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H. L¨ffler J. Rastetter T. Haferlach

Atlas of Clinical Hematology

H. L¨ffler

J. Rastetter

T. Haferlach

Atlas of

Hematology

Initiated by L. Heilmeyer

and H. Begemann

Sixth Revised Edition

With 199 Figures, in 1056 separate Illustrations,

Mostly in Color, and 17 Tables

Clinical

Professor Dr. med. Helmut L¨ffler

Ehem. Direktor der II. Medizinischen Klinik und Poliklinik

der Universit¨t Kiel im St¨dtischen Krankenhaus

Seelgutweg 7, 79271 St. Peter, Germany

Professor Dr. med. Johann Rastetter

Ehem. Leiter der Abteilung f¨r H¨matologie und Onkologie

1. Medizinische Klinik und Poliklinik

Klinikum rechts der Isar der Technischen Universit¨t M¨nchen

Westpreußenstraße 71, 81927 M¨nchen, Germany

Professor Dr. med. Dr. phil. T. Haferlach

Labor f¨r Leuk¨mie-Diagnostik

Medizinische Klinik III

Ludwig-Maximilians-Universit¨t Großhadern

Marchioninistraße 15

81377 M¨nchen

Springer-Verlag Berlin Heidelberg

1st ed. 1955

2nd ed. 1972

3rd ed. 1979

4th ed. 1989

5th ed. 2000

Editions published under license

Spanish edition

published by

Editorial Cientifico-M ´ dica

Barcelona, 1973

Italien edition

published by

PICCIN Editore S.A.S.

Padova, 1973, 1980

German editions

Atlas der klinischen H¨matologie

Springer-Verlag Berlin Heidelberg

1st ed. 1955

2nd ed. 1972

3rd ed. 1978

4th ed. 1987

5th ed. 1999

Japanese edition

published by

Igaku Shoin Ltd.

Tokyo, 1975

Brazilian edition

published by

Revinter Ltd.

Rio de Janeiro, 2002

Japanese edition

Rinsho Ketsuekigaku Atlas

Translated by: Terry C. Telger, Fort Worth, Texas, USA

ISBN 3-540-21013-X Springer Berlin Heidelberg New York

ISBN 3-540-65085-1 5th Edition Springer Berlin Heidelberg New York

Library of Congress Cataloging-in-Publication Data

Bibliographic information published by Die Deutsche Bibliothek

Die Deutsche Bibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data is available

in the Internet at http://dnb.ddb.de

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, spe-

cifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or

in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the

provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always

be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law.

Springer is a part of Springer Science + Business Media

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English editions

Springer-Verlag Tokyo, 1989

Springer-Verlag Berlin Heidelberg 1955, 1972, 1979, 1989, 2000 and 2005

Printed in Germany

The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the

absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and the-

refore free for general use.

Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application con-

tained in this book. In every individual case the user must check such information by consulting the relevant literature.

Cover design: Frido Steinen-Broo, eStudio Calamar, Spain

Production: PROEDIT GmbH, 69126 Heidelberg, Germany

Typesetting: Mitterweger & Partner Kommunikationsgesellschaft mbH, 68723 Plankstadt, Germany

Printed on acid-free paper 24/3150/ML – 5 4 3 2 1 0

Preface to the Sixth Edition

Soon after the 5th edition of this volume appeared, the WHO published de-

tails on the pathology and genetics of the hematopoietic and lymphatic tis-

sues. Work in progress found in short journal articles had already been in-

tegrated into the last edition. Now it was possible to incorporate the new

proposals for classification and diagnosis and to include figures of new types

of leukemia and lymphoma. These include leukemias of dendritic cells, in-

travascular large B-cell lymphoma, the liver-spleen T-cell lymphoma as well

as persistent polyclonal B-cell lymphocytosis, which is placed between be-

nign and malignant.

The present volume completes and extends the cytogenetic and molecu-

lar-genetic characterization of the different diseases and incorporates new

figures. At this point we would like to thank PD Dr. Claudia Schoch, Munich,

for her valuable help and for graciously providing new zytogenetic and FISH

figures. In addition, several figures and tables were replaced, and a schematic

drawing of the topography of lymphoma infiltration in bone marrow (cour-

tesy of Prof. Dr. H.E. Schaefer, Freiburg) was added to the lymphoma chap-

ter.

Even in 2004, diagnosis in hematology and lymphomas starts, as a rule,

with the morphological examination of blood, bone marrow or lymphatic

tissues. It can direct the subsequent use of immunophenotyping, cytoge-

netics and molecular genetics, in this way demonstrating ways of saving

money and avoiding unnecessary investigations.

Gene expression profiling and, in the future, proteomics still represent

very expensive methods that must find their place in diagnosis and prognos-

tic evaluation. Gene profiling studies have already confirmed morphological

subtypes in AML, e.g., M3 and M3V, which cannot be distinguished into

strictly separate groups by cytogenetic and molecular-genetic methods.

New therapeutic measures (especially immunotherapy) have brought inter-

esting progress into the MDS group. For example, the biological entity 5q

minus syndrome, which is well defined by morphology and cytogenetics, re-

sponds very well to treatment with the thalidomide derivative CC 5013. The

fusion gene BCR-ABL, which was originally detected by cytogenesis and is

today routinely detected by FISH or PCR in CML, was the first example of a

specifically tailored molecular therapy in a tumor; certainly other examples

will follow. Cases of ALL involving t(9;22), t(4;11) and t(8;14) have also been

established as separate prognostic groups with special therapeutic problems.

All of these examples demonstrate that a comprehensive arsenal of diag-

nostic methods has to be used today for diagnostic and prognostic decisions

and individualized therapeutic planning.

We are again grateful to Prof. Dr. R. Disko of Munich who agreed to revise

and update the chapter on the principal causative agents of tropical diseases.

Finally we wish to thank Mrs. Stephanie Benko and the entire staff of Spring-

er-Verlag in Heidelberg as well as Ms. Marina Litterer at ProEdit GmbH for

their thoughtful and effective support.

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