Malignant lymphoma of gastric mucosa-associated lymphoid tissue in Jamaica

The recently appreciated concept of Mucosa-Associated Lymphoid Tissue (MALT) and the characteristics of the lymphomas arising therein are discussed with reference to the clinical, histological and immunohistochemical features of the first four cases of gastric MALT lymphomas diagnosed at the University Hospital of the West Indies. These tumours are low-grade B-cell lymphoas, which may undergo high-grade transformation. They are aetiologically associated with Helicobacter pylori (H pylori) infection in the stomach and may be cured in the early stages with antibiotics. Our cases were diagnosed from gastrectomy specimens removed for suspected carcinoma. All were high-grade, and associated with H pylori; 3 cases presented as advanced disease. Documentation of the features of these lymphomas will increase awareness and earlier recognition (AU)

Fine needle aspiration cytology of lymph nodes - abstract

Lymphadenopathy is a common clinical problem with an often diverse differential diagnosis. To determine if fine needle aspiration cytology (FNAC) can provide an accurate and reliable diagnosis of malignancy related lymphadenopathy, the records of 328 patients examined by a single cytopathologist were retrieved for analysis. One hundred and seventy-seven (54 percent) were deemed "reactive," 14 (4.3 percent) were unsatisfactory and 91 (27.7 percent) were positive for malignancy. Of the positives, 35 (38.5 percent) were malignant lymphomas. The diagnosis of malignancy was confirmed in 88 (95.7 percent) ofaspirates; 3 (4.5 percent) were deemed false positive using strict criteria. Typing accuracy of malignant lymphomas was 71 percent and for other forms of malignancy the accuracy was 98 percent. The positive predictive value was 97 percent. The results demonstrate that FNAC can provide a reliable diagnosis of malignancy and malignant lymphomas can be fairly reliably typed by this technique (AU)

The discovery of the vinca alkaloids-chemotherapeutic agents against cancer

In folklore medicine, extracts of the leaves of the subtropical plant Catharanthus roseus (L.) G. Don (sometimes known as Madagascar periwinkle) were reputed to be useful in the treatment of diabetes. This review describes how attempts to verify the antidiabetic properties of the extracts led instead to the discovery and isolation of two complex indole alkaloids, vinblastine and vincristine, which are used in the clinical treatment of a variety of cancers. The two alkaloids, although structurally almost identical, nevertheless differ markedly in the type of tumors that they affect and in their toxic properties. These and related alkaloids have been the subject of many pharmacological and biochemical investigations both in vivo and in vitro in the search for improved cancer treatments. A model system used in these studies, a transplantable lymphoma in Noble strain rats designated Nb2 node, has serendipitously led to the development of a highly sensitive and specific bioassay for lactogenic hormones. (AU)

Human T lymphotropic virus type I antibody patterns: evidence of difference by age and risk group

Detection of human T lymphotropic virus type I (HTLV-I) antibody was assessed on 368 sera from subjects with different clinical features and from different parts of the world. Enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay for purified p24 antibodies (p24-RIA) used as screening tests agreed in 88.7 percent of the sera. The results from 247 selected sera were compared with western blot (WB). WB was reactive in sera five to 25 times more dilute than the last positive ELISA or p24-RIA, but different WB batches varied in sensitivity. ELISA was more sensitive than p24-RIA, and p24-RIA was more specific than ELISA. Indeterminate WB interpretations were common (25.5 percent). Most seropositive intravenous drug abusers had unusually strong p24 bands by WB. Among healthy individuals, positive WB reactivity increased with age, whereas indeterminate reactivity declined (P=.034). Thus more sensitive and -specific HTLV-I antibody tests are needed. (AU)

Concurrent multicentric angiofollicular lymph node hyperplasia and peripheral T-cell lymphoma

Multicentric angiofollicular lymph node hyperplasia (MAFH) is a variant of Castleman's disease, localized angiofollicular lymph node hyperplasia. Unlike Castleman's disease, MAFH sometimes runs an aggressive clinical course culminating in death, mainly from infection and rarely from malignant lymphoma. The lymphoma may develop months or years after the onset of MAFH but may be present at the time of diagnosis. In this paper, we present a case of MAFH with co-existing peripheral T-cell lymphoma, in a 59 year-old man who died from disseminated disease. This adds another to the list of five such cases recorded in the literature since the recognition of MAFH (AU)

