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Clinical Laboratory Techniques↗
Biomedical subjects
C A Hanson
Publications and source records attributed to C A Hanson.
A novel three-color, clone-specific fluorescence in situ hybridization procedure for monoclonal gammopathies.
We have developed a three-color cytoplasmic immunoglobulin (cIg) and fluorescence in situ hybridization (FISH) technique to detect plasma cell chromosomal aneuploidy in patients with multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), and amyloidosis (AL). Immunofluorescent-labeled antibodies to detect light chain expression and six directly labeled alpha-satellite chromosome specific enumeration probes (CEP) were used simultaneously to detect aneuploidy of the plasma cells. The six probes were specific for chromosomes 7, 9, 11, 15, 18, and X. The technique was tested in 12 consecutive patient samples (5 MM, 2 MGUS, 3 SMM, and 2 AL). Based on the alpha-satellite signals, we found trisomic clones for CEP 7 (4 of 12), CEP 11 (4 of 12), CEP X (1 of 12), CEP 9 (8 of 12), CEP 15 (7 of 12), and CEP 18 (5 of 12). Trisomic clones of at least one of the six chromosomes were present in 9 of 12 patients. We believe that this technique efficiently identifies monotypic plasma cells and permits simultaneous analysis of numeric chromosome anomalies by FISH in emerging neoplastic cells. We are in the process of applying this technique to a series of about 100 newly diagnosed monoclonal gammopathy patients.
Adult↗
Bone marrow and peripheral blood involvement in mantle cell lymphoma.
The peripheral blood smears, bone marrow aspirates and biopsies of 46 patients with mantle cell lymphoma were reviewed. The diagnosis of mantle cell lymphoma was established in all cases on extramedullary tissue samples using standard morphologic, phenotypic and molecular genetic criteria. 27/35 patients (77%) had circulating lymphoma cells (median 200%m of all circulating white blood cells; range 5-90%) identified by morphology at some point during the course of their disease. No statistical difference in survival was detected in patients with or without peripheral blood involvement. Lymphoma was identified in bone marrow aspirate specimens from 33/40 patients (83%) and in bone marrow biopsy specimens from 39/43 patients (91%). The pattern of marrow biopsy involvement was nodular (31 cases; 82%), interstitial (19 cases; 50%), paratrabecular (17 cases, 45%) and diffuse (12 cases; 32%). Although the median survival of patients with > or = 50% bone marrow involvement was 13 months, and the median survival of patients with < or = 50% was 49 months; no statistically significant differences between these small subgroups were observed. Mantle cell lymphoma frequently involves the peripheral blood and bone marrow. Its appearance is distinctive but variable, and immunophenotypic studies as well as morphologic confirmation by a biopsy of tissue other than bone marrow is still required for diagnosis.
Adult↗
Acute myeloid leukemia with minimal differentiation. A multiple parameter study.
Acute myeloid leukemia with minimal differentiation (AML-M0) is a recently described entity, and few large studies are available to characterize its clinical and pathologic features. We reviewed blood and bone marrow morphology, cytochemistry, immunophenotyping, and cytogenetics, as well as the clinical findings, of 17 patients with AML-M0. Most patients were male, with a median age of 62 years. Minimal background myelodysplastic features were identified in only 5 of 15 patients. Cytochemical stains for myeloperoxidase and alpha-naphthyl butyrate esterase were negative in the leukemic blasts of all specimens. Positivity for one or both myeloid-associated antigens, CD13 and CD33, was seen in all patients. Both CD34 and HLA-DR were positive in all tested cases. Lymphoid-associated antigens were identified in seven patients; these antigens were typically dim or weak in intensity. Terminal deoxynucleotidyltransferase positivity was seen in 14 of 14 tested patients; monoclonal anti-myeloperoxidase reactivity was seen in the blasts of 2 patients. Abnormal clonal karyotypes were found in 6 of 14 patients. Abnormalities of chromosomes 7 and 13 were the most common findings, most frequently manifested by monosomy 7 and trisomy 13. The median follow-up was 8 months. Eight patients died of their disease, three are alive with disease, and six are in first or second remission (including three patients treated with bone marrow transplantation). When narrowly defined, AML-M0 appears to be a homogeneous entity that affects older and predominantly male patients. It has no single karyotypic abnormality, but complex karyotypes with monosomy 7 and trisomy 13 are commonly found. Acute myeloid leukemia with minimal differentiation is relatively resistant to chemotherapy; however, bone marrow transplantation may provide a better outcome for eligible patients.
