title: Large granular lymphocytosis terminating in a polymorphous B-lymphocytic proliferation after low-dose cyclophosphamide therapy: a case report with necropsy findings.
abstract: A 70-year-old man presented with clonal large granular lymphocytosis of T-suppressor/cytotoxic immunophenotype, neutropenia, paraproteinemia, and proneness to infection. The patient became severely leukopenic during 14 days of chemotherapy with low-dose cyclophosphamide, and remained so after discontinuation of the drug. Clinically, he was thought to have prolonged chemotherapy-induced marrow hypoplasia. At death, 16 days after the last dose of chemotherapy, autopsy confirmed bone marrow hypoplasia and revealed that well-differentiated, polymorphous, and (immunophenotypically and genotypically) polyclonal B-lymphocytes predominated in normal hematopoietic and lymphoid organs. A similar lymphoid infiltrate was intimately associated with multiple ulcers and smooth muscle necrosis in the stomach. These terminal findings resemble B-lymphoproliferative conditions described in certain forms of immune deficiency.
authors.affiliation: Department of Pathology, SUNY-Health Science Center, Syracuse, New York.
authors.forename: H D
authors.initials: HD
authors.lastname: Friedman
authors.forename: A S
authors.initials: AS
authors.lastname: Kurec
authors.forename: J
authors.initials: J
authors.lastname: Goldberg
authors.forename: T E
authors.initials: TE
authors.lastname: Coyle
authors.forename: B J
authors.initials: BJ
authors.lastname: Poiesz
mesh_terms: D000368:Aged; D001344:Autopsy; D001402:B-Lymphocytes / Q000187:drug effects*; D002455:Cell Division / Q000187:drug effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects*; D015322:Gene Rearrangement, B-Lymphocyte / Q000187:drug effects; D015329:Gene Rearrangement, T-Lymphocyte / Q000187:drug effects; D005838:Genotype; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000502:physiology; D008218:Lymphocytosis / Q000139:chemically induced*; D008232:Lymphoproliferative Disorders / Q000139:chemically induced*; D008297:Male; D012192:Retroviridae Infections / Q000175:diagnosis*
chemical_list: D003520:Cyclophosphamide