Plasmacytoma of the mesentery

Extramedullary plasmacytoma represents 3%–5% of all plasma cell neoplasms. Plasmacytomas of the mesentery are extremely rare. We report the case of a 56-year-old man who presented with an abdominal mass and was diagnosed to have plasmacytoma of the mesentery. A literature review was also conducted on publications pertaining to solitary mesenteric plasmacytomas. These patients present late by which time the abdominal mass has reached a significant size. Radiation as a modality for local control has a limited role in treating mesenteric plasmacytomas. Surgery is the preferred modality for local control. Patients must be kept on a regular follow-up as there is a risk of transformation to multiple myeloma.

Composite lymphomas: Experience from a tertiary cancer center in Kerala, South India

OBJECTIVES

Composite tumors are defined as tumors in which there are two different intermixed histologic types. Our objective was to study the clinical and pathologic features of five cases of composite lymphoma.

MATERIALS AND METHODS

Our study included five patients of composite lymphoma diagnosed over a period of 5 years. Clinical presentation, hematological parameters including peripheral smear, bone marrow aspirate, and histopathological examination of lymph node including immunohistochemistry (IHC) were studied. Treatment and follow-up details were also noted.

RESULTS

All the five cases were in the adult age group ranging from 44 to 72 years. All the cases were composite follicular lymphoma (FL) and mixed cellularity classical Hodgkin lymphoma (CHL). Diagnosis in all cases was suspected on morphology by identification of distinct neoplastic follicles in FL and classic Reed-Sternberg cells in CHL and confirmed by IHC.

CONCLUSION

Although rare, composite lymphomas should be kept in mind. Careful histopathological examination of lymph node with identification of distinct morphological features along with IHC helps to arrive at the definitive diagnosis.

Abstract 4994: Downstream targets of Id1 transcription factor in non-small cell lung cancer

Id1 (Inhibitor of DNA binding/Differentiation) is a helix loop helix (HLH) protein, regulates transcription by binding to bHLH transcription factors and preventing their binding to the DNA. Id1 is especially known to mediate repression of E box proteins and Ets transcription factors. Id1 gene is overexpressed in lung, breast, pancreatic and prostate cancer and it is thought to promote the progression and metastasis of these tumors. At the same time, not much is known about its role in non-small cell lung carcinoma.Preliminary studies from our lab shows that Nicotine as well as EGF induces Id1 in both adenocarcinoma and squamous carcinoma cells and is notably upregulated in metastatic lung cancers. Depletion of Id1 also prevents the proliferation and invasion of NSCLS cells. Attempts were made to understand the downstream effectors of Id1 function in lung cancer progression and metastasis. As a step in this direction, A549 (K-Ras mutant, EGFR wild-type) and H1650 (K-Ras wild-type, EGFR mutant) cells were transfected with short interfering RNA (siRNA) for Id1and stimulated with 1μm Nicotine or 100ng/ml EGF. The samples were subjected to microarray analysis to identify various genes upregulated and downregulated in the Id1 siRNA transfected cell lines. 200 genes were upregulated 2 fold or more by Nicotine and 150 by EGF. Few genes such as stathmin like-3 (STMN3), GSPT1 (G1 to S phase transition), TPD52 (tumor protein D52) were downregulated in the absence of Id1 suggesting those are Id1 regulated genes. The microarray results were validated using Real-time PCR for the above genes. Further depletion of these three genes resulted in decreased cell proliferation, migration and invasion. Indeed STMN3 promoter could be induced by Id1 and Id1 was necessary for Nicotine to induce this gene. These results might reveal the mechanisms by which Id1 promotes tumor progression and metastasis. STMN3 is a microtubule destabilizing phosphoprotein which is overexpressed in adenocarcinoma as well as squamous cell carcinoma and induced tumor cell proliferation, migration and matrix invasion in respective cell lines. GSPT1, which is also known as eukaryotic translation release factor eRF3 and TPD52 are also reported to be over expressed in various kinds of cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4994. doi:10.1158/1538-7445.AM2011-4994

Incubation of conditioned fear in the conditioned suppression model in rats: role of food-restriction conditions, length of conditioned stimulus, and generality to conditioned freezing

We recently adapted the conditioned suppression of operant responding method to study fear incubation. We found that food-restricted rats show low fear 2 days after extended (10 d; 100 30-s tone-shock pairings) fear training and high fear after 1-2 months. Here, we studied a potential mechanism of fear incubation: extended food-restriction stress. We also studied whether fear incubation is observed after fear training with a prolonged-duration (6-min) tone conditioned stimulus (CS), and whether conditioned freezing incubates after extended training in rats with or without a concurrent operant task. Conditioned fear was assessed 2 days and 1 month after training. In the conditioned suppression method, fear incubation was reliably observed in rats under moderate food-restriction conditions (18-20 g food/day) that allowed for weight gain, and after extended (10 d), but not limited (1 d), fear training with the 6-min CS. Incubation of conditioned freezing was observed after extended fear training in rats lever-pressing for food and, to a lesser degree, in rats not performing an operant task. Results indicate that prolonged hunger-related stress does not account for fear incubation in the conditioned suppression method, and that fear incubation occurs to a longer-duration (6-min) fear CS. Extended training also leads to robust fear incubation of conditioned freezing in rats performing an operant task and weaker fear incubation in rats not performing an operant task.

