151
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Jensen MD, Handwerger BS, Scheithauer BW, Carpenter PC, Mirakian R, Banks PM. Lymphocytic hypophysitis with isolated corticotropin deficiency. Ann Intern Med 1986; 105:200-3. [PMID: 3014939 DOI: 10.7326/0003-4819-105-2-200] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In a 32-year-old woman, acquired, isolated corticotropin deficiency resulted from postpartum lymphocytic hypophysitis. The literature suggests that lymphocytic hypophysitis may cause acquired deficiencies of anterior, and possibly posterior, pituitary hormones. Immunologic evaluation of our patient failed to uncover anticorticotroph antibodies. Prompt recognition of this potentially fatal condition is important because of the availability of effective treatment.
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152
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Cockerill FR, Hurley DV, Malagelada JR, LaRusso NF, Edson RS, Katzmann JA, Banks PM, Wiltsie JC, Davis JP, Lack EE. Polymicrobial cholangitis and Kaposi's sarcoma in blood product transfusion-related acquired immune deficiency syndrome. Am J Med 1986; 80:1237-41. [PMID: 3524213 DOI: 10.1016/0002-9343(86)90695-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Before presenting to the Mayo Clinic, a 24-year-old white woman had received 35 transfusions of blood products over a 72-hour period in February 1981. Two and one half years later, the diagnosis of polymicrobial cholangitis (Cryptosporidium, Candida albicans, and Klebsiella pneumoniae) was established. Further evaluation demonstrated profound helper T lymphocyte suppression, disseminated Mycobacterium avium-intracellular infection with mycobacteremia, and Kaposi's sarcoma of lymphoid tissue, confirming a diagnosis of acquired immune deficiency syndrome (AIDS). This case represents an unusual infectious complication of AIDS. Additionally, this is believed to be the first report of Kaposi's sarcoma occurring in a patient with AIDS associated with blood product transfusion.
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153
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Weis JW, Winter MW, Phyliky RL, Banks PM. Peripheral T-cell lymphomas: histologic, immunohistologic, and clinical characterization. Mayo Clin Proc 1986; 61:411-26. [PMID: 3086632 DOI: 10.1016/s0025-6196(12)61975-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A review of 40 cases of peripheral T-cell lymphoma identified at our institution between March 1983 and December 1985 revealed a clinically, histologically, and immunologically diverse group of neoplasms that were difficult to classify by conventional histomorphologic criteria for non-Hodgkin's lymphomas. These lymphomas were frequently extranodal at the time of initial manifestation (52%), and their clinical aggressiveness correlated with three major histologic categories--small lymphocytic, diffuse mixed, and large cell. Of the 40 lymphomas, 18 exhibited distinctive histologic features that allowed assignment of these cases into one of four subgroups: (1) angioimmunoblastic lymphadenopathy, (2) lymphomatoid granulomatosis, (3) Hodgkin's-like disease, and (4) Lennert's lymphoma (lymphoepithelioid lymphoma). Study of all our cases that fulfilled the morphologic criteria for lymphomatoid granulomatosis or angioimmunoblastic lymphadenopathy by using immunologic methods for identification of B-cell and T-cell antigens has shown these neoplasms to be peripheral T-cell lymphomas. Therefore, we now consider these earlier proposed entities to be distinct histologic variants of peripheral T-cell lymphoma.
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154
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Freidig EE, McClure SP, Wilson WR, Banks PM, Washington JA. Clinical-histologic-microbiologic analysis of 419 lymph node biopsy specimens. REVIEWS OF INFECTIOUS DISEASES 1986; 8:322-8. [PMID: 3726392 DOI: 10.1093/clinids/8.3.322] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The results of culture and histopathologic examination of 419 lymph node biopsy specimens obtained from 414 patients in 1978-1983 were correlated with clinical histories. The clinical diagnosis was lymphadenopathy of unknown etiology in 113 cases, sarcoidosis in 93, malignant lymphoma in 86, metastatic carcinoma in 17, histoplasmosis in 18, tuberculosis in 13, and other miscellaneous conditions in 79. All but two clinically significant microbial isolates from lymph nodes were either mycobacteria or fungi: the only exceptions were staphylococcal isolates from two children with lymphadenitis. Of 66 lymph nodes associated with bacterial, mycobacterial, or fungal disease, 48 included granulomatous and/or acute inflammatory lesions. Of 33 lymph nodes that were culture-positive, two had histologic evidence of lymphoid hyperplasia, and the remainder included granulomatous and/or acute inflammatory lesions. With one exception, lymph node cultures in immunocompetent patients were positive only when there was a granuloma and/or an acute inflammatory lesion in the tissue. On the basis of these findings, it was concluded that lymph nodes from immunocompetent patients should be cultured only when a granuloma and/or an acute inflammatory lesion are detected and that the cultures can be limited to mycobacteria and fungi.
