The significance of cytogenetic findings of erythroid colonies derived from a Ph+ ALL patient: fundamental differences between Ph+ ALL and blastic phase CML

Cytogenetic analysis was performed on colonies from erythroid burst-forming units (BFU-E) derived from bone marrow (BM) cells of a Ph-positive acute lymphocytic leukemia (Ph+ ALL) patient. A normal diploid karyotype was revealed in all 15 metaphases that could be analyzed in the erythroid colonies. Previous cytogenetic analyses of erythroid colonies obtained from BM cells of patients with Ph+ chronic myelogenous leukemia (CML) revealed that Ph-positive karyotypes were predominant in all 11 cases. Two of them were also examined in blastic phase (BP) and showed 100% Ph+ cells in BFU-E-derived colonies. The present findings suggest that the leukemic process of Ph+ ALL does not involve the erythroid series, which is in contrast to the involvement in CML. This is considered to be a fundamental difference between Ph+ ALL and the blastic phase of CML (BP CML). Clinically, cytogenetic analysis of erythroid colonies from BM cells may constitute a valuable approach for the differential diagnosis between Ph+ ALL and the BP of Ph+ CML.

[Trial of early detection of breast cancer by mass screening in Miyagi Prefecture]

Mass screening for breast cancer which was commenced by Miyagi Cancer Society in 1977 has been carried out on 94953 examinees. The main activities comprise itinerant screening in the communities and group screening at the workplaces. In addition to two types of mass screening, examination was also performed at the detection center. The overall breast cancer detection rate was 0.12% in mass screening. In contrast it was 3.1% at the center. Early breast cancer, however, was more frequently found in mass screening than at the center examination. The cytologic studies of nipple discharge were performed on 14314 subjects as first screening. Positive finding was seen in 5 (0.005%). In high risk group, which also underwent mammography at first screening, the detection rate was higher than that among general examinees. Method for effective procedures for detecting early breast cancer are now under study.

[Evaluation of the malignancy of breast carcinoma using flow cytometry]

Flow cytometric DNA analyses of single cell nuclei were performed on nuclear suspensions prepared from tumors of primary breast carcinomas in 40 patients operated on in our hospital. Fluorescence intensities of propidium-iodide stained cell nuclei were analyzed in a SHOWA DENKO SC-20 cell sorter. The DNA index and the percentage of S-phase cells and DNA aneuploidy were calculated from each DNA histogram. There was a tendency for more advanced nodal tumor involvement to have a higher DNA index, increasing DNA aneuploidy proportions and significantly larger percent of S-phase cells.

Chromosome abnormalities in malignant histiocytosis

Chromosome and pathologic studies were performed on two patients (a 12-year-old boy and a 62-year-old woman) with malignant histiocytosis (MH). Both patients had chromosome abnormalities in their neoplastic cells: the boy's karyotype was 45,Xp+,-Y,9p+,18q-, and the woman's 48,XX,+16, inv(1),mar(5),6p-,10p+,12q+,i(18q),+i(18q). The boy had typical clinical and pathologic findings of MH, and died without achieving remission by chemotherapy. At the initial stage the woman had the clinical and hematologic findings of MH. Chemotherapy was given, but had no beneficial effects. At the terminal stage the bone marrow (BM) biopsy and aspirate, and the autopsy findings, were consistent with those of non-Hodgkin lymphoma, diffuse large cell type, although some histiocytes or abnormal cells in monocyte-macrophage lineage remained in the BM and the autopsied lymph nodes. This study and a review of data on six other cases have failed to establish any specific chromosome changes in MH.

ApoE-2/E-3 ratio of very low density lipoprotein in diabetes mellitus

Apolipoprotein E (apoE) of very low density lipoprotein (VLDL) in 22 diabetic patients was analysed by the method of one-dimensional isoelectrofocussing (IEF). We modified the IEF-method of Kashyap et al. by which apoE isoproteins were easily and accurately determined. The measurement of apoE-2/E-3 ratio was useful for determining apoE phenotypes. In 17 of 22 diabetics apoE phenotype was E3/3, while three patients showed E2/3 and two showed E3/4. ApoE-2/E-3 ratio was reduced from 0.91 +/- 0.07 to 0.73 +/- 0.04 (p less than 0.05) by the one month-period treatment in 10 insulin required diabetics. The ratio was also reduced from 1.06 +/- 0.14 to 0.89 +/- 0.09 (p less than 0.2) in 10 non-insulin required diabetics. The reduction in apoE-2/E-3 ratio was caused by an increase in apoE-3 band and a decrease in apoE-2 band which might be attributed to the changes in the sialic acid-content of isoproteins on the one-dimensional IEF method. Therefore, apoE phenotypes in diabetic patients should be determined when their diabetic state is improved.

