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Childhood lymphoma: Diagnostic accuracy of chest radiography for severe pulmonary complications
Introduction: We sought to determine whether chest radiography can be reliably used to distinguish persistent or relapsing pulmonary lymphoma from a variety of infectious and noninfectious pulmonary conditions that can occur in children receiving treatment for lymphoma.
Methods: We studied chest radiographs of 37 patients (30 with non-Hodgkin's lymphoma, and seven with Hodgkin's disease) who died of paediatric lymphoma or of treatment complications. Pulmonary findings at autopsy comprised lung tumour (
n=14), pleural tumour (
n=12), pneumonia (
n=22), adult respiratory distress syndrome (ARDS;
n=16), haemorrhage (
n=27), and infarction (
n=13). Using a 4-point scale and without knowledge of autopsy findings, three radiologists independently rated antemortem radiographs for the presence of pulmonary tumour, pleural tumour, pneumonia in general, pneumonia caused by viral, bacterial, fungal, and protozoan pathogens, ARDS, pulmonary haemorrhage, and pulmonary infarction. Diagnostic accuracy was defined by the area under the receiveroperating-characteristic curve (A
z).
Results: Diagnostic accuracy was good for pulmonary tumour (A
z, 0.71±0.6), protozoan pneumonia (A
z, 0.77±0.06), and ARDS (A
z, 0.86±0.07) but poor for all other conditions. The absence of both pleural effusions and mediastinal/right hilar lymphadenopathy was significantly associated (
Pâ€0.04) with the absence of lung tumour.
Discussion: The pulmonary processes in these patients can all demonstrate diffuse airspace opacification, and many patients had multiple lung abnormalities at autopsy. The radiologist-readers were unable to identify which pulmonary conditions were responsible for radiographic findings in most patients. The readers were able to identify patients who did not have pulmonary lymphoma. If pulmonary involvement with lymphoma is unlikely, bronchoscopy with bronchoalveolar lavage may be sufficient to establish a diagnosis. When pulmonary lymphoma is a clinical consideration, open lung biopsy is usually required for diagnosis
Planktivory and diet-overlap of densely rakered whitefish (Coregonus lavaretus (L.)) in a subarctic lake
ALK expression in extranodal anaplastic large cell lymphoma favours systemic disease with (primary) nodal involvement and a good prognosis and occurs before dissemination
AimsâIn anaplastic large cell lymphoma (ALCL), the site of origin has been described as an important prognostic factor. Recently, a fusion protein containing anaplastic lymphoma kinase (ALK) was described in systemic nodal ALCL, and shown to be associated with a good prognosis. The aims of this study were to investigate whether the presence of ALK protein differs between ALCL of different sites of origin; to determine whether ALK expression occurs before dissemination to other sites; and, finally, to investigate whether the site of origin remains a prognostic parameter in ALK negative ALCL. MethodsâALK expression, as detected by immunohistochemistry using the monoclonal antibodies ALK1 and ALKc, was studied in 85 ALCLs from different sites of origin. In 22 patients, ALK expression was studied in multiple biopsies from different sites (including 13 skin, 16 lymph node, and nine other). Overall survival time was analysed using the Kaplan Meier method. ResultsâALK expression was found in 20 of 51 systemic ALCLs with (primary) nodal involvement. No ALK expression was found in 15 primary cutaneous, 14 gastrointestinal, and five nasal ALCLs. Multiple and subsequent biopsies of patients showed ALK expression to be identical to that seen in the primary diagnostic biopsy. Kaplan Meier survival curves showed that in ALK negative ALCLs originating from different sites, primary cutaneous cases are associated with an excellent overall survival, whereas the other cases show a comparable five years survival of less than 40%. ConclusionsâIf present, ALK expression favours systemic ALCL with (primary) nodal involvement, and can be used in differentiating between extranodal involvement of systemic (nodal) ALCL and primary extranodal ALCL. ALK is expressed consistently in multiple biopsies of a given patient, indicating that the chromosomal abnormality leading to aberrant ALK expression occurs before dissemination to other sites. Finally, in ALK negative non-cutaneous ALCLs, different sites of origin show comparable poor survival. Key Words: anaplastic large cell lymphoma âą extranodal âą anaplastic lymphoma kinase âą surviva
