Showing papers in "Japanese Journal of Clinical Oncology in 1984"
TL;DR: From the long-term follow-up study it is clearly indicated that the rate of deaths from stomach cancer in the screened individuals was half of the rate in the unscreened individuals.
Abstract: The characteristics of early gastric cancer detected by gastric mass survey were examined. The progress of the screening test using the indirect X-ray examination and the tendency toward reduction in mortality from stomach cancer were evaluated. In 1981 the number of examinees in the gastric mass surveys amounted to over four millions in all Japan. From the data of the gastric mass survey in Miyagi Prefecture the rate of detection of gastric cancer was approximately 0.18% and the ratio of early cancer to surgically treated gastric cancer was 59.4% for 1980-1982. Furthermore, the number of m cancer, small cancer and minute cancer cases detected by the survey has increased year by year. These results are due to various advanced screening tests or close examination techniques. From our long-term follow-up study it is clearly indicated that the rate of deaths from stomach cancer in the screened individuals was half of the rate in the unscreened individuals.
93 citations
TL;DR: The effects of extended systematic lymphadenectomy were evaluated by the rate of survival of the patients and incidence of local failure in 643 patients with single primary adenocarcinoma of the rectum, who were operated on at the National Cancer Center Hospital from 1962 to 1981.
Abstract: The effects of extended systematic lymphadenectomy were evaluated by the rate of survival of the patients and incidence of local failure in 643 patients with single primary adenocarcinoma of the rectum, who were operated on at the National Cancer Center Hospital from 1962 to 1981. Our extended systematic lymphadenectomy consists of high ligation of the inferior mesenteric vessels and meticulous dissection of the abdominopelvic lymphatic system. Potentially curative resection was performed on 495 patients (77%) with seven operative deaths (1.4%). Extended systematic lymphadenectomy was carried out on 74 of 168 patients with Dukes B cancer and 89 of 213 patients with Dukes C cancer. Five-year survival rates for patients with or without systematic extended lymphadenectomy were 83.2% vs 63.7% (P less than 0.05) in Dukes B and 52.5% vs 30.8% (P less than 0.05) in Dukes C classes. The cumulative incidence of local failure at 5 years was decreased from 26.1% to 8.4% (P less than 0.01) and from 44.3% to 24.5% (P less than 0.01) by extended lymphadenectomy in Dukes B and C classes, respectively. Prolongation of operation time (plus 60 min), slight increase in blood loss (plus 150 ml) and no increase in operative mortality (1/161, 0.6%), were observed in the case of extended lymphadenectomy.
77 citations
TL;DR: A new rationale for surgical treatment for early gastric cancer is recommended as follows: local resection of the tumor or R0-resection with preservation of the regional lymph nodes is thought to be sufficient for an intramucosal polypoid carcinoma less than 2.0 cm in diameter.
Abstract: In Japan, R2-gastric resection which consists of gastrectomy, omentectomy and complete removal of Group 1 and 2 regional lymph nodes has been generally accepted as the procedure of choice in the treatment of early gastric cancer during the past 20 years. As a result, surgical treatment for early gastric cancer patients has achieved a very good survival rate, 97.7% and 96.2% 5 and 10 years, respectively, after surgery. To determine a new rationale for surgical treatment for early gastric cancer, the relationship between various prognostic factors and postoperative prognosis in 1,200 patients with early gastric cancer was studied. The survival rate for patients with a single focus of cancer in the stomach was significantly higher than that for patients with multiple foci. The incidence of recurrence was very low (2.8%) as a whole and most recurrence was found in patients who have had invasion into the submucosa with regional lymph node metastasis. The characteristic mode of recurrence was hematogenous metastasis to the liver and lung. The majority of causes of death were non-malignant disease and multiple primary malignant neoplasms. As to the survival rate in relation to the extent of lymph node dissection, no significant difference in survival rate was observed among the three procedures R0-, R1- and R2-resection in single cancer regardless of cancer invasion through the gastric wall. The survival rate for intramucosal carcinoma without lymph node metastases and with Group 1 lymph node metastases in both single and multiple cancer was 100%. In addition, 125 patients with intramucosal polypoid cancer (types I and IIa according to the macroscopic classification of early gastric cancer) showed no lymph node metastasis and had 100% survival. Therefore, from the present study a new rationale for surgical treatment for early gastric cancer is recommended as follows: 1) In general, R1-resection is indicated for intramucosal carcinoma and R2-resection for submucosal carcinoma. 2) Local resection of the tumor or R0-resection with preservation of the regional lymph nodes is thought to be sufficient for an intramucosal polypoid carcinoma less than 2.0 cm in diameter.
