Hemoglobin Villejuif [beta 123(H1) Thr----Ile]: a new variant found in coincidence with polycythemia vera

A new abnormal hemoglobin, Hb Villejuif [beta 123(H1) Thr----Ile] has been discovered during the exploration of a polycythemia in a 87-year-old patient of French origin. The isoelectric focusing of the lysate revealed the presence of a variant hemoglobin with an isoelectric point very close to that of HbA. The oxygen binding properties of the patient's red blood cells being normal, it was clear that the polycythemia was not a consequence of the presence of this hemoglobin. In fact, the red blood cell morphology and the involvement of the other blood cell lines, demonstrating excessive hemopoiesis, led to the diagnosis of polycythemia vera.

Potential therapeutic role of cisplatinum in autologous bone marrow transplantation: in vitro eradication of neuroblastoma cells from bone marrow

Cisplatinum may prove to be a valuable agent for the elimination of diseased cells in the bone marrow of patients with neuroblastoma. In this study, we measured the efficacy of cisplatinum on human neuroblastoma cell lines and on normal human bone marrow progenitors, GM-CFC and CFU-F. Data indicate that the therapeutic index of cisplatinum is high. We set up an experimental model consisting of a mixture of human bone marrow and human neuroblastoma cells in order to confirm these preliminary results in purging conditions. Results indicate that cisplatinum exhibits a high and specific tumoricidal property and appears to be valid in bone marrow purging.

A translocation (7;10)(q35;q21) in a differentiated papillary carcinoma of the thyroid

A case of differentiated thyroid carcinoma is reported. Cell culture techniques and cytogenetic investigations are described. A t(7;10)(q35;q21) appears to be the sole chromosome abnormality.

The initial slope of human tumor cell survival curves: its modification by the oxic cell sensitizer beta-arabinofuranosyladenine

The initial slope of the survival curve, which is a characteristic of each tumor cell line, varies with the histological group of the tumor. It is one of the factors on which clinical radioresponsiveness depends. The DNA dependant DNA polymerase inhibitor beta-ara A acts as an oxic cell sensitizer. This study was carried out on human tumor cell lines to look for a correlation between the degree of radiosensitization induced by beta-ara A and the radiosensitivity of a given cell line. Six human tumor cell lines with different radiosensitivities were used (the survival rate at 2 Gy and D ranged from 20 to 73% and from 1.2 to 3.2 Gy, respectively). beta-ara A had a major toxic effect on all cell lines but this varied greatly from one cell line to another and was concentration dependant; this toxic effect was taken into account when calculating the surviving fractions. For all cell lines, beta-ara A acted as an oxic radiosensitizer and the radiosensitization was concentration dependant. Analysis of the survival curves of the 6 cell lines using the linear quadratic model showed that concentrations of beta-ara A between 200 and 1000 microM induced an increase in the linear component while the quadratic component underwent no systematic change. The sensitizing enhancement ratio (SER) measured from the Ds ratios, varied greatly from one line to another. For example, at a concentration of 500 microM, the extreme values of Ds ratios were 1.5 and 2.6. The radiosensitization is greater, the higher the radiosensitivity of the cell line studied during exponential growth. The results do not favor the use of beta-ara A in the treatment of intrinsically radioresistant human tumors.

[Riedel's thyroiditis. 3 cases]

Three cases of Riedel's thyroiditis are reported. The clinical presentation varied, with thyroid nodule in 2 cases (associated with cervical lymph node enlargement in 1 case) and compressive goitre with mediastinal involvement in the third case. The histological diagnosis of Riedel's thyroiditis is difficult and was made retrospectively in these 3 patients; it is based on the absence of malignant cells and the presence of fibrosis, inflammatory infiltrates and, inconstantly, vascular lesions of the occlusive phlebitis type.

Value of venous catheterization and calcitonin studies in the treatment and management of clinically inapparent medullary thyroid carcinoma

Seventeen patients with medullary thyroid carcinoma (MTC) underwent venous catheterization (VC) for sampling and serum calcitonin (CT) assay. The VC was performed either after an initial treatment in order to detect cervical recurrences and metastases (16 patients) or to prove abnormal CT thyroid secretion before any treatment (one patient). In 16 of the 32 tumoral localizations suspected by VC (50%), a tumoral focus was proven. For selective/peripheral CT gradient value superior to 2.50, 12 localizations of 12 (100%) were proven and for CT gradient value between 1.50 and 2.50, four localizations of 15 (26.6%) were proven. In six patients with exclusive cervical MTC secreting sites, treatment induced a total remission in two cases (12%) and improved in four cases (23%). The authors conclude that VC has a real value to localize MTC secreting sites. A total remission or an improvement can be obtained after treatment when VC detects exclusive cervical tumors.