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155
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Vollertsen RS, McDonald TJ, Younge BR, Banks PM, Stanson AW, Ilstrup DM. Cogan's syndrome: 18 cases and a review of the literature. Mayo Clin Proc 1986; 61:344-61. [PMID: 3486332 DOI: 10.1016/s0025-6196(12)61951-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this article, we review 78 cases of Cogan's syndrome--18 from our institution and 60 from the English medical literature--and describe the clinical, laboratory, radiographic, and pathologic findings associated with this disorder. Patients with Cogan's syndrome should be examined by an ophthalmologist, otolaryngologist, and internist because, in addition to the eye and audiovestibular involvement, systemic manifestations are common. An elevated erythrocyte sedimentation rate, anemia, leukocytosis, and thrombocytosis are common but nonspecific laboratory abnormalities. Serious outcomes include deafness and, less frequently, vasculitis, aortic insufficiency, blindness, and death. Glucocorticoids seem to be effective therapy for active Cogan's syndrome. Aortic valve replacement and vascular bypass grafting are indicated in selected cases. The roles of cytotoxic-immunosuppressive agents and cochlear implantation remain to be clarified.
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156
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Frizzera G, Anaya JS, Banks PM. Neoplastic plasma cells in follicular lymphomas. Clinical and pathologic findings in six cases. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1986; 409:149-62. [PMID: 3087052 DOI: 10.1007/bf00708324] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Six cases of follicular lymphoma contained an abundant plasma cell component. With immunoperoxidase techniques, this was found to demonstrate monotypic cytoplasmic marking for either K or L Ig light chain in five cases, and for IgA heavy chain only in one case. A histogenetic relationship between follicular center cells and plasma cells was suggested by cell forms morphologically intermediate between these two types and by monotypic plasma cells in the neoplastic follicles. The progressive differentiation of follicular center cells into Ig-secreting cells in these cases is likely to be the result of an alteration of the immunoregulatory mechanisms that usually block the differentiation of follicular lymphomas. Four of our patients presented with disseminated disease, three had extranodal presentation and four manifested serum paraproteins. Their median survival was 40 months; two of them died of disease. The published data and our own suggest that follicular lymphoma with plasmacytic differentiation is a malignancy of intermediate grade, with survival and clinical features closer to lymphoplasmacytic/lymphoplasmacytoid lymphoma (LP immunocytoma) than to follicular lymphoma.
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157
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Clauer CR, Banks PM. Relationship of the interplanetary electric field to the high-latitude ionospheric electric field and currents: Observations and model simulation. ACTA ACUST UNITED AC 1986. [DOI: 10.1029/ja091ia06p06959] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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158
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Colon-Otero G, McClure SP, Phyliky RL, White WL, Banks PM. Peripheral T-cell lymphoma simulating Hodgkin's disease with initial bone marrow involvement. Mayo Clin Proc 1986; 61:68-71. [PMID: 3484532 DOI: 10.1016/s0025-6196(12)61400-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In a patient who had fever and cytopenias but no peripheral lymphadenopathy, bone marrow biopsy revealed findings consistent with Hodgkin's disease. Subsequently lymph node biopsy specimens showed lymphoma with features more consistent with peripheral T-cell lymphoma. The clinical features of this patient were those that have been ascribed to an atypical clinical form of Hodgkin's disease. This case illustrates the inadequacy of bone marrow examination as the sole criterion for establishing an initial diagnosis of Hodgkin's disease, particularly in relationship to the newly recognized pleomorphic variants of T-cell malignant lymphoma.
