Characteristics of long-term survivors after treatment for inoperable carcinoma of the lung

Between January, 1971 and August, 1978, 410 patients with histologically or cytologically confirmed inoperable or unresectable carcinoma of the lung of all cell types were treated with curative intent. Forty-five patients lived a minimum of 3 years and 32 patients lived 5 or more years. The 3-year survival rate increased from 7.6% (15/197) between January, 1971 and June, 1975 to 14.1% (30/213) for the interval from July, 1975 to August, 1978 (p less than 0.01). Factors associated with long-term survival were performance status (p less than 0.01), early stage (p less than 0.001), high total dose of radiation (p less than 0.02), large cell carcinoma (p less than 0.01), inoperable for medical reasons (p less than 0.001), and thoracotomy to determine unresectability (p less than 0.04). The difference in survival rates between the two time periods was not related to different patient factors. Survival rates were most improved in the second time period for patients with Stage II or Stage III carcinoma of the lung. Eight patients died from cancer between 36 and 54 months of initial treatment. Five patients died of intercurrent disease without evidence of cancer of the lung after 3 years. An increasing proportion of long-term survivors of inoperable carcinoma of the lung can be expected to result from a better understanding of these diseases, more technically sophisticated external irradiation, and the use of combination chemotherapy for small cell carcinoma.

Prolonged survival in Richter syndrome with subsequent reemergence of CLL: a case report including serial cell-surface phenotypic analysis

The development of a large cell lymphoma in a patient with chronic lymphocytic leukemia (Richter syndrome) is associated with a poor prognosis. There is dispute regarding the clonal origin of the large cell component. We described a patient in whom prolonged remission of the large cell component was achieved with combination chemotherapy, followed by subsequent reemergence of the less aggressive CLL clone. Serial cell surface phenotypic data are presented suggesting origin of both histologies from a common B-cell clone.

Effect of prostaglandin E2 on the electrical activity of cat isolated stomach muscle

Prostaglandins (PGs) are believed to be present in the gastrointestinal tract and to increase the tone of longitudinal muscle layer. However the influence of PGs on the gastric slow wave (SW) is not clarified yet. We therefore investigated the effect of prostaglandin E2 (PGE2) on the electrical and the mechanical activities of feline isolated stomach muscle strips (7 X 1.5 cm), using five capillary electrodes (Ag-AgCl) and an isometric force transducer connected to the antral edge. One hundred and ninety-six strips, obtained from the corpus and antrum of 196 anaesthetized cats, were studied in a muscle chamber filled with Krebs solution (pH 7.4, temperature 36 degrees C) bubbled with 5% CO2 in O2. Exogenous PGE2 concentration-dependently increased the gastric SW frequency without affecting the spike and mechanical activities. Indomethacin decreased the SW frequency. These responses to PGE2 or indomethacin were not blocked by phentolamine, propranolol, hexamethonium, atropine or tetrodotoxin. It is therefore suggested that PGE2 facilitates the development of the gastric SW by an action on the muscle that does not involve cholinergic or adrenergic mechanism.

Hemangioma in a lymph node

Hemangiomas occurring in lymph nodes are extremely rare and, to our knowledge, have been documented in the literature only once previously. We report an additional case that was found incidentally in a patient who had undergone a right hemicolectomy and small-bowel resection for widespread angiodysplasia. In addition, the patient also had a third type of vascular lesion, namely, a hemangiopericytoma of the oral mucosa. We also reviewed the literature regarding vasoformative lesions occurring in lymph nodes.

Adenocarcinoma of prostate presenting as brain metastasis

The diagnosis of brain metastasis from prostate carcinoma is rarely made antemortem, and has previously been reported only in patients with known extensive metastatic disease of long duration. A case of adenocarcinoma of the prostate presenting as a brain metastasis is described. Current concepts of metastatic spread of prostate carcinoma are reviewed.

The prognostic significance of histologic subtyping in small cell carcinoma of the lung

Previously untreated patients with small cell carcinoma of the lung (SCCL), who were treated at the Medical College of Wisconsin with combined chemotherapy and radiation therapy, were retrospectively subtyped according to the 1981 World Health Organization Lung Cancer Classification. Of 54 evaluated patients, 27 (50%) had "oat cell" subtype, 22 (41%) "intermediate cell" variety, and five (9%) were classified as "combined" type. There was no significant difference in response to therapy or median survival between the subtypes. In addition to the absence of prognostic significance among the subtypes, there were many technical factors affecting accuracy of subtyping, including tissue-crushing artifacts, size of biopsy materials, fixation of tissue samples, and variation of subtypes within the same biopsy. We conclude that subtyping of SCCL should not be construed as a prognostic tool or guideline to therapy. However, the recognition that SCCL may manifest in a variety of histologic patterns, some of which may be misinterpreted as a histology other than SCCL, is probably more important for choice of therapy and prognosis than the individual subtypes.

