H. Grant Taylor

Intracranial metastases in prostate cancer

In a clinicopathologic review of 126 autopsied cases with prostate cancer, 14 demonstrated intracranial metastases. Only two of nine symptomatic patients were evaluated for suspected central nervous system metastases prior to death, and five asymptomatic patients were incidentally found to have metastases at autopsy. Intracranial metastases in prostate cancer occur in the setting of widespread disease, and tissue pathology may reveal moderately to poorly differentiated tumor (11 of 14 cases).

Prolymphocytic leukemia: Treatment with combination chemotherapy to include doxorubicin

Prolymphocytic leukemia (PL) is a clinically distinct leukemic disorder. Cytochemical and surface marker characteristics help to differentiate PL from other types of leukemia, including chronic lym‐phocytic leukemia (CLL). In contrast to patients with CLL, those with PL frequently require early therapeutic intervention. Standard treatment regimens for CLL as well as splenectomy and splenic irradiation have not been effective in the treatment of PL. Combination chemotherapy with cyclo‐phosphamide, Doxorubicin, vincristine, and prednisone (CHOP) has produced impressive clinical responses in patients with PL. The treatment of a patient with PL is discussed and the literature is reviewed.

Extragonadal germ cell tumors. Clinicopathologic findings and treatment experience in 12 patients

In patients with primary germ cell tumors, treatment with combination chemotherapy followed by surgical debulking of residual tissue usually produces favorable results. The best treatment for patients with extragonadal germ cell tumors (EGCT) remains a problem. In our series of 12 patients, important clinical features were related to the site of bulky tumor, and all patients exhibited sharply elevated levels of lactate dehydrogenase (LDH), beta subunit human chorionic genadotropin (beta‐HCG), and/or alpha‐fetoprotein (AFP). Each patient was treated with systemic chemotherapy, and ten were treated with the same combination chemotherapy—cyclophosphamide, actinomycin, vinblastine, bleomycin, and cisplatin (VAB) alternating with VP‐16 and vincristine (VV). Of these ten patients, five died of progressive disease, three of whom had brain metastases. The other five are alive and clinically free of disease. The addition of VP‐16 and vincristine did not improve responses. Advanced disease at presentation contributes to the poorer prognosis for these patients. Earlier diagnosis and surgical debulking may improve the long‐term survival of patients with this disease.

Metastatic thymoma with myasthenia gravis. Complete remission with combination chemotherapy

A 29‐year‐old male developed myasthenia gravis 29 months after resection of a “benign” mediastinal thymoma. Metastatic thymoma was found in the pleura 45 months after the initial surgical resection. Combination chemotherapy with cyclophosphamide and doxorubicin produced a complete remission of the metastatic thymoma which has continued for 13 months. Concurrently, there has been a marked increase in neuromuscular function.

Treatment experience with nonseminomatous testicular cancer in patients with stage II and stage III disease.

Thirty‐eight patients with nonseminomatous testicular cancer were treated with cis‐platinum, bleomycin, and vinblastine in combination without a prolonged maintenance phase. Twenty‐six patients with Stage III disease were treated. Seventy‐six percent of those patients treated achieved, complete remission. At a median survival time of 30 months, no patient who achieved a complete remission has relapsed. Twelve Stage II patients given adjuvant therapy remain free of disease at a median time of 23 months. Markedly elevated serum lactate dehydrogenase levels and massive disease were common findings in the patients who did not achieve complete remission. One drug death occurred secondary to sepsis. Symptoms of depression and anxiety were significant dose‐limiting factors in this group of patients.

Skin metastases confined to a field of previous irradiation: Report of two cases and review of the literature

Two cases of tumor recurrence within a previously irradiated skin area are reported. Typical lesions evolve from an erythematous base and progress to induration and tumor papules. A review of clinical literature indicates that irradiation does not increase the frequency of metastases. Experimental data suggest that irradiation does increase metastases as a result of both local mechanical factors and increased tumor‐cell survival.

Lymphocytosis in a patient with malignant fibrous histiocytoma.

Malignant fibrous histiocytoma is an uncommon soft‐tissue sarcoma. Patients with malignant fibrous histiocytoma may present with unusual clinical findings and an apparent association with malignant hematopoietic disease has been reported. We describe a patient in whom a diagnosis of chronic lymphocytic leukemia was made simultaneously with discovery of a large, retroperitoneal malignant fibrous histiocytoma. Following surgical debulking of the tumor, the patients blood and bone marrow findings returned to normal.

Transitional cell carcinoma of the prostate. Response to treatment with adriamycin and cis-platinum

A patient with metastatic transitional cell carcinoma of the prostate achieved an impressive clinical response to treatment with Adriamycin and cis‐platinum. The treatment of transitional cell carcinoma of the prostate is discussed and the literature is reviewed.

Idiopathic acquired sideroblastic anemia terminating in acute myelosclerosis

Acute myelosclerosis is an unusual myeloproliferative syndrome characterized by pancytopenia, absence of massive hepatosplenomegaly, and an absence of tear‐drop poikilocytes. The marrow is usually fibrotic with atypical megakaryocytic proliferation and trilinear dyspoiesis. Median survival is approximately six months from onset of symptoms. The authors report a case of acute myelosclerosis that evolved in a patient two and one‐half years after the onset of idiopathic acquired sideroblastic anemia. A review of the other previously reported case of this unusual transformation and comments on the pathogenesis of the transformation from idiopathic acquired sideroblastic anemia to acute myelofibrosis are included.

Neurologic toxicity associated with hepatic artery infusion HAI of FUdR

SummaryA 66-year-old man with hepatic metastases from gastric adenocarcinoma was treated on two occasions with 5-fluoro-2-deoxyuridine (FUdR) via hepatic artery infusion (HAI). The patient developed neurologic signs and symptoms including disorientation, oculomotor defects, ataxia and multifocal myoclonus during both attempts at HAI. Systemic drug toxicity is unusual when FUdR is given via HAI, and neurologic toxicity has not previously been reported. We postulate individual hypersensitivity to FUdR or selective concentration of FUdR in brainstem structures to explain the toxicity in this case.