Haemorrhagic diathesis is the commonest cause of morbidity and mortality in acute leukaemias (AL). It is most commonly due to thrombocytopenia resulting from bone marrow failure. However, in a significant number of cases, disseminated intravascular coagulation (DIC) plays an important part. Previously it was thought that this mechanism was mainly confined to acute promyelocytic leukaemia (APL), but recently it has also been reported to occur in other subtypes of acute leukaemia. We report the results of a study carried out to find the incidence of DIC in various types of AL at the time of first diagnosis and in the absence of other recognisable causes. DIC was observed in 14(13.4%) cases out of 104 cases of AL studied. Nine out of 49(18.4%) cases of AML and 5 out of 55(9.1%) cases of acute lymphoblastic leukaemia (ALL) showed coagulation abnormalities consistent with DIC. Out of the 9 cases of AML showing DIC, 63 (66.67%) belonged to APL (FAB ME) subtype. Three (60%) out of 5 cases of ALL with DIC had T‐cell immunophenotype. The results indicate that DIC may also occur in types of AL other than APL, particularly in T‐ALL, and should be looked for.
The pattern of cancer antigen (CA-125) expression by immunohistochemistry (IHC) was investigated in malignant and nonneoplastic endometrium in endometrial carcinoma. Ninety cases of primary uterine carcinomas (65 endometrioid [EM] carcinoma, 15 serous papillary [SP] carcinoma, 6 carcinosarcomas [malignant mixed müllerian tumors], and 4 clear cell carcinoma [CC]) and adjacent atrophic and/or hyperplastic endometrium were analyzed by IHC for CA-125 expression. The percentage and intensity of luminal, apical, basal, and diffuse cytoplasmic immunostaining of epithelial cells were categorized on a scale of 0-4. The immunoreaction score (IRS score) was calculated and correlated with the grade and stage of carcinoma according to the histologic type. CA-125 expression (3-4/4) was localized in apical borders of grade 1 and grade 2 EM carcinoma and was weak or negative (0-1/4) in grade 3 EM. Mucinous differentiation in EM was associated with intense luminal and apical staining. Squamous areas and stroma showed no staining at all. SP carcinoma and endometrial intraepithelial carcinoma showed much higher mean IRS score than EM. In malignant mixed müllerian tumors (MMMT), the epithelial component stained as above according to the type of epithelial cell differentiation of the neoplastic cells. Benign proliferative glands showed moderate apical luminal, basal, and cytoplasmic staining. Intense diffuse staining was observed in atypical complex hyperplasia. Different patterns of CA-125 immunostaining were observed in normal, hyperplastic, and neoplastic endometrium. IRS score correlated with the grade but not with the stage of EM carcinoma. The intense different staining pattern of endometrium with atypical complex hyperplasia suggests that CA-125 may be a useful diagnostic aid.
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