Tetsuzo Fujitani

Radiochemotherapy for non‐Hodgkin's lymphoma in palatine tonsil

From January 1966 to December 1980, 367 cases of non‐Hodgkins lymphoma (NHL) were autopsied at Kobe University Hospital. The rate of extranodular type was 76.7% and the most common site of origin was the palatine tonsil. Of 133 patients with NHL in the palatine tonsil, at the Kobe University Hospital 110 were treated. All of the patients were treated by irradiation. Sixty‐one patients were treated by irradiation alone. Forty‐nine patients were treated in addition with conventional chemotherapy using vincristine, cyclophosphamide, endoxan a, and prednisolone. In 14 of 49 patients, adjuvant immunochemotherapy using a Streptococcus pyogenes (OK‐432) was added at maintenance dose in combination with induction radiochemotherapy. The survival curve of the patients treated by radiochemotherapy is better than that of the patients treated by irradiation alone. The survival rates at 0 to 1, 1 to 2, and 2 to 3 years for the patients treated by radiochemotherapy were 81.5, 66.3, and 59.0%, respectively, significantly higher than those of the radiotherapy group. The 5‐year survival rates of the radiotherapy group were 50.2% for Stage I and 26.5% for Stage II patients. The rates increased to 78% and 41.8% by radiochemotherapy. The extranodal NHL of Stage II also frequently develops into the advanced stage and adjuvant chemotherapy is necessary for such patients.

Pathological and biochemical study in the adenoid of mucopolysaccharidosis II

In the patients with mucopolysaccharidosis II (MPS II, Hunters syndrome), conductive and sensorineural hearing deficits are frequently observed. Two patients with MPS II underwent adenoidectomy and an ear douche, and their conductive hearing loss recovered after the surgery. Pathological examination of the adenoids revealed the infiltration of faintly PAS-positive plasmacytes with perinuclear vacuole and strongly Alcian-blue positive fibrotic area. Biochemical study was performed by chromatoscanning of electropholesis. The amount of glycosaminoglicans (GAG) in the specimens was increased 2.8-fold compared with the normal control. The electropholetic pattern showed an increase of dermatan sulfate (DS), heparan sulfate (HS) and hyaluronic acid (HA) in the adenoids of the patients. The ratio of DS to HS was 1.1-1.2. In the patients of MPS II, the accumulation of GAG occurs in the pharyngeal tonsil and causes conductive hearing impairment. We recommend adenoidectomy for such patients.

Clinical and prognostic significance of the T‐B immunological classification of non‐hodgkin's lymphomas

This study was made to test the clinical significance and the prognostic value of the T‐B immunological classification of non‐Hodgkins lymphomas.

SEVENTEEN YEAR'S EXPERIENCE IN THE TREATMENT OF CARCINOMA OF THE MOBILE TONGUE

Two hundred and forty-two patients with squamous cell carcinoma of the mobile tongue were reviewed. Most of them were initially treated by irradiation and then treated surgically for salvage. Cervical node metastases were frequently developed during or after the initial therapy. The patients in the advanced stage showed poor prognosis due to uncontrolled cervical node metastases and/or local recurrence. In the patients with no initial cervical node involvement, better local control and less frequent incidence of subsequently developed cervical node metastases were observed in the group treated by surgery than in those treated by irradiation. In the patients with initial cervical node involvement, no significant difference was noted in the survival yielded by either treatment modality. In advanced carcinoma, combined treatment with radiotherapy and surgical therapy seemed to give better results than with either radiotherapy or surgical therapy alone in this study.

Malignant lymphoma presenting as a parotid mass.

Primary malignant lymphomas of the salivary glands are very rare. Three cases of diffuse B-cell malignant lymphomas, each developing as a parotid mass, were presented. The preoperative early diagnosis is essential in these cases to avoid an unnecessary radical procedure as well as to have a beneficial effect on the prognosis. If there were a possibility of malignant lymphoma, present authors stressed that an incisional biopsy should be performed for diagnosis. The usefulness of immunopathological diagnosis of these tumors has been discussed with regards to the prognosis.

.BETA.-Adrenergic function on nasal mucosa of the patients with allergic rhinitis.

