Akira Sakamoto

Optimal schedule for administering granulocyte colony-stimulating factor in chemotherapy-induced neutropenia in non-small-cell lung cancer

Abstract A prospective randomized study was conducted to determine the optimal schedule of rhG-CSF (recombinant human granulocyte colony-stimulating factor). A group of 33 lung cancer patients treated with MVP therapy (mitomycin, vindesine, and cisplatin) were randomly assigned to three groups: an early prophylaxis group in which rhG-CSF was initiated on day 2 of the MVP cycle; a late prophylaxis group in which rhG-CSF was initiated on day 8; and a therapeutic group in which rhG-CFS was initiated after the onset of neutropenia. Ten patients who had received MVP therapy without rhG-CSF were also analyzed as a no-support group. The incidence of neutropenia was 80% (16/20 courses) in the early prophylaxis group, 44% (8/18) in the late prophylaxis group, 94% (17/18) in the therapeutic group, and 94% (16/17) in the no-support group. The incidence of neutropenia in the late prophylaxis group was less than in the early prophylaxis group (P<0.05), the therapeutic group (P<0.01), and the no-support group (P<0.01). The late prophylactic rhG-CSF schedule was therefore more effective in countering neutropenia than either the early prophylactic or therapeutic schedule.

Small cell carcinoma of the skin "non-Merkel cell type".

An 81‐year‐old Japanese woman developed small cell carcinoma of the skin, which was different from trabecular carcinoma or neuroendocrine carcinoma of the skin. The tumor was composd of spindle‐shaped or fusiform cells with scanty cytoplasm and numerous mitoses. The tumor cells were arranged in a streaming pattern and not in anastomosing trabecular fashion at all. No granules were detected by Grimelius’stain either. Immunoperoxidase staining for neuron specific enolase (NSE) did not reveal any activity. Ultrastructural study showed scanty organelles in the cytoplasm which contained a few round mitochondria, rough endoplasmic reticulum, and free polysomes. Occasionally, filamentous bundles, desmosomes, and intracyto‐plasmic canaliculi were recognized in the cytoplasm, but neurosecretory granules were not found throughout the cytoplasm. Electron microscopic features suggest that this tumor originated from the embryonal stratum germinativum. The present tumor can be distinguished from trabecular carcinoma or neuroendocrine carcinoma of the skin, and may be regarded as “small cell carcinoma” of the skin. ACTA PATHOL, JPN. 35 : 1029–1036, 1985.

FETAL ASCITES A Report of 3 Autopsy Cases

Three rare autopsy cases of fetal ascites were presented and the etiology of each case was described. Case 1 was a male neonate, delivered by cesarean section at 32 weeks’gestation, and died of respiratory failure. The abdomen was remarkably distended with 1020 ml of ascites. The etiology of Case 1 remained unknown even after macroscopic and microscopic examinations. We considered this as “idiopathic” fetal ascites. Case 2 was a female neonate, delivered at 31 weeks’gestation, with marked abdominal distension and cyanosis. Autopsy revealed 435 ml of ascites, and she was considered to have had “polysplenia syndrome” with cardiovascular malformations. Intrauterine heart failure due to cardiac anomalies was thought to be the cause of this ascites. In case 3 embryotomy was carried out under the diagnosis of fetal ascites by ultrasound examination at 22 weeks’gestation. An urachal cyst connected to the dilated urinary bladder and deficiency of musculature of the abdominal wall composed of loose connective tissue with calcification were observed. The abdominal wall was ruptured and 1,960 ml of ascites was measured. Polycystic kidney with renal dysplasia was also found. Case 3 showed “Prune‐Berry syndrome” and fetal ascites may have arisen from these anomalies.

A case of pseudolymphoma of the lung and submandibular gland.

62才,男性.胸部異常陰影と右顎下腺腫瘤にて入院した. 57才時に,右顎下腺腫瘍摘出術の既往がある.胸部X線像および胸部CTでは,左S4と右S6の浸潤影を認めたものの,肺門および縦隔リンパ節の腫大は認めなかった.また,気管支鏡では右中間気管支幹に小結節が散在してみられた.肺の病変部と顎下腺腫瘍部の病理組織学的所見ではリンパ球の増生がみられ,免疫組織学的にはpolyclonal patternを呈し, pseudolymphomaと診断された. prednisolone, vincristine cyclophosphamideの治療で病変部の改善はみられなかったが, 2年半経過した現在,悪化も認めていない.