Margaret A. McIntyre

Low grade stage I and II non-Hodgkin's lymphoma: Results of treatment and relapse pattern following therapy

Sixty-four patients (37 stage I and 27 stage II) with low grade non-Hodgkins lymphoma were treated by surgical excision alone (two patients) or with radiotherapy (53 patients), chemotherapy (five patients) or both (four patients). Actuarial survival was 80.7% at 5 years and 77.9% at 10 years. Actuarial recurrence-free survival at 10 years was 49.4% for stage I and 38.0% for stage II patients. Local control was achieved in 52 out of 56 (93%) patients treated with a radiation dose of 30 Gy or greater. There was no advantage for extended compared with involved, field irradiation. A multivariate analysis identified age, sex, stage and disease site as independent prognostic variables for survival.

Cis-platinum and vindesine in combination in the treatment of non-small cell lung cancer

Sixty-three patients with advanced non-small cell carcinoma of the bronchus were treated with a combination of cis-platinum and vindesine. All patients had measurable disease and were of good performance status; none had received prior chemotherapy or radiotherapy. Thirty-three per cent of patients responded, with five patients achieving complete remission. Median duration of response was 4 months, with a median survival of 14 months in the responsers, compared with 6.5 months in the whole group and 4.8 months in the nonresponders. Severe toxicity was encountered, with alopecia, gastrointestinal toxicity and neurotoxicity common. Myelosuppression and renal toxicity were not dose-limiting. Thus the activity of this drug combination is confirmed, but severe toxicity precludes its widespread use in clinical practice.

Fine needle aspiration biopsy and the otolaryngologist.

A survey of the diagnostic value of fine needle aspiration cytology in ENT practice was carried out over a 3-year period. The 119 aspirates were taken from a variety of head and neck sites and examined by an experienced cytopathologist. Cytology was accurate in 111 (93 per cent), with two false negative aspirates (1.7 per cent) and no false positive results. There were no complications and the technique was found to be a rapid, safe and cost-effective diagnostic tool.

Osteosarcoma of the esophagus.

The case of a 70-year-old man who underwent esophagectomy for a large polypoid sarcoma is described. Detailed examination of the surgical specimen established a diagnosis of osteosarcoma. Although osteosarcomas of the esophagus have been described in dogs, such tumors in humans do not appear to have been previously reported.

Influence of therapy on local control and survival in stage I and II intermediate and high grade non-Hodgkin's lymphoma

In a consecutive series of 113 patients with localized (Stage I and II) intermediate and high grade non-Hodgkins lymphoma we have retrospectively analysed patterns of survival and relapse in relation to presenting features and therapy. Two patients were treated by complete surgical excision. Seventy-two were treated by radiotherapy (RT), 19 by chemotherapy (CT) and 20 by combined CT and RT. A number of different chemotherapy combinations were employed. Overall survival for Stage I patients was 68.3% at 5 years and 65.5% at 10 years; for Stage II patients it was 61.2% at 5 years and 52.2% at 10 years. Recurrence-free survival for Stage I patients was 51.4% at 5 years and 42.1% at 10 years; for Stage II patients it was 46.2% at both 5 and 10 years. Local control by radiation was achieved in 59/72 (82%) patients treated with less than 40 Gy and 19/20 (95%) treated with 40 Gy or more. There was no advantage for extended field irradiation when compared with involved field. Eleven of 19 (58%) patients treated by CT alone achieved complete response (CR). For patients responding completely to CT there was no clear advantage for irradiation of originally involved bulky sites. For patients with Stage II and bulky Stage I disease there was a significant (P = 0.05) improvement in recurrence-free survival (RFS) and a trend (P = 0.192) towards improved overall survival for patients treated by CT alone or together with RT compared with RT alone. Independent variables identified by multivariate analysis were age, with better survival for younger patients (P = 0.034) and histopathological group, with better survival for DPDL compared with DH (P = 0.015).

Case report: Carcinoma in-situ of the testis diagnosed on semen cytology

The case is reported of a patient who presented to an infertility clinic following extensive treatment for testicular teratoma. An incidental finding on semen analysis was of abnormal cells suggestive of carcinoma in-situ. This diagnosis was later confirmed by biopsy of the remaining testicle. Radiotherapy will be given to the testis to ablate the germinal epithelium while sparing Leydig cell function.

Gut mucosal immunity to tissue transglutaminase in untreated celiac disease and other gastrointestinal disorders.

Tissue transglutaminase antibodies have not previously been measured in gut secretions. IgA anti-tissue transglutaminase and anti-endomysium antibodies were measured in paired serum and whole gut lavage fluid samples from patients with untreated celiac disease (N = 36), other gastrointestinal diseases (N = 235), and healthy volunteers (N = 13). HLA DQ2 typing was performed in the celiac patients. Whole gut lavage IgA anti-tissue transglutaminase antibody concentrations were raised in 83% of celiac patients, 4% of disease controls, and 8% of volunteers, and the antibody concentrations were significantly higher in celiac patients than in controls (P < 0.0001). Whole gut lavage IgA anti-endomysium antibodies were positive in 67% of celiac patients, but in none of the controls. Whole gut lavage, but not serum, IgA anti-tissue transglutaminase antibody concentrations were significantly higher in DQ2 positive than negative celiac patients. In conclusion, whole gut lavage IgA anti-tissue transglutaminase antibody concentrations are higher in untreated celiac disease than in other gastrointestinal diseases.

Seminal Fluid Analysis and Carcinoma-In-Situ of the Testis

Publisher Summary This chapter discusses the results of a seminal fluid analysis study and carcinoma in situ (CIS) of the testis. Diagnostic methods were assessed on men most likely to harbor CIS, that is, men about to undergo orchidectomy for suspected TGCT, in whom >90% would have been expected to have CIS adjacent to their tumor. Preorchidectomy semen from these patients was examined cytologically using Papanicolou stain and enzymatically for alkaline phosphatase (AP), the latter assessed both within cells and in seminal plasma. The results were compared with immunocytochemistry using antibodies H17E2 (anti-placental-like alkaline phosphatase—P1AP), TRA 1–60, and M2A. Semen was also examined flow cytometrically to detect aneuploidy. The results of cytometry and cytological staining were correlated with biopsies and fine-needle aspiration cytology (FNAC) taken from the macroscopically normal tubules of the orchidectomy specimen. The quantity of CIS within the biopsy was assessed and compared to the positivity of the aspirates and semen. A comparable group of men with benign testicular pathology were included as were semen samples from men attending the andrology clinic. Papanicolou staining revealed the presence of malignant cells in four patients though this could not be substantiated using AP or immunocytology.