Chronic intractable pain: an atypical presentation of multiple sclerosis

Both acute paroxysmal pains and a variety of chronic pain syndromes have been described in multiple sclerosis. These usually occur in the setting of well-established disease. Although paroxysmal pain has been recognized as a rare first symptom in this disorder, presentation with severe, continuous dysesthesias of long duration has not been previously appreciated. We report the cases of three patients in whom refractory continuous pain signalled the onset of demyelinating disease. These observations further define the clinical spectrum of multiple sclerosis and have implications for the evaluation of patients with chronic neuropathic pains of unknown etiology.

Proliferation of esophageal epithelial cells among residents of Linxian, People's Republic of China

Histopathologic and tritiated thymidine labeling subjects were carried out on esophageal biopsy specimens of 44 human subjects with cytologic evidence of dysplasia from Linxian, People's Republic of China, a high-risk area for esophageal cancer. With the use of histopathologic criteria, 10 cases showed evidence of dysplasia, 20 hyperplasia, and 14 a near-normal morphology when compared with 21 normal cases studied previously from Jiaoxian, a low-risk area for esophageal cancer in the People's Republic of China. Significantly increased labeling indices were found in the esophageal mucosa of the dysplasia and hyperplasia subjects. There was a gradient of increased expansion in the basal layer of proliferating cells progressing from normal to hyperplasia to dysplasia, with the expansion twice as high in the epithelial cell lining in dysplasia when compared with the findings in the normal and near-normal groups. The correlation of proliferative abnormalities with the severity of precancerous lesions of the esophagus indicates that labeling studies may provide a sensitive adjunct to evaluate risk status and any modifications that might result from nutritional intervention.

[Prognostic factors of primary non-Hodgkin's lymphoma of the stomach--clinicopathologic study of 21 cases]

Clinical, X-ray and pathological materials of 21 cases of primary non-Hodgkin's lymphoma (NHL) of the stomach were reviewed. According to NHL classification--working formulation for clinical usage sponsored by NCI, USA, there were 13 (61.9%) intermediate grade, 6 (28.6%) high grade and 2 (9.5%) low grade malignant lymphomas. By X-ray manifestations, they were classified into 5 types: multinodular type (4 cases), infiltrative (4), ulcerative (3), giant rugal (1) and mixed (9). Clinically, 10 lesions were stage I, 4 stage II, 1 stage III and 4 stage IV, 2 unclassified. The median survivals were 101 months for stage I, 15 months for stage II and less than 6 months for stages III and IV. The 5 and 10 year survival rates were 70% and 40% in stage I patients. The prognosis is related to clinical stage, depth of the tumor infiltration and histology type but not related to the tumor size or X-ray manifestations.

Comparative data on cytophotometric DNA in malignant lesions of the esophagus in the Chinese and Japanese

Cell DNA content was microspectrophotometrically determined in tissues of advanced esophageal carcinoma of 50 Chinese and 82 Japanese subjects. DNA distribution patterns were classified into Types I, II, III, and IV, according to the degree of dispersion and the peak value on the DNA histogram. The proportions of high ploidy (Types III and IV) in Chinese and Japanese patients were 68% and 81.7%, respectively. Overall 5-year survival rates of the Chinese and Japanese were 25.3% and 19.8%, respectively. Five-year survival rates of patients with Types II, III and IV were 45.7%, 23.8% and 0% in Chinese patients and 57.1%, 16.1%, and 0% in Japanese patients, respectively. Thus, differences in nationality were not related to the prognosis. The incidences of high ploidy group in those with an advanced esophageal carcinoma were high and were associated with a poor prognosis in both races. DNA distribution pattern of esophageal carcinoma reflected the outcome and malignant potential in the Chinese and the Japanese.

Strontium phosphate transfection of human cells in primary culture: stable expression of the simian virus 40 large-T-antigen gene in primary human bronchial epithelial cells

Strontium ion formed DNA-phosphate precipitates analogous to those formed by calcium but lacking the lethal and differentiation-inducing effects of calcium on many epithelial cell types in primary culture. Human primary bronchial epithelial cells were transiently and stably transfected by using strontium phosphate; the frequency of stable transformation with a plasmid carrying the simian virus 40 large-T-antigen gene was greater than 10(-4).