Clinical features of non-Hodgkin's Lymphoma in Jamaica

The clinical features of 95 patients with non-Hodgkin's Lymphoma (NHL) seen at the University Hospital of the West Indies (UHWI) during a 10-year period are reviewed. The overall male: female ratio was 1.3:1, but in patients under 50 years of age the disease occurred equally in men and women whereas, over 50, there were slightly more men than women (1.8:1). The majority of patients presented with advanced disease. Lymphadenopathy was the most common presenting feature. Hypercalcaemia, leukaemia spill and skin lesions occurred frequently, and most patients with non-Hodgkin's lymphoma showed a diffuse histological pattern. These features are typical of adult T-cell lymphoma/lukeaemia (ATL), and may reflect the high incidence of human T-cell lymphoma virus (HTLV) in Jamaica. Anaemia, hypoalbuminaemia and infections occurred commonly at presentation or during the course of the disease. Important differences are noted between the clinical features of NHL in Jamaica and elsewhere (AU)

Adult T-cell leukemia/lymphoma in Jamaica and its relationship to human T-cell leukemia/lymphoma virus type I-associated lymphoproliferative disease

We had shown previously that the prevalence of human T-cell leukemia/lymphoma virus type I (HTLV-I) antibody positivity is high in Jamaican non-Hodgkin's lymphoma (NHL) patients and that virus-positive patients have the clinical features and poor prognosis of adult T-cell leukemia/lymphoma (ATL). 62 percent of 45 NHL patients diagnosed consecutively between 2/1/82 and 1/31/84 and studied prospectively were HTLV-I-antibody positive. Skin involvement (38 percent), hypercalecemia (44 percent), and leukemia (40 percent) were unusually prevalent and there was a strong association (p < 0.05) with HTLV-I-antibody positivity. 52 percent of the patients had bone marrow infiltration, and 74 percent of these patients were HTLV-I-antibody positive (p=.06). Lymphadenopathy (96 percent), hepatomegaly (60 percent), and splenomegaly (25 percent) were detected with about the same frequency as in other series of NHL patients with advanced disease, and 61-88 percent of these patients were HTLV-I-antibody positive. Patients were classified into those with "typical ATL" (NHL associated with 2 of the 4 features) i) hypercalecemia; ii) histologically proven skin infiltration; iii) leukemia; and iv) bone marrow infiltration, providing that the morphology of infiltrating of leukemic cells was characteristic of ATL; those "consistent with ATL" (NHL associated with 1 of these 4 features); and "non-ATL" (NHL without any of these 4 additional features). Thirty-two (71 percent) of the NHL patients were ATL patients, i.e. had features typical of or consistent with ATL, and 78 percent of these were HTLV-I-antibody positive. HTLV-I provirus was detected in tumour cells of all HTLV-I-antibody positive patients tested. Three (23 percent) of the non-ATL patients were HTLV-I-antibody positive. There was no correlation between histopathological features and the clinical classification of HTLV-I-antibody positivity. Median survival of ATL and non-ATL patients was 16 and 53 weeks. Although the disease was unusually fulminant, 34 percent of the ATL patients had a subacute or chronic course. Skin involvement and leukemia were prominent in these patients. Hypercalecemia was the chief prognostic determinant. Median < 0.05). Hypercalecemia caused 10 deaths, infections 12, and death was due to tumour progression in 4 patients. Infections were usually due to pyogenic organisms and only 2 patients had systemic opportunistic infections. Six (27 percent) of 22 chronic lymphocytic leukemia (CLL) patients were HTLV-I-antibody positive. (AU)

Human T-Cell leukaemia/lymphoma virus-associated lymphoreticular neoplasia in Jamaica

