Rogers C. Griffith

The role of radiation therapy in the management of plasma cell tumors

A retrospective review is reported of 128 patients presenting with multiple myeloma and 16 patients presenting with solitary plasmacytoma. Ninety‐one percent of 116 evaluable patients treated for palliation of painful bone disease received some degree of subjective pain relief. The radiation dose most frequently prescribed was between 1500 and 2000 rad. Of the 278 ports treated, only 17 (6.1%) were re‐treated to the same area at a later date. There was no increase in incidence of re‐treatment with lower radiation doses. Ten of the 13 patients treated for a solitary plasmacytoma with a minimum follow‐up period of three years have local tumor control. The median survival in the solitary plasmacytomas is five and one‐half years. Data from the literature on 27 additional solitary plasma‐cytomas combined with our data suggest an improved local control and a decrease in dissemination with doses greater than 5000 rad. It is concluded that low doses of radiation are usually adequate to treat painful bone lesions of multiple myeloma and doses of 5000–6500 rad in six to seven weeks are recommended for solitary plasmacytomas. Cancer 45:647‐652, 1980.

A Morphologic Study of Intrahepatic Portal-vein Islet Isografts

Isologous pancreatic islets were implanted into the portal vein of rats with streptozotocin-induced diabetes. At intervals of from one to 32 days after transplantation, the intraheptic islet grafts were examined histologically and ultrastructurally, and their vascular supply was determined by later perfusion studies. Implanted islets were found widely dispersed throughout the liver in peripheral interlobular portal venules and surrounded by vacuolated liver cells containing large stores of glycogen. The endocrine cells were structurally normal in each interval examined. By the third day after transplantation the beta cells were depleted of secretory granules in aldehyde-fuchsin preparations. Regranulation returned by the 14th day and was associated with secretory organelle hypertrophy and hyperplasia. Islet cells were found outside the portal areas in direct apposition to hepatocytes forming distinct desmosomes by the first day. While hemoperfusion of the grafts occurred from the moment of implantation into the portal venule, a ual vascular supply derived from periportal arterial and venous sources developed by the 11th day after transplantation, establishing full vascularization of the grafts. Preliminary work is presented to show that an active ingrowth of nerves in the islet graft occurs in association with the process of vascularization.

Influenza virus-specific human cytotoxic T cell clones: Heterogeneity in antigenic specificity and restriction by class II MHC products

Human cytotoxic T lymphocytes specific for A/JAP/57 (H2N2) influenza virus were cloned from in vitro stimulations of peripheral blood lymphocytes. Analysis of the viral specificity in cytotoxic function revealed one clone that killed all type A influenza-infected targets, another clone that was specific for the hemagglutinin subtype of the immunizing influenza virus, and the third clone that demonstrated cytotoxicity restricted to the hemagglutinin of A/JAP/57 and A/JAP/62 (H2N2) and not other type A influenza strains with the H2N2 subtypes. The phenotype of these three clones was Leu 2-, Leu 3+, Leu 4+; MHC restriction of their cytotoxic function was mapped to HLA-DR by a panel of target cells as well as by inhibition of cytotoxicity with monoclonal antibodies. Proliferation of these clones, examined in a tritiated thymidine incorporation assay, was found to be driven by antigen in the absence of exogenous lymphokines. For all three clones antigen-dependent production and secretion of lymphokines with IL-2 activity was demonstrated. The antigen specificity of proliferation and factor production was shown to be identical to the pattern that each clone revealed in its cytotoxic function.

A morphologic study of childhood lymphoma of the lymphoblastic type: the pediatric oncology group experience

For this study 227 non‐Hodgkins lymphomas, registered through the Pediatric Oncology Group clinical studies between 1976 and 1982, were morphologically subclassified into major histologic types and subtypes, and their histopathologic and clinical features were compared. These lymphomas were distributed primarily into only three of the recognized major histologic types: lymphoblastic (LB), 106 (47%) undifferentiated (DU), 49 (21%); and diffuse histiocytic (DH), 72 (32%). These patient groups were found to differ in several ways: (1) the LB lymphomas contained most of the patients under two years of age; (2) the LB lymphomas tended to present in higher clinical stages; (3) the LB lymphomas tended to involve lymph node groups and the bone marrow more often than did the DU and DH lymphomas; and (4) the DU lymphomas had a greater tendency for gastrointestinal tract and other major organ system involvement. The complete remission rate of 96%, for the LB lymphomas was better than for either the DU or the DH lymphomas. The disease‐free survival of the LB lymphomas was significantly better than the DU group, but not the DH group. The LB were histologically divisible into three subtypes: convoluted (C), nonconvoluted (NC), and large cell variant (LCV). The C and NC subtypes preferentially involved the mediastinum and peripheral lymph nodes initially, while the LCV tended to involve the abdomen. However, none of the subtypes differed in clinical stage. The complete remission, and the disease‐free survival rates between these subtypes were not statistically different. Cancer 59:1126‐1131, 1987.

