VI Fig. 177 a – e. Detection of tumor cells in the bone marrow a Cells of metastatic gastric carcinoma in a bone marrow smear b Detection of cytokeratin in the tumor cells of the same case c Osteoclasts along with tumor cells from prostatic carcinoma in a bone marrow smear d Tumor cell infiltration in a bone marrow smear 390 Chapter VI · Tumor Aspirates from Bone Marrow Involved by Metastatic Disease VI Fig. 177 e. Leukoerythroblastic reaction in peripheral blood from the same patient. A normoblast, myelocyte and a metamyelocyte are seen 391 Chapter VI · Tumor Aspirates from Bone Marrow Involved by Metastatic Disease VI Fig. 178 a – c. Detection of tumor cells in the bone marrow a Nest of tumor cells in a patient with prostatic carcinoma b Histologic examination of a core biopsy in prostatic carcinoma. Adenoid structures can be seen c Vessel-like mass of angiosarcoma cells in a bone marrow smear 392 Chapter VI · Tumor Aspirates from Bone Marrow Involved by Metastatic Disease VI Fig. 179 a – e. Detection of neurologic tumor cells in pediatric patients a Bone marrow involvement by medul- loblastoma. Small, round cells with pale chromatin b Higher-power view of the same case c Cells of neuroblastoma, very similar in appearance to a and b d NSE reaction in a bone marrow smear from the case in c 393 Chapter VI · Tumor Aspirates from Bone Marrow Involved by Metastatic Disease VI e “Rosette” arrangement of tumor cells in sympathicoblastoma 394 Chapter VI · Tumor Aspirates from Bone Marrow Involved by Metastatic Disease VI Fig. 180 a – g. Metastatic rhabdomyo- sarcoma in the bone marrow. Rhabdo- myosarcoma can metastasize to the bone marrow in children and in young adults. Not infrequently, the cells are mistaken for those of an acute leuke- mia. In about 70 % of alveolar rhab- domyosarcoma the translocation t(2;13)(q35;q14) is found as cytogenetic aberration a Rhabdomyosarcoma cells in a bone marrow smear. These cells are easily confused with the cells of acute leukemia b Higher-power view of the same case c PAS reaction in the same case. The degree of the PAS reaction is highly variable and sometimes is very intense d Metastatic rhabdomyosarcoma in a histologic marrow section. Note the relatively pale nuclei 395 Chapter VI · Tumor Aspirates from Bone Marrow Involved by Metastatic Disease VI Fig. 180 e – g e Different case of rhabdomyosarcoma with bone marrow involvement f PAS reaction in the same case g Same case, showing the detection of desmin in the tumor cells 396 Chapter VI · Tumor Aspirates from Bone Marrow Involved by Metastatic Disease VI Fig. 181 a, b. Detection of tumor cells in lymph nodes a Renal cell carcinoma. Cluster of tumor cells b Renal cell carcinoma. PAS reaction 397 Chapter VI · Tumor Aspirates from Bone Marrow Involved by Metastatic Disease VII 399 Blood Parasites and Other Principal Causative Organisms of Tropical Diseases 1 7 Blood Parasites 400 7.1 Malaria 400 7.1.1 Tertian Malaria (Plasmodium vivax and Plasmodium ovale) (Fig. 182) 401 7.1.2 Quartan Malaria (Plasmodium malariae) (Fig. 183) 401 7.1.3 Malignant Tertian Malaria (Plasmodium falciparum) (Figs. 184, 186) 401 7.2 African Trypanosomiasis (Sleeping Sickness) 410 7.3 American Trypanosomiasis (Chagas Disease) 411 7.4 Kala Azar or Visceral Leishmaniasis 414 7.5 Cutaneous Leishmaniasis (Oriental Sore) 416 7.6 Toxoplasmosis (Fig. 190) 416 7.7 Loa Loa 417 7.8 Wuchereria bancrofti and Brugia malayi 417 7.9 Mansonella (Dipetalonema) Perstans 420 8 Further Important Causative Organisms of Tropical Diseases 421 8.1 Relapsing Fever 421 8.2 Bartonellosis (Oroya Fever) 421 8.3 Leprosy 423 1 Revised by Prof. R. Disko, Munich. VII 7 Blood Parasites 7.1 Malaria The