19 (34 percent ) of 56 Jamaicans with lymphoproliferative neoplasia had antibody to the human t-cell leukemia/lymphoma virus (HTLV) in their sera. 17 of those positive had either non-Hodgkin's lymphoma (NHL) or chronic lynphocytic leukemia. Of 16 consecutive patients presenting with NHL 11 (69 percent ) were HTLV seropositive. Virus-positive patients with NHL, among whom females were over-represented, had the clinical features and poor survival typical of adult T-cell leukemia/lymphoma. HTLV-associated leukemia/lymphoma is a distinct clinicopathological entity, and the high incidence in this series suggests that HTLV is an important cause of lymphoreticular neoplasia in Jamaica (AU)

The human type-C retrovirus, in Blacks from the Caribbean region, and relationship to adult T-cell leukemia/lymphoma

Type-C RNA tumour viruses have been implicated in the etiology of naturally occurring leukemias and lymphomas of animals. Human T-cell leukimia/lymphoma virus (HTLV) is the first human virus of this class consistently identified in association with a specific type of human leukemia/lymphoma. The isolation of HTLV was made possible by the ability to grow mature T-cell in tissue culture usually with T-cell growth factor (TCGF). We now report a cluster usually with T-cell leukemia/lymphoma among Blacks from the Caribbean in which all eight cases are positive for HLV virus and/or antibody. These patients have diseases that appears indistinguisable from Japanese adult T-cell leukemia/lymphoma which, as we have also reported, is associated with HTLV in over 90 percent of cases. The finding of HTLV antibodies in some of the normal population in the Caribbean and Japan, and the clustering of a specific form of T-cell leukemia/lyphoma in these virus-endemic areas, suggest that HTLV infection may be associated with the occurrence of a distinctive clinico-pathologic entity (Summary)

Crusted scabies in Jamaica

Crusted scabies is reported in 12 patients seen in a one-year period at the Dermatology Unit of the University Hospital of the West Indies. Interesting variations in the clinical presentation have been noted, including muscle weakness, a previously unreported predisposing factor. Crusted scabies is not uncommon in Jamaica and therefore there is greater need for an awareness of the condition both in terms of its underlying associations and its epidemiological significance (AU)

Listeria monocytogenes infection in an immunosuppressed patient

A case of Listeria monocytogenes infection in a 22-year-old woman who received immunosuppressive therapy for malignant lymphoma is described. This is the first reported case of Listeria monocytogenes infection in a patient in Jamaica (AU)

Hyperinfection syndrome with Strongyloides stercoralis in malignant lymphoma

Hyperinfection with Strongyloides stercoralis occurred in three patients with malignant lymphoma. The probable cause was alteration of the immune responses either as a result of the malignant lymphoma or by the treatment given. Though thiabendazole (Mintezol) has produced reasonable results in the treatment of the hyperinfection syndrome, preliminary data suggest that the new broad-spectrum antihelmintic levamisole (Ketrax) is more effective. All patients who live or have lived in an area where strongyloidiasis is endemic should be investigated to detect the presence of the nematode before and during treatment with drugs with immunosuppressive properties. In view of the high mortality with S. stercoralis hyperinfection, vigorous therapy should be instituted before the use of immunosuppressive drugs (Summary)

Combination chemotherapy in the management of lymphoma - abstract

This preliminary report describes our experience with a modification of MOPP regime (nitrogen mustard, vincristine, prednisone and procarbazine) in 21 patients with advanced (Stage III and IV) malignant lymphoma. Six patients had Hodgkin's disease; 9 lymphosarcoma; and 4 reticulum cell sarcoma. The desease was unclassifiable in 2 cases. There were 6 fatalities, none of which could be attributed to therapy. Several side effects of therapy occurred but none of these were serious. Seven patients defaulted for a variety of reasons. Eight patients are still undergoing treatment and 3 of these are at present in remision. The number of patients is at present too small for any firm conclusions to be drawn, but it is probably worthwhile continuing with this form of therapy. However, careful selection of patients is essential, particularly because of the high rate of default (AU)

Immunoglobulins in Jamaicans and Nigerians with immunogenetic typing of myeloma and lymphoma in Jamaicans