Autocrine differentiation-inhibiting factor (ADIF) from chicken erythroleukemia cells acts on human and mouse early BFU-E erythroid progenitors

tsAEV-LSCC HD3 chicken erythroid cells transformed by the avian erythroblastosis virus (AEV) secrete an autocrine differentiation-inhibiting factor, ADIF, which blocks differentiation without affecting proliferation of the chicken erythroid cells that synthesize and secrete it into the culture medium. The chicken erythroleukemia cell ADIF activity is not restricted to avians. It prevents dimethylsulfoxide (DMSO) from stimulating murine Friend erythroleukemia cells to synthesize hemoglobin. ADIF also blocks erythroid differentiation in normal human and murine bone marrow where it selectively targets the early BFU-E (burst-forming) erythroid precursor cells without affecting the more advanced CFU-E erythroid precursor cells or cells of the different granulocyte-macrophage lineage.

Detection and treatment of lung metastases of differentiated thyroid carcinoma in patients with normal chest X-rays

Lung metastases were demonstrated by total-body 131I scans in 23 patients with differentiated thyroid carcinoma, at a time when chest x-ray was normal. This total-body 131I scan was performed after the administration of 2 mCi (in 11 patients) or 100 mCi (in 12 patients). Overall uptake of 131I in lungs was less than 1% of the administered dose in 11 patients. All patients were treated with radioiodine. No lung uptake was found in 20 patients at the last 100 mCi post-therapy scan. Among them, Tg level became undetectable during T4 treatment in eight, lung CT scan showed the disappearance of the micronodules in seven, and lung biopsy did not show evidence of disease in two patients. No patient developed radiation lung fibrosis. In conclusion, favorable responses to radioiodine treatment were observed despite relatively low overall uptake, in relation to the small size of lung metastases. This provides high concentrations of radioiodine and therefore high radiation doses.

Construction and clinical validation of a sensitive and specific assay for serum mature calcitonin using monoclonal anti-peptide antibodies

Using calcitonin (CT) as an hapten, we have generated a library of monoclonal antibodies. Six monoclonal antibodies were developed and analyzed with respect to affinity and specificity for epitopes on CT by enzyme linked immunosorbent assay and radioimmunoassay. These antibodies were used in the construction and the optimization of a two-site monoclonal immunoradiometric assay (m-IRMA) for CT. We used a combination of two monoclonal antibodies to develop an assay which is rapid (overnight incubation), sensitive (10 pg/ml) and strictly specific for the mature form of calcitonin, ie the 32 amino acid-long polypeptide bearing a prolineamide as the C-terminal residue. This assay was utilized to demonstrate that mature calcitonin circulates as heterogeneous molecular species resulting from polymerization of calcitonin by disulphide linkage and/or by aggregation on irrelevant proteins. The clinical relevance of this assay was studied on a series of patients with medullary carcinoma of the thyroid (MCT) and the characteristics of the assay was compared with those of a conventional polyclonal radioimmunoassay. The m-IRMA for CT proved to be useful for both the diagnosis and the follow-up of MCT.

5-Fluorouracil, doxorubicin, and cisplatin regimen in adrenal cortical carcinoma

Five patients with metastatic adrenal cortical carcinoma were treated with a combination of 5-fluorouracil (5-FU), doxorubicin, and cisplatin. All patients had a nonhormone producing tumor. A large tumor burden made them unsuitable for mitotane treatment. Treatment could be evaluated in four patients. A complete remission was achieved in one patient and lasted for 38 months: this patient is still alive and free of disease. Furthermore, a minor response and a disease stabilization also were observed. Cardiotoxicity occurred in one patient and myelosuppression in another patient. This regimen appears to be an active combination for the treatment of metastatic adrenal cortical carcinoma.

Detection of activated ras oncogenes in human thyroid carcinomas

Focus formation following DNA transfection of mouse 3T3-Vill cells was used to search for the presence of activated oncogenes in human thyroid tumors. Oncogenes belonging to the ras family were detected in four out of six thyroid carcinomas (Ki-ras in one anaplastic tumor and one follicular moderately differentiated tumor and Ha-ras and N-ras in two papillary tumors). Normal thyroid tissue samples obtained from two patients, one with an anaplastic tumor and one with a benign adenoma, and samples from 4 benign adenomas and from one toxic goiter of a patient with Graves' disease gave negative results. In one case, restriction enzyme analysis demonstrated the presence of a mutation in codon 12 of the activated Ha-ras oncogene. Our data show that all three ras proto-oncogenes can become activated in malignant thyroid tumors.

