Bone marrow findings in lupus patients with pancytopenia

The marrow findings of 23 lupus patients with pancytopenia were reported. The most common findings were dyserythropoiesis and hypoplasia, both occurring in 9/23 (39%) of the cases. Neither feature was definitely related to cytotoxic drug therapy since most cases were treated by steroids only. Three of the hypoplastic marrows also showed gelatinous transformation, a condition characterized by disruption of marrow architecture, fat atrophy, and deposition of hyaluronic acid. Another common finding was lymphocytosis which occurred in 5/23 (22%) of the cases, 2 of which also had associated plasmacytosis. Two cases were associated with hyperplastic marrow, indicating peripheral destruction of blood cells and compensatory marrow hyperplasia. Reports in the literature on bone marrows in systemic lupus erythematosus are conflicting, describing mainly hypoplasia, vasculitis, plasmacytosis, red cell aplasia, and myelofibrosis. In our series, we found hypoplasia and lymphocytosis/plasmacytosis; in addition we described findings previously unreported: gelatinous transformation, dyserythropoiesis, and marrow hyperplasia.     

Cell suspensions from collagenase digestion of bone marrow trephine biopsy specimens.

A technique for the extraction of cells from bone marrow trephine core biopsy specimens using collagenase digestion was assessed in 39 cases (33 diagnostic and six normal). Diagnostically useful numbers of cells were extracted from all marrows. Morphological assessment of cytocentrifuge preparations of these cells gave a correct diagnosis in 23 (60%) of cases compared with 27 (70%) for the corresponding aspirated marrow smears. Phenotypic analysis using flow cytometry showed persistence of a range of surface membrane antigens following collagenase digestion. Increased autofluorescence was a problem in some cases. Cytochemistry, bone marrow culture, and cytogenetic analysis could also be carried out on these cells. It is concluded that this technique has useful diagnostic applications in cases of dry taps.     

放血增加自体骨髓基质干细胞浓度实验研究

目的:寻找提高骨髓基质干细胞浓度的方法。方法:随机取中国白兔5只,分别在干预前及干预后的第5、7、10天抽取耳缘静脉血进行网织红细胞检测;随机取中国白兔10只,于放血干预前后经股骨大转子抽取骨髓,分别进行离心前后的骨髓基质干细胞培养和计数。对结果进行分析,找出动员后骨髓基质干细胞增多最明显时间。结果:兔骨髓基质干细胞(MSCs)经放血动员后,细胞附壁数目增多,第5天最为明显,与应激前对比,有显著性差异(P<0.05)。结论:自体骨髓基质干细胞(MSCs)经放血动员和浓集后,干细胞数量明显增多。     

Bone marrow embolism in multiple myeloma

Summary Multiple myeloma and the accompanying osteolytic process frequently lead to recognized or subclinical fractures. As a consequence of these fractures bone marrow embolism may occur. During a 15 years period fourteen patients with myeloma were autopsied in Hurley Hospital. In four of the fourteen autopsies unequivocal bone marrow embolism and in two autopsies possible bone marrow embolism was found. In one of the patients the bone marrow emboli, together with fat emboli, were the cause of death. In the other three cases the emboli were incidental findings. We suspect that bone marrow embolism may be a rather frequent complication of myeloma and may lead to pulmonary complications. Occasionally it may be the cause of death.

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Knochenmarksembolie von multiplem Myelom

Zusammenfassung Knochenmarksembolie im Krankheitsverlauf von multiplem Myelom wurde bisher noch nicht in der Literatur beschrieben. In 6 von 14 Patienten mit multiplem Myelom, die von 1952–1967 im Hurley Hospital zur Sektion kamen, wurden Emboli in den kleineren Ästen der Lungenschlagader festgestellt. In 4 Fällen waren diese Emboli ganz eindeutig als Knochenmark zu erkennen. In 2 weiteren Fällen konnten Emboli vermutet werden. Die Erkennung von Knochenmarksembolien im histologischen Präparat kann durch drei Umstände erschwert oder sogar verhindert werden: die in der Regel sehr geringe Zahl solcher Emboli, die bald einsetzende Degeneration und Auflösung und schließlich die Herkunft aus pathologischem Mark. Letzteres weist besonders starke Veränderungen bei Patienten auf, die mit Bestrahlungen oder Chemotherapeutica behandelt wurden. Meist sind diese Knochenmarksemboli lediglich Zufallsbefunde bei Sektionen. Wir meinen jedoch, daß sie gelegentlich auch klinisch in Erscheinung treten können. In einem unserer Fälle führte massive Embolisation von Knochenmark innerhalb kurzer Zeit zum Tod.