67 citations
TL;DR: The rate of detection of small cancer is increasing year by year and can be explained by the progress and widespread application of endoscopy, which will continue to play a large role in diagnosis and treatment of gastric cancer.
Abstract: An analysis of 17,212 lesions from 15,933 patients with early gastric cancer collected from 110 major hospitals and institutes in Japan is presented. The percentage of patients with early gastric cancer was high among persons in their 60s and 50s. The sex ratio (F/M) was 0.5 but it was higher for younger people than for old people. Regarding distribution of the types of early gastric cancer, the depressed group (Types IIc, III) accounted for 73.9% and the elevated group (Types I, IIa) accounted for 15.3%. The elevated group was more frequent in the older age group. In regard to the type and invasion, slight invasion was prominent in types IIb and IIa, while deep invasion was prominent in IIa + IIc. The metastatic rate was 18.4% for IIa + IIc, 11.8% for I and 11% for IIc. The frequency of lymph node metastasis was 4% in intramucosal cancer, 18.9% in submucosal cancer and 11.4% in total. The type in which multiple cancers were most frequent was IIb, followed by IIa. The percentage of differentiated adenocarcinoma was 91.9% in the elevated group and was found more often among the aged. Undifferentiated adenocarcinoma occurred more often among the young. The relationship between site and histology, location and invasion, location and lymph node metastasis etc. were also investigated. We believe that these results should be very useful for detection and treatment of early gastric cancer. The rate of detection of small cancer is increasing year by year. This increase can be explained by the progress and widespread application of endoscopy, which will continue to play a large role in diagnosis and treatment of gastric cancer.
65 citations
TL;DR: Dietary changes, especially reduced intake of salted food mainly due to the wider use of electric refrigerator, were considered as the major reasons of recent decline in mortality.
Abstract: Characteristics of both descriptive and analytic epidemiology of stomach cancer were summarised. Dietary changes, especially reduced intake of salted food mainly due to the wider use of electric refrigerator, were considered as the major reasons of recent decline in mortality. Other features of descriptive epidemiology such as socio-economic variation, lower risk in Okinawa residents and Japanese migrants to the U.S.A. were also described. In analytic epidemiology, daily cigarette smoking was found as a risk-enhancing factor in addition to frequent intake of salted food. Daily intake of green-yellow vegetables, soybean paste soup and milk were considered as risk reducing factors. Possibilities of primary prevention of stomach cancer was discussed based on these findings.
57 citations
TL;DR: The present TNM Classification with the provisional stage-grouping for stomach cancer, which was adopted in 1978, was evaluated for compatibility in respect to survival by using 15,589 stomach cancer patients registered in Japan from 1969 to 1973.
Abstract: The present TNM Classification with the provisional stage-grouping for stomach cancer, which was adopted in 1978, was evaluated for compatibility in respect to survival by using 15,589 stomach cancer patients registered in Japan from 1969 to 1973. Adequacy and usefulness were shown in all categories of T, N, M, pT and pN, individually. Important irrationality in accordance with the TNM General Rules was recognized in both the provisional TNM and p.TNM stage-groupings. More adequate stage-grouping was searched for and is discussed according to the results of statistical analysis of the patients' survival and the principle of the TNM General Rules. New TNM and p.TNM stage-groupings were proposed as the best ones at present.
55 citations
TL;DR: Clinico-epidemiological features of 943 lung cancer patients treated in the Aichi Cancer Center Hospital from 1964-77 were analyzed according to their smoking histories, and it was estimated that about 70% of the Group I tumors originated from main, segmental or subsegmental bronchi, but half from peripheral bronchi in both smokers and nonsmokers.
Abstract: In order to study the characteristics of lung cancer in smokers and nonsmokers, clinico-epidemiological features of 943 lung cancer patients treated in the Aichi Cancer Center Hospital from 1964-77 were analyzed according to their smoking histories About 70% of both male and female patients who smoked fell in Group I (squamous cell, small cell and large cell carcinomas), while of those who did not smoke, 50% of the male and 36% of the female patients fell in Group I The mean age of the patients who smoked was about 60 yr and that of the nonsmokers was 55 yr in both men and women It was estimated that about 70% of the Group I tumors originated from main, segmental or subsegmental bronchi, but half of the Group II tumors (adenocarcinoma) originated from peripheral bronchi in both smokers and nonsmokers One-third of the tumors were seen in the apical and subapical segments of the upper lobes regardless of the smoking history There was no difference between the survival rates for the patients with and without a history of smoking
31 citations
TL;DR: Sixteen cases of malignant peripheral nerve tumors that were recorded in the files of the Department of Orthopedics, National Cancer Center Hospital, Tokyo, between 1972-July 1983 were studied clinicopathologically.