causative Plasmodium organisms are trans- mitted to man as sporozoites in the saliva of the feeding anopheles mosquito. The organisms travel in the bloodstream from the capillaries to the liver, where they undergo further develop- ment. They enter the liver cells (primary tissue forms) in the “pre-erythrocytic phase” of their life cycle, and after a variable period they are re- leased into the peripheral blood as merozoites. There they invade the erythrocytes, inciting a par- oxysm of fever. Inside the red cells the plasmodia (merozoites) mature through several stages, cul- minating in the discharge of merozoites from the remains of the ery throcyte; these then proceed to infect fresh erythrocytes. This process takes about 48 h for the parasite of tertian malaria (Plasmo- dium vivax and Plasmodium ovale) and malig- nant tertian malaria (Plasmodium falciparum) and 72 h for the parasite of quartan malaria (Plas- modium malariae). The different stages can be re- cognized in the blood, depending on the time at which the sample is drawn (see Figs. 182 – 186). Besides asexual reprod uction through division, the organisms are capable of sexual reproduction in their male and female gametocyte forms. The gametocytes unite only in the mosquito, forming oocysts. Sporozoites soon emerge from the cysts and make their way to the insect’ s salivary glands, to enter the capillaries and bloodstream of the next person on whom the mosquito feeds. Game- tocytes that do not enter a mosquito can survive no more than about 40 days in the human body, after which time they can no longer harm their human host. Cycle in the Tissue Infected mosquito bites a host # Inoculation of sporozoites # 1 Parenchymal cells of the liver (tissue schizont) # 2 Strong asexual proliferation (hepatic phase) # 3 After several generations, release of mero- zoites from the schizonts # 4 Entry into the blood (erythrocytic phase) Entry of the Parasite into the Erythrocyte 1. Merozoite recognizes the host erythrocyte. 2. Attaches to the surface of the cell. 3. Must reorient so that its apical end touches the surface of the cell. 4. Invagination develops at the attachment site, and the parasite enters the cell. 5. Erythrocyte reseals, enclosing the merozoite within a vacuole. Development in the Erythrocy te 1. Ring form with a peripheral nucleus and cen- tral vacuole. 2. Trophozoites. 3. Repeated nuclear division. 4. Erythrocyte becomes completely filled with merozoites (Blood schizonts). 5. Erythrocyte rupture, discharging the mero- zoites (8 – 12 P. malariae,18–24P. vivax). 6. Invasion of fresh erythrocytes. 400 Chapter VII · Blood Parasites and Other Principal Causative Organisms of Tropical Diseases [...]... Principal Causative Organisms of Tropical Diseases VII Abb 193 Abb 194 419 7 · Blood Parasites Fig 195 a – d Filariasis a Microfilaria of Mansonella perstans, see also Fig 196 b High-power view of a Loa loa microfilaria with granules in the cell body and conspicuous protoplasm (see also Fig 193) c Low-power view of numerous Loa loa microfilariae in a thick smear d Wuchereria bancrofti, see also Fig 194 VII... infection 109 – lymphocytic focus 110 – paroxysmal nocturnal hemoglobinuria (PNH) 121 – reactive changes 107 – smear 123 – – cellularity 75 – toxic changes 107 Borrelia – duttoni 421 – recurrentis 421 branchiogenic cyst 296 breast carcinoma 388 Brugia malayi 417 C Cabot ring 31, 138 c-ALL eosinophilia 278 CBP-MOZ fusion transcript CD10 267 CD103 313, 326 CD11c 313, 326 237 426 Subject Index CD34-positive... 