A 65-year-old man with marked leukocytosis was admitted for diagnosis and treatment. His peripheral blood leukocyte count was 37,500/microliters and the leukocytes consisted of mature neutrophil-like cells. A high neutrophil alkaline phosphatase score and a normal bone marrow cell karyotype suggested that the patient had chronic neutrophilic leukemia rather than chronic myeloid leukemia. Several neutrophil functions, such as superoxide production, nitroblue tetrazolium reduction activity, and phagocytosis, were elevated. These data and the morphological features (toxic granules and Döhle bodies) indicated that the patient's neutrophils were in an activated stage.
Hypercalcemia occurred in a patient with non-Hodgkin's (B-cell type) lymphoma when generalized lymphadenopathy developed. Despite low normal plasma parathyroid hormone (PTH), nephrogenous CAMP (NcAMP) was not suppressed, and serum and urine PTH-related protein (PTH-rP) levels were elevated. The plasma level of 1,25(OH)2D was within normal range. The combined chemotherapies successfully reduced the tumor size, serum Ca, PTH-rP, and lactic dehydrogenase. Serum osteocalcin was suppressed while the patient was hypercalcemic, and increased after chemotherapy. In the extract of the tumor tissue obtained post mortem, bioactivity stimulating the production of CAMP in osteoblasts was demonstrated along with the immunoreactive PTH-rP. This is the first report of a B-cell lymphoma producing PTH-rP and its association with humoral hypercalcemia of malignancy. (Internal Medicine 31: 968-972, 1992)
A patient with acute myelomonocytic leukaemia (M4 subtype) with pericentric inversion of chromosome 16, inv(16)(p13q22), and a marked basophilia is described. Results from transmission electron microscopy suggested that the basophils were immature. Clinically, although leukaemic cells had a tendency to infiltrate a number of tissues and organs, such as skin, gingiva, liver and lung, the patient was successfully treated with chemotherapy. The increase in basophils accompanied by marrow eosinophilia may be the result of abnormal differentiation of leukaemic cells that have the capacity to differentiate into both the eosinophilic and basophilic pathways.
A 71-year-old woman with leukocytosis was admitted for treatment of malignant lymphoma. During the clinical course, neutrophilia of unknown origin occurred in parallel with the progression of the malignant lymphoma. The supernatant of lymphoma tissue culture contained a high titer of granulocyte colony-stimulating factor (G-CSF), and lymphoma cells were positive when immunohistochemically stained by anti-G-CSF antibody. Western blot analysis and mouse colony assay of the supernatant also confirmed that the lymphoma produced G-CSF.
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