Adult↗
Multiple myeloma associated with diffuse osteosclerotic bone lesions: a clinical entity distinct from osteosclerotic myeloma (POEMS syndrome).
Multiple myeloma usually is characterized by the development of lytic bone lesions. Osteosclerotic myeloma is a rare entity characterized by a single or multiple osteosclerotic bone lesions and often accompanied by a demyelinating polyneuropathy. Multiple myeloma associated with widespread osteosclerotic lesions seen on radiographic studies is exceedingly rare. We describe 3 such cases and review 12 other cases described in the literature. Overall, the patients described herein had a clinical course that resembled multiple myeloma more than osteosclerotic myeloma. However, some patients had features of both diseases. Although rare, multiple myeloma should be included in the differential diagnosis of widespread osteosclerotic bone lesions.
Bone and Bones↗
Clinical correlations of immunophenotypic variations and the presence of trisomy 12 in B-cell chronic lymphocytic leukemia.
In a prospective study of 93 consecutive untreated patients with B-cell chronic lymphocytic leukemia, we examined the clinical relevance of surface immunoglobulin (sIg) heavy chain (HC) and light chain (LC) isotypes, CD11c or CD25 expression, and the presence of trisomy 12 by fluorescence in situ hybridization (FISH). Careful morphologic evaluation was performed to exclude patients with other forms of chronic lymphoid leukemias, including mantle cell lymphoma, prolymphocytic leukemia, and leukemia phase of lymphoma. In addition, clonally restricted sIg and CD5 surface determinant were expressed in all patients. Clinical presentation, including blood cell counts, clinical stage, and organomegaly, did not correlate with any of the measured variables. After a median follow-up period of 3 years, the particular HC or LC isotype or CD11c expression did not correlate with either disease progression or treatment-free survival. However, trisomy 12 and CD25 expressions were both associated with accelerated disease progression and a shorter treatment-free survival time. Our results confirm the adverse prognostic significance of trisomy 12 expression in chronic lymphocytic leukemia and suggest that CD25 expression may have an unfavorable clinical impact.
Adult↗
Acquired von Willebrand's disease due to aberrant expression of platelet glycoprotein Ib by marginal zone lymphoma cells.
A 69-year-old woman presented with splenic marginal zone lymphoma associated with acquired von Willebrand's disease (AVWD). Laboratory abnormalities included markedly decreased plasma levels of factor VIII coagulant (C) activity (VIII:C 28%), von Willebrand's factor (VWF) antigen (Ag) (vWF:Ag < 6%), and VWF ristocetin cofactor (RCo) activity (VWF:RCo, < 12%). VWF multimer analysis revealed a severe type II defect. Treatment with cryoprecipitate, high-dose gamma globulin or desmopressin given intravenously was unsuccessful. Clinical bleeding and coagulation abnormalities showed transient improvement after replacement therapy with Humate-P concentrate. The coagulation abnormalities improved partially after splenectomy and completely after subsequent chemotherapy. The neoplastic lymphocytes in the blood and spleen strongly expressed platelet glycoprotein Ib (CD42) and VWF but not other platelet-associated antigens.
Aged↗
Myelodysplastic syndrome and the patient with unexplained cytopenias.
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Anemia↗
Immunohistochemical demonstration of acid phosphatase isoenzyme 5 (tartrate-resistant) in paraffin sections of hairy cell leukemia and other hematologic disorders.