[Verrucous carcinoma of the cervix]

An extremely rare case of verrucous carcinoma of the uterine cervix is reported. The most outstanding pathologic feature of this malignant tumor is the benign picture of the proliferative squamous epithelium, with remarkable hyperkeratosis and dyskeratosis. Therefore it is difficult for the pathologist to make an accurate diagnosis on the basis of the biopsy material. Surgery may be best treatment of this special tumor for its behavior of slow invasiveness and rare metastasis.

[Malignant fibrous histiocytoma (MFH) of the maxilla--an analysis of 7 cases]

Malignant fibrous histiocytoma is a rare tumor of the soft tissue or bone, especially if located in the head and neck. Up to the present, only 7 cases have been reported (6 in the mandible and only one in the maxilla). From Mar. 1958 to Mar. 1985, 7 patients with maxillary MFH, proved by pathology, were treated in our hospital. The X-ray manifestations were studied and analysed. The main X-ray characteristics are as follows: A large soft tissue mass in the maxilla, extending into the infratemporal fossa, pterygopalatina fossa, orbit, ethmoid sinuses, nasal cavity and cheek. Marked and extensive destruction of the maxilla with some amorphous reactive ossification. The bone appears like melting ice or ground glass. The value of computerized tomography in differential diagnosis and clinical staging of the maxillary malignant fibrous histiocytoma are discussed.

Ovarian steroid involvement in endogenous opioid modulation of LH secretion in seasonally anoestrous mature ewes

In June, 16 mature ewes were ovariectomized and allocated to four groups: 1, saline; 2, naloxone; 3, progesterone implant plus naloxone; 4, oestrogen implant plus naloxone. Steroids were implanted at the time of ovariectomy. At 5 days after ovariectomy, the animals were intravenously infused with saline for 8 h and naloxone (50 mg/h) in saline for 8 h the following day. Three intact ewes were given naloxone in a similar way. During infusions and for 8 h on the day after naloxone, jugular venous blood samples were taken every 15 min and assayed for LH. Naloxone resulted in significant increases in mean LH concentration (P less than 0.01), LH episode frequency and episode height (P less than 0.05) in Group 3 ewes, but was without effect in any other group. These results provide evidence that the progesterone status of the ewe affects its response to naloxone, that progesterone negative feedback on LH release may be mediated by an opioid system, and that increased oestradiol negative feedback during seasonal anoestrus is unlikely to work via increased opioid inhibition of LH.

T-cell lymphoma

Of a total of 3,366 cases of malignant lymphoma in China reviewed histopathologically, T-cell lymphomas accounted for an average of 26.1% among all non-Hodgkin's lymphomas. However, the proportion of lymphomas of T-cell lineage varied in different parts of China, with the highest proportion (30-40%) along the east coast. Immunologic typing of 41 non-Hodgkin's lymphomas by the avidin-biotin-peroxidase complex technique revealed similar patterns. When serum antibodies to human T-cell leukemia virus were assayed in 462 normal men and 103 monkeys, 2-5% of the men and 8.4-15% of the monkeys were positive for antibodies to this virus.

Phenotypic expression of Hodgkin's and Reed-Sternberg cells in Hodgkin's disease

The phenotypic expression of Hodgkin's and Reed-Sternberg (H-RS) cells was determined by analysis with a panel of monoclonal antibodies and peanut agglutinin (PNA) by an immunohistochemical technique. Seven antibodies, including T200, anti-HLA-DR, anti-Leu 10, A1G3, anti-Tac, OKT9, and anti-Leu M1, were found to react with a great majority of H-RS cells. In some cases, H-RS cells also bound PNA. Other antibodies, including those highly specific for T cells (eg, Lyt 3) and B cells (eg, B1, anti-Leu 14) were consistently negative. The results argue against the derivation of H-RS cells from T or B lymphocytes. The H-RS cells were also negatively stained with antibodies which react with monocytes (OKM1, Mo-2, 63D-3), follicular dendritic cells (DRC-1), and natural killer/killer cells (Leu 7, Leu 11a, B73.1). The presence of Leu M1 and Tac in H-RS cells is of interest. Anti-Leu M1 positivity was seen in all 20 of Hodgkin's disease (HD) cases tested and should provide a very useful reagent for differential diagnosis of HD from other reactive and neoplastic conditions. Tac normally is present only on activated T cells. The presence of Tac in H-RS cells may reflect expression of T-cell growth factor receptor or a closely related protein during a stage of neoplastic transformation. Although the nature of the neoplastic cell of HD cannot be determined by these studies, they are consistent with an origin from interdigitating reticulum cells. Both H-RS cells and interdigitating reticulum cells have a similar antigenic phenotype (Leu M1+, T200+, HLA-DR+, Leu 10+, A1G3+, and OKT9+) and a similar pattern of lysosomal enzyme activity.

