[Study on surgical treatment for lung cancer associated with giant bullous disease]

Five patients of primary lung cancer with giant bullous disease underwent surgery from April 1985 to December 1995. All patients were male and heavy smokers, and the median age was 50 years. The location of the tumor was in the right upper lobe in four patients and in the left upper lobe in the other. Three patients were treated by lobectomy and two by sleeve lobectomy. Histological examination showed large cell carcinoma in four patients and poorly-differentiated adenocarcinoma in the other. The pathological stage was I in three. IIIA in one, and IV in the other. Two of three in stage I have survived for more than 6 years postopertively without recurrence, and the other died of brain metastasis. The stage IIIA case and the IV case died 3 years and one year postoperatively, respectively. The clinical features of lung cancer associated with giant bullous disease was discussed by reviewing 33 patients reported in Japan, including our patients. In 13 patients, lung cancer and bullous disease were diagnosed simultaneously (group A), and in 20 patients, bullous disease were diagnosed prior to the appearance of an abnormal shadow due to lung cancer (group B). The patients in group B had a tendency to be diagnosed at an earlier stage of lung cancer than the patients in group A. In the patients of stage I, the 5-year survival rate was 78.6%, however, in the patients of more than stage IIIA, 3-year survival rate was 26.5% and the 5-year survival rate was 0%. Significant differences in the survival curves were demonstrated between the cases with stage I and the cases with more than stage IIIA. In conclusion, in order to improve the prognosis of lung cancer with giant bullous disease, it is considered to be important to detect giant bulla prior to lung cancer, and when a case of bullous disease is found, periodical follow-up must be done to find early stage lung cancer.

Transformation of guinea pig leukocytes by coinfection with human T-cell lymphotropic virus types I and II

OBJECTIVE

The susceptibility of guinea pigs to human T-cell lymphotropic virus (HTLV) infection and of their cardiac blood mononuclear cells (CBMCs) to HTLV-induced transformation were investigated.

STUDY DESIGN/METHODS

Guinea pig CBMCs were cocultured with HTLV-infected cell lines. Guinea pigs were then inoculated with transformed guinea pig CBMCs.

RESULTS

The coculture experiment gave rise to a guinea pig cell line, GP-1, that was coinfected with both HTLV-I and HTLV-II as shown by immunofluorescence staining, electron microscopy, polymerase chain reaction (PCR) using primers specific for the pol region of each virus, and Southern blot hybridization. The GP-1 cell line expressed T-cell markers and monocyte/macrophage markers. Three guinea pigs given an intraperitoneal inoculation of GP-1 cells seroconverted for HTLV-I and became positive for HTLV-I, HTLV-II, or both, as confirmed by PCR.

CONCLUSIONS

Guinea pigs and their CBMCs can be infected with HTLV-I and HTLV-II. This animal system may be useful as an experimental model of HTLV-I and HTLV-II infection.

Analysis of the Smad2 gene in hematological malignancies

A total of 34 leukemia and lymphoma samples (17 clinical samples and 17 cell lines) were analyzed for mutations of the Smad2 gene by reverse transcriptase-polymerase chain reaction single strand conformation polymorphism (RT-PCR-SSCP) analysis. Nine of the 34 samples had 18q chromosomal abnormalities. No shifted bands were detected in any of the hematological malignancies. Our results suggest that resistance to cell growth inhibitory effects of TGF-beta in hematological malignancies is not due to alterations of the Smad2 gene.