Serum IgG concentration was lower in Jamaicans than in Nigerians. The maternal foetal IgG ratio was lower in Jamaican sera than in Nigerian sera. It is suggested that endemic malaria in Nigeria may be responsible for these differences. The higher IgG concentration in the Nigerian cord sera may be further evidence of this. Eighteen new cases of myeloma were detected in Jamaicans between August 1966 and May 1967. Based on Gm typing, only two of these showed evidence of mixed white ancestry. All others had the typical Gm groups of Negroes. Similarly, only two patients out of a total of 17 with malignant lymphoma showed evidence of mixed white ancestry. Twelve of the patients with myeloma showed serum proteins of the IgG type, five were IgA, and one had only light chains in the serum. The majority of the patients had myeloma protein of the kappa type. The Gm typing suggested that six patients had myeloma protein of the y1 heavy chain subclass, and one patient had a y3 subclass heavy chain, the remainder belonging most likely to the y2 heavy chain subclass since y2 occurs about four times as frequently as y4.

The influence of dietary regimens on the incidence of spontaneous neoplasms in the rat - abstract

The levels of caloric and of protein intake were demonstrated to have modifying influence on tumour incidence patterns in the male rat. In a study using five uniform life-long dietary regimens differing only in allotments and in-takes of protein (casein), carbohydrates (sucrose) or of total calories, the total turmour risk was directly and exponentially related to caloric intake. Malignant lymphomas were predominant in rats with high protein in-take, whereas fibromas and fibrosarcomas predominated in rats with low intake. The lowest incidence, the greatest delay in time of occurence, absence of malignant epithelial tumours and greatest life expectancy, were observed when intakes of protein, carbohdrates and total calories were low. Other experiments designed to test the influence of dietary regimens in early life upon tumour incidence later in life will also be discussed briefly (AU)

Report on 151 childhood malignancies observed in Jamaica

During a 10-year period 1958-67, 151 tumors were noted in children under 15 years of age in Jamaica. This comprised 2.9 percent of all malignant tumors observed. Leukemia was the most common form of cancer. The incidence of retinoblastomas was high and surpassed incidences of neuroblastomas and of Wilms' tumors. Kaposi's sarcoma was not observed, and hepatocellular carcinoma was extremely rare. The tumor incidence pattern in Jamaica therefore largely resembles that in the United States and in Western Europe. It contrasts significantly with that in Uganda and in Western Nigeria. This merits attention, since over 90 percent of the Jamaican population is either pure Negro or of predominantly Negro descent as a result of importation from West Africa in former days. (Summary)

Clinico-pathological study of malignant lymphoma in Jamaica

Malignant Lymphoma is a group of diseases of neoplastic aetiology affecting the lymphatic system. Since the description of the Burkitt's tumour (African lymphoma) as a separate entity, and the possibility of virus causation and transmission by insect vectors, there has been a great resurgence of interest in this group of diseases. As the population of Jamaica is of predominantly African origin, even though the environment is different, the study of this group of diseases here may be of considerable interest. The classification of this group has for long been very complex and confused. Even since it has been agreed that histological criteria are the only ones which can be acceptable for accurate diagnosis, there has been no classification, which would satisfy all the workers in the field. But it has long been agreed that simplicity and acceptability are most important criteria regarding classification. Thus a simple classification, which is acceptable to most workers in the field has been used here. Thus malignant lymphoma has been classified as follows: reticulum cell sarcoma, lymphosarcoma, hodgkin's disease, giant follicular lymphoma, Burkitt's tumour (African lymphoma). Between 1958-1965 221 cases of malignant lymphoma were seen. These were divided as follows: reticulum cell sarcoma - 30(14 percent), lymphosarcoma - 73(33 percent), Hodgkin's Disease - 114(51.5 percent), giant follicular lymphoma - 3(1.5 percent), Burkitt's tumour (African lymphoma) - 0. It was found that patients affected by these diseases came to seek medical advice relatively late and that the follow-up is inadequate due to default by patients. There is similarity to the disease pattern of North America and European lymphoma and not to the African lymphoma (AU)