Pituitary apoplexy. Association of degenerative change in pituitary adenoma with radiotherapy and detection by cerebral computed tomography

tachycardia

Congestive

Arrhythmias failure

Heart block cardiac Pericardial

effusion

Blast crisis

gran-

Erythroblastic transformation of chronic granulocytic leukemia was found in seven of 67 unselected patients with blast crisis. This morphologic picture of erythroblastic transformation was indistinguishable from that in erythroleukemia or Di Guglielmo’s syndrome. The median survival of the patients with erythroblastic transformation was two months, considerably less than the four-month median survival in the entire series of 67 patients. Only two brief partial remissions were obtained with combination chemotherapy. The causes of death were primarily hemorrhage and infection, related to thrombocytopenia and neutropenia. In this regard, the patients with erythroblastic transformation resembled all the patients with blast crisis and patients with acute leukemia in general. The erythroblastic transformation seems to represent a morphologic variant of chronic granulocytic leukemia blast crisis, without apparent prognostic or therapeutic implications.

of chronic

transformation

transformation

Erythroblastic

chromosome

Rosenthal S, Canellos GP, Gralnick HR: Erythroblastic ulocytic leukemia. Am J Med 63: 116-124, 1977.

leukemia

Philadelphia

Chronic granulocytic

Certain clinical and morphologic observations in 35 necropsy patients with cardiac sarcoidosis, and in 76 previously described necropsy patients with cardiac sarcoidosis are described. Of the 89 patients with cardiac dysfunction from cardiac sarcoid, death was sudden in 60, secondary to progressive congestive cardiac failure in 20, from recurring pericardial effusion in three and from other or unknown causes in six. Other than premature ventricular beats, ventricular fachycardia was the most common arrhythmia (17 patients) and complete heart block was the most common conduction disturbance (25 patients). Complete bundle branch block occurred in 21 patients. Ventricular aneurysm (eight patients) and papillary muscle dysfunction (possibly 16 patients) were other cardiac disturbances observed. Although coriicosteroid therapy tends to cause fibrous replacement of myocardial sarcoid granulomas. a possible consequence of this medication is the development of ventricular aneurysm.

Roberts WC, McAllister HA Jr, Ferrans VJ: Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group I) and review of 78 previously described necropsy patients (group II). Am J Med 63: 86-108, 1977.

Ventricular

Granulomas computed

tomography

Pituitary adenoma Cerebral

necrosis

change in pituitary adetomography. Am J Med

CCT scan

Hemorrhagic

dehydrogenase

stem cells

Chronic myelocytic Leukemogenesis

leukemia

Glucose-6-phosphate dehydrogenase (G-6-PD) isoenzyme levels were determined in eight women with chronic myelocytic leukemia (CML). The patients were heterozygous at the X-linked G-6-PD locus, so that both isoenzymes were found in normal cells, but only one GG-PD type was found in CML granulocytes. The fact that such single-enzyme phenotypes are found in CML granulocytes, but not in nonleukemic granulocytes provides strong evidence that the disease has clonal origin. Single-enzyme phenotypes were also found in erythrocytes, platelets and cultured blood macrophages indicating that a common stem cell for these ceils is the site of the abnormality. Clonal origin indicates that either the leukemia arises as a consequence of a rare initial event in a single cell, or a series of events occurs in a clone such that it evolves into CML. or both.

Fialkow PJ, Jacobson RJ, Papayannopoulou T: Chronic myelocytic leukemia: clonal origin in a stem cell common to the granulocyte, erythrocyte, platelet and monocyte/ macrophage. Am J Med 63: 125-130, 1977.

Hematopoietic

Glucose-L-phosphate

In 14 of 300 patients with pituitary adenoma, apoplexy developed with pathologic evidence of hemorrhagic necrosis and cystic change in the tumor. In five patients, apoplexy was the initial manifestation; in eight patients, it was associated with radiotherapy. In 12 other patients with pituitary tumors, sudden clinical deterioration occurred: they had predominantly cystic tumors with minor foci of hemorrhagic necrosis. In five patients, this was associated with radiotherapy. Degenerative hemorrhagic, necrotic and cystic changes occur frequently in pituitary tumors and radiation may be potentially dangerous in these cases. To avoid precipitating episodes of sudden visual and neurologic deterioration, prior aspiration and biopsy may be performed through transphenoidal approach in those with intrasellar tumors, whereas in those with extrasellar tumors, cerebral computed tomographic scan may define pathologic features of the pituitary adenoma.

Weisberg LA: Pituitary apoplexy. Assocration of degenerative noma with radiotherapy and detection by cerebral computed 63: 109-I 15. 1977.

Pituitary tumor

Pituitary apoplexy