学及染色体核型分析均支持混合型急性白血病(转换型)的诊断。虽已更换不同的化疗方案,患者化疗效果不明显,反复出现肺部感染及骨髓抑制,均提示其预后比较差。结论：混合型急性白血病十分少见,一般需要结合形态学、免疫表型及细胞遗传学等检查才能做出诊断,对该病的鉴别诊断、治疗方案的选择及预后具有重要意义。     

Trisomy 8 as sole cytogenetic abnormality in a case of chronic lymphocytic leukemia

A 49-year-old man, who had been diagnosed with chronic lymphocytic leukemia (CLL) in 2002, had a normal karyotype in his bone marrow. Trisomy 8 was demonstrated in his peripheral blood in 2005. Fluorescence in situ hybridization using an LSI CEP 8 probe performed on the archival bone marrow specimen showed three hybridization signals in 40% of 200 interphase cells scored. This confirmed that the trisomy 8 abnormality was present in both the blood and bone marrow samples. Trisomy 8 as the sole chromosomal abnormality in CLL is a very rare finding. The prognostic significance of trisomy 8 in CLL remains to be seen.     

慢性淋巴细胞白血病8号染色体三体异常的研究

论 +8异常在CLL群体中少见,其与预后关系暂不明确.     

Long-term cultures of chronic lymphocytic leukemia B cells generate B suppressor cells

B suppressor cells (Bs) were generated by stimulation with PHA-P or concanavalin A of B cells from peripheral blood of B-cell chronic lymphocytic leukemia (B-CLL) patients. They suppressed well allogeneic mixed lymphocyte reactions. Long-term colonies of B cells from B-CLL were established for up to 6 weeks in liquid media, with B cells acquiring properties of suppressor cells while being cultured. Two types of cultures were observed: cells either grew in compact multicellular colonies or formed diffuse monolayers. Cells that remained alive in cultures for a number of weeks, but did not multiply, did not develop suppressive characteristics. Bs cells retained their phenotypic markers in cultures. Mitosis and lymphoblasts, but no differentiation into plasma cells, were observed. PHA-P-generated Bs were cultured in long-term colonies, retaining their suppressor properties. The establishment of long-term cultures of B-CLL cells may facilitate a better understanding of the nature and characteristics of normal and leukemic B cells.     

Constitutive and activation-inducible cyclooxygenase-2 expression enhances survival of chronic lymphocytic leukemia B cells

We recently reported that activated normal human B lymphocytes express Cox-2. These findings prompted us to evaluate whether human B-CLL cells express Cox-2 and synthesize prostaglandins. In contrast to naive human B cells, B-CLL cells constitutively expressed Cox-2 protein and produced PGE2, PGF2alpha, and TXA2. Elevated Cox-2 expression was seen in a subgroup of B-CLL cells that exhibit poor prognostic factors, including unmutated variable heavy chain status and increased CD38 expression. Furthermore, stimulation of B-CLL cells with CD40 ligand plus TNFalpha increased Cox-2 levels. The role of Cox-2 in promoting B-CLL survival was investigated using nonselective and selective Cox-2 inhibitors. Significant reductions in B-CLL survival occurred following Cox-2 inhibition. These new findings support that constitutive Cox-2 expression in B-CLL cells promotes their survival and possibly their expansion in vivo. It will therefore be important to evaluate drugs that inhibit Cox-2 as potential therapeutic agents in B-CLL in vivo.     

Erythrocyte-rosette receptor expression by chronic lymphocytic leukemia B lymphocytes

Erythrocyte (E) rosette-forming cells have been investigated in three patients with B chronic lymphocytic leukemia whose leukemic lymphocytes were easily identifiable. A small percentage of fresh neoplastic cells formed E rosettes in two patients. In every patient, most unstimulated, cultured leukemic lymphocytes became E+ and this was further enhanced by phytohemagglutinin and pokeweed mitogen stimulation or neuraminidase treatment. These E+ B cells lacked detectable T cell antigens (except for a weak expression of an antigen associated with the helper T cell subpopulation in one case). They were unreactive or weakly reactive by immunofluorescence with a monoclonal antibody to the E receptor. However, this antibody completely inhibited E-rosette formation. The enhanced expression of E-rosette receptors by in vitro cultured cells appeared to be dependent upon the presence of a small number of E-rosetting cells at the beginning of the culture. E-rosette receptor expression by leukemic lymphocytes was most likely in a fourth case (out of 9 patients studied). This finding may account for some of the discrepancies in the study of so-called T cells in B chronic lymphocytic leukemia.     

Myeloid leukemia in a urine specimen: A case report and review of the literature

Urinary tract cytology has a long history of utilization for the diagnosis and follow‐up of tumors involving the urothelial tract. As expected, the most common tumor encountered in exfoliative urine cytology is urothelial carcinoma. While the sensitivity of urinary tract cytology for the diagnosis of low‐grade urothelial carcinomas is low, its sensitivity and accuracy for high grade urothelial carcinomas is much higher. However, nonurothelial malignancies, such as hematopoietic malignancies, can also be encountered in urine specimens. Leukemic cells in urine can be diagnosed readily by cytological examination in cases where more invasive procedures are difficult to perform. Additionally, cell block sections can be utilized to determine the immunocytochemical profile of the tumor cells to confirm the diagnosis. Herein we report a case of a 75‐year‐old man with a past medical history of acute myeloid leukemia (AML), who presented with congested heart failure and painless macroscopic hematuria. AML relapse was diagnosed. Cytological examination of the urine using a ThinPrep® smear, cytospin preparation, and immunohistochemical stains performed on the cell block sections were examined. Findings were consistent with leukemic cells of myeloid origin in the bladder washing specimen. Diagn. Cytopathol. 2014;42:700–704. © 2013 Wiley Periodicals, Inc.