Three male cases of sideroblastic anemia, aged 75, 81 and 65, were studied.
Routine iron staining of the bone marrow specimens of sideroblasts (64%, 97% and 88%) among which abnormal ringed sideroblasts existed were 48%, 56%, and 34% respectively.
The all spectrums of electron probe X-ray analysis of siderosomes in the ringed sideroblasts showed a common peak at 6.395 keV, which is compatible with K_α of iron molecule.
The elecronmicrograph of erythroblasts showed deformed mitochondrion containing a lot of iron micell and many deposits of ferritin particles of variable maturity. Some erythroblasts were peculiarly deformed in shape.

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Twenty-one cases with aplastic anemia were treated with a new androgenic hormone, mepitiostane orally at the daily dose of 10 to 50 mg for 25 to 435 days. Each lineal regression was calculated in Hb levels, WBC and platelet counts during the treatment of mepitiostane. A course of mepitiostane treatment with a positive slope of lineal regression was defined as a responder. Decrease of blood transfusion during therapy in the multitransfused cases was considered to be effective concerning Hb. Thirteen out of 20 cases (65.0%) responded to mepitiostane treatment as to Hb, 12 out of 21 (57.1%) as to WBC and 10 out of 21 (47.6%) as to platelet. Mepitiostane was as effective as the other anabolic hormones on the treatment of aplastic anemia when the effect on more than 3 months' course of mepitiostane was compared to that on 160 courses treated with the other anabolic hormones for more than 3 months. Development of impaired liver function seemed less marked in the course of treatment of aplastic anemia with mepitiostane than the other anabolic hormones.

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Three cases of Ig-D myeloma were reported and seventy-nine cases of Japanese Ig-D myeloma in literature were reviewed on clinical manifestations and immunochemical features.
Male predominance, light chain λ predominance, high frequency of B-J proteinuria and renal dysfunction, and low level TTT and ZTT were characteristic in Ig-D myeloma. In the majority of cases, total protein levels were in normal range. No M-component or two spikes of M-component were frequently seen.
Age distribution, chief complaints, osteolytic lesions, extraosseous lesions, morphology of plasma cells, appearance of plasma cells in peripheral blood, and prognosis were similar to those in Imamura's report and Horikoshi's report in which all types of myloma in Japan have been included.
Median survival in our series were shorter than that of Jancelewicz's series, however it is still open to reevaluate because it is difficult to obtain accurate clinical courses from literature. Lymphadenopathy and hepatosplenomegaly whict have been adverted in Jancelewicz's report were considered not to be essential to Ig-D myeloma.

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A case of IgD. λ myeloma was described. A 59-year-old man was admitted to Kyushukoseinenkin Hospital on July 22 with complaint of lumbago since early June, 1974.
The electrophoresis revealed a M-protein of IgD. λ in serum and λ-Bence Jones protein in both serum and urine.
The administration of cyclophosphamide resulted in a rapid improvement of symtoms and laboratory findings, and the patient lived for 22 months after the onset of symptoms. The survival time of this case was much longer comparing with the mean survival of the patients with IgD myeloma. During the clinical course distinct correlative fluctuations were observed in myeloma cell count, serum IgD level and urinary protein amount.
The renal tissue of the patient obtained at autopsy was subjected to the direct immunofluoresent staining procedure using the antisera for immunoglobulins, λ-chain, fibrinogen and C3. The indirect method was also employed for κ-chain. Predominant staining for λ-chain was observed in tubular casts and no specific glomerular fluorescence was observed.

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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.

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The patient was a 13-year-old boy who was hospitalized because of genaral fatigue, low grade fever and cervical lymphadenopathy. On admission lymphoblasts were present as many as 85% of leukocytes in peripheral blood and 97.5% of nucleated cells in bone marrow. These lymphoblasts were 8-15 μ in diameter. The electron microscopy revealed Gall bodies and cytoplasmic fibrils in about 30% and 80% of the lymphoblasts, respectively. E-rosette formation was observed in less than 0.4% of the lymphoblasts at 0°C and less than 0.6% at 37°C. EAC-rosette formation was observed in 3.2% of the cells.
He attained complete remission about 6 weeks after the initiation of the chemotherapy with prednisolone and vincristine.
However, testicular involvement developed, and soon hematological relapse occurred. When relapsed, 90.0% of the lymphoblasts formed E-rosette at 0°C, but only 0.2% of them displayed E-rosette formation at 37°C. More than 99% of the cells reacted with rabbit anti-human thymocyte globulin. Electron microscopically, the Gall bodies decreased in frequency, but the cytoplasmic fibrils were still frequent.
Thereafter complete remission was not attained despite intensive chemotherapy.
About 4 months after the admission, the lymphoblasts formed E-rosette not only at 0°C (50.0%) but also at 37°C (21.3%).

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An autopsy case of a 32-years old female with malignant reticulosis showing T cell marker in the terminal stage was reported.
She developed abdominal pain, cough, sputum and fever, then she was found to have generalized lymphadenopathy and massive abdominal tumor without neoplastic laboratory findings.
A lymph node biopsy from the left inguinal region showed atypical reticulum cell proliferations with eosinophilia and an increase of capillary vessels. VEMP therapy induced her to a complete remission for about 3 years. But after the delivery of a normal boy, abnormal reticulum cells showing T cell marker with leukocytosis were observed in the peripheral blood. Finally she died of septicemia due to candida infection.
In autopsy, abnormal reticulum cells were disseminated in generalized organs like an acute leukemia.