Effectiveness of valproate on delirium and/or aggressive behavior in demented patients: A practical pilot study

This open study was designed to evaluate the efficacy of valproate as a treatment for delirium and/or aggressive behavior in patients with dementia. Of the patients who participated, nine had vascular dementia, two had Alzheimer's disease, one had Parkinson's disease and one had alcohol dependence, all meeting DSM-IH-R criteria for dementia. In these 13 patients, delirium in seven and aggressive behavior in 12 patients were the target symptoms of this study. Valproate was administered orally at a dose of 200-600 mg daily (mean 526 mg, sd=20.4) without changing the dose of the other medications. The effect of valproate on delirium and aggressive behavior was evaluated with the Delirium Rating Scale (DRS) and Gottfries-Brane-Steen Scale (GBS). The total DRS scores decreased in 6/7 patients with delirium (P < 0.05) within 2 weeks. There were significant diferences between the score variances (before and during treatment) of the three categories in the GBS scale: emotional lability (P < 0.01), irritability (P < 0.01) and restlessness (P < 0.01). These findings suggest the effectiveness of valproate treatment for delirium and/or aggressive behavior in demented patients.

Homozygous deletions at 9p21 in childhood acute lymphoblastic leukemia detected by microsatellite analysis

To gain a fuller understanding of the role of deletions of chromosome 9 in the development of childhood acute lymphoblastic leukemia (ALL), we performed detailed deletional mapping of chromosome 9 in 54 primary ALL samples with matched normal DNA using 22 highly polymorphic markers; and this information was combined with our previous data concerning the presence of deletions of CDKN2/INK4A/p16 and CDKN2B/INK4B/p15 in these samples. We have found a very high frequency of loss of heterozygosity (LOH) (31 of 54 cases (57%)) on chromosome arm 9p. As expected, the smallest region of LOH was between D9S1747 and D9S1748 at 9p21, including CDKN2/INK4A/p16, but excluding CDKN2B/INK4B/p15. Homozygous deletions at 9p21 occurred in 23 of 54 (43%) samples (seven of 11 (64%) T-ALL, 16 of 45 (36%) precursor-B ALL). We detected seven cases of homozygous deletions at 9p21 which had not been detected by Southern blot hybridization, showing the power of microsatellite analysis in detecting homozygous deletions. In most cases, homozygous deletions were limited to the region between D9S1747 and CDKN2B/INK4B/p15. We have attempted to determine the mechanism and timing of 9p deletions. Of the 23 samples with homozygous deletions at 9p21, 21 samples had surrounding large LOH. Of the 29 samples with LOH of 9p, homozygous deletion at 9p21 was identified in 22 cases. In addition, six patients have been studied at diagnosis and relapse, all six showed the same 9p21 structure at relapse (normal, three patients; hemizygous deletions, two patients; homozygous deletion, one patient) as their initial presentation. Finally, three patients (homozygous deletion, one patient; hemizygous deletion, two patients) had the IFN-alpha rather than CDKN2/INK4A/p16 deleted. In summary, these data further emphasize the importance of 9p21 loss in the development of childhood ALL.

Morphological study of pituitary tumorigenesis in transgenic mice induced by hybrid oncogene of the thyrotropin beta-subunit and the simian virus 40 large T-antigen

We have created a transgenic mouse, TTP-1, generating anterior pituitary tumors by using the simian virus 40 (SV40) large T antigen gene and human thyrotropin beta-subunit gene. To examine characteristics of tumors, histological details were investigated using light and electron microscopies. The main tumor tissues, composed of small chromophobe cells, were located inferior to but clearly separated from the hypothalamus; however, neuron fibers probably derived from the hypothalamus were observed to invade some tumor tissues. Some differentiated endocrine cells occupied the caudal region of the tumor. Immunohistochemically, SV40 large T antigen was expressed in the cell nucleus of the undifferentiated cell area, whereas cells expressing several hormones were mainly distributed in the differentiated cell area. Electron microscopically, the undifferentiated cells were divided into 2 types; electron-dense and -lucent cells, the nuclei of which were composed of obscured nucleoli and many notable invaginations of the nuclear membrane. No intracellular microfilamentous structures were observed. Sometimes it was noted that cytoplasmic processes were connected with gap junctions. In the intercellular spaces, there were neuron fibrous and synapse-like structures. In the differentiated cell area, the cell membranes directly contacting other cells were relatively smooth, and many gap junctions were demonstrated. Secretory granules, which were round and less than 100 nm in diameter, were more electron dense in smaller cells than in larger cells. They were aligned just below the cell membrane. Immuno-electron microscopically, positive reactions for SV40 were observed in the nuclei of the undifferentiated cell area. In the differentiated cell area, most of the secretory granules were labeled by GH. TTP-1 transgenic mice should provide a valuable animal model for studying the pathogenesis of anterior pituitary tumors.

