Bernard C. Korbitz

Acute leukemia complicating metastatic breast cancer

Acute leukemia occurred in two women after prolonged chemotherapy for metastatic carcinoma of the breast. Palliative radiation therapy was given to both patients within 18 and 22 months, respectively, before the onset of acute leukemia, but the short interval between radiation therapy and the onset of leukemia did not suggest radiation leukemogenesis. Therapy included prolonged administration of cyclophosphamide and chlorambucil and intermittent administration of prednisone, vincristine, 5‐fluorouracil, and methotrexate. The second patient received 6 months of hexamethylmelamine therapy in addition. The types of leukemia and the time interval from chemotherapy are similar to reported cases of acute leukemia during alkylating agent therapy of multiple myeloma, chronic lymphocytic leukemia, and carcinoma of the ovary and lung. The role of chemotherapy in induction of leukemia in these cases remains speculative.

Triple drug therapy in testicular tumors

Thirty‐four patients with disseminated choriocarcinoma, embryonal cell carcinoma, and teratocarcinoma of the testis were treated with triple drug therapy—chlorambucil, methotrexate, and actinomycin D as employed by Li et al. Although two‐thirds of patients with measurable lesions had at least a 50% regression, reactivation usually occurred within 3 months. Four patients have complete regressions which are being maintained, the longest a seven and a half‐year complete remission for a patient with choriocarcinoma. It is recognized that there is a high recurrence rate following orchiectomy even in patients with negative nodes. This fact coupled with the responsiveness of these radioresistant tumors to triple therapy, and without life‐threatening toxicity, led us to employ this as adjuvant chemotherapy for one year in 13 patients following orchiectomy. There has been no recurrence in 11 of these patients, with the longest follow‐up five and one‐half years in a patient with choriocarcinoma. No patient in either series had x‐ray therapy.

Treatment of advanced cancer of the head and neck

The combination of radiation plus 5‐FU produced a significantly increased survival in patients with advanced tonsil and intra‐oral cancer compared to patients who received radiotherapy alone. There was no significant difference in survival between these 2 treatment modalities in advanced cancer of the nasopharynx, hypopharynx, extrinsic larynx, or primary unknown. Similarly, there was no significant difference in survival resulting from these 2 methods of treatment in patients with T1 and T2 as well as T4 head and neck cancers, but a highly significant difference in those with T3 lesions.

Breast carcinoma metastatic to the stomach. Report of a case in a male and review of an autopsy series.

SummaryA male patient with cancer of the breast died of massive gastric hemorrhage. At autopsy a small ulcerated gastric metastasis was found responsible.The autopsies of patients dying of metastatic breast cancer at our hospitals were reviewed, and the incidence of these lesions established and compared with the experience of others. When indicated, surgical intervention may afford useful palliation.

Coumarin-induced skin necrosis in a sixteen-year-old girl.

Abstract The entity of coumarin-induced skin necrosis has received relatively little attention in the United States, and is probably unknown to many practicing physicians. This unusual complication of coumarin anticoagulant therapy is characterized by the development of gangrenous areas of skin and subcutaneous tissue in certain patients, predominantly women. Sites of predilection are the thighs, breasts, buttocks and legs. There is no relation between the prothrombin level and development of this pathologic process. This report deals with the occurrence of this syndrome in a 16 year old girl receiving orally administered Coumadin ® (sodium warfarin). The noteworthy aspects of this case are the young age of the patient and the fact that this is only the fourth reported instance of this complication due to sodium warfarin. The possible roles of hypersensitivity and the hypercoagulable state in the pathogenesis of this entity are discussed. It is proposed that prompt recognition of this complication with subsequent substitution of heparin therapy for the coumarin drug may significantly decrease the morbidity and mortality of this syndrome.

Splenic myelosuppressive syndrome. A case report

A patient is presented who exhibited granulocytopenia, thrombocytopenia, splenomegaly and hypoplastic marrow which persisted for 8 years, despite empirical attempts at therapy with corticosteroids and other agents. Following splenectomy, however, the peripheral blood count returned to normal and serial bone marrow biopsies revealed a gradual normalization of the previously hypoplastic bone marrow. Examination of the spleen yielded no evidence to incriminate splenic sequestration of any of the formed elements. The literature pertaining to chronic neutropenia is briefly reviewed and a hypothesis presented regarding the role of the spleen in the etiology of this patients hematologic disease. The authors believe that this case report lends support to Damesheks2 concept of a splenic humoral influence on hematopoiesis.