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LTC ASKOLD D. MOSIJCZUK, MC, USA; COL FREDERICK B. RUYMANN, MC, USA
Section of Pediatric Hematology-Oncology Department of Pediatrics Fitzsimons Army Medical Center Aurora, CO 80045

Section of Pediatric Hematology-Oncology Department of Pediatrics Walter Reed Army Medical Center Washington, DC 20012

Am J Dis Child. 1982;136(2):175.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—Dr Green's letter raises a question that has been confusing in the medical literature. As noted by Dr Green, histiocytosis is associated with a variety of infectious and hemolytic states. However, in HMR, the histiocytes have cytologic atypia consistent with a malignant process. Although none of the seven cases of HMR that occurred after ALL reported in our article had serologic tests performed to rule out Epstein-Barr virus, cytomegalovirus, or toxoplasmosis, each case met the criteria of a malignant histiocytic proliferation.

Risdall et al¹ emphasized that histiocyte proliferation with viral infection is benign. Cohen and colleagues² linked HMR and Epstein-Barr virus infection without any qualifiers.

In discussing Dr Green's letter and questions with Karcher et al,³ who reported two cases of HMR occurring after ALL quoted in our article, Karcher et al³ emphasized that cytologically atypical histiocytes are required for a diagnosis of HMR, . . . [Full Text PDF of this Article]

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