High serum levels of CA125 and interleukin-6 in a patient with Ki-1 lymphoma

We report a 53-year-old-man with an aggressive Ki-1 lymphoma who had high serum CA125, a marker protein of the epithelial ovarian cancer, and interleukin-6 (IL-6) concentrations. Both CA125 and IL-6 levels decreased after chemotherapy and elevated with disease progression. The patient's lymphoma cells obtained before chemotherapy grew continuously in vitro, were IL-6 dependent and were found to secrete CA125 in culture medium. These results indicate that CA125 can be secreted by Ki-1 lymphoma cells and IL-6 may promote the growth of Ki-1 lymphoma cells.

TEL is one of the targets for deletion on 12p in many cases of childhood B-lineage acute lymphoblastic leukemia

Abnormalities of the short arm of chromosome 12 including loss of heterozygosity (LOH) and TEL/AML-1 fusion resulting from a t(12;21)(p13;q22) translocation are frequently observed in childhood acute lymphoblastic leukemia (ALL). We investigated 21 DNA samples of childhood ALL which had LOH at 12p13. Rearrangement of TEL was observed in eight cases and another case showed a homozygous deletion of TEL. Two informative samples with TEL rearrangement had a deletion localized to the 5' region of this gene. The deletion in these two cases includes the helix-loop-helix (HLH) domain. This is consistent with the hypothesis that the normal tel can heterodimerize with the TEL/AML-1 gene product and inhibit the transforming capacity of the chimeric protein. Presumably, loss of the HLH of the normal remaining TEL allele abrogates this tumor suppressor-like function. The case with homozygous deletion of TEL is also consistent with this gene having qualities of a tumor suppressor. One unusual case had T-ALL rather than B-lineage ALL and the leukemic cells had rearrangement of TEL, but they did not have an alteration of the remaining TEL allele suggesting that the etiology of this disease may be different. This analysis further emphasizes the importance of loss of the normal TEL allele in childhood precursor B-lineage ALL.

An HTLV-I carrier with Graves' disease followed by uveitis: isolation of HTLV-I from thyroid tissue

We report a long-term (14-year) follow-up of a human T-lymphotropic virus type I (HTLV-I)-infected male who was successively afflicted with Graves' disease followed by uveitis. HTLV-I proviral DNA was detected by polymerase chain reaction in the thyroid tissue and HTLV-I was isolated from thyroid tissue by coculture with peripheral blood lymphocytes from an HTLV-I-uninfected healthy female. This case study supports a close relationship between Graves' disease and uveitis in an HTLV-I carrier.

Human herpesvirus 6 (HHV-6)-positive Burkitt's lymphoma: establishment of a novel cell line infected with HHV-6

Human herpesvirus 6 (HHV-6) DNA has been detected in several human lymphoproliferative disorders. We report a case of HHV-6-infected Burkitt's lymphoma, from which a cell line, designated Katata, has been established. Katata cells had an immature B-cell phenotype with an L3 morphology and carried a t(8;14)(q24;q32) chromosomal abnormality. The HHV-6 DNA sequences were detected in both the patient's tumor cells and Katata cell line by polymerase chain reaction using three sets of primers that target different regions of HHV-6 DNA. The presence of HHV-6 DNA in Katata cells was also shown by Southern blot hybridization with the BamHI fragment of HHV-6. It is likely that the virus is in a latent state, since (1) virion-associated protein was not expressed in Katata cells, (2) transcriptional level of the immediate-early gene was very low, and (3) no viral particles were observed by electron microscopy. Katata cells were highly tumorigenic in nude mice and the tumor cells also contained HHV-6 DNA. We have successfully obtained several clonal lines by allowing the cells to form colonies in soft agarose and by the limiting dilution method. HHV-6 DNA was detectable in all 13 clones analyzed, suggesting that virtually all Katata cells are infected with HHV-6. This is the first report of a case of HHV-6+ Burkitt's lymphoma in the absence of Epstein-Barr virus. Furthermore, there has been no report of lymphoma cell lines that are persistently and nonproductively infected with HHV-6. The Katata Burkitt's lymphoma cell line, therefore, would provide a useful tool for studies of the mechanisms of HHV-6 latency and reactivation.