312, 329 bcl-2 312 B-CLL 311 – cytogenetic aberration 311 BCR/ABL translocation 134, 144 Bence-Jones myeloma 355 Berlin blue – iron stain 10 – reaction 73 Bernard-Soulier syndrome 117, 118 bilinear acute leukemia 180 bilobed nucleus 205 binucleated – erythroblast 103 – lymphocyte 307 – microkaryocyte 164 Birbeck granule 132 blast-like cell 304 blood – cytochemistry 17 – reactive changes 107 – smear... the rest of the patient’s life, signifying that the infection has entered its latent stage Recently, the so-called test of avidity proved to be of help in calculating the duration of infection (acute or chronic) Infection must be massive before there is significant lymphadenitis with clinical manifestations such as headache, low-grade fever, and single or multiple lymph node enlargement, particularly... disease 122, 123 G-CSF 108 – left shift 113 giant – metamyelocyte 93, 94 – platelet 52, 117, 118 – proerythroblast 98, 99 Glanzmann-Naegeli thrombasthenia 117 glucose-6-phosphate dehydrogenase deficiency 82 glycogen 268 – storage disease type I 127 – cytochemical determination 11 GM-CSF 108 Golgi esterase 198 granular lymphocyte 66 granule 38 granulocytopenia 114 granulocytopoiesis 109 – giant forms... Organisms of Tropical Diseases VII Fig 191 Kala azar (Leishmania donovani) Splenic aspirate contains numerous leishmaniae, most intracellular, with a dark nucleus and rod-shaped kinetoplasts (picture of “two nuclei”) in a pale bluish-red cytoplasm Some of the organisms are pear-shaped (diameter 4lm) 7.4 Kala Azar or Visceral Leishmaniasis Causative Organism: Leishmania donovani All types of leishmania... organisms that cause enlargement of the affected erythrocytes with the appearance of “Schuffner dots” in the cells ¨ Malignant tertian malaria (falciparum malaria) is the most severe, life-threatening form of the disease The fever pattern is, due to an incomplete synchronization of the parasite population, nonspecific and may resemble that of tertian malaria or may consist of daily attacks mimicking a... Wuchereria bancrofti and Brugia malayi Transmission: By flies of the genus Chrysops A period ranging from weeks to several months passes after inoculation before microfilariae are detectable in the peripheral blood Wuchereria bancrofti and Brugia malayi microfilariae are nocturnally active, reaching a peak in the peripheral blood around midnight A Pacific island subspecies of W bancrofti (var pacifica)... dyserythropoietic anemia 102 – type I 102 – type II/III 103 dysgranulocytopoiesis 158, 163 dysmegakaryocytopoiesis 160 dysplasia 158 dysplastic eosinophils 221 E early neutrophilic granulocytopoiesis 76 EDTA 4 – EDTA-induced pseudothrombocytopenia 118 elliptocyte 31, 85 eosinophilia 107 eosinophilic – granulocytes 41 – leukemia 108 – promyelocyte 111 epitheloid cell 302, 303 Epstein-Barr virus 304 erythroblast... Very often, serologic reactions become positive approximately 4 to 8 weeks after the infection is acquired Considerable time passes before microfilariae can be detected in the peripheral blood Fig 194 Wuchereria bancrofti, hematoxylin stain The microfilaria of this species is 224 – 296 lm long and sheathed (h) The nuclei (k) of the somatic cells are loosely arranged and do not extend to the tip of the . most severe, life-threatening form of the dis- ease. The fever pattern is, due to an incomplete synchronization of the parasite population, non- specific and may resemble that of tertian malaria or. of the tsetse fly. Often a primary focus (trypanoso- mal chancre) develops at the site of inoculation (e.g., on the shoulder, upper arm, or neck), pro- ducing central swelling, erythema and often. the parasite of tertian malaria (Plasmo- dium vivax and Plasmodium ovale) and malig- nant tertian malaria (Plasmodium falciparum) and 72 h for the parasite of quartan malaria (Plas- modium malariae).