The demonstration of tartrate-resistant acid phosphatase (TRAP) activity has long been a cornerstone in the diagnosis of hairy cell leukemia (HCL). Recently a monoclonal antibody to this enzyme has been developed that can be used in an immunoperoxidase method on paraffin-embedded tissues. By using a peroxidase-labeled streptavidin biotin method, paraffin sections of B5 and formalin-fixed tissue from 86 cases of HCL (41 bone marrow, 36 spleen, 9 liver) were stained with the antibody to TRAP and compared against staining for CD20 (L26) and DBA.44 (DAKO, Carpinteria, Calif). In addition, 193 specimens (127 bone marrow, 42 lymph node, 19 spleen, 5 other) from a variety of neoplastic and nonneoplastic hematologic conditions were stained using the monoclonal antibody to TRAP. For comparison, these cases were also stained with DBA.44. In the cases of HCL, 80 of 86 specimens were immunoreactive for TRAP. While the antibody to TRAP generally stained less than 50% of the hairy cells, CD20 and DBA.44 stained 90% and 50% to 60% of hairy cells, respectively. Two of three cases of marginal zone lymphoma showed weak immunoreactivity to the TRAP antibody. Two specimens from a patient with Gaucher's disease and 8 of 13 cases of mastocytosis also showed positivity to the TRAP antibody in the macrophages and mast cells, respectively. In contrast, staining for DBA.44 was positive in 3 of 9 cases of B-cell large cell lymphoma, 1 of 4 cases of mantle cell lymphoma, and in the paraimmunoblasts of 1 of 7 cases of small lymphocytic lymphoma. Only HCL was TRAP and DBA.44 positive. This antibody to TRAP is a useful addition to the diagnosis of HCL but should be used in conjunction with CD20 and DBA.44. The use of this antibody to determine minimal residual disease after chemotherapy was not addressed.
Acid Phosphatase↗
Capillary endothelial cell tropism of PVC-211 murine leukemia virus and its application for gene transduction.
PVC-211 murine leukemia virus (MuLV) causes neurodegenerative disease following inoculation of neonatal, but not adult, mice and rats. It was previously shown that tropism for brain capillary endothelial cells (CEC) was a determinant of the viral neuropathogenicity. In this study, we demonstrate that host age-dependent replication of PVC-211 MuLV in vivo occurs in CEC in the brain as well as in other organs, such as the liver, kidney, and heart. In contrast, primary explant cultures of CEC derived from brains and livers of adult and neonatal rats could be infected by PVC-211 MuLV, suggesting that the age-dependent susceptibility was abrogated in vitro. Although CEC were generally less susceptible to MuLV-mediated gene transduction than fibroblasts, treatment of CEC with 2-deoxyglucose followed by inoculation of a PVC-211 MuLV-pseudotyped vector in the absence of heparin improved the transduction efficiency. These observations support the possibility that PVC-211 MuLV may be useful for establishing models of CEC gene transduction.
Animals↗
Effects of subtle changes in the SU protein of ecotropic murine leukemia virus on its brain capillary endothelial cell tropism and interference properties.
PVC-211 murine leukemia virus (MuLV) is a neuropathogenic variant of Friend MuLV (F-MuLV) that causes a rapidly progressive neurodegenerative disease in susceptible rodents. PVC-211 MuLV, but not the parental F-MuLV, can infect rat brain capillary endothelial cells (BCEC) efficiently, and the major determinant for BCEC tropism of PVC-211 MuLV is localized within the XbaI-BamHI fragment of the viral genome containing the 5' half of the env gene. To further dissect the XbaI-BamHI region for its effects on BCEC tropism, we constructed recombinant viruses between PVC-211 MuLV and F-MuLV and tested their infectivity on a cell line established from rat BCEC. Our results indicated that Glu116-to-Gly and Glu129-to-Lys substitutions in the background of the F-MuLV envelope SU protein were sufficient for conferring BCEC tropism on the virus. Interference studies of these viruses on Rat-1 fibroblastic cells showed that the structure of the SU protein encoded by the XbaI-BamHI region also has significant effects on their affinity for the rat ecotropic MuLV receptor. These results support the possibility that structural elements I and II of the SU protein are important determinants for virus-receptor interaction.
3T3 Cells↗
Follicular lymphoma with involvement of the splenic marginal zone: a pitfall in the differential diagnosis of splenic marginal zone cell lymphoma.
