Effect of doxorubicin on [omega-I-131]heptadecanoic acid myocardial scintigraphy and echocardiography in dogs.

The effects of serial treatment with doxorubicin on dynamic myocardial scintigraphy with [omega-I-131]heptadecanoic acid (I-131 HA), and on global left-ventricular function determined echocardiographically, were studied in a group of nine mongrel dogs. Total extractable myocardial lipid was compared postmortem between a group of control dogs and doxorubicin-treated dogs. A significant and then progressive fall in global LV function was observed at a cumulative doxorubicin dose of 4 mg/kg. A significant increase in the myocardial t1/2 of the I-131 HA was observed only at a higher cumulative dose, 10 mg/kg. No significant alteration in total extractable myocardial lipids was observed between control dogs and those treated with doxorubicin. Our findings suggest that the changes leading to an alteration of myocardial dynamic imaging with I-131 HA are not the initiating factor in doxorubicin cardiotoxicity.

Increased numbers of lymphocytes with single class surface immunoglobulins in Hodgkin's disease.

Lymphocyte populations with abnormal kappa/lambda ratios have been described previously in B-cell non-Hodgkin's lymphomas and in lymphoid hyperplasia. The authors studied 12 patients in whom lymph nodes diagnostic of Hodgkin's disease contained evidence of monoclonal lymphocyte proliferation. One patient subsequently was found to have a B-cell lymphoma. The others have not been found to differ in any important characteristic from 25 Hodgkin's disease patients with normal ratios studied for comparison.

Nodular mixed cell lymphoma with monoclonal gammopathy.

Malignant lymphomas are rarely accompanied by a serum M component. Such neoplasms are usually of lymphocytic cell type and, with extremely rare exceptions, of diffuse pattern. A patient with an unusual malignant lymphoma of mixed cell type characterized by follicular structures and vascular proliferation was found to have a serum monoclonal gammopathy (IgM kappa) of over 4 g/dl. Remission accompanied by a pronounced reduction in the M protein was achieved with Chlorambucil. Subsequent relapse was characterized by the emergence of a large cell lymphoma with IgM kappa surface immunoglobulin. No concomitant rise in the serum M component accompanied relapse.

Malignant fibrous histiocytoma of prostate gland.

The English language medical literature does not contain any definitive reports of malignant fibrous histiocytoma (MFH) arising in the prostate gland. A case of prostatic MFH is described, characterized by rapid local tumor progression and pulmonary metastases. The histologic diagnosis was supported by immunohistochemical and electron microscopic studies.

Non-Hodgkin's lymphomas. Analysis of 92 cases using the 'international' classification.

Ninety-two non-Hodgkin's lymphomas in which cell-surface-marker studies were done were classified according to the "international" classification. Relationships among immunologic phenotypes and classification categories were evaluated. Although several categories were homogeneous for immunologic cell type, others were heterogeneous. The latter were found among the diffuse lymphomas and especially those of mixed-cell type. No histological feature other than a follicular architecture, proved to be specific to or exclusive of B, T, or non-B-non-T tumors. Since adequate diagnostic classification requires both morphological classification and immunologic classification based on cell-surface-marker techniques, provision for such studies should be made in the case of any biopsy specimen in which malignant lymphoma is suspected. Such studies may also assist in distinguishing large-cell lymphoma from undifferentiated carcinoma and malignant lymphoma from atypical lymphoproliferative processes.

Lymphocyte populations with abnormal kappa:lambda ratios in reactive lymphoid hyperplasia.

The lymph node biopsies of 12 patients with lymphadenopathy due to reactive hyperplasia contained lymphocyte populations with increased percentages of B-cells and abnormal numbers of cells with single class surface immunoglobulins. Ten patients were followed for periods of 3-30 months: one developed a non-Hodgkin's lymphoma and one Hodgkin's disease. One other has persisting lymph node enlargement. Two patients had nonlymphoid malignancies. The other six remain well without lymphadenopathy. Twenty-five of 40 patients with reactive lymph node hyperplasia and normal kappa/lambda ratios followed for 9-36 months had a similar incidence of lymphoid malignancy and persistent lymph node enlargement. The follow-up data so far available do not support a hypothesis that reactive lymphoid hyperplasia with increased numbers of cells with single class surface immunoglobulin is associated with higher morbidity than reactive hyperplasia containing the usual polytypic lymphocyte populations.

Fine-needle aspiration biospy of the thyroid.

Fine-needle thyroid aspiration biopsy has a 20-year history in Scandinavia but has seen little use in North America owing to concern about the dissemination of malignant disease and the more limited use of aspiration cytology in general. We have reviewed our experience with this method in 103 cases, and on the basis of our work and the accumulated evidence of others, believe that the procedure is of considerable practical value with little or no risk to the patients under study.

The diagnosis and classification of Hodgkin's disease is still a problem.

The initial histopathologic diagnosis and Rye classification of 172 cases of Hodgkin's disease referred to a regional cancer centre during a period of 8 years was reviewed prospectively by a pathologist in the cancer center who referred 82 cases to a panel made up of pathologists practicing in the region. The proportion of cases with errors in the diagnosis of Hodgkin's disease or Rye classification fell from 47.6% in the first year to 23.1% in the third year and 17.4% in the final year. The performance of the panelists did not vary in any consistent way over the 8-year period. The mean level of agreement among the panelists was 86.7% for the diagnosis of Hodgkin's disease and 63.3% for the Rye classification. A regional program for the ongoing prospective review of all histological diagnoses of Hodgkin's disease can improve the accuracy of initial diagnosis and Rye classification but significant discrepancies persist.

Evaluation of histological grading (Gleason) in carcinoma of the prostate: adverse influence of highest grade.

The value of the Gleason system of histological grading in carcinoma of the prostate is a subject of considerable controversy. The value of this system is demonstrated in a group of 488 patients treated radically with radiation therapy. Analysis, utilizing the Gleason system in these patients, indicates that the worst histological grade identified is most important in determining the prognosis. Since nearly 18% of our patients have more than two grades identified, simple identification of primary and secondary grades, ie, the two predominating grades, is inadequate and may underestimate the aggressiveness of the tumor. This finding has implications in the analysis of the results of treatment and in determining the method of treatment in individual patients.

Burkitt cell leukemia following treatment of Hodgkin's disease: report of a case and review of the literature.

The development of Burkitt cell leukemia (FABL3) [1] in a patient 7 years after successful treatment of Hodgkin's disease (HD) by combined modality (chemotherapy and radiotherapy) therapy is described. The B-cell nature of the leukemic blasts is shown by immunologic surface marker studies. While L3 leukemia is very rarely seen following therapy for HD, diffuse lymphoma of small noncleaved cells (LSNC)--resembling the Burkitt tumor--is more common in this setting.

Association of breast cancer with meningioma. A report of five cases.

Five patients with diagnosed breast cancer who developed meningiomas are reported. The literature contains reports of an additional 25 such patients. Some authors have noted hormonal sensitivity and the presence of hormone receptors in some meningiomas. Because breast cancer is a common tumor of women, it is probable that any association between breast cancer and meningioma is fortuitous. Two patients in this small series each had a sister with breast cancer, one of them also had three other first-degree relations with colon cancer. Three of the patients had other tumors as well as breast cancer. It is important to fully investigate brain lesions in patients with breast cancer so that potentially curable meningiomas are not mistaken for metastases.