Epstein-Barr virus-associated carcinomas of the esophagus and stomach

The Epstein-Barr virus (EBV) is associated with nasopharyngeal lymphoepithelioma and certain types of lymphoma. We studied the presence of EBV in Japanese patients with esophageal and gastric carcinomas. The polymerase chain reaction was used for the detection of EBV DNA, in situ hybridization was used for the detection of latent EBV infection, and immunohistochemical studies were used for the detection of EBV-encoded latent membrane protein in formalin-fixed and paraffin-embedded surgical specimens. Positive reactions for EBV were shown in two of 31 cases of gastric carcinoma and in one of 30 cases of esophageal carcinoma; these reactions were detected by all of the above methods only in the carcinoma tissue specimens. The morphologic features of these three cases included undifferentiated carcinoma with a lymphoid stroma; these features were very similar to those of lymphoepithelioma in the nasopharynx. A negative reaction for EBV was demonstrated in each of the other 29 cases of gastric and esophageal carcinoma. The results suggest that EBV is associated with gastric or esophageal undifferentiated carcinoma with a lymphoid stroma, just as it is associated with nasopharyngeal lymphoepithelioma.

Univariate and multivariate analyses of the prognostic significance of discontinuous intramural metastasis in patients with esophageal cancer

A review of 167 cases of esophageal carcinoma without preoperative treatment revealed 24 (14.4%) to have intramural metastasis (IM) within the esophagus. Among the clinicopathologic factors, the length of the lesions (P < 0.01), lymph node metastasis (P < 0.001), and the depth of the invasion of the tumor (P < 0.0001) were found to be statistically significant different factors between the two groups of patients both with and without intramural metastasis. The survival curve for patients with IM was significantly lower than that for patients without IM (P < 0.0001). A univariate analysis revealed that the depth of invasion, lymph node metastasis, IM (P < 0.0001), and the length of the lesion (P < 0.001) all had a significant correlation with the prognosis. Moreover, in a multivariate analysis, the depth of the invasion (< 0.001), length of the lesion (0.001), and IM (0.049) were all determined to be significant prognostic factors. Therefore, IM is considered to be one of the independent significant prognostic factors for predicting a poor prognosis in esophageal cancer.

[DNA heterogeneity and its significance in colon carcinoma]

We performed DNA flow cytometry analysis of colon carcinomas from the viewpoint of DNA heterogeneity. The materials were 25 colon carcinomas and 17 metastatic lymph nodes. Four different regions were examined in each primary tumor. The DNA index (DI) was classified into four groups. We classified the primary tumors into homogeneous and heterogeneous group according to the DI of the four regions of each case. Ten of 25 (40%) were classified as homogeneous and 15 (60%) as heterogeneous. The heterogeneous group tended to show more aggressive clinicopathologic characteristics. The corresponding rate between the maximum DI in the primary tumor and the DI in the metastatic lymph node was 65% (11/17). The maximum DI of the primary tumors was mostly seen in the metastatic lymph nodes, suggesting high metastatic potentiality of the higher DI clones. The examination of DNA heterogeneity may be useful for detecting the more precise character of the colon carcinomas. In heterogeneous cases, the higher corresponding rate of DI between primary and metastatic lesions suggested that metastasis occurred frequently in primary lesions containing gathering larger DI cells.

[Complex karyotypic abnormality in an aged patient with acute myeloid leukemia (M 2)]

A 74-year-old man was admitted on November 1986 because of general fatigue. His peripheral blood showed pancytopenia without immature cells since December 1985. Hematological data showed RBC 150 X 10(4)/microliter, PLT 7,000/microliter, WBC 12,000/microliter with 93.6% leukemic cells. The bone marrow smear revealed NCC 14.5 x 10(4)/microliter with 76% leukemic cells. The leukemic cells were characterized by faint staining with peroxidase stain and strong positivity for CD 13 antigen determined with immunoperoxidase method and flow cytometric analysis. The chromosomal analysis of tumor cells represented as follows: 44, XY, -3, -4, -9, -20, 2q+, 6p-, 7q-, 12q+, +2 mar. Although remarkable reduction of leukemic cells in peripheral blood was obtained one month after initiation of 19-days intravenous continuous infusion of N4-behenoyl-1-beta-D-arabinofuranosylcytosine (BHAC), he suffered from severe systemic candida infection with severe leukopenia and died. Not only advanced age but also complex karyotypic abnormality would contribute to failure of treatment in this case. The significance of complex karyotypic abnormality in acute non-lymphocytic leukemia in discussed based on the current literature.