Abstract: Sixteen cases of malignant peripheral nerve tumors that were recorded in the files of the Department of Orthopedics, National Cancer Center Hospital, Tokyo, between 1972-July 1983 were studied clinicopathologically. The patients' ages ranged from 24-51 years, and both sexes were affected equally. Histologically, in 13 cases of nerve sheath tumors the tumors were spindle-cell type, two of these patients had manifestation of multiple neurofibromatosis (von Recklinghausen's disease). One malignant epithelioid schwannoma was found to arise from the tibial nerve. Other two cases were of primitive neuroectodermal tumors (primary malignant peripheral neuroblastoma) which showed rosette formation. The common primary symptoms in all patients were a noticeable mass which increased in size over a variable period of time, with or without associated pain and tenderness. Ultrastructural findings of spindle-cell type (in 7 tumors examined) and epithelioid type (1 tumor) showed evidence of Schwann cell differentiation of the tumors in all cases. Immunohistochemically, by the PAP method (Sternberger), staining for S-100 protein was positive in 3 of 14 tumors. Ultrastructural findings in two S-100 protein-positive cases showed evidence of Schwann cell differentiation better than the S-100 protein-negative cases, such as pronounced interdigitation of cytoplasmic processes, presence of fibrous long-spacing collagen and well-developed basal lamina. Local recurrence occurred in nine patients, and metastasis was found in five. The total 5-year survival rate was 58.5%. Tumors associated with multiple neurofibromatosis and primary peripheral neuroblastomas had the worst prognosis. Complete removal of the tumor by means of wide excision as primary treatment seemed to be the most important factor in decreasing the morbidity and mortality rates.
27 citations
TL;DR: It is found that the mortality of lung cancer in Taiwan has been increasing rapidly for both sexes and the rate of increase is probably the highest in the world.
Abstract: In order to determine whether the epidemiological characteristics of lung cancer have changed within a certain period of time in Taiwan and to propose some causative factors for its rapid rate of increase we performed chronological and epidemiological studies based on the analysis of: (1) available vital statistics and demographic data for Taiwan after 1932; (2) data reported by WHO for international comparison; (3) prevalence surveys carried out in 1972-73 and 1977-78; and (4) 7,307 clinical cases collected from major hospitals since 1952. Some possible factors, i.e., the smoking history of patients, yearly tobacco consumption, geographical distribution of patients, and the number of motor vehicles were studied in correlation with epidemiological characteristics. We have found that the mortality of lung cancer in Taiwan has been increasing rapidly for both sexes. The rate of increase is probably the highest in the world. The prevalence rate increased from 15.26 per 100,000 population in 1972-73 to 22.35 in 1977-78. The male to female ratio has remained unchanged, roughly at 2:1, over the past 50 years. Adenocarcinoma contributed to about 60% of lung cancer in women and 35% in men. This proportion has not changed during the past 30 years. The cancer showed a striking urban predominance. The causes of the rapid increase in lung cancer in Taiwan cannot be explained solely by tobacco smoking, particularly for women, although it certainly plays an important role.
22 citations
TL;DR: This report describes a 63-yr-old man with lung cancer accompanying hypertension, hyperpigmentation, muscle weakness, psychosis, hypokalemia, hyperglycemia, hyponatremia, massive natriuresis and lower serum osmolality than urine osmoling.
Abstract: This report describes a 63-yr-old man with lung cancer accompanying hypertension, hyperpigmentation, muscle weakness, psychosis, hypokalemia, hyperglycemia, hyponatremia, massive natriuresis and lower serum osmolality than urine osmolality. Elevated levels of plasma and urine corticosteroids and of plasma immunoreactive adrenocorticotropic hormone (ACTH) were not altered by the administration of large amounts of dexamethasone. Elevated plasma antidiuretic hormone (ADH) values were also demonstrated. Postmortem examinations revealed small cell lung carcinoma with extensive metastasis, bilateral adrenocortical hyperplasia and Crooke's degeneration of the pituitary gland. Immunoradiological and immunohistochemical studies demonstrated the presence of immunoreactive ACTH, ADH and gastrin-releasing peptide in the tumor tissue. Beta-melanocyte-stimulating hormone, calcitonin and carcinoembryonic antigen were also detected by one of the methods. Hence, this is a rare case of lung cancer with multiple hormone production and clinical and laboratory evidence of both the ectopic ACTH and ADH syndromes.
