Vesiculobullous variant of adult T-cell leukemia/lymphoma in a Caribbean Émigré

Adult T-cell leukemia/lymphoma (ATLL) results from human T-cell lymphotropic virus (HTLV) type I infection and may present as a diverse array of cutaneous findings. Often these clinical manifestations are non-specific and overlap significantly with cutaneous T-cell lymphoma (CTCL). However, it is exceedingly rare for a patient suffering from ATLL to develop vesicular or bullous pathology and only a handful of such cases have been reported in the literature. The authors describe a patient of Jamaican descent afflicted with ATLL who developed an impressive vesiculobullous eruption. This case provides further support of the near complete clinical overlap between ATLL and CTCL. Patients from HTLV endemic areas with consistent clinical manifestations should have viral serologies drawn as the treatment and prognosis of ATLL and CTCL differ greatly.     

Abortifacient Potential of Aqueous Extract of Senna alata Leaves in Rats

Objective To study the abortifacient activity of aqueous extract of Senna alata leaves in female Wistar rats.Methods Pregnant rats weighing 143.65 ± 13.11 g were completely randomized into 5 groups（A-E）.Rats in group A（negative control） were orally administered,once daily with 0.5 ml of distilled water on days 10-18 post-coitum while those in groups B,C,D,and E were treated exactly like the negative control except they received the same volume containing 2.85 mg/kg body weight of mifepristone（group B,reference drug）,250,500 and 1 000 mg/kg body weight of the extract respectively（groups C-E）.Results Phytochemical screening of the extract showed positive results for saponins（1.22%）,flavonoids（1.06%）,cardiac glycosides（0.20%）,cardenolides and dienolides（0.18%）,phenolics（0.44%） and alkaloids（0.52%）.Respiratory distress,salivation,diarrhoea,changes in the appearance of hair as well as maternal mortality were not observed at any time during the exposure period except in the mifepristone-treated animals where there was episode of diarrhoea and tiredness.The extract significantly reduced（P〈0.05） the number of life foetus,weight and survival ratio of the foetus,numbers of implantations and Corpora lutea,implantation index,progesterone,prolactin,estradiol,follicle stimulating and luteinizing hormones whereas the number of dead foetus,number and percentage of rats that aborted,percentage vaginal opening,resorption index,pre-and post-implantation losses increased significantly.In addition,mifepristone-treated animals produced resorption index that compared well with the distilled water control.There was also no dead or life foetus and serum progesterone concentration was increased in the animals treated with mifepristone.All cases of abortion were accompanied with vaginal bleeding.Although,the final weight of the rats increased significantly,the feed and water intake were not significantly altered in all the treatment groups.The weight of the uterus,uterine-body weight ratio,length of the right uterus horn and uterine cholesterol decreased significantly in all the treatment groups.The uterine alkaline phosphatase activity and glucose concentration increased in only the extract-treated animals whereas mifepristone decreased the uterine alkaline phosphatase activity and glucose content of the animals.Conclusion This study has provided evidence to the age-long claim of S.alata leaves in ＂washing the uterus＂.The abortifacient properties were most pronounced at 500 and 1 000 mg/kg body weight of the extract and were similar to the animals treated with 2.85 mg/kg body weight of mifepristone.Hormonal influence,changes in implantation site,estrogenicity and uterogenicity are suggested as possible mechanism of abortifacient activity of aqueous extract of S.alata leaves.Overall,the extract may be used as an abortifacient especially at 500 and 1 000 mg/kg body weight and therefore not safe for consumption as oral remedy during pregnancy.     

RUNX1 amplification in AML with myelodysplasia‐related changes and ring 21 chromosomes

Ring 21 is an unstable structural abnormality of chromosome 21 that can lead to RUNX1 gene amplification. We present a unique case with a carrier patient of a constitutional ring chromosome 21 (partial monosomy and trisomy 21) with dysmorphic features and congenital malformations phenotype, who developed acute myeloid leukaemia with myelodysplasia‐related changes and two ring 21 chromosomes with RUNX1 amplification. The patient's constitutional ring 21 chromosome showed alterations in tumour suppressor genes, and oncogenes, but not in RUNX1. RUNX1 gene expression at acute myeloid leukaemia diagnosis, showed no upregulation, so other genes may also be the genetic amplification targets in this patient. Copyright © 2016 John Wiley & Sons, Ltd.     

Inter‐ and intra‐patient clonal and subclonal heterogeneity of chronic lymphocytic leukaemia: evidences from circulating and lymph nodal compartments

Whole exome sequencing and copy number aberration (CNA) analysis were performed on cells taken from peripheral blood (PB) and lymph nodes (LN) of patients with chronic lymphocytic leukaemia (CLL). Of 64 non‐silent somatic mutations, 54 (84·4%) were clonal in both compartments, 3 (4·7%) were PB‐specific and 7 (10·9%) were LN‐specific. Most of the LN‐ or PB‐specific mutations were subclonal in the other corresponding compartment (variant frequency 0·5–5·3%). Of 41 CNAs, 27 (65·8%) were shared by both compartments and 7 (17·1%) were LN‐ or PB‐specific. Overall, 6 of 9 cases (66·7%) showed genomic differences between the compartments. At subsequent relapse, Case 10, with 6 LN‐specific lesions, and Case 100, with 6 LN‐specific and 8 PB‐specific lesions, showed, in the PB, the clonal expansion of LN‐derived lesions with an adverse impact: SF3B1 mutation, BIRC3 deletion, del8(p23·3‐p11·1), del9(p24·3‐p13·1) and gain 2(p25·3‐p14). CLL shows an intra‐patient clonal heterogeneity according to the disease compartment, with both LN and PB‐specific mutations/CNAs. The LN microenvironment might contribute to the clonal selection of unfavourable lesions, as LN‐derived mutations/CNAs can appear in the PB at relapse.