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Presented at the 57th meeting of the International Academy of Pathology, Chicago, March 4, 1968.     

肺栓塞肺动脉能谱CT胸部扫描影像学特征及其诊断价值

目的：探讨肺栓塞（PE）肺动脉能谱CT胸部扫描影像学特征及其诊断价值。方法：回顾性分析53例高度疑似PE患者,获取单能量能谱CT肺动脉造影（CTPA）图像和碘基肺灌注图,记录CTPA图像和碘基肺灌注图检出的肺动脉栓子数目及其分布、分型情况;分析肺动脉能谱CT胸部扫描影像学特征;比较不同栓塞程度及类型能谱CT扫描碘基值;比较栓塞区与对照区能谱CT扫描碘基值、水基值和CT值等能谱CT扫描参数。结果：以CTPA为金标准,53例高度疑似PE的患者中确诊32例。能谱CTPA检出162个栓子,完全型栓子37个,非完全型栓子125个;碘基肺灌注图检出171个栓子,完全型栓子49个,非完全型栓子122个。中心型、偏心型和完全型栓子栓塞区能谱CT扫描碘基值均明显低于对照区（P<0.05）;附壁型栓子栓塞区能谱CT扫描碘基值与对照组无显著差异（P>0.05）;完全型栓塞区碘基值显著低于中心型、偏心型和附壁型等非完全型栓塞区（P<0.05）。结论：PE肺动脉能谱CT胸部扫描影像学特征主要表现为肺动脉内充盈缺损、肺动脉扩张、肺动脉高压、马赛克征、轨道征等征象,肺动脉能谱CT胸部扫描碘基肺灌注...     

The diagnosis of fatal pulmonary fat embolism using quantitative morphometry and confocal laser scanning microscopy

The postmortem diagnosis of fat embolism syndrome (FES), traditionally based on the histological demonstration of fat globules, needs a quantitative analysis of both the size and localization of the fat emboli, which is essential for a reliable grading of the pulmonary fat embolism. The clinical data and the autopsy records of 2738 autopsies were retrospectively evaluated, and 21 cases in which FES was pointed out as cause of death were selected and compared with 21 fatal cases referred to as major trauma in which the cause of death was not attributed to fat embolism, and with 47 fatal cases as control group, respectively. The following parameters were investigated: the total area of the embolized tissue; the total number of emboli; the mean area of the emboli; the mean percentage of the embolized tissue area as compared with the total tissue area of each sample; the total percentage of the embolized tissue area as compared with the total tissue area of all slides. The most reliable parameters seem to be the ratio between embolized tissue areas as compared with the total tissue area of each sample. These parameters showed a good correlation with the clinical data.     

Coronary artery embolism with special reference to invasive procedures as the source.

Since 1978, there have been sporadic reports of coronary artery embolism caused by cardiac catheterization, percutaneous transluminal coronary angioplasty, and other invasive procedures. To determine whether coronary artery embolism has increased with the wider application of such procedures, we searched for patients with coronary artery emboli among the autopsy cases with suspected acute myocardial infarction at the National Cardiovascular Center from 1977 to 1990. Of the 28 patients with emboli, 10% of the total autopsy cases of myocardial infarction was confirmed in 18. Infarction was diagnosed clinically in only six of these patients and directly caused the death of 11 of the 18 patients. In contrast to previous reports, where a minority of coronary emboli were caused by instrumentation, 14/28 patients in our series had coronary embolism due to invasive procedures, including eight patients with atheromatous emboli. half of the myocardial infarcts caused by embolism were hemorrhagic. Thus, coronary emboli are not so rare as once thought, and they may increase further with the progress of invasive diagnostic and surgical interventions. The possibility of coronary embolism thus needs to be kept in mind by all clinicians in the cardiovascular fields.     

