Genotypic and immunohistological demonstration of the progression of an unusual reactive-like B-cell lymphoproliferative disorder to a high grade diffuse lymphoma.

In the present study the clinical and pathological evolution of a reactive-like B-cell lymphoproliferative disorder with an unusually high content of T cells is described. Immunogenotypic analysis showed that the same phenotypically atypical B-cell clone, characterized by the unusual presence of an immunoglobulin (Ig)K gene rearrangement, with the heavy chain (IgH) gene in germline configuration, was invariantly present in all phases of the disease. The disorder showed an indolent course for a long period of time during which the clonal B-cell population coexisted with an abundant, reactive T-cell component in different locations of the disease. These findings, together with the observation of spontaneous progression and regression phases of the disorder and its responsiveness to corticosteroids, suggest that functional interactions between the B-cell clone and the polyclonal infiltrating T cells probably were involved in the pathogenesis of the disease. After the administration of the antiblastic treatment, a progressive reduction of the reactive T-cell component was observed with the concomitant evolution to a diffuse large cell (immunoblastic) B-cell lymphoma and the appearance of an IgH gene rearrangement. The biological characteristics and the clinical evolution of the case described here are similar to those reported for the so-called "T-cell-rich B-cell lymphomas" (TCRBCLs). These findings suggest that the T-cell-rich pattern may identify a group of B-cell lymphoproliferations with common pathogenetic mechanisms and clinical behavior.

Primary gastric non-Hodgkin's lymphoma--does surgery still play any role?

36 patients with primary gastric non-Hodgkin's lymphoma (PGL) (stage Ie and IIe) were treated at the Comprehensive Cancer Center of Aviano (PN) Italy. The median follow-up time of the patients was 59 months (range 10 to 117). The pre-operative diagnosis of PGL was established by using endoscopy in 70% of the patients. There was understaging in non-invasive methods of diagnosis in comparison to laparotomy. Prognostic factors such as: stage, grade according to the Working Formulation, size, depth of penetration of the gastric wall and resectability of the tumor, were taken into consideration in the treatment plan. This consisted of surgical resection of the gastric lymphoma where feasible and according to the bad prognostic factors escalating adjuvant treatment was included: group I (n = 6) patients were treated only by surgery (S), II (n = 8) by S+radiotherapy (RT) (n = 5) or S+chemotherapy (CT) (n = 3), III (n = 17) by S+RT+CT and IV (n = 5) by non-resectable S+RT+CT. There were no statistically significant differences in the survival rate, calculated by Kaplan-Meier method, between the first three groups of patients. Only stage of disease (P = 0.048) and resectability of the lesion (P = 0.003) had a significant influence on survival. There were no serious complications observed in either S, RT or CT treatment. The estimated 5-year survival rate after management was 100%, 75% and 88%, respectively for stage Ie (n = 21), stage IIe (n = 15) and all together.

Early gastric cancer: diagnosis, surgical treatment and follow-up of 45 cases.

AIMS AND BACKGROUND: The 5-year survival rate of early gastric cancer (EGC) is 85%-100% after "curative" resection, as compared to 20%-30% in advanced gastric cancer (AGC). Because of this relatively high cure rate, the interest in the diagnosis and therapy of EGC has been steadily increasing. The present study, based on 45 EGCs, is aimed at a critical evaluation of the diagnostic procedures and surgical options. METHODS AND RESULTS: Forty-five patients with early gastric cancer (27 men and 18 women; median age, 62 years; range, 28-84) were diagnosed and operated on. They represented 22.5% of all patients with gastric cancer (200) treated in the period July 1987 to January 1998. Forty-one patients were from the northeastern part of Italy. The most frequent symptom was epigastric pain (84%). Barium upper gastrointestinal radiography findings were strongly suggestive of malignancy in 41 cases (91%). Preoperative histopathological diagnosis of adenocarcinoma was performed in 43 cases (95.5%). In two cases (4.5%) severe epithelial dysplasia (associated with ulcer) was the first diagnosis, but the final diagnosis on the basis of the resected specimens was a well differentiated adenocarcinoma. The primary surgical procedure included i) subtotal distal resection (37 cases) with Billroth 11 (33) and Billroth I (4) reconstructions; ii) total gastrectomy (3) for proximal neoplastic extension; iii) proximal gastric resection (2) for cardial cancer; iv) degastro-total gastrectomy (3) for cancer of the stump. Two patients, previously treated with conservative surgery, underwent degastro-total gastrectomy for neoplastic microfocal extension to the margin of resection and for early anastomotic recurrence, respectively. Mural infiltration was limited to the mucosa and submucosa in 27 and 18 cases, respectively. Lymph node metastases were found in three mucosal and five submucosal tumor cases, involving either the first or the second echelon. No operative deaths or postsurgical complications occurred in this series. In the follow-up period (median, 36 months; range, 3-120) four patients died due to other causes; one developed liver metastases, another developed oropharyngeal cancer and two died of biopsy-proven lung cancer without evidence of gastric cancer recurrence. CONCLUSIONS: The clinical presentation of EGC is aspecific. Preoperative endoscopy with biopsy remains the most sensitive diagnostic procedure. For treatment, subtotal distal gastric resection with lymphadenectomy is the "gold standard" but in some instances total gastrectomy may be indicated. Accurate pathological examination establishes the depth of infiltration, as well as the superficial extension of tumors and the lymph node status. Although the prognosis of EGC is favorable, a medium-term follow-up should be planned.

Primary lung melanoma.

A rare case of primary malignant melanoma of the lung in a 30 year-old female is reported. A chest x-ray and C.T. scan revealed a mass 3 cm in diameter. The patient underwent left lower lobectomy for cure.