Microsatellite instability and other molecular abnormalities in childhood acute lymphoblastic leukaemia

Microsatellite instability (MSI) has been considered to represent the defect of DNA mismatch repair systems and has been implicated in the tumourigenesis of several human malignancies. To investigate the possible presence of microsatellite instability in childhood acute lymphoblastic leukaemia (ALL), we examined 48 primary ALL samples. Instability was determined at 85 different microsatellite loci localized to 12 different chromosome arms. Microsatellite instability was detected in five (10%) samples. Interestingly, the instability was found at chromosomal regions associated with frequent alterations. Two samples had instability at the microsatellite marker within the TEL gene on chromosome arm 12p. Two other samples had instability at a microsatellite marker close to CDKN2/p16 on 9p; one of these samples had a homozygous deletion at 9p21. The fifth sample had instability at the microsatellite marker on 6q, which we have found is a frequent region of loss of heterozygosity in childhood ALL. Taken together, instability was rare in childhood ALL, but was localized to the three most frequently deleted chromosome regions in childhood ALL, suggesting that localized microsatellite instability may identify a fragile chromosomal region which could result in alteration of surrounding target genes and lead to leukaemia.

Angioimmunoblastic lymphadenopathy with disseminated human herpesvirus 6 infection in a patient with acute myeloblastic leukemia

A 47-year-old man with acute myeloblastic leukemia (AML) developed angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) 4 months after induction chemotherapy for AML. During a leukopenic period, the patient suffered from pericarditis with massive pericardial effusion in which human herpesvirus 6 (HHV-6) DNA was detected. Although complete remission of AML was achieved, fever persisted and atypical skin rash followed by generalized lymphadenopathy along with polyclonal hypergammaglobulinemia appeared. A diagnosis of AILD was made on a biopsy specimen of the inguinal lymph node. The patient died of fulminant hepatitis and the autopsy showed lymphomatous infiltrates involving the liver, bone marrow, lungs, spleen, kidneys and heart. HHV-6 DNA sequences were identified in the biopsy specimen of the lymph node and in the involved organ tissues. HHV-6 in this patient was variant B. It is known that HHV-6 can be reactivated in immunocompromised patients and causes severe complications. This unusual clinical course suggests that the immunosuppression associated with AML and the additional iatrogenic immunosuppression following cytopenia-inducing chemotherapy predisposed the patient to reactivated HHV-6 infection. The sequential detection of this virus before and after manifestation of AILD may support the evidence that HHV-6 infection could directly or indirectly trigger AILD. This is the first time that such a sequence of events has been reported to our knowledge. The possibility of HHV-6 infection should be considered when unexplained fever and generalized lymphadenopathy are seen in patients with leukemia, and administration of antiviral agents should be considered for the diagnostic evaluation.