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159
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160
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Jacknow G, Frizzera G, Gajl-Peczalska K, Banks PM, Arthur DC, McGlave PB, Hurd DD. Extramedullary presentation of the blast crisis of chronic myelogenous leukaemia. Br J Haematol 1985; 61:225-36. [PMID: 3862425 DOI: 10.1111/j.1365-2141.1985.tb02821.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We report the clinical histories and a multiparameter pathological study of the extramedullary lesions of seven patients with chronic myelogenous leukaemia in whom the initial clinical presentation of blast crisis (BC) was in an extramedullary site (lymph nodes in six, mandibular mass in one). Bone marrow BC was demonstrated simultaneously or within a few months in four patients. Three patients received chemotherapy only, four underwent bone marrow transplant. Six patients died within 1 year from diagnosis of extramedullary BC, one is alive without disease. The longest survivals (12+, 12, 11 months) were those of patients who never developed bone marrow BC and were recipients of bone marrow transplant. Studies of extramedullary disease included: histology; histochemistry for chloracetate esterase (CAE) and lysozyme; assays for TdT; electron microscopy; immunofluorescence for Fc-receptors, immunoglobulins and lymphoid and myeloid antigens by a panel of monoclonal antibodies; and cytogenetics. Three cases were classified as myeloid BC based on histochemistry and/or ultrastructure and immunology (OKM1+, MCS2+, IG10+); two as lymphoid BC (CAE-, lysozyme-, TdT+), one of them expressing a T-cell phenotype. Cytogenetic analysis of extramedullary lesions and simultaneous or subsequent bone marrows demonstrated identical karyotypes in three patients and significantly different karyotypes in one.
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161
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Ellis JH, Banks PM, Campbell RJ, Liesegang TJ. Lymphoid tumors of the ocular adnexa. Clinical correlation with the working formulation classification and immunoperoxidase staining of paraffin sections. Ophthalmology 1985; 92:1311-24. [PMID: 3906488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Eighty-eight patients with ocular adnexal lymphoid lesions examined at the Mayo Clinic between 1970 and 1982 were evaluated. The histopathologic type was reclassified using the working formulation. Paraffin sections were evaluated with immunoperoxidase staining. There were 11 "pseudotumors" and 77 lymphomas. Sixty lymphomas were small lymphocytic type A; 27 tissues had a monoclonal staining pattern, and 4 had a polyclonal staining pattern. Five of the pseudotumors had a polyclonal staining pattern; none had a monoclonal pattern. The remainder did not stain or tissue was not available. Thirty-six of the 44 lymphomas that presented in the ocular adnexa remained localized. There were no distinguishing features between conjunctival and orbital lymphomas. Significant damage to the ocular tissue occurred in 15 of the 63 patients treated with radiation therapy. Older, asymptomatic patients with a favorable histologic type may not require treatment; therapy is reserved for specific indications. The probability of survival to five or seven years differs little from that expected in the general population.
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162
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Banks PM. Pregnancy and lymphoma. Arch Pathol Lab Med 1985; 109:802. [PMID: 3839651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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163
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Dorman SA, Danos LM, Caron BL, Smith TF, Goellner JR, Banks PM. Detection of Chlamydia trachomatis in Papanicolaou-stained cervical smears by an indirect immunoperoxidase method. Acta Cytol 1985; 29:665-70. [PMID: 2413668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A two-step (indirect) immunoperoxidase method directed against Chlamydia trachomatis was developed. The method was then used to evaluate the specificity of cytologic changes suggestive of C. trachomatis in Papanicolaou smears of cervical specimens from women who were culture-negative for the organism. Positive immunoperoxidase staining was detected in 9 of 21 cases (43%) tested. Technical problems, especially background staining, precluded interpretation in the remainder of the cases. Cervical cytology, as demonstrated by immunoperoxidase staining, may, in some instances, be more sensitive than the culture. However, because the etiology of cytologic changes not specifically identified by immunoperoxidase staining may be due to other organisms or factors, immunoperoxidase procedures, as described, should not replace culture for confirmation of cytologic findings suggestive of C. trachomatis.
