A 19-year-old man with acute lymphoblastic leukemia (ALL) presented with 82,000 WBC/microL, 57% eosinophils, and cardiorespiratory symptoms. Lymphoblast infiltration of the meninges and testes developed without eosinophil infiltration at these sites and peripheral blood and marrow lymphoblast counts progressively increased, while blood eosinophilia disappeared. The patient's bone marrow cells had a clonal cytogenetic abnormality--t(5;14), (q?,q32)--which disappeared during remission and reappeared during disease relapse. Including this case, three patients with ALL and hypereosinophilia have had cytogenetic studies with G-banding. All three had 14q + chromosomal abnormalities and two had a similar translocation t(5,14), (q?,q32). Survival of the 26 ALL patients with hypereosinophilia reported since 1973 was similar to that of 52 age- and sex-matched historical-control patients without hypereosinophilia treated during the same time interval.

Twelve new cases of an unusual, benign vasoproliferative and inflammatory disorder of unknown etiology, angiolymphoid hyperplasia with eosinophilia (ALHE), are described and contrasted clinically and pathologically with those appearing in the literature. Only recently recognized in the United States, the disease is of singular importance because the vascular component may be confused histologically with angiosarcoma, thereby resulting in unwarranted aggressive therapeutic measures. ALHE characteristically affects adults and presents in the head and neck region as either solitary or multiple cutaneous tumors. The lesions are pruritic, frequently bleed after minor trauma, and may be associated with peripheral eosinophilia and regional lymphadenopathy. On rare occasions, the disease may masquerade as a salivary-gland tumor, cause stenosis of the external auditory canal, or present as an osseous lesion of the skull. Extrafacial tumors are uncommon. Excision is the most frequent form of therapy; however, local irradiation, corticosteroids, electrodessication with curettage, and chemotherapy have also had varying degrees of success.

Cerebrospinal fluid (CSF) eosinophilia is a rare finding most often associated with central nervous system inflammatory processes, including parasitic, bacterial, and mycotic infections. It has also been seen as an allergic phenomenon. We present two cases of CSF eosinophilia occurring concurrently with sterile shunt malfunction. We speculate that CSF eosinophilia in our patients might have resulted from an allergic response to a foreign material such as suture, surgical glove powder, hair, cotton fibers, antibiotics, or silicone rubber. The incidence of sterile CSF eosinophilia after shunting is not known. Information concerning the role of eosinophilia in the development of shunt malfunctions is also lacking. An increased awareness of this possibility and further investigation are warranted.