Dual infection of rabbits with human T cell lymphotropic virus types I and II

Attempts were made to generate a rabbit model of dual infection with human T lymphotropic virus (HTLV) types I and II. Four groups (A, B, C, and D) of three rabbits each were used. Group A was inoculated with the RW-1 cell line coinfected with HTLV-I and HTLV-II and group B was transfused from a dually infected rabbit. Polymerase chain reaction (PCR) using primers specific for the pol region of each virus detected both HTLV-I and HTLV-II in all group A and two group B rabbits, but HTLV-II only in the remaining group B rabbit. Groups C and D already infected with HTLV-I and HTLV-II, respectively, were inoculated with an HTLV-II- or HTLV-I-producing cell line. One group C rabbit became PCR-positive for both viruses but the other five resisted superinfection with the respective viruses. During prolonged observation, three of the six dually infected rabbits converted to single (HTLV-I or HTLV-II) infection. The in vivo dual infection was confirmed by in vitro establishment of a lymphoid cell line coinfected with HTLV-I and HTLV-II. It was also possible to establish coinfected lymphoid cell lines from HTLV-I-infected rabbits by coculture with lethally irradiated HTLV-II-producing cells and vice versa. The mechanism of viral elimination in dually infected rabbits, as well as that of protective immunity against superinfection, remains to be elucidated.

PTHrP-mediated hypercalcaemia in a case of CML blast crisis

We report a 52-year-old man with chronic myelogenous leukaemia (CML) who developed hypercalcaemia in blast crisis. There was a high serum level of parathyroid hormone-related protein (PTHrP). The leukaemia cells secreted PTHrP into culture medium when cultured in vitro and were shown to express PTHrP mRNA by reverse transcription-polymerase chain reaction. Transplantation of the leukaemia cells into nude mice resulted in the production of Ph1 chromosome-positive tumours which caused increased levels of calcium and PTHrP in the blood. These results indicated that the hypercalcaemic event in the patient was induced by PTHrP of CML cell origin.

Progressive effect of alpha-phenyl-N-tert-butyl nitrone (PBN) on rat embryo development in vitro

In the present study we demonstrated the effects of the spin-trapping agent alpha-phenyl-N-tert-butylnitrone (PBN) on the in vitro development of rat embryos at the early stage. In rat embryos, PBN increased the speed of the first cleavage and had no toxicity during pregnancy after embryo culture. These results showed that reactive oxygen species (ROIs) that were formed by activating molecular oxygens through redox reactions regulated the speed of development for early-stage embryos. Thus, PBN caused a decrease in the level of ROIs and toxicity and an in increase in the level of the development of rat embryos. On the other hand, PBN could not decrease the 2-cell block in vitro nor increase the blastulation rate, in contrast to the fact that a scavenger of superoxide anions, SOD, is effective in doing so for mouse embryos. From these results it was concluded that free radicals play an important role in the in vitro development of rat embryos at the early stage, but play no role in the decrease of the 2-cell block or their blastulation rate. It should be noted that PBN had no toxicity for embryonic development at the 2-cell stage.

Polymerase chain reaction amplification of Asp f I and alkaline protease genes from fungus balls: clinical application in pulmonary aspergillosis

Asp fI(18 kDa) and alkaline protease (33 kDa) are the 2 major antigens which are derived from Aspergillus (A.) fumigatus and have been implicated as possible virulence factors in the pathogenesis of Aspergillus-induced diseases. We attempted to detect fragments of genes encoding both proteins from fungus balls obtained at surgery or autopsy by polymerase chain reaction (PCR) amplification and then used PCR to test clinical samples. Frozen-stored fungus ball samples from a patient with acute myeloid leukemia complicated by Aspergillus pneumonia and from a patient with pulmonary aspergilloma were studied. We successfully amplified a 315 bp PCR product, the target sequence for Asp f I, and a 747 bp PCR product as a target sequence for alkaline protease (ALP) in both cases. In addition, 13 clinical samples including sputum specimens from patients with pulmonary aspergillosis were also examined. PCR analysis for the Asp f I (ALP) gene in clinical samples showed positive results in 5/10 (6/10) patients with pulmonary aspergilloma and in 3/3 (1/ 3) patients with invasive pulmonary aspergillosis. Culture data on A. fumigatus revealed positive results in 3/9 patients with pulmonary aspergilloma and in 2/3 patients with invasive pulmonary aspergillosis. This method can be used to recognize the involvement of A. fumigatus in various clinical settings where conventional culture results are not readily available.