Effect of pharmacological manipulations of neuropeptide Y and corticotropin-releasing factor neurotransmission on incubation of conditioned fear

We recently developed a procedure to study fear incubation in which rats given 100 tone-shock pairings over 10 days show low fear 2 days after conditioned fear training and high fear after 30 or 60 days. Here, we studied the role of the stress-related peptides, neuropeptide Y (NPY) and corticotropin-releasing factor (CRF), in fear incubation. We gave rats either 10 or 100 30-s tone-0.5-s footshock pairings over 1 day (short training) or 10 days (long training) and then assessed tone-cue-induced conditioned suppression of lever responding 2 days after short training or 2 days and 1 month after long training. Prior to testing, we injected NPY (5-10 microg, i.c.v.), the NPY Y1 receptor antagonist BIBO3304 (20-40 microg, i.c.v.), the NPY Y2 receptor antagonist BIIE0246 (2.5-5 mg/kg s.c.), the non-selective CRF receptor antagonist D-Phe CRF(12-41) (10 microg, i.c.v.), or the CRF1 receptor antagonist MTIP (10-20 mg/kg s.c.). Conditioned suppression after long training was higher after 1 month than after 2 days (fear incubation); conditioned suppression was robustly expressed 2 days after short training (non-incubated fear). Both incubated and non-incubated fear responses were attenuated by NPY. In contrast, D-Phe CRF(12-41), MTIP, BIBO3304, or BIIE0246 had no effect on conditioned fear at the different time points. Results confirm previous work on the potent effect of exogenous NPY administration on conditioned fear, but the negative results with BIBO3304 and BIIE0246 question whether endogenous NPY contributes to incubated (or non-incubated) fear. Results also suggest that CRF receptors are not involved in cue-induced fear in the conditioned suppression procedure.

Effect of a serotonin depleting regimen of 3,4-methylenedioxymethamphetamine (MDMA) on the subsequent stimulation of acetylcholine release in the rat prefrontal cortex

The amphetamine analog 3,4-methylenedioxymethamphetamine (MDMA) is considered to be selectively neurotoxic to serotonergic nerve terminals. Although the long term effects of MDMA on serotonin (5-HT) terminals have been well studied, other potential neurochemical consequences associated with MDMA-induced 5-HT depletion have been less well investigated. In view of the cognitive impairments in human MDMA abusers and the role of acetylcholine (ACh) in learning and memory, it was of interest to determine the influence of a 5-HT depleting regimen of MDMA on subsequent stimulation of ACh release in the prefrontal cortex (PFC). Male rats received vehicle or MDMA (10 mg/kg, i.p. every 2 h for four injections) and underwent in vivo microdialysis 7 days later to assess the subsequent drug- (e.g., MDMA, 5-HT1A agonist) or stress- (e.g., tail pinch, presence of an intruder rat) induced stimulation of ACh release. The increase in the extracellular concentration of ACh in the PFC produced by MDMA (10 mg/kg, i.p.) was significantly less in rats previously exposed to the neurotoxic regimen of MDMA than that in control animals. In contrast, there was no difference in the magnitude of the stimulation of cortical ACh release elicited by the 5-HT1A agonist, 8-hydroxy-2-(di-n-propyl-amino)tetralin (8-OH-DPAT, 0.3mg/kg, s.c.), tail pinch (30 min) or the presence of an intruder rat (40 min) between control animals and animals previously exposed to a neurotoxic regimen of MDMA. These results suggest that although MDMA-induced 5-HT depletion diminishes subsequent MDMA-induced ACh release, there is little impact on cortical ACh release elicited by the stress of pain or the novelty of an environmental intruder.

Poorly differentiated carcinoma of the lung presenting with Lambert--Eaton myasthenic syndrome

Lambert-Eaton myasthenic syndrome commonly seen in small-cell lung cancer represents an autoimmune reaction against antigens coexpressed by tumor and neurons. It is rarely seen with other histologic subtypes. Symptoms antedate the appearance of the neoplasm by weeks to years. Therapeutic options range from immunosuppression, plasmapheresis, pharmacologic facilitation of neuromuscular transmission, and definitive therapy of the primary tumor. This case report describes the rare association of Lambert-Eaton myasthenic syndrome with non-small-cell lung cancer.

