Massive sludging of leukaemic cells in blood vessels is a frequent and often lethal complication of leukaemia. In a retrospective clinicopathological study on the causes of death in 52 patients with acute myeloid leukaemia and myeloproliferative disease, pulmonary leucostasis was found in 40% of the patients. In many of these patients the vessels of the heart, brain and testes were also involved. In search for signs and symptoms specific for leucostasis, the clinical records of the 21 patients with leucostasis (the study group) were compared to those of 20 patients without leucostasis (the control group). Dysfunction of the organs most affected by leucostasis, namely lungs, heart and brain, was found more often in the study group than in the controls, but the combination of unexplained fever with cardiopulmonary and/or central nervous system failure occurred almost exclusively and in half of the patients with leucostasis. Leucostasis occurs predominantly, but not exclusively, in patients with high leucocyte counts, and especially, but again not exclusively, when the leucocyte counts rise sharply.

A case ofangiotropic large cell lymphoma is reported in which the patient presented with only pulmonary symptoms. It suggests that this rare and highly malignant lymphoma should be considered in the differential diagnosis of interstitial lung disease, and shows the value of open lung biopsy in unexplained interstitial lung disease. This patient responded well to treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone.Angiotropic large cell lymphoma is a rare disease characterised histologically by proliferating mononuclear cells within the lumen of capillaries, venules, arterioles, and small arteries.' Originally described in cutaneous small vessels,4 later reports have shown that various organs may be affected, especially the nervous system and adrenal glands.5Previously angiotropic large cell lymphoma was known as "malignant angioendotheliomatosis" presuming an endothelial origin of the tumour cells; but recent studies using cell surface markers suggest a lymphoid origin,236 and the terms angiotropic large cell lymphoma3 and malignant intravascular immunoblastic lymphoma7 have been suggested. We report a case presenting with pulmonary symptoms. Case reportA 56 year old woman, an insulin dependent diabetic, was admitted to hospital because of persistent fever over the preceding week, progressive exertional dyspnoea, a nonproductive cough, and malaise. Two years earlier she had had pancreatitis during a period of alcohol abuse, but she had since abstained from alcohol. Until the onset of fever she had been well. There were no complaints of weight loss, skin lesions, disorientation, arthralgia, pruritis, or nocturnal sweats. Ske kept a parakeet and a cat and had no known allergies. Her only treatment was insulin.Physical examination showed that she had a fever of 39°C and bilateral fine inspiratory rales at the bases of both lungs. No lymphadenopathy or hepatosplenomegaly was detected.The erythrocyte sedimentation rate was 45 mm in the first hour and the white blood cell count 4-8 x 109/1, with 57% segmented neutrophils, 17% band neutrophils, 18% lymphocytes, 3% monocytes, 1% myelocytes, 2% eosinophils, and 1% basophils. Arterial blood gas analysis showed the

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A series of testicular germ cell tumours (46 seminomas and 27 non-seminomas) was studied immunohistochemically with regard to the presence of alpha FP and HCG. In three seminomas, HCG reactive syncitiotrophoblast-like giant cells (STLG) were found. Immunoreactive alpha FP did not occur in seminomas. In differentiated mature teratomas HCG or alpha FP could not be demonstrated. In embryonal carcinomas with or without teratoma (MTI/MTU/MTT) HCG immunoreactivity was found in 83%, usually localized in STLG. In 75% of these tumours alpha FP could be demonstrated. This protein was localized in foci of endodermal sinus or yolk sac differentiation, but also in single cells and cell clusters in areas of embryonal carcinoma. In some cases syncitial cells were present which contained both HCG and alpha FP. Immunostaining of tumour markers appeared not to provide important additional criteria for classification of these tumours in the currently available classifications. The significance of HCG containing STLG in seminomas deserves further investigation. Prospective studies of embryonal carcinoma with or without teratoma (MTI/MTU/MTT) will be necessary to evaluate the possible prognostic importance of the presence of alpha FP or HCG or both.

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