20 citations
TL;DR: The two paradoxical phenomena in the gastritis-like group, "high frequency of less malignant appearance" and "increase in number of cases" not only indicate the inadequacy of the conventional criteria for the recent cases but also show that the gast arthritis-like malignancy is detectable.
Abstract: In order to make the endoscopic diagnosis of early gastric cancer more accurate, we determined the endoscopic and clinicopathological characteristics of the 129 cases of early gastric cancer with less malignant appearance among the 978 cases of the disease with a solitary lesion detected at the National Cancer Center Hospital during the period between 1962 and 1981. According to findings required to make a differential diagnosis, the endoscopic appearance of the 978 cases were divided into the following four groups: 170 cases of polypoid, 587 of ulcerative, 119 of gastritis-like and 102 of advanced cancer-like. Among the four groups, the frequency of cases with less malignant appearance was quite high in the gastritis-like group. The lesion in this group was defined as the cancerous lesion which shows only superficial mucosal abnormality, not associated with any polypoid or ulcerative components. Chronologically, it has been rapidly increasing in recent years. These two paradoxical phenomena in the gastritis-like group, that is, "high frequency of less malignant appearance" and "increase in number of cases" not only indicate the inadequacy of the conventional criteria for the recent cases but also show that the gastritis-like malignancy is detectable. New additional endoscopic criteria for the gastritis-like malignancy, for example, irregular margin of the shallow mucosal depression, disproportion of the mucosal granularity, irregularity on the erythematous change and discoloration are essential in order to detect much more cases with less malignant appearance.
TL;DR: Criteria for these treatments for early gastric cancer is established and nine patients are alive after more than five years.
Abstract: With the tremendous development of gastroenterological endoscopy, it has become possible to treat some types of early gastric cancer by endoscopy. There are two principal methods for this purpose, endoscopic polypectomy using a high frequency electric current and laser endoscopy. We developed the technic and instruments of endoscopic polypectomy, in 1972. Since then, we have experienced 358 cases of gastric polypoid lesions treated by endoscopic polypectomy. Nineteen patients with the elevated type of early gastric cancer were treated by endoscopic polypectomy. Seven patients were operated on after polypectomy and 12 were followed without surgery. Out of the 12 patients, nine are alive after more than five years. On the other hand, we started research to apply lasers for treating early gastric cancer in 1978. Since then, 18 patients have been treated by laser endoscopy, with Nd-YAG laser, argon dye laser or a combination of both lasers. We have established criteria for these treatments for early gastric cancer.
TL;DR: This is the first report of the coexistence of these two lesions, and esophagoscopy is necessary to find a superficial esophageal carcinoma coexisting with esophAGEal leiomyoma.
Abstract: A case of superficial spreading squamous cell carcinoma located just over a leiomyoma is presented. The patient complained of slight dysphagia and an esophagogram showed an elevated tumor in the middle thoracic esophagus. Esophagoscopy revealed an ulcerative mucosal lesion over the elevated lesion and biopsy showed that the lesion was a squamous cell carcinoma. Blunt dissection of the esophagus with esophago-gastro-anastomosis was performed. There was neither lymph vessel invasion nor lymph node metastasis. His post-operative recovery was satisfactory and he is doing well two years after the operation. A review of the Japanese and English literature revealed that a few cases of esophageal carcinoma coexisting with esophageal leiomyoma have been reported. There was no report of superficial esophageal carcinoma coexisting with esophageal leiomyoma. This is the first report of the coexistence of these two lesions, and esophagoscopy is necessary to find a superficial esophageal carcinoma coexisting with esophageal leiomyoma.
TL;DR: Adult T-cell leukemia/lymphoma (ATL/L) is clustered in southwestern Japan, especially in the Nagasaki and Kagoshima areas, and it was shown that this clustering correlated with the presence of antibodies to antigens of a new C-type RNA leukemia virus.