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164
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Otteman LA, Greipp PR, Ruiz-Argüelles GJ, Banks PM, Li CY, Katzmann JA. Infectious mononucleosis mimicking a B cell immunoblastic lymphoma associated with an abnormality in regulatory T cells. Am J Med 1985; 78:885-90. [PMID: 2859806 DOI: 10.1016/0002-9343(85)90301-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An elderly woman is described with infectious mononucleosis in whom cervical node biopsy was interpreted as showing immunoblastic lymphoma. Concomitant reactive lymphocytosis, Epstein-Barr virus serologic results consistent with an acute infection, and demonstration of polyclonal B cell infiltration of other tissues argued against intervention. Defective in vitro T cell responses were demonstrated during the acute phase of Epstein-Barr virus infection. Infectious mononucleosis has rarely been reported as mimicking a non-Hodgkin's lymphoma. At 18 months, our patient's course has been typical for infectious mononucleosis with no evidence of disseminated malignancy.
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165
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Chan WC, Brynes RK, Spira TJ, Banks PM, Thurmond CC, Ewing EP, Chandler FW. Lymphocyte subsets in lymph nodes of homosexual men with generalized unexplained lymphadenopathy. Correlation with morphology and blood changes. Arch Pathol Lab Med 1985; 109:133-7. [PMID: 3156572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Frozen sections of lymph nodes from 20 homosexual men with chronic generalized lymphadenopathy and of lymph nodes showing follicular hyperplasia from 14 patients without known risk factors of the acquired immunodeficiency syndrome were studied with monoclonal antibodies to T-cell subsets and to the HLA-DR antigen. In T-cell areas of the lymph nodes, excluding tertiary paracortical nodules, the mean T-helper-to-T-suppressor ratio (Th/Ts) +/- 1 SEM was significantly lower in the homosexual group (1.07 +/- 0.06) when compared with the control group (2.49 +/- 0.23), P less than .0001. In seven homosexual men, cell suspensions from the same lymph nodes were analyzed using a fluorescence-activated cell sorter. Results obtained by this method and by immunohistochemistry were comparable except in a homosexual man whose lymph node contained large tertiary paracortical nodules. Although the Th/Ts ratios of the blood and lymph nodes of the same patients were both low, there was not good correlation between the two sets of values (r = .2). Furthermore, there was not good correlation between blood lymphocyte count and lymph node Th/Ts ratios (r = .45). The lymph node Th/Ts ratios of the homosexual patients show less variations compared with the control group. The patient who subsequently developed multiple opportunistic infections had the lowest value. Whether the lymph node Th/Ts ratio has prognostic significance in patients with the lymphadenopathy syndrome warrants further investigation.
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166
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Blair TJ, Evans RG, Buskirk SJ, Banks PM, Earle JD. Radiotherapeutic management of primary thyroid lymphoma. Int J Radiat Oncol Biol Phys 1985; 11:365-70. [PMID: 3918965 DOI: 10.1016/0360-3016(85)90159-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to evaluate the radiotherapeutic management of 38 patients, with malignant lymphoma of the thyroid, seen at the Mayo Clinic between 1965 and 1979. There were 8 males and 30 females with ages ranging from 34 to 90 years (mean age of 65 years). A tissue diagnosis was made in all patients and tissue was available for reclassification under the "Working Formulation" in 31 of the 38 patients. Twenty-six patients had intermediate grade histology, four low grade and one indeterminate. Twenty patients were clinical Stage IE, 14 patients Stage IIE, one patient Stage IIIE, one patient Stage IV and two patients were unstaged. All patients were treated with approximately 4000 rad megavoltage irradiation (range 2400-6000 rad) to the neck only (10 patients) or neck and mediastinum (28 patients). Twenty patients received subdiaphragmatic radiotherapy and four patients received adjuvant chemotherapy. Median follow-up was 56 months with minimum follow-up of 30 months. Overall disease-free survival at five years was 59%. Of 14 patients who experienced a recurrence, 10 (71%) failed in two or more sites. The most common site of failure was in para-aortic lymph nodes. One year survival following recurrence was 29%; however, four of six patients receiving salvage therapy survived at least two years. Patients receiving radiation treatment to the neck and mediastinum and those with no gross residual disease at the initiation of radiotherapy were less likely to develop a recurrence. Patients receiving a planned break during the course of therapy did not have reduced overall disease-free survival. However, 4 of 20 patients (20%) who received split course therapy failed within the radiation fields compared to 2 of 18 patients (11%) who had no treatment break. Only 1 of 4 patients (25%) receiving adjuvant chemotherapy survived one year. Side effects of radiotherapy were minimal. We believe the radiotherapeutic management of clinical Stage IE and IIE primary thyroid lymphoma should include treatment of the neck, axillae and mediastinum to a dose of approximately 4000 rad using a continuous course technique. Additionally, gross total removal of the disease surgically may be beneficial.
