Abstract After initial French‐American‐British (FAB) diagnosis by a multiinstitutional Southwest Oncology Group panel, slides of acute leukemia cases were recirculated to panel members for second review. The reproducibility of the FAB classification is analyzed. The classification is reproducible in the 70% range in panel reviewer hands and allows remarkable reproducibility in the morphologic and cytochemical distinction of acute lymphoid leukemia (ALL) from acute myeloid leukemia (AML). The limitations of a morphologic and cytochemical classification of acute leukemia are discussed. A simplification of the FAB system, merging M1, M2, and M4 as M7, is proposed; this simplification improves the system's reproducibility.
The area postrema (AP) is a small, circumventricular organ located in the dorsal medulla and is characterized by an anastomosed capillary network with no blood-brain barrier. It contains the chemoreceptor trigger zone for vomiting, which is activated by noxious stimuli in the blood. Lesions to the AP produce a clinical syndrome referred to as area postrema syndrome (APS), which is characterized by intractable nausea, vomiting, and hiccups. APS manifests frequently as neuromyelitis optica spectrum disorders (NMOSD), where antibodies attack aquaporin-4 receptors, which are found in abundance in the AP. Its vascular supply is delivered by the anterior spinal artery or, at times, by small vessel branches of the vertebral artery itself. Ischemic stroke is the fifth leading cause of death in the United States; however, APS due to ischemic stroke has rarely been described. We present a case of a 62-year-old male with ischemic stroke in the cerebellum and brainstem, which produced intractable APS due to extension within his AP. He was treated with metoclopramide 10 mg four times daily and ondansetron 8 mg every eight hours, which relieved his symptoms. Recognizing that the patient's intractable nausea and vomiting was attributable to AP involvement was valuable in limiting further extraneous workup and focusing on our medical management. Ischemic stroke should be considered in the differential for APS. Given the size of the AP, thin-cut high-resolution diffusion-weighted MRI is warranted in patients with clinical APS. Recognizing that intractable nausea and vomiting may be attributable to stroke is valuable in mitigating extraneous and ineffective medical management. The patient case we describe in our report further outlines these findings.
Two cases of patients with prostatic granulocytic sarcoma in whom urinary obstruction occurred are presented. The diagnosis was made by tissue examination with hematoxylin and eosin and specific esterase stains. One patient had a myelodysplastic syndrome and the other patient had acute myeloblastic leukemia. In both cases the diagnosis of prostatic granulocytic sarcoma was unexpected. Granulocytic sarcomas should be considered in the differential diagnosis of urinary obstruction in patients with myeloperoliferative or myelodysplastic syndromes. Cancer 59:142–146, 1987.
The Pediatric Oncology Group analyzed 103 cases of childhood acute lymphocytic leukemia (ALL) with an acid phosphatase stain and with a series of immunologic markers. As reported by others, the authors demonstrated a high correlation of acid phosphatase (AP) positivity and T-ALL. However, a subset of T-ALL was acid phosphatase negative, and some non-T, non-B, non-pre-B-ALL cases were AP positive. The predictive value of the AP test was, therefore, poor as a marker of T-ALL. AP- negative T-ALL cases appeared to be a distinctive subset of TALL, and AP negativity an intrinsic characteristic of this subset, rather than a failure of the test system. AP-positive n-ALL cases demonstrated no difference from AP-negative cases and, in particular, no evidence of early T-ALL differentiation.
Sixty rat hind-limb allotransplantations across strong histocompatibility barriers were performed. Group I (isograft controls), (Lewis-Brown-Norway [LBN] to LBN) limb transplantations were performed; Group II (rejection controls), LBN limbs transplanted to Lewis rat LEW recipients with no immunosuppressive treatment; Group III (steroid group), fluocinolone acetonide (50 muml;/ml) was applied topically; Group IV (cyclosporine group), 4 mg/kg of cyclosporine was administered subcutaneously daily; Group V (combination group), combined systemic cyclosporine with topical fluocinolone acetonide was administered daily. Group II: Limb rejection was present on the fourth day. Group III: Limb survival was extended for 3 weeks with no signs of skin rejection in 75% of animals. Group IV: Rejection was complete at 3 weeks. Group V: Limbs survived to 6 weeks. Topical steroid prevented skin rejection and delayed rejection of other components of the composite allograft. Combined treatment of topical steroid and low cyclosporine doses significantly extended survival rate of limb allografts. Inceoglu S, Siemionow M, Chick L, Craven CM, Lister GD. The effect of combined immunosuppression with systemic low-dose cyclosporin and topical fluocinolone acetonide on the survival of rat hind-limb allografts. Ann Plast Surg 1994;33:57–65