Angiofollicular lymph node hyperplasia (Castleman's disease) associated with vertebral destruction

A 45‐year‐old man presented with lower thoracic pain, proteinuria, and destruction of thoracic vertebra from an adjacent unresectable paraspinal mass which, on biopsy, demonstrated angiofollicular lymph node hyperplasia (AFLNH). The patient received 3939 rad in 22 fractions to the mass and associated area of vertebral destruction. The patient is currently asymptomatic without recurrence of pain or progression of neurologic symptoms 5 years after radiotherapy. There has been resolution of the previous proteinuria. Serial computerized tomography scans and x‐rays show no change in the paraspinal mass nor resolution of the vertebral destruction adjacent to the mass. A search of the English literature has failed to identify any previous association of AFLNH and bone destruction.

Spinal Ewing sarcoma: misleading appearances.

The plain radiographic and computed tomographic (CT) findings in two unusual cases of spinal Ewing sarcoma are reported. Radiographic features resembling neuroblastoma in one case and aneurysmal bone cyst in the other were present. These findings may be misleading and distinguishing characteristics in each case are discussed.

A morphologic study of childhood lymphoma of the undifferentiated type the pediatric oncology group experience

A retrospective analysis of 49 cases of undifferentiated non‐Hodgkins lymphoma, registered through the Pediatric Oncology Groups randomized clinical trials between 1976 and 1982, suggests that the histologic distinction between Burkitts and non‐Burkitts tumor is clinicopathologically irrelevant in children. Patients with undifferentiated lymphoma were stratified morphologically into three subtypes: Burkitts (B; 18 patients); non‐Burkitts (NB; 21 patients); and small noncleaved, not‐otherwise‐specified (NOS; 10 patients). Median age at presentation was 10 years for B; 12 years for NB; 6 years for NOS; and 10 years overall. Univariate analysis of clinical and laboratory data at presentation, yielded no significant differences between B, and NB patients. Complete remissions were obtained in 75% of the patients, and there were no significant differences in complete remission rate among the different morphologic subtypes of undifferentiated lymphoma. There were no significant differences in the estimated disease free survival between B, and NB patients. No morphologic parameters were identified that were predictive of prognosis. Cancer 59:1132‐1137, 1987.

A morphologic study of childhood lymphoma of the diffuse “histiocytic” type the pediatric oncology group experience

Of 227 cases of pediatric non‐Hodgkins lymphoma with adequate histopathologic material for review, 72 (32%) were classified as diffuse “histiocytic” lymphoma (DHL). These cases were further divided into different morphologic subtypes according to the Lukes—Collins classification, and the National Cancer Institute Working Formulation, to ascertain whether there were any significant prognostic differences among the different subtypes. The results of our study showed that 40 patients were classified as immunoblastic lymphomas, and 32 were called large follicular center cell (FCC) tumors. Of the 40 patients with immunoblastic histology, 19 had morphologic features of the clear cell type and were interpreted as consistent with T‐immunoblastic lymphomas; an additional two had polymorphous features also consistent with T‐cell type: 17 had plasmacytoid features, and were morphologically classified as B‐immunoblastic lymphomas; two could not be subtyped. Of the 32 patients with morphologic features of FCC lymphomas, 29 were classified as large noncleaved type, and three as large cleaved type. A clinicopathologic analysis showed that 90% of the patients obtained complete remission, and there were no significant differences in complete remission rate among the different morphologic subtypes of DHL. The estimated five year disease‐free survival for all patients was over 70%, with no failure after the second year; and there were no significant differences in the disease‐free survival among the different subtypes. The only clinical differences that we found, were that patients with lymphomas of FCC (large noncleaved) type (1) were younger (P = 0.01); (2) had less nodal involvement (P = 0.03); and (3) had more organ involvement (P < 0.01). We conclude that the morphologic subclassification of DHL in children currently has limited clinical prognostic significance. Cancer 59:1138‐1142, 1987.

A lymphoproliferative disorder caused by human T-lymphotropic virus type I: Demonstration of a continuum between acute and chronic adult T-cell leukemia/lymphoma

A 35-year-old black man is described who had a human T-lymphotropic virus type I (HTLV-I) infection while living in a non-endemic region. A lymphoproliferative disorder developed that might be considered as a transition stage between acute and chronic adult T-cell leukemia/lymphoma. This suggests that HTLV-I-induced neoplasias represent a continuous disease spectrum.

Antibody Diversity Patterns and Structure of Idiotypic Determinants on Murine Anti- α(1 → 3) Dextran Antibodies

Idiotypic (variable-region) antigenic determinants have been extremely important to the study of immunoglobulins. These antigenic determinants have been widely used to examine variable-region expression in immunoglobulin populations because they offer a simple, sensitive, serological approach to variable-region structure. There are many different categories of idiotypic determinants: ligand-modifiable (binding site determinants), ligand-nonmodifiable (framework determinants), VL-specific, VH-specific, and those requiring both VL and VH. In addition, determinants shared by variable regions known to be structurally different are called IdX, cross-reactive, or public idiotypes, while those apparently restricted to identical variable regions are IdI, individual, or private idiotypes.