Comparing Tuberculin Anergy Skin Test Reactions and Lymphoblastic Transformation in Medical Student

Background: Tuberculin Skin Test (TST) reaction is an accepted screening test for diagnosing acute and latent Tuberculosis (TB) infection among at-risk populations. It is performed with a standard Protein Purified Derivative (PPD) solution. The skin reaction of PPD is unreliable to distinguish natural infection from the Bacillus Calmette Guerin (BCG) effect. The present survey aimed to determine the prevalence of Tuberculin Anergy (TA) reactions among medical students. Accordingly, we evaluated its sensitivity, specificity, and efficiency by applying the Recall Panel Antigen Test (RPAT) and the Lymphoblastic Transformation Test (LTT). Methods: The participants were sequentially enrolled in this study according to the designed protocol. The current study was conducted on healthy medical students before registering for the hospital training course. All research subjects were healthy, having a cicatrix of Bacillus Calmette Guerin (BCG) vaccination on the arm, and at a young age (20-24 years). Results: In total, 180 medical students met the inclusion criteria of the study. The study subjects’ Mean±SD age was 22±3.07 years (male=89, female=91). Moreover, 75 (42%) subjects presented a TA reaction in the first step of TST screening. Furthermore, 13 (64%) individuals presented a negative result of the RPAT. The sensitivity and specificity of the TST reactions, compared with the LTT were 100% and 94.4 %, respectively. Conclusion: Significant TA reactions were found among medical students with positive cicatrix post-vaccinated. The obtained data suggested that the BCG protection for individuals may be decreased as time expired. Consequently, the medical students will especially be at high risk for TB infection during the clinical training course. The collected data highlighted the patient-safety from the viewpoint of forensic medicine.

Research of the Philadelphia Chromosome in Chronic Myeloid Leukemia: Diagnostic and Prognostic Interests

Myeloproliferative syndromes are cell proliferation involving one or more medullary lines without blocking maturation. Chronic myeloid leukemia (CML) is the most common of these syndromes, it corresponds to the monoclonal proliferation of a multipotent stem cell; the myeloblastic or lymphoblastic transformation of CM. has a poor prognosis. The Philadelphia chromosome t(9;22)(q34;q11) is the first cytogenetic abnormality that has been associated with a malignant process. It is found in 89 to 95% of CML. The search for the Philadelphia chromosome (Ph1) has multiple interests: Diagnostic, prognostic and in therapeutic monitoring. The search for the Philadelphia chromosome by molecular cytogenetics makes it possible to remedy the poverty of cell suspensions in metaphase to take up the inconclusive results of classic cytogenetics on nuclei in interphase and to detect residual disease during therapeutic monitoring. Through the literature review, we highlight the importance of the identification of the Philadelphia chromosome in Myeloproliferative Syndromes for the improvement of the quality healthcare of the affected patients.

Simultaneous Discordant B-Lymphoblastic Lymphoma and Follicular Lymphoma

Objectives We report a rare case of B-lymphoblastic lymphoma (B-LBL) and low-grade follicular lymphoma (FL) identified concurrently in biopsies from different sites at the initial diagnosis in a 39-year-old man. The clonal relationship between the 2 histologic subtypes was investigated. Methods A diagnosis of FL grade 1/2 (low grade) was made by bone marrow (BM) biopsy. B-LBL was identified in biopsies from the testis and pancreas. Cytogenetic and molecular analyses were performed to investigate their clonal relationship. Results Interphase fluorescence in situ hybridization analyses and G-banding karyotype analyses identified the BCL2-IGH and MYC-IGH translocation in tumor cells from both the BM and testis. The tumor cells from the BM and testis shared the same IGH VDJ usage and a high degree of somatic mutations. These findings suggest that acquisition of MYC gene rearrangement is a critical event for lymphoblastic transformation of FL. Of note, the presence of intraclonal diversity in the B-LBL sample further suggests an earlier or concurrent event of MYC translocation than the somatic IGH mutation in the germinal center and the dedifferentiation of lymphoma cells to a precursor stage of B-cell development. Conclusions B-lymphoblastic transformation of FL can occur with MYC gene rearrangement.