Biomedical subjects
Publications and source records attributed to K Tamura.
We present a rare case of a patient with coexisting parotid oncocytoma and chronic thyroiditis who received two therapeutic doses of [131I]iodide for a recurrent oncocytoma (oxyphilic granular cell adenoma), resulting in a definite reduction in tumor volume. We suggest that radioiodine therapy for a recurrent oncocytoma is an effective form of tumor therapy.
A 61-year old asymptomatic woman had a five-year history of pulmonary nodular lesions on routine radiographs. She underwent open lung biopsy, which revealed nodular lesions in the lungs and thickened pleura. Histological examination showed amyloid deposits in the pulmonary parenchyma and adjacent pleura. Congo Red staining of the specimen demonstrated green birefringence under polarized light. This affinity for Congo Red dye remained after potassium permanganate treatment, suggesting primary amyloidosis. Multiple nodular amyloidosis of the lungs should be included in the differential diagnosis of multiple pulmonary nodules.
In the 15-year period 1970 to 1984, the Detection Center of Hokkaido Cancer Society discovered 2,508 gastric cancer cases (1,681 male, 827 female) including 999 cases of early gastric cancers. The survey included 2.01 million people in Hokkaido. Among the cases, 2,508 were diagnosed as stomach cancer, which amounted to 0.12% of the total screened during the period. The proportion of early gastric cancers has been increased over this period. Of those suffering from gastric cancer, 2,287 cases were operable. Mucosal carcinoma accounted for 479 cases, carcinoma with invasion to submucosa accounted for 520 cases. Early gastric cancer numbered 999 cases, or 43.6% of the operable cases. Advanced cancer or cancer with invasion beyond the muscularis propria totalled 1,288 cases, or 56.4% of the operable cases. The relative survival rate was calculated which shows the survival ratio of detected cancer cases to the general population: 67.8% 5-year, 64.0% 10-year and 63.5% 15-year survival rate. These results show that cancer detection leads to a good relative survival rate. The relative survival rate flattens after five years, because the curve of the survival rate of cancer patients decreases gradually, while the expected survival rate of the general population remains constant. If lead time is not considered, the 5-year relative survival rate is satisfactory: if it is considered, however, the 10- or even 15-year survival rate may well be estimated. The 15-year relative survival rate of surgically treated early gastric cancer, advanced gastric cancer and total cancer are 94.0%, 51.0% and 70.7% respectively. These data clearly show that early gastric cancer treated surgically carries an excellent chance for 15-year survival when compared to advanced cancer. One may also note the relatively high survival rate of 63.5% in all gastric cancer patients discovered by this program; this figure reflects a high proportion of early gastric cancer among all cancers. As presented, the mass screening program does have positive effects in reducing gastric cancer deaths by detecting more early gastric cancer cases than among usual clinic patients.
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Adult T-cell leukemia (ATL) is one of the most difficult diseases to treat because of severe underlying immune deficiency and metabolic disturbance. Interferon has potent antiviral, antiproliferative, and immunomodulating properties, and therefore, this may be a good agent to treat such immune deficient patients with peripheral T-cell leukemia. During a period from April 1984 to August 1985, six patients were treated with interferon-beta (IFN-beta), and interferon-gamma (IFN-gamma) was given to five patients. Three patients achieved partial remission by IFN-beta administration with a response duration of 1, 1.5, and 12 months respectively, whereas one complete remission and two partial responses were experienced by IFN-gamma treatment with 4, 4, and 2 months of response. Side effects of IFN-beta were similar to those of IFN-gamma including fever, chills, fatigue, mild hematologic depression, and transient hepatic enzyme abnormalities. These promising results warrant further well-designed clinical trials including combination with other agents or modalities of treatment.
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Cytomegalovirus (CMV) infection frequently occurred in patients with malignant lymphoma of T-cell origin, especially with adult T-cell leukemia (ATL). This was evidenced by histopathological examination at autopsy, isolation of CMV, and detection of CMV antibodies that indicate recent or active infection. Cellular immune response was suppressed in most ATL patients when examined by skin hypersensitivity reaction to purified protein derivatives (PPD), streptococcal antigens (SuPs), and phytohaemoagglutinin (PHA). None of the CMV-positive patients reacted to them. Thus, the presence of tumor cells of T-cell origin and the absence of skin hypersensitivity reaction seem to be risk factors for CMV infection. Each CMV isolate exhibited unique DNA fingerprints, suggesting that cross-infection of CMV did not occur among the ATL patients on the same ward.
Advanced squamous cell carcinoma of the head and neck, lung, esophagus, and uterine cervix is still a challenging cancer to the medical practice. We have treated 23 such patients with a combination of cis-platinum, vincristine, and peplomycin. Cis-platinum was given at a dose of 60 mg/m2 on day 1, and 1.0 mg/m2 of vincristine was given on day 3, followed 6 hours later by peplomycin 10 mg/day by continuous infusion iv or sc over the next 5 days. This combination was given every 3 weeks. The overall response rate was 71% for 17 evaluable patients, including one complete response. The median duration of response and survival was 2 and 5 months, respectively. Six other patients with esophageal and cervical carcinoma were treated with two cycles of this combination followed by radical radiation therapy or surgery. Five of them achieved significant response prior to radical treatment. Major side effects were nausea, vomiting, alopecia, and mild myelotoxicity, which were acceptable. This regimen, with a high response rate and acceptable toxicity, warrants further investigation.