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A case of systemic amyloidosis which was initially diagnosed by congo red staining on bone marrow aspirate is presented.
A 71-year-old male patient had been hospitalized since February 1977 under the diagnosis of nephrotic syndrome, and he was found to have monoclonal protein in the serum. To evaluate further his disease, he was admitted to our hospital in May 1977.
On physical examination, edema was noted at lower extremities without lymphadenopathy nor hepatosplenomegaly. Skeletal x-rays showed no abnormalities. An ECG demonstrated left axis deviation, clockwise rotation and diminished R waves in chest leads, suggesting amyloid heart. Blood urea nitrogen was 20 mg/dl, cholesterol 297 mg/dl and erythrocyte sedimentation rate 72 mm in one hour. The serologic test for syphilis was positive in the blood and in the spinal fluid. Total serum protein was 5.6 g/dl, and protein electrophoresis showed M peak in the fast gamma region. Urinalysis disclosed a 3+ test for protein. Immunoelectrophoretic analysis of the serum and urinary proteins identified an abnormal gamma peak as Ig A (λ) in the serum without Bence Jones protein in the urine. Peripheral blood showed moderate anemia and no atypical cells. An aspirate of sternal marrow was normocellular, revealed 22.4 per cent plasma cells including primitive form. It was also noted that an “amyloid” deposit was localized to the medullary vessels by histological studies of the clot section of the aspirate. Subsequently rectal and skin biopsies were positive for “amyloid” and a diagnosis of systemic amyloidosis was made.

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Only two cases of cranial nerve involvment in IgD myeloma have been reported in Japan. Pleural involvement with fluid accumulation has been found in four cases of myeloma.
A rare autopsy case of a 61-year-old male with IgD myeloma who presented Foix syndrome and fluid accumulation with myeloma cells in pleural cavity was described.
The initial symptom of this patient was the right chest tumor, which was resected and was histologically diagnosed as plasmacytoma. A month after, he had headache and diplopia and admitted to our hospital. The physical and laboratory examinations revealed Foix syndrome and the tumor on the left chest was suspected to be caused by myeloma. Later, accumulation of the pleural fluid with numerous myeloma cells and increase of IgD immunoglobulin were observed.
Many acidophilic inclusions were seen in the myeloma cells. They were ultrastructurally fibrillar and did not react with anti-IgD immunoglobulin.
The patient was treated with oral administration of Melphalan and Prednisolone and local irradiation with Lineac. A transient and partial recovery of the symptoms followed. He died of the tumor dissemination seven months after the onset.
An autopsy revealed the tumors in the parasinus, especially sphenoid sinus, lymph nodes, esophagus, stomach, larynx, trachea, liver and testis. Histological findings of the kidneys were compatible with those of the myeloma kidney.

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A case of acute granulocytic leukemia with pyruvate kinase deficiency of erythrocyte and bone marrow chromosome aberration was reported.
The patient, 49-year-old man, was admitted to our hospital in September, 1973 for precise examination of severe anemia. On physical examination icterus and hepatosplenomegaly were noted. Blood examination showed hemoglobin 7.4g/dl, RBC 225×10⁴/mm³, Ht 23.8%, MCV 103 μ³, MCHC 31.7%, reticulocytes 28‰, 86 erythroblasts per 100 leucocytes in the peripheral blood, WBC 2,100 with 31% Auer body positive blast cells, platelets 9.0×10⁴/mm³, indirect bilirubin 1.24gm/dl, serum iron 195 γ%, Vitamin B₁₂ 425 pg/ml. A bone marrow examination revealed erythroid hyperplasia with macrocytosis and 29% blast cells contained Auer rods in the cytoplasm. Hemolysis test including haptoglobin determination were within normal limits.
On Nov. 1974, when he was readmitted due to remarkable anemia with reticulocytosis and high percentage myeloblasts in the peripheral blood, pyruvate kinase deficiency of red blood cells and bone marrow chromosome aberration (centromeric spreading) were found. This enzymatic deficiency was considered not to be hereditary in nature and chromosome aberration was also different from that encountered usually with leukemia or erythroleukemia. His clinical course was rather mild without any anti-leukemic drugs and no aggressive increase of leukemic cells in the bone marrow and peripheral blood was observed until 3 months before his death.

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A case of ALL of apparent B-cell origin is reported. A 75-yearold male was admitted to the Kaneda Hospital beca-use of general malaise and gross hematuria. There was splenomegaly on admission but hepatomegaly and lymphoadenopathy were not palpable. The hematological findings were as follows; RBC 400×10⁴/mm³, Hb 13 gm/dl, WBC 25×10⁴/mm³ with 83% lymphoblasts. Nucleated cell count of bone marrow was 28×10⁴ with 85% lymphoblasts. The leukemic cells had remarkable anisocytosis, very fine chromatin structure of the nuclei with 1∼2 well defined nucleoli. The peroxidase-, PAS-, Sudan black B-reactions and phagocytosis were all negative. In the examination of surface markers, 99% of the cells disclosed the existence of surface-associated heavy chain with μ and δ receptors, the 59.5% of the cells for C₃ receptor and the 40.5% of the cells for IgG Fc receptor without E rosette formation. Autopsy findings revealed an enlarged spleen with heavy infiltration of leukemic cells and an infiltration in the liver, lower end of ureter and urinary bladder without solid tumor formation. Finally, the clinic, laboratory and histopathologic findings in this case of ALL have been discussed with review of the related literature.

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