Abstract: Adult T-cell leukemia/lymphoma (ATL/L) is clustered in southwestern Japan, especially in the Nagasaki and Kagoshima areas. It was shown that this clustering correlated with the presence of antibodies to antigens of a new C-type RNA leukemia virus. Surface marker analysis of neoplastic T-cells of ATL/L patients shows the helper/inducer phenotype (Leu-1+, Leu-2a- and Leu-3a+). On the other hand, the association between T-cell malignancy including ATL/L and monoclonal gammopathy is very rare. Three unique cases of ATL/L with monoclonal gammopathy are reported. Yet the meaning of an M-component in T-lymphocytic proliferation remains uncertain. The relationship between the leukemia virus, ATL/L-cells and monoclonal gammopathy is discussed.
TL;DR: A case of multiple primary malignant tumors of the liver (cholangiocarcinoma and malignant hemangioendothelioma) that developed 40 years after Thorotrast administration is described, with radiological and autoradiographic findings.
Abstract: A case of multiple primary malignant tumors of the liver (cholangiocarcinoma and malignant hemangioendothelioma) that developed 40 years after Thorotrast administration is described, with radiological and autoradiographic findings. The estimated organ dose to the liver was approximately 580 rads.
TL;DR: An extremely rare case of coexistent carcinoma arising in a cystosarcoma phyllodes of the breast is reported in a 41-year-old Japanese woman referred with a lump in the right breast.
Abstract: An extremely rare case of coexistent carcinoma arising in a cystosarcoma phyllodes of the breast is reported. A 41-year-old Japanese woman was referred with a lump in the right breast. A tumor measuring 5.6 X 3.6 X 3.2 cm was removed by local excision. Histological examination revealed foci of papillo-tubular carcinoma within the benign cystosarcoma phyllodes. Radical mastectomy was performed and the axillary lymph nodes showed no metastasis. While 22 cases of coexistent carcinoma and cystosarcoma phyllodes in the same breast have been reported, in only nine of those cases, the carcinomas including this case have developed within the cystosarcoma phyllodes.
Journal Article•
TL;DR: An unusual tumor of the trachea was found in a 76-year-old woman, which resembled an adenoid cystic carcinoma in having many cystic spaces, but the fairly uniform tumor cells gradually merged with the myxomatous or hyalinous stroma.
Abstract: An unusual tumor of the trachea was found in a 76-year-old woman. The tumor resembled an adenoid cystic carcinoma in having many cystic spaces, but the fairly uniform tumor cells gradually merged with the myxomatous or hyalinous stroma, and foci of squamous metaplasia and glycogen-rich adenoma-like components were also observed. S-100 protein was demonstrated immunohistochemically in the tumor cells. This tumor was diagnosed as a pleomorphic adenoma (benign mixed tumor) of the trachea.
Journal Article•
TL;DR: After esophagectomy, free jejunal autografts were used for reconstruction in 11 patients and pedunculated colons in two patients and two supportive vascular anastomoses were effective and caused no complication.
Abstract: After esophagectomy, free jejunal autografts were used for reconstruction in 11 patients and pedunculated colons in two patients. A microvascular technique was applied immediately after the resection. A vascular anastomosis gave a new blood supply for the free jejunal graft, and in the case of the pedunculated colon gave support to improve circulation. During the grafting procedure, neither cooling nor heparinization was needed. No graft failures have occurred. The main complication of free jejunal grafts was leakage of the proximal anastomosis of the bowel, but all three leakages healed spontaneously. Two supportive vascular anastomoses for the pedunculated colons were effective and caused no complication. All 13 patients could eat regularly at the time of their discharge.
TL;DR: The closely similar reactivity of T-zone histiocytes with anti-S100 protein and OKT-6 monoclonal antibodies indicated that these two markers can be employed for paraffin and frozen sections, respectively.
Abstract: The heterogeneity of histiocytes in primary lung cancer was investigated by immunohistochemical methods using anti-S100 protein and anti-lysozyme antibodies on paraffin sections and OKT-6 monoclonal antibody on frozen sections. T-zone histiocytes (Langerhans cells and their precursors stained by anti-S100 protein and/or OKT-6 monoclonal antibodies) heavily infiltrated tumor tissues and regional lymph nodes in cases of moderately or well-differentiated adenocarcinoma, especially in areas of papillary growth or bronchiolo-alveolar pattern. These cells were interspersed amongst tumor cells showing dendritic figures and were occasionally present in squamous cell carcinoma. However, they were seldom found in other histological types, particularly in small cell carcinoma and carcinoid tumor. The distribution of these cells was different from that of lysozyme-positive macrophages. In this connection, T-zone histiocytes were thought to have a different immunological function from that of the monocyte-macrophage series against lung cancer. The closely similar reactivity of T-zone histiocytes with anti-S100 protein and OKT-6 monoclonal antibodies indicated that these two markers can be employed for paraffin and frozen sections, respectively.
