Frank I. Jackson

PRIMARY BREAST LYMPHOMA - AN IMMUNOHISTOLOGIC STUDY OF 20 NEW CASES

Primary malignant lymphomas of the breast (PBL) are uncommon. the authors report the clinical, histologic, and immunoperoxidase findings on 20 cases recorded at the Alberta Cancer Registry over the last 23 years. These cases were then added to material on 257 cases abstracted from the literature and analyzed. It was found that there are two clinicopathologic types of PBL. the first affects pregnant or lactating women with bilateral, diffuse disease, is rapidly fatal, and corresponds histologically to a Burkitts‐type lymphoma. the second is unilateral at presentation and afflicts a broad age range, but primarily older women. This has a variable course only part of which is predicted by histologic grade and stage. Tumor size, treatment, and side of presentation were not found to be significant prognostic factors. Histologically, these tumors can be grouped into large cell B‐cell lymphomas, monocytoid B‐cell lymphomas (MBCL), and undifferentiated, some of which may be T‐cell. Evidence suggesting that the MBCL of breast are the equivalent of the malignant lymphomas of the mucosa‐associated lymphoid tissues (MALT) is reviewed. the breast is a hormone‐dependent member of the MALT and therefore it is interesting that two of these tumors were strongly positive for estrogen receptors.

Iatrogenic alterations in radionuclide biodistributions.

The biodistribution of radiotracers used in diagnostic imaging is grossly and recognizably altered by a wide variety of drugs and other treatment modalities, such as surgery and radiotherapy. Knowledge of such altered biodistribution is important both in making diagnostic inferences from scans and in dosimetric considerations.

Bone Scintiscanning Updated

Use of modern materials and methods has given bone scintiscanning a larger role in clinical medicine, The safety and ready availability of newer agents have led to its greater use in investigating both benign and malignant disease of bone and joint. Present evidence suggests that abnormal accumulation of 99mTc-polyphosphate and its analogues results from ionic deposition at crystal surfaces in immature bone, this process being facilitated by an increase in bone vascularity. There is, also, a component of matrix localization. These factors are in keeping with the concept that abnormal scintiscan sites represent areas of increased osteoblastic activity, although this may be an oversimplification. Increasing evidence shows that the bone scintiscan is more sensitive than conventional radiography in detecting focal disease of bone, and its ability to reflect the immediate status of bone further complements radiographic findings. The main limitation of this method relates to nonspecificity of the results obtained.

Scintigraphy of Sacroiliac Joints in Acute Anterior Uveitis: A Study of Thirty Patients

HLA-B27 is a transplantation antigen found in a high proportion of patients with ankylosing spondylitis. Recently, an association has been shown to exist between HLA-B27 and acute uveitis, even in the absence of ankylosing spondylitis. We have examined the HLA antigen profile of 45 patients with acute nongranulomatous anterior uveitis and have confirmed this relation. In addition, using 90mtechnetium stannous pyrophosphate we have been able to demonstrate abnormal bone scan in 19 of 30 patients studied. Such abnormalities are limited to the sacroiliac joints but are otherwise the same as those seen in overt ankylosing spondylitis. Seven of the 19 patients did not have HLA-B27. These factors suggest that acute anterior uveitis may often represent a manifestation of a spondylitic diathesis even in the complete absence of any suggestive symptomatic or radiologic change and, in some cases, even though the antigenic marker HLA-B27 may be absent.

Sympathetic Denervation and the Bone Scan

Three patients, all having sustained a unilateral lower limb sympathectomy, are described. In all three uptake of bone-seeking tracer in the affected limb was increased with this increase being accentuated at the metaphyses of the long bones.

Lymphocutaneous fistula following renal transplantation.

A patient is described in whom the postoperative management after renal transplantation was complicated by a wound discharge. A radionuclide technique of solving the clinical dilemma is discussed, using scintilymphangiography and qualitative assays.

Localization of Acute Inflammatory Foci in Man with 99m Tc-S.C. Labeled Granulocytes

Human granulocytes can be radiolabeled with 99mTc- S.C. and used to image sites of focal inflammation. Labeling is best achieved by culture, in the presence of serum, for one hour at 25°C. The cells remain viable and 80-85% of the injected activity is associated with the granulocyte fraction of blood. Of 52 patients investigated by the technique, 20 had sites of focal inflammation correctly identified and 19 had normal findings, with no focal disease subsequently identified. A falsenegative result occurred in 11 patients, with falsepositive findings in two. While of clinical help in localizing focal inflammation when positive, the examination does not reliably exclude this possibility at its present stage of evolution in our hands.

Cystic thyroid mass following I-131 treatment of papillary thyroid carcinoma: An unusual complication

Several unusual complications of I-131 therapy for thyroid carcinoma are known. Two patients who developed a further unusual event that consisted of a palpable mass and cystic degeneration are described.

Gallium Scanning and Melanoma

Excerpt To the editor: Kirkwood and his colleagues do an injustice in reflecting that our data on the same subject lack validation (1). The validation is explicitly spelled out in our article as be...

Scintigraphic Recognition of Pancreatic Pseudocysts

Scintigraphic findings in two patients with pancreatic pseudocysts are discussed. In both patients a photon-deficient area in the region of the pseudocyst was found in both the 75Se-selenomethionine and 99mTc-pertechnetate scintiscans. In one patient aortic displacement by the mass was suggested. The 99mTc-pertechnetate scans afforded readier recognition of photon-deficient areas by virtue of the greater photon flux.