George P. Sartiano

Carcinocythemia (carcinoma cell leukemia) due to metastatic carcinoma of the breast: report of a case.

A patient with a 17‐year course of metastatic lobular carcinoma of the breast is described who developed large numbers of circulating carcinoma cells which were easily detectable in several routine peripheral blood smears shortly before death. This rare complication of carcinoma has been called “carcinocythemia.” Carcinocythemia is probably due to widespread infiltration of many bone marrow sites and may also be related to splenectomy, which may impair reticuloendothelial clearance of circulating tumor cells. The differential diagnosis of carcinocythemia from superimposed acute myelogenous leukemia, which can complicate radiotherapy and chemotherapy for the primary tumor, is discussed. Cytomorphology, histochemistry, and electron microscopy of abnormal circulating cells should aid in the distinction of these two processes. Cancer 40:3107‐3111, 1977.

Observations following Corynebacterium parvum administration to patients with advanced malignancy. A phase I study

There has been increasing interest regarding the use of Corynebacterium parvum (CP) with other modalities in the management of primary cancer. Due to the paucity of specific information available relative to CP toxicity, a Phase I study was carried out in patients with advanced disease. The purpose of the investigation was not to evaluate the effect of CP on tumor growth. From 273 injections of CP in 40 patients it was observed that following intravenous (i.v.) infusion of CP: a) a febrile response and chills of considerable severity occurred in almost all patients and did not appreciably diminish in intensity following repetitive administrations; b) nausea, vomiting, headache, and confusion were not infrequent; c) a “flu‐like” syndrome lasting 24 to 48 hours occurred following almost all courses of CP; d) blood pressure elevations occurred on occasion and were related to the severity of other side‐effects; hyper‐ or hypotension was not a problem; e) there were no anaphalactic reactions. Pretreatment with a single administration of 100 mg of hydrocortisone prior to CP infusion markedly and in some instances dramatically diminished the toxicity and made acceptable the use of i.v. CP on an outpatient basis. The use of i.v. CP in patients with cerebral metastases may be hazardous. Subcutaneously administered CP resulted in a significant number of undesirable local reactions. Evaluation of delayed cutaneous hypersensitivity response, immunoglobulins, complement, and E‐ and EAC‐rosette‐forming cells during CP administration failed to demonstrate significant change from injection values. Results were similar whether hydrocortisone pretreatment was or was not employed. From the standpoint of toxicity it now seems appropriate to use i.v. CP, particularly following pretreatment with hydrocortisone, in a controlled clinical trial to evaluate its therapeutic effectiveness in the management of primary cancer.

Ameloblastoma of the Mandible with Pulmonary Metastasis

A patient with ameloblastoma of the mandible with histologically confirmed pulmonary metastases 9 years after onset of tumor is described. The effectiveness of three chemotherapeutic agents (cyclophosphamide, methotrexate, Adriamycin), each given alone intravenously, were evaluated. Marked symptomatic improvement was noted with Adriamycin therapy. Ten previous cases of metastatic ameloblastoma are reviewed. The incidence of metastases cannot be predicted on the basis of histology. Three commonly discussed modes of metastasis are via hematogenous and lymphatic routes and the unusual mechanism of aspiration of tumor cells.

Nephrotoxic and cytoproliferative effects of streptozotocin: report of a patient with multiple hormone-secreting islet cell carcinoma.

The nephrotoxic and cytoproliferative side effects observed in a patient with Streptozotocin‐treated, multiple hormone‐secreting, pancreatic islet cell carcinoma are described. Streptozotocin induced prolonged partial remission of the patients multiendocrine syndrome but resulted in progressive azotemia, which was controlled by temporary hemodialysis. A renal biopsy, the first to be reported in detail in such a condition, demonstrated a tubulo‐interstitial nephritis and a glomerular alteration consisting of cellular nodules. At autopsy there were numerous bilateral renal cortical spindle cell “tumors” and cellular aggregates in glomeruli. These findings suggest that the tumorigenic effects of Streptozotocin demonstrated in animals may also occur in man.