Distinctive cytoplasmic surface activity in benign and leukemic bone marrow cells: ultrastructural definition and clinicopathologic correlation

A distinctive ultrastructural finding, observed in a case of acute lymphoblastic leukemia (ALL) and previously unreported on the surface of bone marrow cells, is described. The alteration is referred to as distinctive cytoplasmic surface activity (DCSA). For further delineation, study of 130 consecutively submitted bone marrow specimens was undertaken. All samples were obtained from children and included diverse myeloid leukemias, acute lymphoblastic leukemia, normal marrows, and abnormal but non-neoplastic conditions. The DCSA was composed of simple and complex interconnected tubular elements in continuity with the cytoplasmic membrane, probably, sharing its glycocalyx. The intensity of the DCSA varied but, its presence was detected in one third of the 130 cases. Except for rare marrows (three cases) with DCSA bearing polymorphs, all positive cells were lymphoid in origin, usually originating from non-B, non-T ALL patients. In very few non-neoplastic cases, DCSA-positive lymphocytes also were found. Review of the literature shed little light on the subject but disclosed rare instances in which DCSA was illustrated in benign as well as malignant lymphoid cells. Based on this information and the observations made throughout the study, it is surmised that DCSA may be the morphologic expression of a cellular function, probably a form of micropinocytosis. Despite its prevalence in ALL cases, it appears to be nondiagnostic and nonspecific to a cell line.     

Pulmonary bone marrow embolism in nonselected autopsy material

We analyzed the incidence of bone marrow emboli of the pulmonary arteries in nonselected autopsy material involving 620 cases. We evaluated the incidence of these emboli, age, sex, underlying disease and microscopic picture. It was found that bone marrow emboli of the pulmonary arteries occurred in 7% of cases, most frequently in patients aged from 50 to 69 years and they were located in the medium and small-lumen arteries. It was found that bone marrow emboli of the pulmonary arteries may complicate posttraumatic bone fractures, costal and sternal fractures in the course of reanimation as well as malignant neoplasms and shock.     

Discordant immunophenotypic profiles of adhesion molecules and cytokines in acute myeloid leukemia involving bone marrow and skin

We investigated the role of adhesion molecules in skin involvement by acute myeloid leukemia (AML) using immunohistochemical analysis. Ten paired cases of skin and bone marrow biopsy specimens from patients with myeloid leukemia cutis (MLC) and 15 bone marrow biopsy specimens from patients without MLC were studied with antibodies directed against CD29, CD34, CD54, CD62-L, CD183, and cutaneous lymphocyte antigen (CLA). CLA was expressed in all cases of leukemia whereas CD54 was negative within blasts. CD62-L was expressed in 4 of 10 specimens of marrow infiltrates with MLC and 6 of 10 specimens of matching skin infiltrates; in marrows without MLC, only 2 of 15 were positive. CD29 was expressed in 1 of 10 marrow infiltrate specimens with MLC and 4 of 10 matching skin infiltrate specimens; in marrows without MLC, only 1 of 15 were positive. CD183 was expressed in 1 of 10 marrow infiltrate specimens with MLC and 4 of 10 matching skin infiltrate specimens; in marrows without MLC, CD183 was negative. The gain of CD62-L, CD29, and CD183 expression in bone marrow and skin infiltrates in leukemia cutis, relative to bone marrow infiltrates of cases without MLC, suggests a role for these markers in AML homing to skin.     

The effect of decellularized bone/bone marrow produced by high-hydrostatic pressurization on the osteogenic differentiation of mesenchymal stem cells

Decellularized bone/bone marrow was prepared to provide a microenvironment mimicking that of the bone marrow for three-dimensional culture in vitro. Bone/bone marrows were hydrostatically pressed at 980 MPa at 30 °C for 10 min to dismantle the cells. Then, they were washed with EGM-2 and further treated in an 80% EtOH to remove the cell debris and lipid, respectively. After being rinsed and shaken with PBS again, treated bone/bone marrows were stained with hematoxylin and eosin (H-E) to assess the efficacy of decellularization. Cells were determined to have been completely removed through H-E staining of their sections and DNA quantification. Rat mesenchymal stem cells (rMSCs) were seeded on the decellularized bone/bone marrows and cultured for 21 days. The adhesion of rMSCs on or into decellularized bone/bone marrows was confirmed and proliferated over time in culture. The osteogenic differentiation effect of decellularized bone/bone marrows on rMSCs in the presence or absence of dexamethasone was investigated. Decellularized bone/bone marrows without dexamethasone significantly increased alkaline phosphatase (ALP) activity, indicating promoted osteogenic differentiation of rMSCs. In an animal study, when decellularized bone/bone marrows were implanted into the rat subcutaneous, no immune reaction occurred and clusters of the hematopoietic cells could be observed, suggesting the decellularized bone/bone marrows can provide a microenvironment in vivo.     

