Iodine-131 and malignancy.
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Biomedical subjects
Publications and source records attributed to T F Warner.
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An unusually large number (108) of carcinoids was discovered in the ileum of a 63-year-old male. The clustering and size distribution of tumor nodules suggests that the phenomenon reflects mucosal metastasis from a dominant parent tumor rather than multicentric neoplastic foci. A predilection for the antimesenteric mucosa was also observed and may be related to mucosal lymphatic spread of the carcinoid tumor.
Occlusion of mesenteric vessels due to fibrosis and adventitial elastosis complicated ileal carcinoids and resulted in infarction of bowel in two patients. Synovial sarcoma antedated the carcinoid syndrome in one patient who died; carcinoma of the breast was discovered one year after hemicolectomy in the other. This rare mesenteric occlusive lesion is associated exclusively with ileal carcinoids; it is poorly recognized and the mortality is high.
We report on an 89-year-old female admitted with signs of intestinal obstruction in whom three independent adenocarcinomas of the proximal jejunum were found. Multiple foci of pyloric gland metaplasia, glandular hyperplasia and dysplasia, carcinoma-in-situ, and several varieties of adenocarcinoma were identified on microscopic examination of 14 cm of excised jejunum. Multifocal adenocarcinoma of the small intestine is extremely rare. We are not aware of any case harboring the complex changes described herein.
Light and electron microscopic examination of a goblet cell carcinoid revealed cells with pleomorphic neurosecretory-type granules, cells containing mucin some of which also contained these granules and less differentiated cells lacking the aforementioned features. Recent embryologic and anatomic studies of developing avian and mammalian gut, respectively, show that intestinal APUD cells are probably of endodermal origin. Therefore, mixed carcinoid tumors such as the goblet cell variant could arise in crypt base stem cells.
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Light microscopic examination of a basalioma (basal cell carcinoma) revealed unusual keratinizing cells resembling signet ring cells with pink cytoplasmic inclusions. Ultrastructurally the inclusions consisted of filamentous masses encircled by abundant tonofilaments giving a striking picture of abnormal individual tumor cell keratinization.
Proliferating pilar cysts are rare tumors which occur most commonly on the scalp of elderly women. The infiltrative areas of these tumors should be differentiated from epidermoid carcinoma because they are usually benign. The intimate association of this entity with a spindle cell component is described here, to our knowledge for the first time.
The mitogenic response (determined by uptake of [3H]-thymidine) of two different BALB/c myeloma lines, normal BALB/c spleen cells and spleen cells from tumour-bearing mice in primary culture to PHA, Con A, PWM and Robinia pseudoaccacia (RPA) extract was determined by measuring the uptake of [3H]-thymidine over 96 h. The pattern of the response of tumour and tumour-spleen cells to the 4 different lectins was similar, and different from that of normal spleen cells. The unstimulated cultures of tumour and tumour-spleen cells displayed an initial increased uptake of [3H]-thymidine, whereas stimulated cultures displayed a low initial uptake of label. After an initial phase of inhibition, ADJ-PC5 myeloma cells were stimulated by PHA and PWM to a greater extent than were normal spleen cells. On the other hand, normal spleen cells gave a markedly better response to Con A and RPA. The mitogenic response of tumour-spleen cells to all 4 lectins was intermediate between those observed for tumour and normal spleen cells; they responded better to Con A and RPA than did tumour cells but were not as responsive as spleen cells, whereas the converse was true for their response to PWM and PHA. In agreement with other reports, the data suggest that the responsiveness of tumour-spleen cells was due to the presence of tumour cells in this tissue. These results indicate that there is no definite evidence of an impaired lectin-responsiveness in lymphoid cells of mice bearing a myeloma.
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Patients with myeloma harbour circulating lymphocytes which bear the idiotypic determinants (SIg-id+ cells) of their own myeloma protein. Circulating white cells with abnormal karyotypes have been found in other patients with this disease. SIg-id+ lymphocytes have also been identified in the peripheral blood of myeloma-tumour-bearing mice. Murine myelomas have been propagated in vivo from circulating mononuclear cells that possessed myeloma-tumour-associated antigens. This and other evidence reviewed here points strongly to the involvement of circulating lymphocyte-like stem cells in the spread of human myeloma.
A carcinoid tumour of the cervix in a 64-year-old woman is described. It is the first time that this rare tumour has been associated with carcinoma-in-situ.
Cells of myeloma or fibrosarcoma were inoculated s.c. into BALB/c mice. Intact skins and tissue sections from animals killed at periodic intervals after inoculation of tumor cells were examined macroscopically and microscopically. The development of new blood vessels, probably involved in vascularization of the tumor, was observed around the nerves adjacent to the deposit of tumour cells. This occurred 5 days after inoculation of cells and before the tumour had a mean diameter of less than 1 mm. Lesser degrees of "perineural angiogenesis" were noted after s.c. inoculation of mineral oil, Freund's complete adjuvant or implantation of intact spleen, but none was observed with killed tumour cells.
BALB/c mice bearing subcutaneous ADJ-PC5 myelomas had hematologic findings suggestive of a preleukemic syndrome: thrombocytopenia, anemia, leukocytosis, and megakaryocytic hyperplasia. Six BALB/c myelomas were successfully transplanted sc by fragments or cell suspensions of spleens from mice bearing a subcutaneous tumor, though typical myeloma cells were difficult to visualize by light microscopy in these spleens. The fidelity of transmission of the ADJ-PC5 myeloma by this procedure was shown by the retention of idiotypic specificity of the immunoglobulin produced by the tumor in a radioimmunoassay. The tumorigenic cell that homed to the spleen was apparent as early as 8 days after sc transplantation of the myeloma. The spleens of tumor-bearing mice, however, could destroy or suppress the expansion or growth of a limited number of cells that had migrated to the spleens. Tumorigenic cells present in the peripheral circulation constituted 2-3% of the leukocytes. These cells, however, had reduced levels of the murine myeloma viral and cell-associated antigens, were difficult to detect by an indirect immunofluorescence assay, and did not rapidly divide in this environment, as indicated by the very low number of cells detected by autoradiography.
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It is suggested that Kaposi's sarcoma is the result of a chronic immunological reaction between antigenically altered or transformed lymphoid cells and normal lymphocytes. In the course of this local graft-versus-host type activity, an angiogenesis factor is liberated and intense proliferation of mesenchymal and endothelial cells ensues. During the G.V.H.-like activity, an oncogenic virus is either transferred to or induced in the cells responsive to the angiogenesis factor. Thus, the stage is set for neoplastic transformation of these cells in an environment which is conducive to the progressive growth of the virally transformed vasoformative mesenchyme.