Visceral leishmaniasis is infrequently reported in renal transplant recipients. A 40-year-old renal transplant recipient developed hepatosplenomegaly and pyrexia of unknown origin 5 months after transplantation. Visceral leishmaniasis was confirmed on bone marrow examination. The usual dose of antiparasitic therapy with stibogluconate sodium failed to eradicate Leishmania donovani. High-dose conventional therapy with stibogluconate sodium for an extended period of time was successful in the treatment of a relapse of leishmaniasis.

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Macrophage activation syndrome (MAS) is a clinical syndrome caused by an excessive proliferation of T lymphocytes and well-differentiated macrophages; an entity distinct from malignant histiocytosis. Although rheumatologic conditions are the common cause of MAS, a wide range of infections are also seen to cause MAS. We report an adolescent with severe Plasmodium falciparum malaria and MAS. He fulfilled six out of eight criteria required to diagnose hemophagocytic lymphohistiocytosis.

Context.—Advances in information technology have made electronic systems productive tools for pathology report generation. Structured data formats are recommended for better understanding of pathology reports by clinicians and for retrieval of pathology reports. Suitable formats need to be developed to include structured data elements for report generation in electronic systems. Objective.—To conform to the requirement of protocol-based reporting and to provide uniform and standardized data entry and retrieval, we developed a synoptic reporting system for generation of bone marrow cytology and histology reports for incorporation into our hospital information system. Design.—A combination of macro text, short preformatted templates of tabular data entry sheets, and canned files was developed using a text editor enabling protocol-based input. The system is flexible and has facility for appending free text entry. It also incorporates SNOMED coding and codes for teaching, research, and internal auditing. Results.—This synoptic reporting system is easy to use and adaptable. Features and advantages include pick-up text with defined choices, flexibility for appending free text, facility for data entry for protocol-based reports for research use, standardized and uniform format of reporting, comparable follow-up reports, minimized typographical and transcription errors, and saving on reporting time, thus helping shorten the turnaround time. Conclusions.—Simple structured pathology report templates are a powerful means for supporting uniformity in reporting as well as subsequent data viewing and extraction, particularly suitable to computerized reporting.

Midkine (MK) was originally cloned as a product of a retinoic acid-responsive gene. The rationale for studying MK expression is based on previous reports showing that it transforms 3T3 cells, and that it acts as an autocrine growth factor in Wilm's tumors, and that its overexpression has been associated with worse outcome in bladder carcinoma. Besides bladder carcinoma, its expression was reported in various solid tumors. We investigated the expression of MK protein and/or MK gene in biopsied specimens from 40 patients with primary malignant lymphoma, 21 with Hodgkin's disease (HD) and 19 with non-Hodgkin's lymphoma (NHL). Reed-Sternberg (R-S) cells were stained positive in 10 of 16 HD cases evaluated by immunohistochemical method, whereas 18 of 19 NHL cases did not stain, and one B-cell NHL stained weakly positive. Immunostaining analysis was extended to established cell lines and to normal lymphocytes with or without lectin stimulation or with EB virus transformation. Among hematopoietic cells examined, erythro- or megakaryoblastic leukemia cell lines (K562, MEG-01 and UT7) were positive, while normal lymphocytes (except the EB virus-transformed one) and most myeloid and lymphoid cell lines (except Raji cells) were negative. On the contrary, solid tumor cell lines showed high and strongly positive staining including cell lines derived from of lung gastric, colon, and a pancreatic cancer. Using semi-quantitative reverse transcription polymerase chain reaction (RT-PCR), which is suitable for the detection of weakly expressed mRNA, the relative ratio of MK mRNA to beta-actin mRNA of samples was measured and compared in cases where RNA was available. The mean values of relative ratio (MK/beta-actin) of HD were almost twice as those of NHL samples, peripheral blood T cells, and spleen B cells. Our findings showed that MK is expressed in Reed-Sternberg cells of HD, and that MK might play a role in the pathogenesis of HD.