Primary signet-ring cell carcinoma of the urinary bladder

Sixty-one cases of adenocarcinoma of the urinary bladder presenting between 1966 and 1981 were reviewed. Among the only seven cases of primary adenocarcinoma of the urinary bladder, three were classified as primary signet-ring cell carcinoma. These 3 cases were reviewed with the 11 previously reported cases in the literature. Primary signet-ring cell carcinoma of the urinary bladder occurs predominantly in men (12 men, 2 women) with age ranging from 38 to 83 years. It usually runs a rapidly fatal course despite therapy. The characteristic clinical, gross, and histomorphologic findings and pathogenesis of this rare bladder malignancy are discussed.

Hodgkin's disease followed by mycosis fungoides in the same patient. Case report and literature review

Hodgkin's disease and mycosis fungoides are only rarely reported to occur in the same individual. The authors report a patient who initially presented with Hodgkin's disease but later died with massive visceral mycosis fungoides. This sequence of events is unique in the world's reported lymphoma experience.

Prostate carcinoma presenting as intracranial hemorrhage. Case report

The authors report a case of subdural metastasis from a prostatic carcinoma presenting as an acute intracranial subdural and intracerebral hemorrhage. The pertinent literature is reviewed.

Basophilic staining in pulmonary alveolar proteinosis. Report of three cases

Material filling the alveoli in pulmonary alveolar proteinosis has been shown to be eosinophilic by hematoxylin-eosin (HE) staining of lung tissue. No previous evidence has suggested a different result from a frozen section. We noted three cases, in 1972, 1973, and 1982, of basophilic staining of this characteristic alveolar material on unfixed, frozen sections; these cases later showed the usual eosinophilic properties when HE staining was performed at room temperature on formaldehyde solution-fixed, paraffin-embedded sections. These observations are important in that failure to recognize this possibility may initially lead the surgical pathologist away from the correct diagnosis or falsely suggest a problem in stains or staining techniques.

Association of an extracellular protein (chondrocalcin) with the calcification of cartilage in endochondral bone formation

We examined bovine fetal epiphyseal and growth plate cartilages by immunofluorescence microscopy and immunoelectron microscopy using monospecific antibodies to a newly discovered cartilage-matrix calcium-binding protein that we now call chondrocalcin. Chondrocalcin was evenly distributed at relatively low concentration in resting fetal epiphyseal cartilage. In growth plate cartilage, it was absent from the extracellular matrix in the zone of proliferating chondrocytes but was present in intracellular vacuoles in proliferating, maturing and upper hypertrophic chondrocytes. The protein then disappeared from the lower hypertrophic chondrocytes and appeared in the adjoining extracellular matrix, where it was selectively concentrated in the longitudinal septa in precisely the same location where amorphous mineral was deposited in large amounts as demonstrated by von Kossa staining and electron microscopy. Mineral then spread out from these "nucleation sites" to occupy much of the surrounding matrix. Matrix vesicles were identified in this calcifying matrix but they bore no observable morphological relationship to these major sites of calcification where chondrocalcin was concentrated. Since chondrocalcin is a calcium-binding protein and has a strong affinity for hydroxyapatite, these observations suggest that chondrocalcin may play a fundamental role in the creation of nucleation sites for the calcification of cartilage matrix in endochondral bone formation.

Renal oncocytoma. A clinicopathologic study

Seven cases of renal oncocytomas are described. Two cases were from recent surgical and autopsy material seen within a period of ten months. Four cases were reclassified as renal oncocytomas from a 20 year review of 63 renal cell carcinomas removed operatively. One case was identified from a nine year review of 31 renal cell carcinomas coded in our autopsy files. All patients were males; mean age was 69 years. The smallest tumor measuring 0.3 X 0.3 X 0.3 cm represents the smallest renal oncocytoma reported. The largest tumor weighed 2350 g. It is the largest renal oncocytoma so far reported in the literature. Two of the cases were found in polycystic kidneys. None of the seven patients presented with symptoms related to the tumors and the subsequent clinical course was benign in all cases. Differential diagnosis from renal cell carcinoma is discussed in terms of light and electron microscopic and radiologic aspects. The previously reported cases in the literature are reviewed.