Parasitological and immunological diagnoses of strongyloidiasis in immunocompromised and non-immunocompromised children at UberlĂąndia, state of Minas Gerais, Brazil DiagnĂłstico parasitolĂłgico e imunolĂłgico da estrongiloidĂase em crianças imunodeprimidas e imunocompetentes na cidade de UberlĂąndia, MG, Brasil
Parasitological and immunological diagnoses were part of a study conducted among 151 children, 83 immunocompromised (IC) and 68 non-immunocompromised (non-IC) aged from zero to 12, seen at the University Hospital, Universidade Federal de UberlĂąndia, State of Minas Gerais, Brazil, from February, 1996, to June, 1998. Three fecal samples from each child were analyzed for the parasitological diagnosis by Baermann-Moraes and Lutz methods. The immunological diagnosis to detect IgG and IgM antibodies was carried out by the indirect immunofluorescence antibody test (IFAT) with cryo-microtome sections of Strongyloides stercoralis and Strongyloides ratti larvae as antigens and by the ELISA test with an alkaline extract of S. ratti as the antigens. Of the 151 children 5 (3.31%) were infected with larvae of S. stercoralis (2 cases IC, 2.41%, and 3 cases non-IC, 4.41%). The IFAT-IgG detected 7 (8.43%) serum samples positive among IC, and 2 (2.94%) cases among non-IC. The ELISA-IgG test detected 10 (12.05%) serum samples positive among IC, and 1 (1.47%) case among non-IC. The IFAT-IgM detected 6 (7.22%) positive cases among IC, and 3 (4.41%) cases among non-IC. ELISA-IgM test detected 10 (12.05%) positive cases among IC, and 3 (4.41%) cases among non-IC. It was concluded that the immunological tests can help in the diagnosis of strongyloidiasis in immunocompromised children.<br>O diagnĂłstico parasitolĂłgico e imunolĂłgico da estrongiloidĂase foi realizado em 151 crianças (83 imunodeprimidas -ID e 68 imunocompetentes -IC) de zero a 12 anos de idade internadas no Hospital de ClĂnicas da Universidade Federal de UberlĂąndia, Minas Gerais, Brasil, no perĂodo de fevereiro de 1996 a junho de 1998. Para o diagnĂłstico parasitolĂłgico trĂȘs amostras de fezes de cada indivĂduo foram processadas pelos mĂ©todos de Baermann-Moraes e de Lutz. O diagnĂłstico imunolĂłgico para a detecção de anticorpos IgG e IgM foi realizado atravĂ©s das reaçÔes de imunofluorescĂȘncia indireta (RIFI) utilizando-se como antĂgeno cortes de 4 micra de larvas filariĂłides de Strongyloides stercoralis e Strongyloides ratti e do teste ELISA utilizando-se como antĂgeno extrato alcalino de larvas de S. ratti. Das 151 crianças, 5 (3,31%) estavam infectadas com S. stercoralis (2 casos ID, 2,41% e 3 casos IC, 4,41%). A RIFI- IgG detectou 7 (8,43%) amostras de soros positivas nas ID, e 2 (2,94%) nas IC. O teste ELISA-IgG detectou 10 (12,05%) amostras de soros positivas nas ID, e 1 (1,47%) nas IC. A RIFI-IgM detectou 6 (7,22%) casos positivos nas ID, e 3 (4,41%) nas IC. O teste ELISA-IgM detectou 10 (12,05%) casos positivos nas ID e 3 (4,41%) nas IC. Concluiu-se que os testes imunolĂłgicos podem contribuir para o diagnĂłstico da estrongiloidĂase em crianças imunodeprimidas
Immunophenotypic identification of possible therapeutic targets in paediatric non-Hodgkin lymphomas: a children's oncology group report
Childhood non-Hodgkin lymphomas in the United Kingdom: findings from the UK Children's Cancer Study Group.
A cytotoxic phenotype does not predict clinical outcome in anaplastic large cell lymphomas.
AIM: To investigate whether anaplastic large cell lymphomas (ALCL) expressing cytotoxic proteins have a relatively worse clinical outcome compared with ALCL lacking a cytotoxic phenotype. METHODS: 59 primary cases of ALCL originating from different sites were investigated by immunohistochemistry for the presence of the cytotoxic proteins T cell intracytoplasmic antigen (TIA-1) and granzyme B in the neoplastic cells. Since site of origin and expression of anaplastic lymphoma kinase (ALK) strongly influence prognosis, the presence of a cytotoxic phenotype was also investigated in relation to the primary site of origin (lymph node, gut, or skin) and ALK expression. The prognostic value was investigated by analysis of overall and relapse-free survival time, including Cox regression analysis. RESULTS: 39 of 59 ALCL (66%) appeared to have a cytotoxic phenotype as shown by expression of TIA-1 or granzyme B or both in the neoplastic cells. The presence of a cytotoxic phenotype did not have any influence on prognosis. Even when the survival data were corrected for site of origin and stage at presentation or were analysed separately for ALK positive and negative cases, no prognostic influence of a cytotoxic phenotype was observed. CONCLUSIONS: In primary biopsies of patients with ALCL, the presence of a cytotoxic phenotype is not related to clinical outcome of the disease