Primary small cell anaplastic carcinoma of the breast diagnosed by fine needle aspiration cytology: a case report

BACKGROUND

Small cell anaplastic carcinoma most commonly presents as a lesion in the central portion of the lung but occasionally is found in peripheral locations. Only seven cases originating in the breast have been described. To our knowledge, the preoperative diagnosis of this entity by fine needle aspiration has not been previously reported in the cytologic literature.

CASE

A 67-year-old female presented with a 4 x 3-cm, rapidly growing mass in the left breast. On fine needle aspiration (FNA) the tumor was soft to the needle and yielded a highly cellular aspirate.

CONCLUSION

In this case the morphologic interpretation of FNA, combined with the immunocytochemical demonstration of neuron-specific enolase in tumor cells, was extremely helpful in establishing the nature of the breast tumor.

Spontaneous carotid-cavernous fistula and multiple arterial dissections in type IV Ehlers-Danlos syndrome. Case report

A 43-year-old woman without phenotypic expression of Ehlers-Danlos syndrome developed a spontaneous unilateral carotid-cavernous fistula (CCF). Attempts at balloon occlusion of the CCF were unsuccessful, and caused multiple arterial dissections and lacerations eventually leading to massive retroperitoneal hemorrhage and death. The CCF was demonstrated during postmortem studies. In addition, the patient had independent dissections of the internal carotid artery at the site of the fistula and an intracavernous aneurysm of the contralateral internal carotid artery. Despite widespread dissections, the major arteries showed only mild histological abnormalities. Morphometric analysis of collagen from the aorta revealed an increase in large-sized fibers, consistent with deficiency of Type III collagen.

The glucose tolerance of the West African dwarf goats

Glucose tolerance tests conducted on 4 adult goats and 3 kids, injecting glucose intravenously (0.5 g/kg body weight), showed that the former required 180 min and the latter 45 min after injection, to restore blood glucose to normal. For the adult goats, the turnover rate (K) was 0.38 +/- 0.03/hr, turnover time (TT) 2.64 +/- 0.18 hr and half-time (T 1/2) 110.24 +/- 7.73 min for glucose clearance while for the kids, these were 1.59 +/- 0.12/hr, 0.64 +/- 0.04 hr and 26.05 +/- 4.36 min respectively. The higher glucose clearance in the kids than in the adults may be attributed to a more efficient insulin response and to greater glucose utilization than in the former. The dwarf goats appear to differ substantially from the cows in their homeostatic responses to induced hyperglycemia.

Complementary use of computerized tomography and technetium scanning in the diagnosis of accessory spleen

A patient with a previous splenectomy presented with acute gastrointestinal bleeding. He was found to have a benign gastric ulcer, esophagogastric varices, and a mass indenting the gastric fundus. Abdominal computerized tomography and technetium liver-spleen scanning established the diagnosis of an accessory spleen as cause for the mass effect. This diagnostic approach obviated the need for arteriography and exploratory laparotomy.

Ketamine sequelae. Evaluation of the ability of various premedicants to attenuate its psychic actions

The ability of a number of drugs to abolish the emergence delirium and unpleasant dreams which follow anaesthesia induced with 2 mg/kg ketamine was studied. These included three benzodiazepines, droperidol and 'neurolept' combinations and four commonly-used premedicants. When given intravenously 10 min before induction of anaesthesia flunitrazepam and lorazepam gave best results. In a subsequent study, these two benzodiazepines and diazepam were given intravenously 30-40 min before induction of anaesthesia. There was no doubt that 4 mg lorazepam gave the greatest protection and is worthy of further study in this respect.

Studies of drugs given before anaesthesia XXVI: lorazepam

Lorazepam has been studied as preanaesthetic medication given by mouth, i.m. and i.v. Sediation and side-effects and the incidence of anterograde amnesia in patients having a standard operation under methohexitone-nitrous oxide-oxygen anaesthesia were assessed. In a preliminary study of three i.m. (2-, 4- and 8-mg) and six oral (1-,2-,2.5-,4-,5- and 8-mg) doses, the optimum dose was found to be 4 mg for patients with an average weight of 60 kg. This dose was studied in detail when given by all three routes and compared with the commercially available 2.5- and 5-mg tablets. Even when given i.v., there was a delay of 30-40 min in the onset of maximum sedative effect and drowsiness persisted for at least 4 h. Although the onset of action by i.m. injection was slightly faster than when the drug was given by mouth this advantage was more than offset by the high frequencies of pain at the site of injection and restlessness which persisted for 20-40 min. Oral lorazepam in doses of 2.5-5.0 mg was a reliable, effective sedative which could be recommended for routine preanaesthetic medication, provided rapid recovery was not essential. Its soporific effect was accompanied by an appreciable incidence of anterograde amnesia.