Subungual melanoma. A clinicopathologic study of 16 Japanese cases

Melanoma occurs much less frequently among Japanese than among white people. The occurrence of subungual melanoma is uncommon both among white and among Japanese people. However, the authors found 16 subungual melanomas among 86 cases of cutaneous melanoma (19%) at their clinic, quite a high incidence. Of these, 69% (11/16) occurred on the hands and 31% (5/16) on the feet. By far the most common site was the right thumb. Histologic examination revealed that 67% were characterized by acral lentiginous, 50% by superficial spreading, and that there were no nodular melanomas. Most were Clark's Level IV and V at the time of diagnosis. The 5-year survival rate for subungual melanoma was 40%. No statistically significant differences in rate were found between subungual melanoma and volar melanoma. The term "acral" melanoma is recommended to describe the melanomas in the acral regions, because it is descriptive of the regions directly affected.

Involvement of I-J epitopes in the self- and allo-recognition sites of T cells: blocking of syngeneic and allogeneic mixed lymphocyte reaction-responder cells by monoclonal anti-I-J antibodies

Monoclonal anti-I-Jk antibodies (mAbs) were found to inhibit syngeneic and allogeneic mixed lymphocyte reactions by blocking the responder T cells but not the stimulator cells. Only the responses of H-2k and H-2a strains were inhibited. Three different anti-I-Jk mAbs (1G8, 4B11, and KN34) showed different inhibitory patterns in allogeneic mixed lymphocyte reactions of individual H-2k strains, depending on the H-2 and immunoglobulin heavy chain variable region (IgVH) genes possessed by the stimulator strains. The results indicated that I-J epitopes are involved in the self- and allo-recognition sites of T cells, which are clonally distributed and used to recognize Ia plus IgVH-linked products.

Three-dimensional atypical structure in intraductal carcinoma differentiating from papilloma and papillomatosis of the breast

The basic architectural pattern of intraductal proliferative lesions of the breast was established by reconstructing serial sections of luminal spaces and interluminal areas of glandular structures. The materials were surgical specimens from twenty patients with intraductal carcinoma, papilloma, papillomatosis, or so-called borderline lesion. In papilloma and papillomatosis, the luminal spaces were tubular and interconnected forming a three-dimensional (3-D) network, whereas carcinoma was a porous structure with dispersed lumina. The latter represented 3-D atypical structure in intraductal carcinoma. In borderline lesion the architecture was an intermediate type, with separate lumina partially transformed into tubular shapes. It was also confirmed that the porous structure of carcinoma observed in 3-D reconstructions corresponded to the cribriform pattern seen in 2-D figures, while the network of papilloma produced a complex glandular pattern. A geometric parameter was devised to measure the different 3-D patterns of lumina and their 2-D expressions. It was concluded that the 3-D architectural pattern of intraductal proliferations was sufficiently characteristic to be of diagnostic value in differentiating these diseases.

Postheparin plasma lipoprotein lipase activity in heterozygotes of familial lipoprotein lipase deficiency

Serum lipoprotein pattern, apoproteins and two postheparin triglyceride lipases were analyzed in a patient with familial lipoprotein lipase (LPL) deficiency and her family. Serum of the patient showed extreme hyperchylomicronemia and her postheparin plasma LPL activity was distinctly decreased. None of heterozygotes had any type of hyperlipoproteinemia. The mother and brother of the patient had moderately decreased LPL activity. There were no consistent changes in hepatic triglyceride lipase (H-TGL) activity among heterozygotes. These results suggest that assay of LPL may be helpful for detection of heterozygotes in familial LPL deficiency.

Chromosomes and causation of human cancer and leukemia. LIV. Near-tetraploidy in acute leukemia