TL;DR: Early gastric cancer may be said to be changing, with factors contributing to such changes contributing to the progress and multiplication of diagnostic techniques, changes in age composition of the population and changes in environmental factors.
Abstract: At the National Cancer Center, 1,300 patients with early gastric cancer were operated on during a period of 21 years, from 1962 to the end of May 1983, and the chronological sequence of the pathological features was analyzed by dividing the 21 years into five periods (I approximately V). The number of elderly patients, especially those above the age of 70 years increased with time, reaching about 20% of all patients in the later period. As to the CMA classification, lesions in A region (antral region) tended to increase, reaching 32.8% in the last period. Lesions on the anterior and posterior wall increased, reaching 20.2% and 30.5%, respectively. Lesions on the greater curvature side were almost unchanged in frequency. The depressed type of carcinoma tended to increase in frequency in the later period, accounting for 75.3% of the total. The depressed type lesions, especially those consisting mainly of IIc element, were therefore subdivided into deep IIc and shallow IIc. In the later period, shallow IIc or not readily detected indistinct IIc increased markedly, reaching 83.3% in Period V. In the initial period, 40% of the lesions were larger than 5 cm. In the later period, lesions larger than 5 cm decreased to 10%, and more than 40% were 2 cm or smaller. Histologically, differentiated and undifferentiated types were found at almost the same frequency. In the later period, the differentiated type became more frequent, reaching as much as 58.2%. Ulcerative lesions (presence of ulcers or ulcer scars in the cancerous lesions) comprised more than 90% of depressed type early gastric cancer, but gradually decreased to 71.9% in the later period. From these findings, early gastric cancer may be said to be changing. Factors contributing to such changes were studied with reference to the progress and multiplication of diagnostic techniques, changes in age composition of the population and changes in environmental factors.
TL;DR: A 23-year-old man who was diagnosed as having CML and treated with busulfan was admitted to the authors' hospital because of increasing hepatosplenomegaly and pronounced lymphadenopathy, and died of pneumonia.
Abstract: We report a case of chronic myelogenous leukemia (CML) associated with pronounced peripheral lymphadenopathy, with the cells having the philadelphia (Phl) chromosome and T-cell features. A 23-year-old man who was diagnosed as having CML and treated with busulfan was admitted to our hospital because of increasing hepatosplenomegaly and pronounced lymphadenopathy. An axillary lymph node biopsy disclosed that the malignant cells formed rosettes with neuraminidase-treated sheep red blood cells (En) (95.0%) and were positive for Leu 1 (91.8%). Of the cytochemical reactions, peroxidase was negative and periodic acid-Shiff, acid alpha-naphthyl acetate esterase and beta-glucuronidase were all positive. The karyotype of the bone marrow cells was 46 XY Phl positive (22q-), and that of the lymph node cells was 51 XY Phl positive +8, +9, +18, +19, +21, 22q-. He was treated with various anti-leukemic agents and irradiation. Despite such treatments, he died of pneumonia. This is a report of a CML patients with blast crisis and tumor formation characterized by T-cell features.
TL;DR: A 10-year-old girl with systemic lupus erythematosus (SLE) and autoimmune hemolytic anemia developed acute leukemia 10 months after the diagnosis of SLE.
Abstract: A 10-year-old girl with systemic lupus erythematosus (SLE) and autoimmune hemolytic anemia developed acute leukemia 10 months after the diagnosis of SLE. Leukemic cells had both the myeloid character, as shown by peroxidase activity, and T-cell surface antigen. The SLE-like syndrome as a paraneoplastic syndrome is discussed.
TL;DR: Skin biopsy was valuable for diagnosis and the immunostaining with anti-S100 antibody was a good marker to characterize infiltrating Histiocytes, and pathogenesis of histiocytosis X was discussed in relation to T-zone histiocytes.
Abstract: Thirty-five cases of histiocytosis X in the National Children's Hospital were clinicopathologically studied. Fourteen cases were categorized in diffuse histiocytosis X, Letterer-Siwe type (DHX), 19 cases in multifocal eosinophilic granuloma (MEG) and 2 cases in unifocal eosinophilic granuloma (UEG). Nine of 14 DHX died, of which 6 died of opportunistic infection due to hypoproteinemia and pancytopenia, and 3 died of pulmonary fibrosis probably due to histiocytic infiltration and resultant lymphedema. Infiltration of histiocytes in the bone marrow, thymus and lungs, in addition to the lymphoreticular organs, was conspicuous in autopsy cases of DHX. Skin biopsy was valuable for diagnosis and the immunostaining with anti-S100 antibody was a good marker to characterize infiltrating histiocytes. Prognostic factors and effects of treatments were also evaluated. Only one of 19 MEG died of opportunistic viral infection, but a longer duration for treatment was usually necessary compared to that for DHX. Pathogenesis of histiocytosis X was discussed in relation to T-zone histiocytes.
