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Two children prepared for bone marrow transplantation with total-body irradiation and cyclophospha mide developed hypertension, microscopic hematuria, proteinuria, diminished renal function, and anemia six months after transplantation. Light microscopy of the kidneys revealed mesangial expansion, glomerular capillary wall thickening, and lumenal thrombosis. Electron microscopy demonstrated widening of the subendothelial space due to the deposition of amorphous fluffy material. In one patient, immunofluorescence micros copy revealed glomerular capillary wall deposition of fibrin and immunoglobulins. The clinical and histologic findings support the diagnosis of radiation nephritis. Patients prepared for bone marrow transplantation with total-body irradiation and cyclophosphomide should be followed closely after transplantation for the development of hypertension, proteinuria, and renal in sufficiency.

The present study is a detailed analysis of the cytogenetic features of leukemic cells from 104 immunologically classified acute lymphoblastic leukemia (ALL) (78 B lineage and 26 T lineage) cases. Clonal chromosomal abnormalities were found in marrow blasts from 77 of 104 (74%) cases. Hyperdiploidy was much more frequent in B-lineage ALL cases, whereas normal diploidy was more common in T-lineage ALL cases. Fifty-nine of 104 cases (46 of 78 B-lineage ALL and 13 of 26 T-lineage ALL cases) had structural chromosomal abnormalities. Structural abnormalities involving 2p11. 7p13, 7p22, proximal q arm of 7(7q11 or 7q22), 11q23-24, and translocations involving 12p11-13 appeared to be B-lineage specific. By comparison, structural abnormalities involving 7p15, 7q32, and 14q11 displayed T-lineage specificity. Structural abnormalities involving 9p22-p23 or 14q32, del (6)(q21-q23), del (12)(p11-p13), and the Philadelphia chromosome were found in B-lineage as well as T-lineage ALL cases. This study expands the current knowledge about immunopheNotype-karyotype associations in ALL. © 1989 by Grune & Stratton, Inc.

• One hundred thirty-nine children with neoplasms were studied using magnetic resonance imaging (MRI). This procedure was as accurate as computed tomography in predicting tumor histology, except that MRI was unable to detect small areas of tumor calcification. Magnetic resonance imaging could accurately identify the organ of origin of tumor masses and differentiate soft tissue from fat, fluid, or hemorrhage. In addition, MRI was helpful in planning surgery in many cases: (1) It was better than computed tomography in defining the size and extent of soft-tissue tumor masses. (2) It was accurate in defining the extent of the spread of bone sarcomas in the bone marrow. (3) Without requiring the injection of intravenous contrast agents, it accurately defined displacement, encasement, or invasion of major abdominal blood vessels by Wilms' tumors and neuroblastomas. As a means of evaluating pediatric neoplasms, MRI is noninvasive, painless, and well tolerated by children, and it uses no radiation.(Arch Surg 1986;121:522-529)

During detailed immunophenotypic analyses of marrow blasts from 336 acute lymphoblastic leukemia (ALL) patients, a very small percentage of cases reactive with B-cell-directed as well as T-cell-directed monoclonal antibodies (MoAbs) were identified. Five ALL cases were biphenotypic since they coexpressed CD2 (Tp50) and CD19 (Bp95) antigens at the single-cell level. The composite immunophenotype of these biphenotypic ALL cases was [TdT +HLA-ABC+CD2 +CD3-CD10+CD13-CD14-CD16-CD19+CD20-CD21 CD33-CD34+Bgp95-Cμ-slg-]. Low-molecular-weight B-cell growth factor (LMW-BCGF), recombinant interleukin-2 (rlL-2), and rlL-3 stimulated the proliferative activity of biphenotypic leukemic lymphocyte precursors without inducing differentiation. In the presence of the phorbol ester TPA, leukemic blasts from two cases differentiated along the B precursor pathway to the [CD2-CD10+CD19+CD20+Cμ+slg-] pre-B cell stage. Bi-phenotypic ALL cases did not share a common configuration and gene rearrangement pattern of the immunoglobulin heavy chain genes or T-cell receptor (TCR) genes. Three cases had rearranged Cμ genes but germline TCR genes, one case showed rearrangement of both Cμ and TCR genes, and the remaining case had rearranged TCR genes but germline Cμgenes. All five patients attained prompt remission after standard induction chemotherapy. Three to four years after initial diagnosis, four patients are now off chemotherapy and remain alive in their first remission. One patient relapsed at 3 years, 7 months, but promptly achieved complete remission after reinduction chemotherapy and remains in second remission off chemotherapy >3 years after her reinduction therapy. With two-color immunofluorescence staining techniques and multipa-rameter flow cytometric analyses, we identified a small population of CD2+CD19+ lymphoid cells in fetal livers (FLs) and fetal bone marrows (FBMs), which may represent the putative normal counterparts of biphenotypic ALL blasts. A CD2+CD19+ normal biphenotypic lymphoid precursor cell line, designated FL 8.2 CD2+, was established from an FL of 8-weeks of gestational age by Epstein-Barr virus (EBV)-induced blastoid transformation. The composite immunophenotype of FL 8.2 CD2+ cell line was [TdT + HLA-ABC + HLA-DR+ CD2 + CD5-CD7-CD10 + /-CD13- CD19+CD20-CD21+ CD22+CD33- CD34+/ - Bgp95- CDw40+Cμ- slgD-slgM- ]. FL 8.2 CD2+ cells showed germ-line patterns of immunoglobulin heavy-chain joining region, heavy-chain constant region, k light-chain constant region genes, and TCR β-chain genes. Cross-linking of CD2 as well as CD19 antigens on FL 8.2 CD2+ cells caused an increase of intracellular ionized calcium. The transmembrane signalling activity of CD2 and CD19 on FL 8.2 CD2+ cells uniquely indicates that these differentiation antigens may be already functionally operative at a very early stage in human lymphocyte ontogeny even prior to lineage commitment. To our knowledge, the present study provides unprecedented evidence for the existence of biphenotypic lymphocyte precursors in the human hematopoietic system and represents the first report on GD2+CD19+ bipheno-typic ALL.