Primary gastrin cell hyperplasia. Report of five cases and a review of the literature

Primary gastrin cell hyperfunction of the gastric antrum as a clinical syndrome consists of basal hypergastrinemia, an exaggerated gastrin response to feeding, the absence of any ectopic source of gastrin secretion, and peptic ulcer disease. The number of G-cells were quantitated in the gastric antrum of five patients with clinically diagnosed primary G-cell hyperfunction, and the results were compared to controls with a variety of gastric diseases. Patients with the clinical diagnosis of primary G-cell hyperfunction had a significantly increased number of antral G-cells (p less than 0.05). The clinical syndrome of primary G-cell hyperplasia appears to be associated with hyperplasia of G-cells rather than with the hypersecretion of gastrin by a normal number of G-cells.

Hairy cell leukemia: a B cell neoplasm with a unique antigenic phenotype

A panel of B, T, and monocyte antibodies was used to study the phenotype of hairy cell leukemia. It was found that the neoplastic cells had monoclonal surface immunoglobulins and, in addition, reacted with B1, HLA-DR, Leu 10, and Tac. Most of the above markers are features of B cell lymphocytes. However, Tac is a monoclonal antibody normally reactive with activated T lymphocytes. All other antibodies reactive with T cells were negative. An additional unexpected finding was intranuclear reactivity in 4/5 cases with an antibody to TdT. TdT enzymatic activity was not demonstrable by biochemical assay. All five cases were nonreactive with monocyte antibodies. The findings support the concept that hairy cell leukemia is of B cell lineage but demonstrates an unusual phenotype not seen in other normal or neoplastic B lymphocytes.

Pulmonary carcinoids. Immunohistochemical demonstration of brain-gut peptides

Antisera raised against serotonin, gastrin, somatostastin, motilin, bombesin, calcitonin, secretin, glucagon, ACTH, neurotensin, and pancreatic polypeptide carboxyterminal hexapeptide were employed to immunohistochemically stain seven pulmonary carcinoids. Argentaffin and argyrophil stains were also performed on all cases. Serotonin-like immunoreactivity was present in four tumors, pancreatic polypeptide-like immunoreactivity in four tumors, bombesin-like immunoreactivity in two tumors and ACTH-like immunoreactivity in one tumor. The cells shown to contain neuroendocrine products constituted a minority cell population in all tumors except the ACTH-immunoreactive tumor. This study suggests that pulmonary carcinoids, like their abdominal counterparts, contain a variety of neuroendocrine products, and may produce more than one neuroendocrine product. Serotonin and pancreatic polypeptide-like immunoreactivity were the most prevalent neuroendocrine products demonstrable in this study.

The neuroendocrine products of intestinal carcinoids. An immunoperoxidase study of 35 carcinoid tumors stained for serotonin and eight polypeptide hormones

The intestinal carcinoid tumors of 26 patients were stained for the presence of serotonin, gastrin, somatostatin, motilin, secretin, glucagon, pancreatic polypeptide, ACTH, and neurotensin. Argentaffin and argyrophil stains were also performed in all cases. Thirty-five separate tumors (counting metastases and multiple primaries) from the 26 patients were studied. Serotonin was present in 30 of the 35 tumors. Nineteen tumors contained serotonin only. Fourteen tumors contained multiple neuroendocrine products. One tumor contained gastrin only. One tumor did not stain immunohistochemically, but was argyrophilic. Metastatic deposits were studied in nine patients. Some metastases produced the identical neuroendocrine products as the primary tumor, whereas others produced either additional or fewer hormones than the primary tumor. Moreover, different metastases from the same primary tumor were observed to produce different hormones. Argyrophilic cells were present in all cases and were much more numerous than cells staining by immunohistochemistry. Argyrophilic cells probably contain monoamines and polypeptide hormones in addition to those studied in this series. The argyrophil stain was the best general stain in this study for the demonstration of neuroendocrine cells. Argentaffin staining was negative in ten cases that were serotonin positive and two argentaffin positive cases were serotonin negative. The carcinoid syndrome, as clinically defined by the presence of flushing and diarrhea, was noted in five patients, all of whom had serotonin-containing small bowel carcinoids. Endocrine-related symptoms were not clinically appreciated in the remaining patients.