Hirokuni Taguchi

Adult T-cell leukemia in two siblings acute crisis of smoldering disease in one patient

Two cases of human T‐cell leukemia virus (HTLV)‐positive adult T‐cell leukemia (ATL) in brother and sister are presented. Six of 15 members of this family were seropositive for antibodies for ATL‐associated antigens (ATLA). The sister of the ATL patient developed overt ATL after 5 years and 8 months of smoldering ATL. Immunologic examinations during the smoldering phase were normal except for negative skin tests for purified protein derivative. Factors leading to the induction of ATL among HTLV carriers remain to be studied.

Generalized lymph node metastasis of early uterine cancer in an HTLV-I carrier

Generalized lymphadenopathy due to metastases of keratinizing squamous cell carcinoma developed in a 68‐year‐old woman who was a carrier of human T‐cell leukemia Type I (HTLV‐I). On her 74th hospital day, she died of massive metastases of the superficial and deep‐seated lymph nodes, thyroid, lungs, pleura, liver, spleen, pancreas, kidneys, and retroperitoneum. At autopsy, the primary tumor was found in the uterine cervix. The depth of stromal invasion was approximately 4.0 mm. Such an extensive dissemination usually does not occur in cervical cancer with this type of early stromal invasion. It is conceivable that the chronic HTLV‐I infection compromised the immunosurveillance against cancer and accelerated progression of the disease in this patient.

Diagnosis of carcinoma of the papilla of vater by duodenofiberscopy: Simultaneous attempt on endoscopic observation, aspiration cytology, retrograde pancreatocholangiography and biopsy

SummaryClinical features and validity of a duodenofiberscopic examination for the diagnosis of carcinoma of the papilla of Vater were evaluated on 13 cases preoperatively diagnosed endoscopically. Followings are the conclusions derived. 1) Average age was 59.8 years. Incidence was equal among men and women. 2) As initial symptoms, general fatigue and easy fatigability or symptoms of cholangitis should be emphasized. 3) Other important symptoms include jaundice, fever with chills and weight loss. Abdominal pain, when present, was noted as one of symptoms of cholangitis in most cases. 4) Important laboratory findings include elevated serum bilirubin and alkaline phosphatase, elevated erythrocyte sedimentation rate, positive occult blood in stool. 5) Carcinomas of the papilla of Vater were divided into 3 types (type I, II and III) according to endoscopical and pathological findings. Clinical features and laboratory findings were discussed in relation to the type of lesions. Characteristic endoscpic findings of each type of the lesions were described. Validity of aspiration cytology, pancreatocholangiography and biopsy under duodenofiberscopic observation was also discussed. As a result, duodenofiberscopy was considered to be the most useful method for the diagnosis of carcinoma of the papilla of Vater because it provides us with an opportunity to perform simultaneously an endoscopic observation, aspiration cytology, pancreatocholangiography and biopsy.

Biphenotypic leukemia with a new translocation, t(2;6)(q31;q23).

A t(2;6)(q31;q23) was found in a patient with acute biphenotypic leukemia. This cytogenetic change has not been reported previously in acute lymphocytic leukemia (ALL) or biphenotypic leukemia, although deletion of 6q has been frequently found in ALL.