[Management in cases of accidental contamination by iodine radioisotopes]

Iodide can reduce radioactive iodine thyroid uptake and whole-body irradiation. Maximal effectiveness is obtained when 3 conditions are fulfilled: adequate dosage: potassium iodide 130 mg (i.e. iodide 100 mg) as tablets in adults and older children, 50 mg in infants under one year of age; prompt administration after contamination and daily treatment as long as the contamination persists. Depending on the importance and duration of the contamination, different dosages may be required. In any case, children must be given priority for prophylactic measures.

Follow-up of patients with differentiated thyroid carcinoma. Experience at Institut Gustave-Roussy, Villejuif

The recent introduction of sTSH assays allows for a definite control of the inhibition of TSH secretion. Clinical examination and serum thyroid hormone measurements are necessary to obviate hyperthyroidism. Relapses may occur after decades of apparent complete remission. Follow-up should be pursued throughout the patient's lifetime. Two specific means allow the detection of relapses at a stage when X-rays are still normal: measurement of serum thyroglobulin and 131I total body scan. Their combined use is recommended.

Granulopoietic differentiation in long-term bone marrow cultures from children with congenital neutropenia

The capacity of granulopoietic precursor cells (CFU-GM) to differentiate in vitro was evaluated in five children with congenital neutropenia using short-term colony assays and long-term marrow cultures. In all five children, methylcellulose assays revealed normal numbers of CFU-GM, which displayed an appropriate response to various sources of GM-CSF and differentiated up to the polymorphonuclear leukocyte state (PMN). In contrast, neutrophil PMN were not observed in long-term bone marrow cultures from three patients, despite a normal production of CFU-GM, myeloblasts, and promyelocytes during the 5-6 week culture period. Thus, in these patients, the characteristic "block" in granulocytic maturation observed in vivo was reproduced in vitro in long-term cultures. Granulocytic differentiation proceeded normally in long-term cultures from the two other patients, thus indicating heterogeneity in the expression of the defect. These results might indicate abnormal interactions between stromal and hematopoietic cells in long-term marrow cultures from some patients with congenital neutropenia. Furthermore, our results showed some correlation between the granulocytic defect in vitro and the clinical outcome in vivo.

Structure and expression of c-myc and c-fos proto-oncogenes in thyroid carcinomas

Tumour specimens from 23 patients with thyroid carcinoma, 22 patients with thyroid adenoma, 3 with Graves' disease, and tissues from 8 normal thyroid glands were analyzed by Southern blot hybridization for the physical state of c-myc and c-fos proto-oncogenes. In 4 patients, both the primary tumour and lymph node metastases were analyzed. No amplification or rearrangement of the two proto-oncogenes was detected. Total RNAs were also analyzed. Elevated levels of the 2.4 kb c-myc RNA and of the 2.2 kb c-fos RNA were found in 13/23 (57%) and 14/23 (61%) of the cancer patients, respectively. High levels of c-myc transcripts were more frequently found in thyroid carcinomas with unfavourable prognosis. Concomitant elevated levels of both c-myc and c-fos RNAs were found in 8 cancers. High levels of c-myc RNA were also found in 1 out of 22 specimens of adenoma, in 1 specimen of Graves' disease and in 2 normal thyroid glands. High levels of c-fos RNA were found in 20 of the 22 adenoma samples and in 2 out of 8 normal thyroid tissues. These data indicate that the overexpression of c-myc and c-fos genes is independent of an alteration of the loci. The high levels of c-fos found in adenoma may be associated with the differentiation state of these tumours.

Differentiated thyroid carcinoma in childhood: long term follow-up of 72 patients

Seventy-two children with differentiated thyroid cancer who were 16 years old or younger at the time of initial treatment were followed for a median time of 13 yr. Initially, 18% had lung metastases, and 74% had palpable lymph nodes. Capsular invasion was found in 67%, and histological lymph node involvement in 90%. The recurrent laryngeal nerve chain and the jugulo-carotid chain were involved with the same frequency (greater than 80%). The anterior superior mediastinum was involved only in patients with involvement of the recurrent laryngeal nerve chain. Forty-three patients had a complete remission after initial treatment. In patients without distant metastases for whom surgery was macroscopically incomplete, relapses occurred 5 times more frequently than in patients whose surgery was complete. Six patients died from thyroid carcinoma at ages ranging from 19-44 yr, 12-33 yr after initial treatment, and 1 died from intercurrent disease. Despite favorable long term survival (90.3% at 20 yr), the standardized mortality ratio was equal to 8.1. This study underlines the need for complete surgical treatment and compulsive follow-up, which should be continued throughout the patient's life, in order to detect and effectively treat relapses of thyroid cancer.

