Primary or secondary central nervous system (CNS) involvement by marginal zone B-cell lymphoma (MZBCL) is rare. A retrospective analysis of patients was done with MZBCL involving the CNS, diagnosed and treated at our institution between 2004 and 2010. We identified 10 MZBCL patients with primary (six) or secondary (four) CNS involvement. Five patients presented with primary dural lymphoma and were treated with surgical resection, whole-brain radiation, or systemic chemotherapy. Only one patient had CNS relapse 5 years later. A single patient with primary intraocular lymphoma achieved clinical remission with ocular radiotherapy and systemic chemotherapy. Four patients had ocular MZBCL within 5 years of the initial diagnosis of primary ocular adnexal MZBCL and primary splenic MZBCL. There was no evidence of local recurrence in all but one who developed systemic relapse after 3 years of follow-up. Primary or secondary CNS involvement by MZBCL display indolent clinical behavior and have a generally favorable prognosis, underlining the importance of their differentiation from aggressive lymphomas that more commonly involve the CNS.

Plasmablastic lymphoma (PBL), initially characterized as an aggressive lymphoma arising in the jaw and oral mucosa in HIV-infected patients, was recently reported to occur with extraoral manifestations, heterogeneous histologic findings, and variable association with immunodeficiency states. We reviewed clinical, morphologic, and immunophenotypic features of 13 cases of PBL to determine whether these different subtypes represent distinct morphologic and clinical entities. Two distinct subtypes of PBL were identified and classified as oral and extraoral PBL. The oral PBLs were strongly associated with HIV infection and commonly demonstrated plasmablastic morphologic features without plasmacytic differentiation. Extraoral PBLs tended to occur in patients with underlying non-HIV-related immunosuppression and universally demonstrated plasmacytic differentiation. The patients with oral PBL demonstrated better overall survival compared with patients with extraoral PBL (P = .02). Our findings suggest that PBL with oral and extraoral manifestation represent 2 distinct clinicopathologic entities.

Blinded readers examined peripheral smears of 108 children with steady sickle cell (SC) disease and controls by counting ten 100× microscope fields and calculating percent of irreversible and reversible SC from total red cell population SC index (SCI). SCI was correlated to disease severity, and transfusion, hydroxyurea, or neither. Controls had a mean of 0.28% SC (range 0-0.64). Children with hemoglobin SS had a mean SCI of 5.12% ± 5.37 (range 0-30). SCI increased 0.33% with each increasing year (p <0.0001). Patients with SCI > 0.64 were 3.32 times as likely to experience clinical complications (p = 0.0124). Although blood transfusions and hydroxyurea decreased percent of SC, 72% treated patients had SCI >0.64, correlating with persistent sickling. This standardized method quantifies SC in peripheral smears. Percent of SC increased with age and correlated with disease severity, especially hemolytic complications, providing readily available information with minimal or no extra cost.

The sensitivity, specificity, and positive and negative predictive values for the detection of group B streptococci from Lim enrichment broth with sheep blood agar (SBA), with selective Streptococcus agar (SSA), and by a peptide nucleic acid fluorescent in situ hybridization (PNA FISH) assay were as follows: for culture on SBA, 68.4%, 100%, 100%, and 87.9%, respectively; for culture on SSA, 85.5%, 100%, 100%, and 94.1%, respectively; and for the PNA FISH assay, 97.4%, 98.3%, 96.1%, and 98.9%, respectively.Streptococcus agalactiae, which is a member of the group B streptococci (GBS), is a gram-positive bacterium that can cause invasive disease in newborns (1,2,8). The aim of this study was to compare two types of media and the peptide nucleic acid (PNA) fluorescent in situ hybridization (FISH) assay for their abilities to detect GBS from Lim enrichment broth.Two hundred fifty-one genital swab specimens were obtained over a 6-week period from pregnant women as part of their routine diagnostic evaluation (8). All swabs were collected by the clinical staff by the use of routine protocols and sterile double swabs. For this institutional review board-approved study, the following assays were performed in a blinded manner (i.e., the results from each subsequently performed assay were unavailable to the person performing the next assay).Culture on sheep blood agar (SBA) was performed by laboratory staff by the following protocol. The swab specimens (both swabs in the dual swab specimen were used) were directly inoculated onto an SBA plate (plate 1) and then into a vial of Lim selective enrichment broth (which was incubated in 5 to 10% CO 2 at 37°C). Beta-hemolytic colonies were sought the next day, and if any were present, they were subcultured for purity. At this time, the Lim broth was also subcultured onto an SBA plate (plate 2). On the following day (day 3), the cultures plates were again examined and tested to determine if they contained GBS (see below). If GBS were not found on plate 1, then suspect colonies were sought on plate 2; and if any were present, they were subcultured for purity. Any potential GBS from the purity plate that were derived from plate 2 (day 4) were tested to determine if they were GBS.The Lim broth, following the initial phase of incubation described above, was also subcultured onto group A-selective Streptococcus agar (SSA) with 5% sheep blood (no. 221780; BD, Sparks, MD). The package insert indicates that this medium also supports the growth of GBS. This subculture was incubated as described above. On the first day following incubation, beta-hemolytic colonies were sought, and if any were present, they were subcultured for purity onto SBA (and incubated in 5 to 10% CO 2 at 37°C). These were subcultured for purity onto SBA rather than SSA because in our experience the performance of the GBS latex agglutination assay has been less reliable when it is done with colonies from the SSA plates than when it is done with colonies from SBA plates (data not shown). Following another 24 h of incubati...