Cytologic diagnosis of fat emboli in peripheral blood during sickle cell infarctive crisis

A diagnosis of fat emboli can be suspected in a patient presenting with the typical symptoms of the fat embolism syndrome, but is rarely proved pathologically, except at autopsy. We described a 25-yr-old man with sickle cell anemia who developed an infarctive crisis complicated by unexplained fever, neurologic change, and respiratory abnormalities. Blood drawn from the femoral vein and examined cytopathologically yielded necrotic bone marrow elements admixed with fat. The cytologic finding of fat emboli from necrotic bone marrow provided the diagnosis and helped guide subsequent medical intervention. This simple test is recommended for patients at risk for fat emboli to aid in the clinical diagnosis. Diagn. Cytopathol. 17:54–56, 1997. © 1997 Wiley-Liss, Inc.     

Comparison of clinical and postmortem diagnosis of pulmonary embolism.

The incidence of pulmonary embolism and the number of clinically missed diagnoses of it in necropsies carried out between 1960 and 1984 at this department were investigated. Pulmonary embolism primarily affects elderly people with serious underlying disease; in this study it was found more often in women. The incidence of pulmonary embolism (9% of all necropsies) was unchanged during the period studied. In contrast, pulmonary embolism as the "sole" cause of death increased (p less than 0.0005). Although most pulmonary emboli were the immediate cause of death, the clinical diagnosis was often missed (in 84% of all cases). Furthermore, such clinically missed diagnoses increased over the years (p less than 0.005), especially in patients with heart disease and cancer. Without necropsy there will be considerable underdiagnosis of pulmonary embolism, therefore providing a misleading figure in the death statistics for this often fatal disease.     

A retrospective study of the incidence and classification of bone marrow disorder in cats (1996–2004)

An 8-year retrospective study of bone marrow reports was conducted to evaluate the incidence and classification of feline bone marrow disorders. Bone marrow reports from 203 cats were reviewed. Blood smears, bone marrow aspiration smears, bone marrow core biopsy specimens, and case records were reviewed for all cats with the exception of those bone marrows reported to be nondiagnostic or cytologically normal. Bone marrows with nonneoplastic/nonmyelodysplastic pathologic changes (n=96) were subclassified into 16 categories. Frequently observed disorders included erythroid hyperplasia, nonregenerative immune-mediated anemia, pure red cell aplasia, aplastic anemia, bone marrow necrosis, myelofibrosis, and lymphocytosis. Dysmyelopoiesis (n=27) was subcategorized into myelodysplastic syndromes (n=20) and secondary (n=7) dysmyelopoiesis. Thirty-four cases of acute leukemia, 3 cases of chronic lymphocytic leukemia, and 14 cases of other neoplasia were identified. These results indicate that a relatively small group of disorders account for the majority of the feline bone marrow disorders. Routine evaluation of blood and bone marrow aspiration smears and core biopsy specimens is needed for proper classification of bone marrow disorders. Ancillary testing, including flow cytometry and immunophenotyping, are useful in some circumstances.These experiments comply with the current laws of the USA     

Value of bilateral bone marrow biopsy specimens in non-Hodgkin''s lymphoma.

A study of 260 patients with non-Hodgkin's lymphoma (NHL) who underwent bilateral bone marrow biopsy at initial diagnosis showed marrow disease in 99 (38%) cases. The highest incidence of disease (83%) was seen in small lymphocytic lymphoma (SLL) and the lowest (19%) in diffuse large cell lymphoma (DLCL). Among cases with positive marrows, disease was bilateral in all 15 cases of SLL but in only 10 of 20 (50%) of the DLCL cases. In 30 of 99 (30%) positive marrows disease was unilateral. Follicular lymphomas were strongly associated with a paratrabecular pattern, with 40 of 45 positive cases showing this. Discordant histology was seen in six of 20 positive cases of DLCL and two of 37 positive cases of follicular small cleaved cell lymphomas (FSCCL). A bone marrow aspirate was positive in only 56 of the 99 (57%) cases. Peripheral blood disease was present in 15% of the bone marrow positive cases and in 6% of the cases overall. The incidence of marrow disease varies with the histological subtype of lymphoma. The paratrabecular pattern is associated with follicular lymphoma, and bilateral biopsy specimens increase the positivity rate in most subtypes of NHL.     