TL;DR: A 52-year-old Japanese woman with adult T-cell leukemia (ATL) initiated with central nervous system (CNS) symptoms, her chief complaints were paraplegia and left facial palsy was diagnosed.
Abstract: We treated a 52-year-old Japanese woman with adult T-cell leukemia (ATL) initiated with central nervous system (CNS) symptoms. Her chief complaints were paraplegia and left facial palsy. CNS-ATL was diagnosed because of the following three features. 1) Various sized lymphoid cells with marked nuclear convolution were numerous in her cerebrospinal fluid. 2) These cells were a monoclonal proliferation of T lymphocytes with OKT 4 marker. 3) The patient's serum was positive for anti-ATL associated antigen (ATLA). Although the neurological signs and symptoms improved markedly after intrathecal administration of combined chemotherapy (methotrexate, cytarabine and corticosteroid), these ATL cells were highly resistant to radiation therapy. The abdominal mass which developed in the course of the disease was diagnosed as a tumor formed of ATL cells, and VEPA (vincristine, endoxan, prednisolone and adriamycin) was administered with marked success.
TL;DR: The result of the present study suggests that repeated biopsy from correct sites and discussion of the lesions between clinicians and pathologists are very important.
Abstract: In order to determine the reliability of endoscopic biopsy in diagnosis of early gastric cancer, and to clarify the problems with biopsies, preoperative endoscopic biopsies from 771 early gastric cancer cases were reviewed and analyzed clinicopathologically in comparison with surgically resected specimens. The 771 cancers were surgically resected at the National Cancer Center Hospital during the period from 1972 to 1982. Definite histological diagnosis was obtained in 87.4% of the carcinomas at the initial biopsies. Repeated biopsy raised the percentage of correct definite diagnoses to 96.1%. False-negative (including suspicion of cancer) diagnosis was most frequent in the case of depressed lesions (50 lesions). Half of the false negatives were found to be due to sampling errors by the endoscopists. The other half of these 50 lesions were diagnosed as "suspicious of malignancy" because of the histological difficulty in differentiating early gastric cancer from regenerative atypia with intestinal metaplasia, or because there was not enough information, or for the other reasons. Most of the 31 false-negative diagnoses at the initial biopsy from elevated lesions were reported as adenoma (group III) or suspicious of carcinoma (group IV), indicating that differential diagnosis between well-differentiated adenocarcinoma and adenoma is very difficult. The result of the present study suggests that repeated biopsy from correct sites and discussion of the lesions between clinicians and pathologists are very important.
Journal Article•
TL;DR: 2-Mercaptoethane sulphonate (mesna) injections for prophylaxis of CY-induced hemorrhagic cystitis were found to be effective in reducing the incidence of the delayed type in 21 (53.8%) of 39 patients treated, but did not reduce the total incidence of CY, which seemed to have a poor prognosis and often continued until the patient died.
Abstract: The situation regarding hemorrhagic cystitis after conditioning for bone marrow transplantation (BMT) in Japan was surveyed and analyzed. Thirty-seven of 110 patients (33.6%) developed hemorrhagic cystitis after conditioning for BMT with cyclophosphamide (CY) and total body irradiation. In two of these 37 patients the cystitis was virus (adenovirus)-induced. In the others it was diagnosed as CY-induced. The severity and duration of CY-induced hemorrhagic cystitis were related to its onset. The delayed type of hemorrhagic cystitis induced by CY seemed to have a poor prognosis and often continued until the patient died. Therefore, late-onset hemorrhagic cystitis should be followed carefully and its prophylaxis may be important. 2-Mercaptoethane sulphonate (mesna) injections for prophylaxis of CY-induced hemorrhagic cystitis were found to be effective in reducing the incidence of the delayed type in 21 (53.8%) of 39 patients treated, but did not reduce the total incidence of CY-induced hemorrhagic cystitis.