Follicular lymphomas (FL) involving the spleen arise in and expand the germinal centers of the white pulp, whereas mantle cell lymphomas arise in the mantle zone and surround the benign germinal center. The recently described marginal zone cell lymphoma (MZCL) is a B-cell neoplasm characterized by concentric expansion of cells around the follicle, with or without infiltration of the mantle zone or germinal center. In addition, the immunoglobulin heavy chain gene is rearranged although none of the MZCL reported have been shown to be positive for the bcl-2 gene translocation by molecular studies. We report a patient with FL showing preferential involvement of the marginal zone of spleen morphologically mimicking a primary splenic MZCL. The patient reported here had a well-documented previous lymph node diagnosis of FL. The immunoglobulin heavy chain gene and bcl-2 gene rearrangement analysis confirmed the clonal origin of both the original FL, as well as the lymphoma, with a marginal zone pattern in the spleen.
Base Sequence↗
Acute promyelocytic leukemia with t(15;16;17;19) and unusual fluorescence in situ hybridization pattern with PML and RARA probes.
We report a 58-year-old female with typical morphological and clinical features of acute promyelocytic leukemia in whom a complex translocation involving chromosomes 15, 16, 17 and 19 was detected using conventional cytogenetics and fluorescence in situ hybridization (FISH) with chromosome specific paints. RARA-PML fusion was not evident by FISH, but the RARA signal was split in 74.5% of cells. GTL-banding and FISH with probes for PML, RARA and chromosome 15 specific paint raise the possibility of PML-RARA fusion on the abnormal chromosome 19 in the complex translocation. The unusual PML-RARA fusion may be related to this patient's poor response to induction therapy with all-trans-retinoic acid.
Chromosomes, Human, Pair 15↗
Detection and classification of acute leukemia by the Coulter STKS Hematology Analyzer.
This study evaluated the ability of the Coulter STKS Hematology Analyzer (Coulter, Hialeah, FL) to detect and classify acute leukemias involving the peripheral blood. One hundred ten acute leukemias cases with circulating blasts were studied: 72 acute myeloid leukemias were divided into "high WBC count (> 11.0 x 10(9)/L)" (28 AML, 22 ALL) and "normal/low WBC count (< or = 11.0 x 10(9)/L)" (44 AML, 16 (ALL) categories. Most cases in the high WBC count group elicited the blast suspect flag. The remaining cases of AML and ALL in both the high WBC and normal/low WBC count group were detected by the blast flag, other suspect flags, and/or definitive flags. Only one case of AML-M6 was initially missed using these flag combinations; a subsequent analysis elicited the blast flag. The blast populations in the high WBC count group were localized into characteristic myeloblast or lymphoblast regions of the scatterplot in 82.1% of AML and 63.6% of ALL cases, respectively. However, the remaining cases had indeterminate or aberrant scatterplot patterns, such that an accurate leukemia classification was not possible. The scatterplot pattern also was not helpful in differentiating AML FAB subclasses. The authors conclude that using a combination of appropriate suspect and definitive flags to trigger checking criteria and microscopic review, the Coulter STKS Hematology Analyzer will be successful in detecting virtually all cases of acute leukemia involving the peripheral blood. Although the scatterplots may give useful information, the patterns obtained are not sufficiently distinctive to aid in classifying acute leukemias.
Acute Disease↗
Heterogeneity and clinical relevance of the intensity of CD20 and immunoglobulin light-chain expression in B-cell chronic lymphocytic leukemia.
In a prospective study, peripheral lymphocytes of 93 previously untreated patients with B-cell chronic lymphocytic leukemia (B-CLL) were evaluated with flow cytometry for the intensity of CD20 and surface immunoglobulin (sIg) light-chain (LC) expression. Molecules of equivalent soluble fluorescence were used to classify intensity of surface antigen expression as "strong," "moderate," or "weak." Despite reproducible morphological consistency with B-CLL, variability in intensity of CD20 and sIg light chain expression was substantial. CD20 intensity was classified as weak in 62% of patients, moderate in 12%, and strong in 26%. Expression of sIg light chain was weak in 76% and strong in 24%. The patients were followed up for a median of 3.1 years. Intensity of expression of CD20 and sIg light chain was not correlated with any presenting feature at the time of phenotyping, including clinical stage and degree of lymphocytosis or organomegaly. Similarly, clinical course of the disease, time to progression, response to therapy, and overall and treatment-free survival were not predictable from the intensity of CD20 or sIg light chain expression. In conclusion, bright expression of CD20 or sIg light chain is not an unusual feature in B-CLL and may not influence clinical presentation or short-term prognosis.