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167
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Abstract
Twenty-six lymph node biopsy specimens from twenty-three patients with Sézary syndrome were microscopically evaluated and compared with nodal specimens from six patients with pre-Sézary syndrome and four control patients with dermatopathic lymphadenopathy. Three phases of nodal involvement by cerebriform lymphocytes were perceived. A trend toward greater effacement of lymph node tissue (phase II or phase III) could be related to longer duration of disease. Unchanged stable histologic features were seen in repeated specimens at intervals as long as 6 years. Cases of pre-Sézary syndrome were of phase 0 or phase I, with nodal histology overlapping that of many of the cases of typical Sézary syndrome. In contrast to mycosis fungoides, Sézary syndrome, with its hematogenous circulation of cerebriform cells, features early recognizable nodal infiltration. The degree of nodal involvement does not consistently correlate with the prognosis.
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168
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Miller RT, Mukai K, Banks PM, Frizzera G. Systemic lymphoproliferative disorder with morphologic features of Castleman's disease. Immunoperoxidase study of cytoplasmic immunoglobulins. Arch Pathol Lab Med 1984; 108:626-30. [PMID: 6204622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Lymph node biopsy specimens from nine patients with a systemic lymphoproliferative disorder morphologically resembling Castleman's disease were studied for the presence of cytoplasmic immunoglobulins. After trypsinization of tissue sections, the avidin-biotin-peroxidase method was used to stain for IgG, IgA, and IgM heavy chains and kappa and lambda light chains. All cases showed polyclonal proliferation of plasma cells. The predominant immunoglobulin class observed was IgG. The IgM-containing cells tended to be localized concentrically around germinal centers. No notable changes were seen in multiple biopsy specimens from five patients. Polyclonal staining was also observed in lymph nodes obtained at autopsy from a patient who died of a disseminated atypical immunoproliferative process. The polyclonal staining pattern in these cases confirms the reactive nature of this systemic lymphoproliferative disorder.
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169
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Obayashi T, Kawashima N, Kuriki K, Nagatomo M, Ninomiya K, Sasaki S, Yanagisawa M, Kudo I, Ejiri M, Roberts WT, Chappell CR, Reasoner DL, Burch JL, Taylor WL, Banks PM, Williamson PR, Garriott OK. Space Experiments with Particle Accelerators. Science 1984; 225:195-6. [PMID: 17837939 DOI: 10.1126/science.225.4658.195] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Electron and plasma beams and neutral gas plumes were injected into the space environment by instruments on Spacelab 1, and various diagnostic measurements including television camera observations were performed. The results yield information on vehicle charging and neutralization, beam-plasma interactions, and ionization enhancement by neutral beam injection.
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170
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Schomberg PJ, Evans RG, Banks PM, White WL, O'Connell MJ, Earle JD. Second malignant lesions after therapy for Hodgkin's disease. Mayo Clin Proc 1984; 59:493-7. [PMID: 6588280 DOI: 10.1016/s0025-6196(12)60440-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Among 169 adult pathologically staged patients with Hodgkin's disease who were treated at the Mayo Clinic between 1974 and 1978, we identified four cases of second malignant lesions that developed. The median duration of follow-up after diagnosis for the entire population was 4.1 years. Of the 169 patients, 73 received irradiation only, 19 received chemotherapy only, and 77 received both chemotherapy and radiation therapy. In all four patients with second malignant lesions, Hodgkin's disease was in apparent remission at the time of diagnosis of the second tumor. These four patients had received either total nodal irradiation or six or more cycles of chemotherapy as initial treatment (and one of them had received both treatment modalities). Thus, intensive therapy might be hypothesized to have played a role in the development of the second malignant tumor. To our knowledge, the development of non-Hodgkin's lymphoma within a previously irradiated field after treatment of Hodgkin's disease with radiation therapy only has not been reported previously. Although further studies with longer follow-up should be conducted, our analysis supports a definite risk for development of a second malignant lesion not only after combined-modality treatment or chemotherapy for Hodgkin's disease but also after irradiation only.