Cellular immunity in hodgkin's disease: Comparison of cutaneous reactivity and lymphoproliferative responses to phytohemagglutinin

Two parameters of cell mediated immunity, cutaneous reactivity to four intradermal antigens and the in vitro lymphoproliferative response to PHA, were evaluated in 27 patients with untreated Hodgkinss disease. By both criteria, this immune defense system was impaired; only 59% of the patients reacted to one or more antigens (virtually all normal subjects respond to at least one test), and the average response to PHA was reduced by 57%. However, within each anatomical stage, individual patients showed wide variations in response. Only the small group of patients with Stage IV disease showed abnormalities significantly different from other patients; the PHA response in those with extralymphatic disease was appreciably reduced. An additional 26 patients who had relapsed after initial therapy were also studied; in this group, the average mitogenic response was comparable to patients with untreated Stage IV disease. of note, the two measures of cellular immunity frequently yielded discordant results. An abnormal response in either assay was frequently associated with a normal determination in the other. In this regard, the mean PHA response in patients showing at least one positive skin test was 2017 ± 470 c.p.m./106 lymphocytes, and in the anergic group, 1811 ± 573. These observations suggest that neither skin test reactivity nor the response to PHA fully assesses the status of cell mediated immunity in patients with Hodgkins disease.

Primary Reticulum Cell Sarcoma of the Uterus

The authors present a case of primary uterine reticulum cell sarcoma who developed disseminated disease 6 years after undergoing a total abdominal hysterectomy. Review of the literature reveals 27 other patients with uterine lymphomas. Abnormal vaginal bleeding was the presenting complaint in 66% (14/21) of patients. Reticulum cell sarcoma was the most frequent histologic type, 68% (19/28). 28% of patients were alive and well 6-24 years after therapy.

The Demonstration of Separate DNA Polymerase Activities In Intact Isolated Rat Liver Nuclei by Means of Response to Bleomycin and Arabinosyl Cytosine 5-Triphosphate

Rat hepatic nuclei, isolated and studied in vitro, tend to reflect changes occurring in DNA synthesis in the intact rat (1). Nuclei from normal rat liver synthesize minimal amounts of DNA, while nuclei from a partially hepatectomized rat show a marked increase in thymidine tri-phosphate incorporation. This increase probably represents continuation of elongation of replicating DNA strands begun in vivo (2). Studies of extracts of rat liver nuclei suggest that there are at least two separate DNA polymerase activities: a tightly-bound activity which rises in quantity along with DNA replication following hepatectomy and is inhibited by cytosine arabinoside 5′-triphosphate (ara-CTP), and a loosely-bound activity which rises little or not at all after partial hepatectomy and is insensitive to ara-CTP (3). We have previously reported that Bleomycin causes dose-related and time-related increases of 3H-thymidine triphosphate incorporation into DNA of isolated normal rat liver nuclei (4). This incorporation is presumably carried out by a DNA polymerase reacting to structural DNA damage produced by the Bleomycin. The studies reported herein provide evidence that the increased 3H-thymidine triphosphate incorporation which follows addition of Bleomycin to isolated rat liver nuclei is mediated by a DNA polymerase activity that is different from the polymerase activity that increases following partial hepatectomy.

Primary Malignant Melanoma of the Vagina

The authors present 5 cases of primary malignant melanoma of the vagina and have reviewed 74 additional cases from the literature. The prognosis is extremely poor for this disease as compared to the u

Serum Long-Chain Alcohol Levels in Healthy Individuals and in Patients with Breast Cancer

Total long-chain alcohols were analyzed in blood sera from normal individuals and patients with diagnosed breast cancer. Tetra-, hexa- and octadecan-1-ol were the major long-chain alcohols detected in both groups. While the qualitative composition of the serum alcohols was similar in the two groups the average alcohol content of the serum of the breast cancer patients was approximately six times greater than that of the normal group. This difference in serum alcohol levels between the two groups was significant at p less than 0.01.

The Effect of Several Antitumor Agents on 3H-TTP Incorporation in Host Liver and Hepatoma Nuclei

Six different tumor antibiotics have been investigated in a nuclear incorporating system for their ability to inhibit 3H-TTP incorporation. Both host liver nuclei and nuclei prepared from two different Morris hepatomas have been used in the investigation. Three of these anti-tumor agents inhibit 3H-TTP incorporation equally in host liver and hepatoma nuclei, two preferentially inhibit incorporation in hepatoma nuclei and one stimulates incorporation preferentially in host liver nuclei. The effects of these compounds on nuclear DNA has been analyzed on neutral and alkaline sucrose density gradients. The nuclear incorporation system appears to be useful as a screening test system for potential anti-tumor agents.