Prevention of human T cell lymphotropic virus type I infection in Japanese macaques by passive immunization

Prophylaxis against human T cell lymphotropic virus type I (HTLV-I) is of primary importance for the eradication of adult T cell leukemia and other diseases associated with this virus. Hyperimmune globulin (H-IgG) prepared from healthy blood donors with high antibody titers for HTLV-I was evaluated for its prophylactic effect against HTLV-I in Japanese macaques (Macaca fuscata). Normal IgG (N-IgG) prepared from seronegative healthy blood donors was used as control. Both preparations contained 50 mg/ml IgG and H-IgG had a neutralizing antibody titer of 1:7100 by vesicular stomatitis virus (HTLV-I) pseudotype neutralization assay. Two macaques were infused with 2 ml/kg N-IgG and three macaques were immunized with 2-0.5 ml/kg H-IgG. They were immediately challenged by inoculation of 8 x 10(6)/kg cells from an HTLV-I-producing rabbit lymphoid cell line (Ra-1). Another macaque was immunized with 1 ml/kg H-IgG 24h after inoculation of 8 x 10(6)/kg Ra-1 cells. HTLV-I infection, as determined by seroconversion and verified by polymerase chain reaction, occurred in both of the N-IgG-injected macaques but in none of the four H-IgG-injected macaques. These results demonstrate the protective efficacy of H-IgG against HTLV-I infection in a primate model and provide an experimental basis for passive immunization trials in humans.

Differential tumorigenicity between Epstein-Barr virus genome-positive and genome-negative cell lines with t(11;14)(q13;q32) derived from mantle cell lymphoma

Epstein-Barr virus (EBV) genome has been detected in several human lymphoproliferative diseases, but the oncogenic function of EBV is not fully understood. We previously established EBV-positive (SP-50B) and EBV-negative (SP-53) cell lines with the t(11;14)(q13;q32) chromosome abnormality from a single patient with mantle cell lymphoma. Monoclonal EBV DNA in a circular episomal form was demonstrated in the SP-50B cells by Southern blot hybridization with the EBV-terminal fragment probe. SP-50B cells were positive for not only EBV-encoded nuclear antigen-1 (EBNA1) but also latent membrane protein-1 and EBNA2. None of the EBV-encoded proteins was expressed in SP-53 cells. The isogenic EBV-infected and EBV-free cell lines of neoplastic clones made it possible to examine a tumorigenic role of EBV. Only EBV-positive SP-50B cells possessed malignant phenotypes, such as growth ability in low serum, colony formation in soft agarose, and tumorigenicity in nude mice. On the other hand, a lymphoblastoid B-cell line established by infecting the patient's normal B lymphocytes in vitro with exogenous EBV had no tumorigenicity. These results suggested that EBV infection, if it occurred in neoplastic lymphoma cells, could play a role in acquisition of malignant phenotypes.

Biphenotypic leukemia with a new translocation, t(2;6)(q31;q23)

A t(2;6)(q31;q23) was found in a patient with acute biphenotypic leukemia. This cytogenetic change has not been reported previously in acute lymphocytic leukemia (ALL) or biphenotypic leukemia, although deletion of 6q has been frequently found in ALL.

HTLV-I-seronegative, genome-positive adult T-cell leukemia: report of a case

An HTLV-I-seronegative case of adult T-cell leukemia (ATL) carrying the HTLV-I genome is reported. Screening serological tests were negative and Western blot analysis revealed only a faint band for HTLV-I p24. Polymerase chain reaction (PCR) disclosed the presence of HTLV-I gag, pol, env, pX, and LTR sequences in the lymph node and peripheral blood. Southern blot analysis revealed a monoclonal integration of HTLV-I in the lymph node and peripheral blood. The tumor cells expressed viral antigens after short-term culture. The clinical course was consistent with ATL in that the patient exhibited hypercalcemia and abnormal lymphocytosis as well as hepatosplenomegaly and lymphadenopathy. We recommend that PCR analysis for HTLV-I be performed even in seronegative cases when ATL is clinically suspected.