Untae Kim

Hemangioendothelial sarcoma of liver from chronic arsenic intoxication by fowler's solution

In this case report treatment of psoriasis with Fowlers solution (potassium arsenite; 17 years) led to hemangioendothelial sarcoma of the liver 7 years after discontinuation of the drug. Fowlers solution is a carcinogen and, as seen from a review of the literature, hemangioendothelial sarcoma of the liver is not an uncommon manifestation of chronic arsenic exposure.

Effect of platelet transfusion on hemorrhage in patients with acute leukemia: An autopsy study

The effect of platelet transfusion therapy in acute leukemia was studied in 27 cases, whose autopsy findings were compared to 30 similar cases treated prior to availability of such therapy. Major hemorrhage which was considered to be the proximate cause of death was present in 63% of the controls, but occurred in only 15% of the platelet‐treated group. This difference was highly significant (p <.001). Of the 30 patients who did not receive intensive platelet therapy, 15 (50%) had gross intracranial hemorrhage and 27 (90%) had gross pulmonary hemorrhage. In contrast, of the 27 patients in the study group who had received platelet therapy, 5 (19%) had gross intracranial hemorrhage and 14 (52%) had gross pulmonary hemorrhage. The platelet‐treated patients had a significantly decreased incidence of intracranial hemorrhage (p < .05) and of pulmonary hemorrhage (p <.005) compared to the control group of patients. The incidence of gastrointestinal hemorrhage was slightly lower in the study group; there were no differences in the amount of hemorrhage in the heart and kidney. The transfusion of large numbers of platelets significantly reduced the incidence and severity of hemorrhagic complications in these patients with acute leukemia and may have slightly prolonged their survival.

Appraisal of aspiration cytology in management of Hodgkin's disease

The value of aspiration cytology in the management of Hodgkins disease is shown in this study of 228 paients and 403 aspirations; 385 from lymph nodes and 18 from extranodal masses. In all patients the initial diagnosis was established on surgical biopsy. Aspirates were helpful in staging, defining extension of unusual radiation fields, and in recognizing residual disease and relapses after therapy. Adequate material was obtained in 80% of aspirations. The diagnosis of Hodgkins disease could not be established in the adequate cytologic sample in 9.9% of cases. In 5.5%, the diagnosis was that of benign reactive hyperplasia and in 4.4%, non‐Hodgkins lymphoma. Unsatisfactory material was usually obtained from nodes less than 1 cm in diameter or from residual lesions following radiation or chemotherapy. Only 14 of 93 such lesions proved to have active disease during follow up. There were no significant complications. Characteristics of the varied aspects of aspirated tumor cells found in Hodgkins disease are described.

Long survival in Hodgkin's disease

Abstract The records of fifty-eight patients with Hodgkins disease who survived for ten or more years from the time of diagnosis are reviewed in detail. These patients had more localized disease and a more favorable distribution of histologic patterns on admission than patients who died of Hodgkins disease within ten years. However, neither these factors nor the treatment they received (principally, radiation therapy) are sufficient to explain their long survival. Host factors, possibly related to cellular immune mechanisms, appear to play a major role in determining in which patients remissions will be prolonged. Our data confirm the reports of others that the nodular sclerosis histologic type of Hodgkins disease has distinctive clinical features. This form of the disease occurs predominantly in young female subjects in whom mediastinal adenopathy uniformly develops during its course and in whom manifestations of Hodgkins disease are tolerated which usually preclude long survival. Complete clinical remission of ten years or more warrants consideration of the possibility that a patient may have been cured of his Hodgkins disease. Only three of twenty-three patients with such remissions have shown subsequent evidence of Hodgkins disease, during follow-up periods approaching forty years.

Squamous cell carcinoma in dominant type epidermolysis bullosa dystrophica.

The unusual genetic disorder epidermolysis bullosa dystrophica has been reported in several patients in whom the chronic cutaneous scars led to the development of cutaneous squamous cell carcinoma. However, only one of these previously reported cases involved the autosomal dominant form of the disease; the remainder occurred in its recessive counterpart. We report the second and third patients with squamous cell carcinoma associated with the dominant form of epidermolysis bullosa dystrophica. In addition, we not only observed the previous electron microscopic findings of decreased numbers of anchoring fibrils beneath the basal lamina but have also noted marked disruption of the basal lamina itself.