Some pharmacological factors influencing the absorption of diazepam following oral administration

Plasma diazepam concentrations were measured by gas-liquid chromatography in samples of blood from adult female patients follwing diazepam 10 mg orally, alone or in combination with metoclopramide, morphine, pethidine or atropine. Patients receiving metoclopramide had higher plasma diazepam concentrations than those in the control group, while the addition of morphine, pethidine or atropine resulted in lower plasma diazepam concentrations throughout the 90-min period of the study. In the control goup peak plasma concentrations were reached by 60 min. The addition of metoclopramide increased the rate of diazepam absorption and peak concentrations were reached by 30 min, while morphine, pethidine and atropine reduced the rate of absorption with no apparent peak being reached by 90 min.

The influence of three antacids on the absorption and clinical action of oral diazepam

Diazepam 10 mg given orally alone or with one of the three antacids (aluminium hydroxide 40 ml, magnesium trislicate 30 ml, sodium cirate 30 ml) was given in a single dose at random to 200 women undergoing minor gynaecological procedures. The concomitant use of aluminium hydroxide or sodium citrate hastened the onset of the soporific effect of diazepam marginally, while magnesium trisilicate tended to delay it. The estimation of plasma diazepam concentrations over 90 min in a similar series of 67 patients showed that the absorption of diazepam was increased significantly by the use of aluminium hydroxide, but there were no striking differences in the four groups. The clinical implications of these findings are discussed.

Pentobarbitone premedication for anaesthesia. The influence of the preparation and route of administration on its clinical action

Studies were carried out in the pre-operative period on patients premedicated with 100 mg pentobarbitone given by mouth or by intramuscular injection into the buttock. The injections were given by doctors using a 4 cm needle or by nurses using the needle of their choosing and two preparations were used. One was a freshly prepared aqueous solution and the other the commercially available organic solution (Nembutal) with propylene glycol, alcohol and water as solvents. An unacceptably high incidence of persistent injection site pain occurred after the use of the organic preparation but not with the aqueous solution. Otherwise no difference was detected between the effects of the two preparations. Drugs injected by doctors were, on the whole, more effective as premedicants than those injected by nurses. Oral pentobarbitone was not as effective a premedicant as the intramuscular preparation and its anxiolytic action did not differ from that of the placebo. Relief of apprehension was disappointing with all preparations of 100 mg pentobarbitone and was not as good as with diazepam. This may be attributed to the use of too small doses but larger injection volumes would have caused their own problems.

Plasma pentobarbitone levels. Influence of the preparation, route and method of administration

In fit women plasma pentobarbitone was measured by gas-liquid chromatography after 100 mg given by mouth or intramuscular injection in the buttock using aqueous and organic solutions. Differences in plasma levels with the two solutions were not striking. Considerable inter-administrator difference occurred with significantly higher plasma levels when the drug was injected by a doctor using a 4 cm 21 s.w.g. needle as compared with nurses who used no specified injection technique. The oral route gave significantly higher plasma levels than nurse-given injections.

Plasma pentobarbitone levels. Estimation by gas-liquid chromatography after clinical doses

A simple and relatively quick method of estimating pentobarbitone in plasma samples is reported using an ether extraction and gas-liquid chromatography. Glutethimide was used as the internal standard and proved reliable. Reproducible results were obtained in plasma following 100 mg pentobarbitone given by mouth or intramuscular injection. Evaporation in a heating block at 37 degrees C and storage of samples at -20 degrees C prior to analysis is recommended.

Hematology of the Indian elephant (Elephas maximus)

Blood samples from 11 baby elephants, 14 tuskers, and 16 females comprising 5 pregnant and 11 nonpregnant nonlactating elephants (Elephas maximus) were analyzed to assess the hematological values and the influence of age, sex, and pregnancy on these. The results obtained show that, compared with other mammals, the erythrocyte count in the blood of elephants is low and the mean corpuscular volume (m.c.v.), mean corpuscular hemoglobin (m.c.h.), and erythrocyte sedimentation rate (e.s.r.) are high. The very high values for m.c.v. and m.c.h. and the low erythrocyte count seen in elephants suggest that in the evolution of blood though they are more advanced than reptiles and birds in having eliminated the nuclei from the erythrocytes, they are still in the primitive state compared with the other mammals in as much as their erythrocytes have not attained the efficiency in the transportation of blood gases that results from a reduction in size to facilitate numerical increase. A low erythrocyte count and packed cell volume, a high e.s.r., an increase in neutrophils, and a decrease in the percentage of lymphocytes and eosinophils characterize pregnancy. In baby elephants there is an increase in the total leucocyte and lymphocyte counts and a decrease in eosinophils.