No abstract

Repeated bone marrow biopsies of 12 patients with chronic myelocytic leukemia (CML) and 13 patients with idiopathic myelofibrosis (IMF) were compared. The amount of cellularity, the composition of the cell population, and the stromal changes were assessed. Both diseases were divided into four stages, each with a consistent morphologic pattern. In CML, Stage 1 presented a tremendous increase in granulocytes and a drop of the erythroid series; Stage 2 showed a shift to myelocytes and a moderate increase of blasts; in Stage 3 there was a strong increase of blasts and the reappearance of red cells; and in Stage 4 hematopoietic cells disappeared with metastases of abnormal blasts to many organs. The stroma showed a progressive fibrosis so that by Stage 4 there was a totally fibrotic marrow. With IMF, Stage 1 presented a dysharmonic trilinear proliferation; in Stage 2 there was a maximum of cellularity, which remained trilinear; in Stage 3 there was a decrease of hematopoietic cells; and in Stage 4 these cells disappeared, but hematopoietic cells in dilated sinusoids of the empty marrow became apparent. The stroma showed a progressive fibrosis, ending by Stage 4 in a totally fibrotic marrow indistinguishable from the similar stage of CML. Careful analysis of the bone marrow biopsy findings permitted the stage of the disease and hence the prognosis to be determined; Stage 3 for CML means death within a short period of time. In clinically “acute” myelocytic leukemia, the biopsy helps to make the distinction between Stage 3 of an unsuspected CML and acute myelocytic leukemia.

Documentation of gastrointestinal lesions in Brucella infections is sparse. A case of Brucella melitensis type 3 infection accompanied by erosive lesions of the colon, observed by endoscopy and histopathologic examination, is reported. Such gastrointestinal lesions have not been described since 1934. Before 1934 only postmortem observations are recorded.

A 39-year-old Ugandan student is described presenting with general malaise, fever and a pulmonary infiltrate. Open lung biopsy showing infarction and positive ANCA lead to a diagnosis of Wegener's granulomatosis and a treatment with immunosuppressive drugs was instituted. Five weeks after admission, however, sputum cultures turned out to be positive for Mycobacterium tuberculosis. The importance of ANCA-interpretation and the possibility of false positive results is discussed.