[Role of ultrasensitive TSH assay and ultrarapid total thyroxine assay in the thyroid studies]

The diagnostic value of high sensitivity thyrotrophin assay (HS-TSH) and that of ultra-short determination of total thyroxine (T4) by fluorescence polarization (T4-TDX) were evaluated in 284 patients (29 hyperthyroid, 137 euthyroid without treatment and 118 under substitutive therapy). After comparing the clinician's first impression with the results of these laboratory tests the proportion of correctly classified untreated euthyroid patients was the same with T4-TDX as with HS-TSH (90%). In contrast, this proportion in hyperthyroid patients was about twice as low with HS-TSH (23%) as with T4-TDX (42%). While HS-TSH gives a better diagnostic evaluation, T4-TDX is an excellent indicator of the degree of hyperthyroidism. In patients under suppressive therapy HS-TSH and T4-TDX provide a better evaluation of therapeutic effectiveness.

[Postoperative surveillance of differentiated thyroid epithelioma. Contribution of the ultrasensitive determination of TSH]

Ultra-sensitivity TSH assays were performed, using Behring's kit (sensitivity: 0.03 microU/ml, in 183 patients operated upon for differentiated thyroid carcinoma and followed up while under treatment with L-thyroxine. Clinically, all patients were euthyroid. TSH was undetectable in 38 patients and within normal limits in 93. A negative correlation was found between the logarithm of thyroxine plasma levels and that of TSH levels, but there were many discrepancies (normal thyroxine level with undetectable TSH, high thyroxine level with normal TSH level). This study shows that the ultra-sensitive TSH assay provides accurate information on the inhibition of TSH secretion. Clinical evaluation and plasma thyroxine assays are needed to make sure that the patient is in a euthyroid state.

Cytogenetic studies on patients with medullary carcinoma of the thyroid

Cytogenetic studies were carried out on stimulated lymphocyte cultures of patients with medullary carcinoma of the thyroid. Of 32 patients studied, seven had a hereditary carcinoma, and five had multiple endocrine neoplasia type 2A and two had type 2B. Neither a constitutional chromosome abnormality nor an increase in chromosomal breakage were detected in these patients.

Incubation of autologous bone marrow graft with ASTA Z 7557: comparative studies of hematological reconstitution after purged or nonpurged bone marrow transplantation

Thirty-three patients with advanced solid tumors were treated by high-dose chemotherapy (combined high-dose melphalan), followed by cryopreserved autologous bone marrow transplantation (ABMT). Thirteen of them had bone marrow (BM) tumor involvement at diagnosis, and BM harvest was purged with 50 micrograms/ml ASTA Z 7557 before cryopreservation. Following incubation, in vitro growth of granulomonocytic colony-forming cells (GM-CFC) was regularly inhibited (greater than 99%). Hemopoietic reconstitution after purged and nonpurged ABMT was studied. All patients experienced engraftment. However, peripheral leukocyte and granulocyte recoveries were delayed significantly in patients receiving purged BM (mean 27 and 26 days) compared with those observed in patients receiving nonpurged BM (mean 18 and 18 days). These results confirm that purged BM, despite GM-CFC depletion after in vitro treatment, ensures engraftment after high-dose chemotherapy, but prolonged pancytopenia is observed and postgraft hemopoietic recovery is delayed. A clinical trial is necessary to evaluate the efficiency of the purging technique in eradicating residual tumor cells.

Long-term results of treatment of 283 patients with lung and bone metastases from differentiated thyroid carcinoma

We assessed the results of treatment in 283 patients with lung or bone metastases from differentiated thyroid carcinoma who were followed for up to 40 yr (median, 44 months) after the discovery of the metastases. The survival rates from the time of discovery of the metastases were 53% at 5 yr, 38% at 10 yr, and 30% at 15 yr; 156 patients died. Multivariate analysis revealed that only 4 variables had an independent prognostic significance for survival. They were extensive metastases, older age at discovery of the metastases, absence of radioiodine uptake by the metastases, and moderately differentiated follicular cell type. The site of metastases (lung or bone) was not a prognostic factor for survival after treatment of metastatic disease. Remission was achieved in 79 patients after metastases were found. The only predictive factor for 5-yr disease-free survival after treatment of metastases was the initial extent of disease. Our results suggest that the aim of management should be to detect and treat metastases in patients with thyroid cancer as early as possible.