Abstract
A 67-year-old female was admitted to our clinic on April 15, 1976, with chief complaints of systemic lymph node swelling, skin rash and fever.
Physical examination on admission revealed anemia and hepatosplenomegaly. Laboratory examination showed a positive Coombs test, a moderate increase in titer of Toxoplasma antibody and a relative lymphocytosis with about 10% of lymphoblastoid cells in the peripheral blood. Electrophoretic analyses of the serum showed diffuse hypergammaglobulinemia without the M-component. Massive excretion in her urine of the κ-chain, λ-chain and Fc like fragments was found and daily excretion amounts were calculated to be 53 mg/day, 40 mg/day and 5 mg/day, respectively.
Biopsy of the supraclavicular lymph node on admission disclosed a proliferation of lymphoblastoid cells and plasma cells, prominence of small vessels and the deposition of an amorphous PAS-weakly-positive interstitial materials. The second biopsy of the cervical lymph node demonstrated destruction of the normal architecture with marked proliferation of lymphoblastoid cells.
Combined chemotherapy with VEP and Levamisole controlled the complaints in part, however she died of gastric bleeding on September 20, 1976.
Post mortem examination showed a decrease of lymphoblastoid cells in the lymph nodes, however, infiltration of these cells were noted in the liver, spleen, lung, suprarenal glands and bone marrow. Almost all of these cells infiltrated in the liver were confirmed to be stained with fluorescence conjugated anti-B cell serum.
From these clinicopathological findings, this case was considered similar in many ways to “immunoblastic lymphadenopathy” described by Lukes et al. Some discussions were made in connection with many abnormalities in immunological findings of this disease.
