SYNOPSIS A patient with atypical acute leukaemia is described. This patient has, in addition, monoclonal IgG hyperglobulinaemia without myelomatous lesions and is living and well three years after diagnosis.The cell types found in the blood and in the bone marrow are atypical, and the histochemical findings are discussed.The relationship between monoclonal hypergammaglobulinaemia and malignant blood diseases is also discussed, and the literature on the subject reviewed.Recently it has become clear that monoclonal hypergammaglobulinaemia is not necessarily diagnostic of myeloma or Waldenstrom's macroglobulinaemia. Thus, it has been found in asymptomatic persons by Fine (1967) in approximately 2% of the population over 60 years of age and in 0 4% under the age of 60. This type of abnormality has been called 'benign' or 'essential idiopathic monoclonal hypergammaglobulinaemia'. It has also been described in association with different neoplastic and non-neoplastic diseases (Danon, Clauvel, and Seligmann, 1967;Fine, 1967;Hallen, 1966;and Waldenstrom, 1964).The association with malignant blood diseases is not so rare. It has been found frequently enough in chronic lymphocytic leukaemia, lymphosarcoma, reticulum cell sarcoma, and Gaucher's disease (Azar, Hill, and Osserman, 1957;Hallen, 1966;Pratt, Estren, and Kochwa, 1968 and Schwartz, 1964; Ritzmann, Stoufflet, Houston, and Levin, 1966).We have studied a patient who has an atypical form of acute leukaemia and monoclonal hypergammaglobulinaemia (IgG type A) and is living and well three years after the initial diagnosis.
Case ReportThe patient, a 63-year-old farmer, was admitted to hospital in April 1965 with the chief complaints of pain in the lower extremities aggravated by physical work and of a feeling of tickling. He also complained of loss of appetite and of weight, weakness, lassitude, and a low-grade fever in the afternoons.Physical examination showed a pale, well groomed, rather thin man. Neither the lymph nodes, liver, nor spleen were palpable. No petechiae or haematomas were seen. A complete neurological examination was unrevealing. Ar-terial pulses were found in the lower extremities.Urine analysis gave protein 0-10 %; blood urea was 0 29 %; blood cholesterol, 153 mg %(esterified 90 mg %); thymol turbidity, 7 units; ZnSO4 turbidity, 23 units; cephalin-cholesterol flocculation, 2+; prothrombin time, 13/13 sec.; total on 12 May 2018 by guest. Protected by copyright.