Near-tetraploid cell populations were observed in a case of T-cell acute lymphoblastic leukemia (T-ALL) and in one of acute myeloblastic leukemia (AML). In the ALL case, hyperdiploid chromosomal changes, characterized by an isochromosome 17q [i(17q)], as well as other changes, were seen at the onset of the disease. At the first relapse, hypertetraploid cells appeared in about 10% of the mitoses in the bone marrow (BM), and by the second and third relapses, the hypertetraploidy was present in more than 90% of the mitoses in the BM. Even though karyotypic instability was evident, all abnormal karyotypes contained one or two i(17q) at every sampling. In spite of karyotypic instability at each relapse, karyotypic evolution was observed whenever relapse occurred. A normal female karyotype was confirmed in the BM of each period. Immunologic examinations performed at each sampling revealed no recognizable changes before and after the appearance of tetraploidy. In the AML case, which was classified as FAB M2, cytogenetic examination was performed at diagnosis and relapse. In both, hypotetraploid cells were observed in over 60% of the BM cells; the modal chromosome number was 90. Banding analysis was successful at relapse, and a pseudodiploid clone characterized by t(8;21) and a hypotetraploid clone with two t(8;21) and a loss of two Y chromosomes were observed in the same BM sample. A normal male karyotype was also observed in BM cells. In both cases, giant and bizarre blasts were seen in the BM. A close correlation between near-tetraploid mitoses and giant and bizarre blast cells in BM smears of the same samples was observed. Previously published tetraploid acute leukemia cases analyzed with banding methods were accumulated and compared with our two cases.

Lectin-binding patterns of breast carcinoma: significance on structural atypism

We have investigated lectin-binding profiles of the human breast epithelia and the structural atypism in intraductal carcinoma. The lectino-histochemical probes using biotin-labeled peanut agglutinin (PNA), soybean agglutinin (SBA) and wheat germ agglutinin (WGA) with avidin-biotin peroxidase complex were performed on formalin-fixed and paraffin-embedded specimens from 24 patients. While normal and benign hyperplastic epithelia were stained almost in luminal borders and apical cytoplasmic surfaces, intraductal carcinoma additionally showed conspicuous staining of intracytoplasmic lumina and supranuclear cytoplasmic margins. The lectin-binding pattern found in papillary hyperplasia was completely different from that in intraductal carcinoma; the former was an irregular network structure along luminal borders, whereas the latter was not only a cribriform but also a rosette structure along intracytoplasmic lumina and supranuclear cytoplasms. Such lectin-binding patterns seemed to reflect the change of cell polarity in malignant transformation. The significance of these observations in elucidation of structural atypism was discussed in relation to 3-D structure of intraductal carcinoma.

[A case of multiple myeloma treated with long-term peritoneal dialysis]

A 54-year-old female was admitted to our hospital in November 1979 with a history of lumbago and proteinuria. She was diagnosed as suffering from chronic renal failure (CRF) due to multiple myeloma (Bence-Jones kappa type). Intermittent COP therapy (a combination of cyclophosphamide, vincristine and prednisolone) and peritoneal dialysis were started. Her clinical condition was improved and well controlled by peritoneal dialysis over a period of 26 months until she died of pneumonia. Renal failure due to multiple myeloma has been a very poor prognosis. Hemodialysis has been used for renal failure much more frequently than peritoneal dialysis. In this case, control of chronic renal failure due to multiple myeloma with peritoneal dialysis was successfully performed over a long period of time. Peritoneal dialysis, therefore, may be an effective therapy for CRF due to multiple myeloma.

Significance of abnormalities involving chromosomal segment 11q22-25 in acute leukemia

Six hundred and thirty unselected cases of acute leukemia, with complete data regarding age, karyotype (with breakpoints), and the diagnosis according to the FAB classification, were available in the literature and from our unpublished cases for comparing the incidence of chromosomal abnormalities involving the long arm of chromosome #11 among age groups in acute nonlymphocytic leukemia (ANLL) and acute lymphocytic leukemia (ALL). A statistically highly significant difference (p less than 0.001) was observed between the incidence of ANLL cases with chromosome aberrations involving 11q22-25 in childhood (less than or equal to 15 years) versus that in adults (greater than 15 yr). This statistical difference was not only related to infant cases (less than or equal to 12 months), but also to cases of children over 1 year of age. The incidence of the 11q22-25 abnormality in childhood cases (greater than 1 yr to less than or equal to 15 yr) was statistically significant (0.025 less than p less than 0.05) when compared to the incidence in adult cases. The incidence of the 11q22-25 abnormality in infant cases was much higher when compared to that of older cases with either ANLL or ALL (p less than 0.001 in each leukemia). This trend was not observed in cases with the 11q11-21 abnormality and this may imply that the origin and meaning of the 11q11-21 abnormality may differ from that of the 11q22-25 abnormality. Twenty-three infants with acute leukemia (AL) with the 11q22-25 abnormality were available from previous reports and our unpublished case. The median ages of ANLL, ALL, and all AL cases were 16 weeks, 9 weeks, and 15 weeks, respectively. The tendency of the 11q22-25 abnormality to be common in infants with ANLL or ALL under 6 months of age may suggest that it has a close correlation with the origin(s) or mechanism(s) related to the occurrence of infant AL.