Factors Influencing Metastasis of Breast Cancer

Metastasis is the most critical attribute of all human cancers, particularly for those of nonvital, surface organs such as the breast. In general, patients undergoing removal of small breast tumors, prior to the development of axillary lymph node metastases, have a better cure or long-term survival rate than those with large tumors or axillary involvement. The ten-year survival rate of women with small breast cancers treated with standard extirpative surgery has been reported to be more than 80%, dropping to about 50% when one to three axillary lymph nodes are involved, and to 25% when more than three nodes are positive.(1, 2) Consequently, greater efforts are being directed toward the early detection of breast cancer by various means. However, even some small tumors may have already spread to the regional lymph nodes by the time they are clinically detected, and, in other instances, the cancer may recur and disseminate widely after an extended period of dormancy. The annual mortality rate of breast cancer patients, reported as 39%, has not changed over the past 40 years.(3) This lack of improvement in the survival rate can be attributed mainly to our deficient understanding of the biology of metastasis, and, more directly, to the insufficient knowledge of its mechanisms. Therefore, a critical analysis of factors influencing metastasis of breast cancer may be a useful and timely task.

Splenic T and B lymphocytes and their mitogenic response in untreated Hodgkin's disease

The splenic T and B cell distribution in 79 patients with untreated Hodgkins disease was quite similar to that in 15 control patients with non‐Hodgkins lymphoma or carcinoma. The mean T lymphocyte percentage was slightly higher in involved spleens than in uninvolved spleens of patients with Hodgkins disease. There was no significant difference in the T and B cell distribution between tumor area and tumor‐free area of the same spleens of Hodgkins disease patients. Splenic T and B cell distribution did not correlate well with the clinical features of Hodgkins disease. The splenic T cell percentage was significantly lower than that of the peripheral blood T cell percentage (P < 0.05), while the splenic B cell percentage was significantly higher than peripheral blood B cell percentage (P < 0.01) in 13 patients with untreated Hodgkins disease. The splenic T lymphocyte response to PHA was significantly higher than the peripheral blood T lymphocyte response (P < 0.05), and the splenic B lymphocyte response to PHA, in the presence of irradiated autologous splenic T lymphocytes, was also significantly higher than the peripheral blood B lymphocyte response (P < 0.05) in 8 and 6 patients with untreated Hodgkins disease, respectively. Since the control splenic cells, utilized in this study were obtained not from patients with non‐neoplastic disease, but from patients with neoplastic disease other than Hodgkins disease, our data are not conclusive, but only suggestive of normal T and B cell distribution and function in uninvolved spleens of patients with untreated Hodgkins disease. Cancer 45:767‐774, 1980.

Differential permeability of lymphatic and blood vessels in determining the route of metastasis as demonstrated by indirect lymphography

Indirect mammo-lymphography with serial radiograms was made on rats bearing three established rat mammary carcinomas (SMT-2A, TMT-50, MT-W9B), with the water-soluble contrast medium, Iotasul. In the lymphogenously metastasizing SMT-2A, fine lymphatic sprouts from the tumor were seen converging into an afferent lymph vessel that was extending toward a metastatic regional lymph node, in 15–30 min. For 45 min, the dye remained localized in the primary tumor with no other vascular structures or viscera visible until it emerged in the urinary bladder, indicating that Iotasul was absorbed slowly into the systemic circulation via lymphatics and diluted beyond recognition by lymph and blood, and then reconcentrated in urine. In contrast, in the hematogenously metastasizing TMT-50, Iotasul was rapidly diffused into the blood stream, revealing the inferior caval vein within 5 min, and by 15 min the heart, aorta, common carotid arteries, kidney and ureter were all clearly revealed. In the non-metastasizing MT-W9B host, several small vascular markings around the tumor were seen by 10 min and the outline of kidneys and urinary bladder in 15 min, suggesting that the dye was also absorbed through blood capillaries but somewhat slowly. Thus, the differential vascular permeability in rat mammary tumors revealed by Iotasul has not only helped to distinguish lymphatics from blood vessels, but also to correlate it with their metastatic potential.