Journal Article•
TL;DR: Pt(II) is a potent inducer of SCE in human lymphocytes in vivo and in vitro, and follow-up study of the long-term survivors who have been treated with this agent for cancer is necessary because of the possible occurrence of secondary neoplasms.
Abstract: Sister chromatid exchanges (SCE) frequency in cultured lymphocytes from seven patients with lung cancer receiving cis-Diamminedichloroplatinum(II) (Pt(II] for chemotherapy was studied. Significantly increased SCE frequency was observed in all the patients, six of whom received intravenous infusion of Pt(II) and one of whom received the agent as an intrapleural infusion. In addition, a dose-dependent increase in the frequency of SCE was observed in lymphocytes from healthy subjects upon exposure to Pt(II) in vitro. The results of the present study revealed that Pt(II) is a potent inducer of SCE in human lymphocytes in vivo and in vitro. It thus appears that follow-up study of the long-term survivors who have been treated with this agent for cancer is necessary because of the possible occurrence of secondary neoplasms.
TL;DR: Data indicate that decreased NK activity of childhood ALL in complete remission during maintenance therapy is due to a decrease in total NK cells and impaired function of both NKnon-T and NKT cells.
Abstract: The natural killer (NK) activity of circulating lymphocytes of 38 children with acute lymphoblastic leukemia (ALL) in complete remission was studied by 51Cr-release cytotoxicity assay. NK activity of the non-T-cell fraction (NKnon-T) and of the T-cell fraction (NKT) was also measured. In addition, the number of circulating NK cells was determined by an immunofluorescence technique using monoclonal anti-Leu-7 (HNK-1) antibody. Total NK activity of the ALL patients in complete remission was impaired during maintenance therapy (P less than 0.001) and after cessation of therapy (P less than 0.05). NK activity of NKnon-T and NKT cells was equally impaired (P less than 0.05). The numbers of Leu-7+ cells and NK activity units were decreased during maintenance therapy (P less than 0.05), but approached normal after cessation of therapy. These data indicate that decreased NK activity of childhood ALL in complete remission during maintenance therapy is due to a decrease in total NK cells and impaired function of both NKnon-T and NKT cells.
TL;DR: The data indicate that determination of the CEA level in effusions, when done in combination with cytological examinations, may have additional value in diagnosis of lung cancer.
Abstract: For determining the value of carcinoembryonic antigen (CEA) levels in diagnosis of malignant tumors of the lung, the CEA levels in 187 specimens of pleural fluid and sera obtained simultaneously from patients with pleural fluid were measured. In all 70 patients with benign diseases, the CEA levels in the effusions were less than the cut-off value of 5 ng/ml (mean +/- SD: 1.44 +/- 1.01 ng/ml). In contrast, in 88 of 117 patients (75.2%) with malignant diseases, the CEA levels in the effusions were over 5 ng/ml (25.3 +/- 24.5 ng/ml) and in 58 of the 117 patients (50.4%), the CEA levels in the serum were values of 5 ng/ml or more (11.9 +/- 18.4 ng/ml). There was a significant correlation between the CEA levels in the effusions and in the sera. The CEA levels in effusions in patients with malignant lung tumors were usually much higher than those in their sera. The incidence of CEA levels of 5 ng/ml or more in both the serum and effusion was highest in the patients with adenocarcinoma. These data indicate that determination of the CEA level in effusions, when done in combination with cytological examinations, may have additional value in diagnosis of lung cancer.
TL;DR: A total of 3,010 patients with gastric cancer were operated on in surgical department during the 13-year period from 1968 to 1980, and 204 patients with liver metastasis detected at the initial surgery were studied, finding median survival in the resected group was two to three months longer than in the nonresected group.
Abstract: A total of 3,010 patients with gastric cancer were operated on in our surgical department during the 13-year period from 1968 to 1980. Out of these, 204 patients with liver metastasis detected at the initial surgery were studied. The incidence was 6.8%. The primary lesion was resected in 104 of the 204 cases. Male patients comprised about 75% and 60- to 69-year-old patients constituted about 45%. In relation to the site of the primary lesion, cancer invading to all areas of the stomach comprised 44% of the nonresected group, while cancer located in the lower portion was more frequent than that in the upper portion in the resected group. The resected stomach was analyzed histopathologically. Most of the cancers belonged to Borrmann gross types II and III. Histologically, papillary and well- or moderately differentiated tubular adenocarcinomas constituted 65% and medullary type 61.5%. Concerning the prognosis, median survival in the resected group was two to three months longer than in the nonresected group. When chemotherapy was performed, survival was prolonged a further two to three months.