The purpose of this study was to investigate the jS-adrenergic function on the nasal mucosa of the patients with allergic rhinitis who showed positive skin test, positive provocation test and eosinophilia in their nasal secretion.The cells, which were scraped from the mucous blanket on the nasal mucosa using a small curette, released histamine after the challenge of allergen (×10 house dust), but this release was inhibited 5 minutes after incubation with 10-4 or 10-5M of 1-isoproterenol. The cells from mucous blanket were also incubated in the Tris ACM buffer with or without 10-5M of 1-isoproterenol, and cyclic AMP levels in the cells were measured using radio-immunoassay. The levels of cyclic AMP incubated with 1-isoproterenol were four times higher than those without 1-isoproterenol.Nasal provocation was performed using the disk method. Nasal resistance was measured by the combined rhinomanometry and sneezes, nasal secretion and swelling of the turbinate were observed for 5 minutes after provocation. The increase of nasal airway resistance and allergen-induced nasal symptoms caused by provocation was inhibited after spraying 1-isoproterenol. This responsiveness to 1-isoproterenol as Radrenostimulant suggested that the adenyl cyclase activity and adrenoceptor function of the cells on the nasal mucosa were normal in the patients with nasal allergy.

A case of rhinoscleroma.

Rhinoscleroma is endemic in eastern Europe, North and Central Africa, and South and Central America. It is a rare disease in Japan. In 1917, Kuzume first reported a Japanese case of scleroma of the pharynx. Until 1982, only 3 Japanese cases had been reported. Rhinoscleroma is a chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here is a 41-year-old Japanese female. Her chief complaint is nasal deformity and nodular swelling of the nasal vestibule. Physical examination revealed: narrow nostrils, hard nasal wings, tumefaction of the left nostril, crusting of the nasal cavity, nodular swelling of the posterior wall of the naso- and mesopharynx, and scarring of the lateral wall of the pharynx. Laboratory findings were normal. The TB skin test was negative. A biopsy of the inferior turbinate showed a marked subepithelial infiltration with lymphocytes, plasma cells and macrophages. A PAS stain of the specimen showed large vacuolated histiocytes containing Klebsiella organisms (so-called Mikulicz cells). Klebsiella, Streptococcus agalactiae and Escherichia coli were recovered from the nasal secretion, and Klebsiella rhinoscleromatis was identified biochemically. The patient was treated with total doses of 20g of streptomycin and 8.4g of minocyclin and at the time of this writing is clinically free of disease.

Primary tuberculosis of the nasal cavity

A woman, aged 43, came to the out-patient department complaining of progressive right nasal obstruction and epistaxis. Nasal examination showed granulomas with crusts in the bilateral Kiesselbach areas and anterior end of the right inferior turbinate. We took this tissue for biopsy, and sections showed tuberculosis of the nasal mucosa.She had no past history of pulmonary tuberculosis and X-rays of the chest and sinuses were reported normal. Whole-body examination showed no other suspected tuberculous focus. She was cured by general chemotherapy only using streptomycin, INAH and RFP. She has been followed up for the past two years and is symptom-free, with no local or general signs of recurrence.

The effectiveness of combination therapy (irradiation and chemotherapy) for malignant lymphoma in the palatine tonsill

1. 口蓋扁桃悪性リンパ腫の放射線単独治療群の1年から4年までの生存率は, 64%, 47%, 36%, 34%であったが, 放射線化学療法併用群では82%, 66%, 60%, 49%と生存曲線は有意に上昇が認められた.2. 実測生存率による0～1年, 2～3年で放化群の生存率が有意に高かった.3. Stage I では放単群と放化群の生存率に有意差を認めなかった.4. Stage II では0～1年, 2～3年の観察期間で放化群の生存率は放単群に比較して, 有意に高かった.5. Stae III, IVでも放化群の生存期間の延長が認められた.6. Lucus-Collins の分類では Non-T Non-B の生存率が最も良く B-cell lymphoma, T-cell lymphoma でも他領域の悪性リンパ腫に比較して予後は良好であった.

Extramedullary Plasmacytoma of the Oropharynx Producing κ-Type Bence-Jones Protein

A case of extramedullary plasmacytoma in the oropharynx of a 41 yearold woman is reported. Histologically, the tumor was plasmacytoma consisting mainly of matured plasma cells and showing a deposit of amyloid in the interstitial structure. Immunoelectrophoretic studies of the concentrated urine specimen revealed a κ-type Bence-Jones protein even though there was no increase in blood M-proteins. Lineac electron radiation of 5,100 rad was given over a period of eight weeks but no effect was noted. After the tumor was surgically removed, follow up of the patient was made for 2 years without evidence of recurrence or metastasis.