Adult↗
Hematologic disorders associated with deletions of chromosome 20q: a clinicopathologic study of 107 patients.
To study the pathogenetic significance of acquired del(20q), bone marrow morphology and clinical histories of 107 patients with hematologic disorders and the del(20q) were studied. In 84 cases representing myelodysplastic syndromes (47), myeloproliferative disorders (31), acute myeloid leukemia (3), pure red blood cell aplasia (2), and angioimmunoblastic lymphadenopathy with dysproteinemia (AILD-like T-cell lymphoma (1), 20q- was the sole karyotypic abnormality. The breakpoints on chromosome 20 were not constant, and in 77% of cases, only a fraction of the studied metaphases had del(20q). In 23 cases, including myelodysplastic syndromes (13), myeloproliferative disorders (6), acute myeloid leukemia (2), and autoimmune disorders (2), 20q- occurred with other cytogenetic abnormalities, including del(5q), -7, +8, 13q deletion or translocation, and +21. Despite the diagnostic heterogeneity, the bone marrow morphologic abnormalities consistently involved the erythroid precursors and megakaryocytes. 20q- is a primary cytogenetic abnormality occurring in hematologic disorders unified morphologically by dysplasia in erythroid precursors and megakaryocytes. In conjunction with other studies of disorders involving del(20q) or genes on the long arm of chromosome 20, the findings suggest that del(20q) disproportionately affects a common megakaryocytic/RBC stem cell.
Acute Disease↗
Analysis of the unique hamster cell tropism of ecotropic murine leukemia virus PVC-211.
PVC-211 murine leukemia virus (MuLV) is a neuropathogenic variant of Friend MuLV (F-MuLV). Previous studies from our laboratory demonstrated that unlike the parental F-MuLV, PVC-211 MuLV can infect rat brain capillary endothelial cells efficiently and that it has acquired genetic changes responsible for its expanded cellular tropism. To determine if PVC-211 MuLV also has expanded its host range, we tested its infectivity on Chinese hamster ovary-derived CHO-K1 cells, which are generally resistant to ecotropic MuLV. The results indicated that PVC-211 MuLV, but not F-MuLV, was highly infectious for CHO-K1 cells. Studies using glycosylation inhibitors and glycosylation mutants of CHO-K1 cells, as well as interference studies, suggested that PVC-211 MuLV has acquired the ability to interact with the ecotropic MuLV receptor on CHO-K1 cells that has undergone glycosylation-dependent modification. Using chimeric viruses between PVC-211 MuLV and F-MuLV, we were able to localize the viral genetic element crucial for CHO-K1 cell tropism within the env gene of PVC-211 MuLV and show that glycine at position 116 and lysine at position 129 of the envelope glycoprotein SU were important. These viral determinants also appear to confer tropism for other hamster cells resistant to ordinary ecotropic MuLVs. Further studies on the interaction between PVC-211 MuLV and the receptor on hamster cells may provide novel insights into the molecular mechanisms for receptor recognition and binding by viral envelope glycoproteins.
3T3 Cells↗
Spectrum of diseases associated with increased proportions or absolute numbers of peripheral blood natural killer cells.
In a retrospective review of 1501 lymphoid flow cytometric studies of peripheral blood, we identified an increased proportion of natural killer cells in 125 cases (8%), 49 (3%) of which had a concomitant increase in absolute number of natural killer cells. Of the latter, the most frequent associated disorder was chronic natural killer cell lymphocytosis. Substantial quantitative increases in natural killer cells were also observed in some patients with lymphoma, leukaemia, immune thrombocytopenic purpura, or myelodysplastic syndrome. Our study provides incidence figures and clinical associations of an increased number of natural killer cells in the peripheral blood.
Flow Cytometry↗