Malignant pleural mesothelioma presenting as superior vena cava syndrome

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Papillary fibroelastoma of the heart. Report of six cases

Papillary fibroelastoma is a rare cardiac lesion, mostly encountered as an incidental finding at the time of autopsy but occasionally seen during life. Although this condition generally is asymptomatic, a few cases had been associated with clinical problems, such as embolic phenomena, angina pectoris, outflow tract obstruction, and sudden death. We studied six examples of this lesion, five occurring on the cardiac valves and one on the left ventricular septum. In one, the lesion was detected by echocardiography, which represents to our knowledge only the third published case in which the lesion was visualized by this diagnostic procedure and only the fourth in which the lesion was seen during life. We believe that echocardiography is sensitive in the detection of this often small, intracardiac lesion, useful in evaluating whether a case, by virtue of its size or location, carries a significant risk of causing clinical problems and therefore requires treatment.

Coexistence of chronic lymphocytic leukemia and Hodgkin's disease

Two cases with coexistent chronic lymphocytic leukemia (CLL) and Hodgkin's disease (HD) are reported. The HD was discovered on biopsy specimens of enlarged lymph nodes, four and two years, respectively, after the initial diagnosis of CLL. Although CLL and HD are usually regarded as two distinct lymphoproliferative disorders, 35 cases of HD complicating CLL have been reported. A review of this literature and the author's two cases suggest that the coexistence of these two entities represent separate and unrelated lymphoproliferative disease. The use of lymphocyte cell surface marker analysis in the second case supports this conclusion.

Ameloblastoma of the maxilla with distant metastases and hypercalcemia

A case of metastatic ameloblastoma of the maxilla with secondary hypercalcemia in a 54-year-old man is presented. After treatment with surgery, chemotherapy, and radiotherapy, the patient was found to have multiple metastases and severe hypercalcemia associated with high levels of parathormone-like substance in the peripheral blood. At autopsy he was found to have widespread metastases and nephrocalcinosis.

Noncaseating granulomas of the pancreas. Probable sarcoidosis

The patient presented with evidence of common bile duct obstruction and at surgery had narrowing of the distal common bile duct secondary to noncaseating granulomas of the pancreas, most probably sarcoidosis. Although pancreatic sarcoid is rare, this entity should be included in the differential diagnosis of pancreatic disease.

Chromatin-negative Klinefelter's syndrome with focal megalencephaly

At autopsy, 72-year-old white male with chromatin-negative Klinefelter's syndrome, mental retardation, psychotic behavior, and carcinoma of the lung was noted to have right unilateral focal cerebral and cerebellar megalencephaly with broad gyri, a cytoarchitectually abnormal cortex, and thickened cerebral vessels. Literature about the neuropathology of Klinefelter's syndrome and several cases of other chromosome aberrations (XYY and XO syndromes) are reviewed. These neuropathological changes are thought to be related to clinical manifestation.

Localization of proteoglycan monomer and link protein in the matrix of bovine articular cartilage: An immunohistochemical study

Using monospecific antisera and immunofluorescence microscopy, proteoglycan monomer (PG), and link proteins were demonstrated throughout the extracellular matrix of bovine articular cartilage. A narrow band of strong pericellular staining was usually observed for both molecules, indicating a pericellular concentration of proteoglycan monomer: this conclusion was supported by dye-binding studies. Whereas PG was evenly distributed throughout the remaining matrix, more link protein was detectable in interterritorial sites in middle and deep zones. Well-defined zones of weaker territorial staining for link protein stained strongest for chondroitin sulfate. Trypsin treatment of cartilage resulted in a loss of most of the PG staining, but some selective retention of link protein, particularly around chondrocytes in the superficial zone at and near the articular surface. This residual staining was largely removed if sections were fixed after chondroitinase treatment. After extraction of cartilage with 4M guanidine hydrochloride, only PG remained and this was concentrated in the superficial zone. These observations are shown to support the concept of aggregation of PG and link protein with hyaluronic acid (HA) in cartilage matrix, and the binding of PG and link protein to HA, which is attached to the chondrocyte surface. Culture of cartilage depleted of PG and link protein by trypsin demonstrated that individual chondrocytes can secrete both PG and link proteins and that the organization of cartilage matrix can be regenerated in part over a period of 4 days.

Intrathoracic lipomas. Report of three cases and review of the literature with emphasis on endobronchial lipoma

Intrathoracic lipomas are rare, benign neoplasms of unknown origin, with symptoms depending primarily on their location and size. They frequently represent on incidental roentgenographic finding and are clinically significant in that they may simulate malignant tumors and, when located endobronchially, may cause irreparable lung damage. Three cases of intrathoracic neoplasms are reported herein, and the English literature on the subject reviewed. In some cases, bronchoscopic examination may yield the diagnosis of endobronchial lipoma but, in general, thoracotomy is required for diagnosis. A more complete classification is suggested and the preferred mode of treatment is discussed.

Superficial temporal-middle cerebral artery anastomosis associated with glioblastoma multiforme

The authors report a case in which glioblastoma multiforme was intimately associated with a surgical anastomosis of the superficial temporal artery to a branch of the middle cerebral artery.