Emboli in bulls killed in Spanish traditional bullfighting

The finding of brain tissue fragments in blood and lungs of cattle stunned in slaughterhouses has raised concerns about food safety in the context of the bovine spongiform encephalopathy epidemic. In the present study, the possible occurrence of brain tissue emboli in animals killed in traditional Spanish bullfighting was investigated. Thorough histological analysis of multiple possible target organs was carried out in 434 bulls. No evidence of brain tissue embolism was obtained, but emboli from diverse sources were detected in pulmonary and hepatic tissue of a significant number of animals. These emboli seem to have been caused by the use of a long sword, which extensively disrupts intra-thoracic and intra-abdominal organs and vascular structures.     

Increased angiogenesis in the bone marrow of HIV-positive patients with myelodysplasia

AIM: Little is known about the significance of angiogenesis in the bone marrow of HIV-positive patients with myelodysplastic features (MDF). However, this process has been associated with the pathogenesis of primary myelodysplastic syndromes (MDS). The aim of the study was to investigate angiogenesis in the bone marrow of HIV-positive patients. METHODS: Bone marrow biopsies from 28 HIV-positive patients were immunostained for factor VIII and the microvessel density (MVD) was quantitatively evaluated and compared with that of 32 biopsies from patients with primary MDS and to 18 control bone marrows from patients with no evidence of bone marrow disease. RESULTS: Bone marrow MVD in HIV-positive patients was similar to that of MDS. However, both groups revealed significantly higher MVD counts compared to those of control bone marrows (MDF vs controls P=0.022, MDS vs controls P=0.001). CONCLUSIONS: Bone marrow from HIV-positive patients with MDF reveals similar microvessel counts compared to those with primary MDS, although both differ significantly from that of control bone marrow. Elucidation of the mechanisms underlying bone marrow angiogenesis in HIV-positive patients, may provide further insights into the pathobiology of AIDS and might be of value for the development of new therapeutic strategies for this disease.     

Persistence of inhibitory activity against normal bone-marrow cells during remission of acute leukemia.

Bone-marrow cells from patients with acute leukemia in remission were tested for their capacity to produce a substance (leukemia-associated inhibitory activity, LIA) that inhibits the formation of granulocyte and macrophage colonies in cultures of normal, but not of leukemic, bone marrow. LIA was detected in extracts of whole marrow in only eight of 83 patients in remission. However, extracts of slowly sedimenting cells, separated by velocity sedimentation from the marrows of eight patients in remission whose whole marrow had produced no LIA, produced inhibitory material in all cases. Extracts of the more rapidly sedimenting cells from these marrows contained an inactivator of LIA. Three of six patients in remission whose unfractionated marrow was unresponsive to LIA had a subpopulation of colony-forming cells that was sensitive to the inhibitor. These observations suggest that certain cellular functions dot not completely return to normal during remission of acute leukemia.     

Morphological Features and Physical Analysis of Causative Factors

Materials from 213 autopsy cases collected by the Pathology Team of the Special Committee for Investigation of Effects of Atomic Bombs, the National Science Council of Japan, were reviewed and sequence of the events, especially in the bone marrow from cases dead between a few days and 120 days after the exposures, was discussed in the light of newer knowledges in radiation pathology. The regeneration of the hematopoiesis in the irradiated bone marrows appeared to initiate from some surviving differentiated marrow cells and not from the so-called stem cells. Distorsion of the bone-marrow structures may have some bearing to abnormal regeneration, hyperplasia and neoplasia of the marrow elements.     

Fat embolism syndrome: Clinical and imaging considerations: Case report and review of literature

Fat embolism syndrome (FES) is a serious clinical disorder occurring after trauma, orthopedic procedures and rarely in non-traumatic patients. Fat emboli develop in nearly all patients with bone fractures, but they are usually asymptomatic. Small number of patients develop signs and symptoms of various organ system dysfunction due to either mechanical obstruction of capillaries by fat emboli or due to hydrolysis of fat to fatty acids. A triad of lung, brain and skin involvement develop after an asymptomatic period of 24 to 72 hours. This symptom complex is called FES. The incidence reported is up to 30%, but many mild cases may recover unnoticed. Diagnosis of fat embolism is clinical with nonspecific, insensitive diagnostic test results. Treatment of fat embolism syndrome remains supportive and in most cases can be prevented by early fixation of large bone factures. Here we report two cases of traumatic fat embolism, which were diagnosed initially by Gurd''s criteria and subsequently confirmed by typical appearance on magnetic resonance imaging (MRI) of the brain in these patients. These patients were successfully treated with supportive management. In conclusion, diagnosis of FES needs high index of suspicion, exclusion of other conditions and use of clinical criteria in combination with imaging. Magnetic resonance imaging of the brain is of great importance in diagnosis and management of these patients.