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171
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Buechner SA, Winkelmann RK, Banks PM. T cells and T-cell subsets in mycosis fungoides and parapsoriasis. A study of 18 cases with anti-human T-cell monoclonal antibodies and histochemical techniques. ARCHIVES OF DERMATOLOGY 1984; 120:897-905. [PMID: 6233942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Skin lesions from 15 patients with mycosis fungoides (MF) and from three with parapsoriasis were studied immunohistochemically with monoclonal antibodies against T cells (Leu 1) and against T-cell subsets (Leu 2a, Leu 3a). Lymphoid cell reactivity was diverse among these sampled cases. In two cases of parapsoriasis and nine of MF, there was a predominance of helper/inducer (Leu-3a-reactive) cells over suppressor/cytotoxic (Leu-2a-reactive) cells. In one case of parapsoriasis and one (advanced tumor stage) of MF, there was suppressor/cytotoxic cell predominance. One case of MF showed strong reactivity for both T-cell subset markers. Four cases of MF (two plaque-stage and two tumor-stage) featured a predominant cell type in the dermis which was nonreactive for all three antibodies. The intraepidermal lymphoid cellularity was Leu-1-reactive in ten cases of MF and two of parapsoriasis. Among these 12 cases, the intraepidermal cellularity was Leu-2a-reactive in four and Leu-3a-reactive in three. The use of such studies of T-cell subsets on in situ cutaneous lymphoid infiltrates may demonstrate a correlation with cytomorphology, clinical stage, and disease prognosis.
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172
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Strand WR, Banks PM, Kyle RA. Anaplastic plasma cell myeloma and immunoblastic lymphoma. Clinical, pathologic, and immunologic comparison. Am J Med 1984; 76:861-7. [PMID: 6547021 DOI: 10.1016/0002-9343(84)90998-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To test whether highly anaplastic myeloma and immunoblastic lymphoma are truly identical disease processes, simultaneous series were compared in respect to cytomorphologic features, immunoglobulin content or secretion, clinical and laboratory findings, and patient survival. Although the series partially overlapped in each studied feature, different trends served to distinguish them. Of the 14 patients with myeloma, all were dead at two years, whereas six of the 22 patients with lymphoma were disease-free at 35 to 78 months. Only 50 percent of patients with myeloma received intensive chemotherapy, whereas all 19 patients with stage III or IV lymphoma received such therapy. Myelomas secreted predominantly IgA heavy chain rather than IgG and lambda light chain rather than kappa. Lymphomas contained predominantly IgM rather than IgG and kappa rather than lambda. There were no IgM myelomas and no IgA lymphomas. The shorter survival of patients with the extremely anaplastic form of myeloma, as compared with patients who had immunoblastic lymphoma, may relate, in part, to prior therapy for previous lower grade myeloma; however, intrinsic differences in the nature of these two disease processes are reflected in their disparate immunologic characteristics.