Clinical and cytogenetic aspects of a female infant with trisomy 21 and the fragile X [fra(X)] chromosome are reported. Most of the facial characteristics of the patient are those observed in Down syndrome, but some features such as long face with prominent forehead and lower jaw, and large ears are related to the fra(X) syndrome. The origin of an additional chromosome 21 may be ascribed to maternal first meiotic nondisjunction in our case. It has been suspected that female carriers of the fra(X) chromosome may be predisposed to meiotic nondisjunctional events. However, there is probably no relationship between the two chromosomal abnormalities in our case because of the maternal age at the delivery.
A granular cell tumor (granular cell myoblastoma) of the ascending colon in a 48-year old male is reported. The tumor was detected by barium enema study as a sessile polyp, and colonofiberscopy revealed submucosal tumor. It was removed by endoscopic polypectomy. Macroscopic examination showed the characteristic features of granular cell tumor. The avidin-biotin-peroxidase complex (ABC) method for detection of S-100 protein demonstrated that the cytoplasm of tumor cells and the pleomorphic nuclei were strongly stained with anti-S-100 protein serum, which supports the concept of the Schwann cell origin of granular cell tumor.
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Two patients with meningeal neoplasms and nearby vascular anomalies are reported. The lesions were excised and histologically confirmed. One patient had a meningotheliomatous meningioma and an arteriovenous malformation involving the right frontal lobe; the other, a hemangiopericytoma and an arteriovenous malformation in the right parietooccipital region.
The leukemic cells of adult T-cell leukemia (ATL) usually express the helper/inducer associated antigen reactive with anti-CD4 antibodies but not with anti-CD8. We present a 63-yr-old woman with ATL characterized by circulating leukemic cells with CD4+/CD8- phenotype, hepatosplenomegaly with no lymphadenopathy, and the presence of proviral DNA of human T-cell leukemia virus I in the leukemic cells. She was successfully treated with interferon beta and the remission lasted for 12 months. She then relapsed in the lymph nodes with minimal peripheral blood involvement. The neoplastic cells of the lymph node now co-expressed CD4 and CD8 antigens indicating that the change in clinical manifestation was accompanied by a phenotypic change of the leukemic cells.
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Mediastinal germ cell tumors are divided into seminomas and non-seminomatous germ cell tumors. The former is a radiosensitive tumor that can be successfully treated by surgery and radiation. The latter is much more malignant than the former, however, the therapy has been making remarkable progress owing to CDDP. Nevertheless, the median survival time of patients with mediastinal involvement is 14 months, much lower than that seen in patients with testicular involvement. From our 12 patients and a review of the literature, we drew the following conclusions. If malignant germ cell tumors are suspected among anterior mediastinal tumors affecting male patients of around 20 years old, tumor markers such as AFP and HCG must be investigated and then, tissue histology should be diagnosed from specimens obtained by mediastinoscopy or anterior mediastinotomy. In the case of NSGCT, or AFP and/or hCG producing seminoma, the first choice is the chemotherapy including CDDP. Seminomas, that do not produce either AFP or HCG, can be treated by surgery and radiation. If the patients have tumor markers such as AFP and/or HCG, these are very useful to evaluate the efficacy of the therapy. When the efficacy of chemotherapy reaches the maximum, adjuvant surgery may be indicated. Chemotherapy should be continued, when malignant tissues are present in the resected mass.
Twenty-three patients with low natural killer syndrome (LNKS), 7 males and 16 females, are reported here. These LNKS patients had an age range from 14 to 77 years, with a median of 36.5 years. LNKS is a newly proposed category of immune disorders, being characteristically diagnosed by lowered NK cell activity against K562 target cells as a definite laboratory abnormality, in association with general clinical symptoms of remittent fever and uncomfortable fatigue, persisting without explanation for more than 6 months. Other immune parameters, such as the DNA synthesis of peripheral blood mononuclear cells (PBMCs) in either the presence or absence of mitogens, the T4+/T8+ ratio and the number of Leu-11+ PBMCs, were usually within the normal range. Also, routine laboratory tests did not detect any abnormal findings. The LNKS patients responded well to the administration of an immunopotentiator called 'lentinan', a glucan extracted from the Japanese mushroom Lentinus edodes, despite no responses to conventional fever treatments such as the administration of antipyretics or antibiotics. All LNKS patients observed were universally free of antibodies in their sera to human T-lymphotropic retroviruses I and III, and lymphadenopathy was infrequent, indicating that the LNKS is a syndrome independent of acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Antibodies to other known viruses tested such as Epstein-Barr or measles virus, or cytomegalovirus were also negative or not significantly elevated in the sera before the initiation of lentinan administration. If a virus is the cause of LNKS, it may be a new, unknown virus or an unknown substrain of known viruses. None of the LNKS patients has died of this syndrome.