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173
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Ducatman BS, Wick MR, Morgan TW, Banks PM, Pierre RV. Malignant histiocytosis: a clinical, histologic, and immunohistochemical study of 20 cases. Hum Pathol 1984; 15:368-77. [PMID: 6370827 DOI: 10.1016/s0046-8177(84)80036-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
To better characterize the diagnostic criteria and clinical behavior of malignant histiocytosis, 20 patients treated at the Mayo Clinic during a 25-year period were studied. A wide spectrum of cytologic differentiation was observed, with cells ranging from bland to highly anaplastic; hemophagocytosis was prominent only in conjunction with a bland histologic appearance. In surgical specimens, the diagnosis of malignant histiocytosis necessitated the use of immunoperoxidase methods for lysozyme, immunoglobulin light chain, and alpha-antitrypsin content, as well as cytochemical stains for acid phosphatase and nonspecific esterase. All autopsies showed that organ involvement had varied somewhat from that reported earlier. The correct diagnosis of malignant histiocytosis was made prior to death in only ten of the 20 cases. The mean survival in the 17 fatal cases was 7.6 months; three of the seven patients treated by aggressive chemotherapy achieved complete remission. Relatively longer survival was correlated with initial confinement to the skin and the absence of cytopenia or liver function abnormalities. Three patients with pulmonary involvement from malignant histiocytosis had apparent inappropriate antidiuretic hormone secretion in the absence of central nervous system disease. The accelerated clinical progression of malignant histiocytosis and its response to current chemotherapeutic regimens make rapid diagnosis and familiarity with the pathologic variations seen in this disorder imperative. Routine utilization of special light-microscopic and immunohistochemical stains is mandatory.
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174
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Scheen SR, Banks PM, Winkelmann RK. Morphologic heterogeneity of malignant lymphomas developing in mycosis fungoides. Mayo Clin Proc 1984; 59:95-106. [PMID: 6700269 DOI: 10.1016/s0025-6196(12)60243-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
From an extensive series of patients with mycosis fungoides, we identified 12 in whom subsequently developing extracutaneous (lymph nodal) lymphoma manifested morphologic features other than those of so-called cutaneous T-cell lymphoma. Six patients had features diagnostic of Hodgkin's disease, two had morphologic and cytochemical features consistent with T-cell lymphoma but without the morphologic features ascribed to cutaneous T-cell type, and four had morphologic characteristics most consistent with B-cell lymphoma. Although in most cases of mycosis fungoides the lymphomas exhibit morphologically distinctive features of mycosis cells, we propose that in occasional cases this morphologic correlation is not present.
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175
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Schomberg PJ, Evans RG, O'Connell MJ, White WL, Banks PM, Ilstrup DM, Earle JD. Prognostic significance of mediastinal mass in adult Hodgkin's disease. Cancer 1984; 53:324-8. [PMID: 6690014 DOI: 10.1002/1097-0142(19840115)53:2<324::aid-cncr2820530225>3.0.co;2-e] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The authors analyzed the prognostic significance of mediastinal involvement with Hodgkin's disease in 169 pathologically stage adults (greater than or equal to 17 years) treated at the Mayo Clinic between 1974 and 1978. Sixty percent of the patients presented with mediastinal disease, evenly divided between those with a mediastinal to thoracic ratio (MTR) less than 0.33 and greater than or equal to 0.33. They were of younger average age and were more likely to have nodular sclerosis histologic subtype than those patients without a mediastinal mass. The median follow-up from diagnosis was 4.1 years with 90% of the patients being followed for 2 or more years. The 5-year disease-free survival (DFS) for the radiation only group was 70% in patients without mediastinal disease, 53% in the less than 0.33 MTR group and 44% in the greater than or equal 0.33 MTR group (P = 0.25). The 5-year survival was 92% in the patients without mediastinal disease, 88% in the less than 0.33 MTR group and 90% in the greater than or equal to 0.33 MTR group (P = 0.70). This lack of significant difference both in the 5-year DFS and survival between the three groups was also seen in the patients taken in toto (169) and in those receiving combined modality treatment (36). However, in early stage (I and II) patients, treated with radiation only, those with a large mediastinal mass had a 5-year DFS (33%) that was significantly worse than both the small mass patients (71%) and those with no mediastinal mass (87%) P less than 0.005). The pattern of relapse in the 40 patients who failed following treatment by radiation only was not affected by an increasing size of mediastinal involvement. At the time of this analysis 27 of the 40 patients who had relapsed following treatment by radiation only (all stages) had remained free from second relapse. The authors do not believe that the current data either support or negate the use of a combined modality approach in the initial treatment of Hodgkin's disease patients presenting with a large mediastinal mass. Only further follow-up will establish whether the treatment of patients, who have relapsed following radiation only, is durable and results in an overall survival comparable to that obtained by using combined modality initially.
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