Aggressive natural killer cell lymphoproliferative disorder associated with Epstein-Barr viral RNA

Lymphoproliferative disorder of natural killer cells is a heterogeneous disorder, and an association with Epstein-Barr virus (EBV) is suggested in some cases. A Japanese male presenting with recurrent nasopharyngeal problems developed fever, generalized lymphadenopathy, and hepatosplenomegaly. Separated cells from lymph nodes were shown to have a natural killer (NK) cell, CD2(+), CD3(-), CD16(+), CD56(+), HLA-DR(+) phenotype. A progressive abnormality of hepatic function was associated with hepatorenal failure and death. A serologic study suggested reactivated EBV infection. In situ hybridization (ISH) studies showed Epstein-Barr virus-encoded RNA (EBER)-1 in lymph nodes, with lymphocytes infiltrating the liver and tissue from ethmoid sinus surgery 3 years prior to development of obvious lymphoproliferative disease. Polymerase chain reaction performed on lymph node DNA, using oligonucleotide primers specific for the EBV lymphocyte-determined membrane antigen (LYDMA) gene, revealed a single band, suggesting monoclonal proliferation of the tumor. NK activities of the lymphocytes from the lymph node and peripheral blood were markedly decreased. These findings suggest a close relationship between EBV infection and development of NK cell lymphoproliferative disorder.

A case report of midgut nonrotation treated by laparoscopic Ladd procedure

We performed laparoscopic survey and treatment on a 17-year-old girl who was diagnosed as having complete midgut nonrotation. The Ladd procedure was successfully performed laparoscopically. The patient was discharged 6 days after the operation. Laparoscopic operation is a useful tool for the correct diagnosis and treatment of intestinal malrotation disease in the adult patient.

Laparoscopic transhiatal esophagectomy for advanced thoracic esophageal cancer

We performed transhiatal subtotal esophagectomy under laparoscopic guidance to reduce the invasiveness of subtotal esophagectomy while preserving dissectional accuracy. In six cases of advanced thoracic esophageal cancer with distant metastasis, we used a special type of handpiece of ultrasonic surgical aspirator (CUSA) for laparoscopic surgery to dissect the esophagus from surrounding tissues and to isolate vessels entering it while viewing with the video monitor. Hemostasis of isolated vessels was effected by clips or electrocoagulation. There was no massive bleeding from the mediastinum during the operation, nor was there postoperative bleeding or infection. All patients regained normal swallowing ability and were discharged. Transhiatal esophagectomy under laparoscopic guidance is considered a safe, less invasive operative treatment for patients who are suffering from advanced thoracic esophageal cancer.

[Serum concentration of pyridinoline cross-linked carboxy-terminal telopeptide of type-I collagen (ICTP) and carboxyterminal propeptide of human type I procollagen (PICP) in the diagnosis of bone metastases]

Recently discovered bone metabolic markers are expected to play an additional role in the diagnosis of bone metastasis. We measured bone metabolic markers, serum pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP) and carboxyterminal propeptide of human type I procollagen (PICP) in 224 patients with breast cancer (106 with bone metastases), 61 patients with prostatic cancer (30 with bone metastases), 45 patients with lung cancer (17 with bone metastases) and 13 patients with miscellaneous cancers (7 with bone metastasis) and compared the values in the presence and absence of bone metastasis. ICTP and PICP increased significantly in patients with bone metastases. By the analysis of sensitivity and specificity, the cut-off levels were considered to be 5.0 ng/ml for ICTP and 140 ng/ml for PICP. In lung cancer (bone metastases are mostly of osteolytic), ICTP was excellent marker in detecting bone metastasis. In breast cancer (bone metastases are mostly of mixed type), ICTP was good in detecting bone metastases. In prostatic cancer (bone metastases are mostly of osteoblastic), ICTP and PICP were good markers in detecting high grade of bone metastases. Over all, ICTP was more sensitive in the diagnosis of bone metastases than PICP. However, both markers were not effective in detecting low grade bone metastases. ICTP and PICP should play a supportive role to imaging modalities in the diagnosis of bone metastases.

Bone metabolic markers in bone metastases

The efficacy and cost/performance benefit of radionuclide bone scintigraphy in monitoring metastatic bone activity remain controversial. Recently developed bone metabolic markers are expected to play an additional role in the diagnosis of bone metastasis. We measured osteoclastic and osteoblastic markers in 267 patients with breast cancer (100 with bone metastasis), 38 patients with prostatic cancer (25 with bone metastasis), 50 patients with lung cancer (12 with bone metastasis) and 33 patients with miscellaneous cancers (13 with bone metastasis) and compared the values in the presence and absence of bone metastasis. Bone metabolic markers, both osteoclastic and osteoblastic, increased significantly in patients with bone metastasis. In breast cancer (bone metastasis is mostly of the mixed type), osteoclastic markers were good in detecting bone metastasis. In prostatic cancer (bone metastasis is mostly osteoblastic), osteoclastic and osteoblastic markers were equally effective in detecting bone metastasis. In lung cancer (bone metastasis is mostly osteolytic), osteoclastic markers were elevated preferentially in bone metastasis. Over all, osteoclastic markers were more sensitive in the diagnosis of bone metastasis, and among osteoclastic markers, serum pyridionoline-cross-linked carboxyterminal telopeptide was the most efficient in both specificity (91.0%) and sensitivity (48.6%) for detecting bone metastasis.

Microtubule changes in hematologic malignant cells treated with paclitaxel and comparison with vincristine cytotoxicity

Using immunofluorescence microscopy with an anti-alpha tubulin monoclonal antibody, we examined the microtubule changes induced by paclitaxel in pathologic cells from 38 hematologic malignancies, and compared the morphologic and cytotoxic changes with those induced by vincristine in vitro. Malignant cells cultured without paclitaxel or vincristine (controls) showed well-developed microtubules radiating from a microtubule organizing center (MTOC). Malignant cells cultured with paclitaxel showed bundling of microtubules and those cultured with vincristine showed crystal formation of the microtubules. In 28 lymphoid malignancies, the difference in the percentage of cells showing microtubular changes with paclitaxel and vincristine was significant (paired t test) after 2h p < 0.01, after 4h P < 0.05, and after 20 h P < 0.05. As paclitaxel is not in clinical use for the treatment of hematologic malignancies in Japan, no clinical material was available. In 6 out of 9 patients with lymphoid malignancies with a previous history of combined chemotherapy including vincristine, paclitaxel produced microtubular changes in a higher percentage of cells than did vincristine. In 10 myeloid malignancies, the percentages of the cells with microtubular changes induced by paclitaxel was also higher than those induced by vincristine (P < 0.05 in 2 h, p < 0.01 in 4h, and p < 0.05 in 20h). Although the number of studied cases was small, this suggests that paclitaxel is as effective as vincristine in certain hematologic malignancies. As microtubular changes induced by paclitaxel and vincristine are easy to assess, the study of microtubular changes induced in vitro by antimicrotubular agents may prove useful in predicting the chemotherapeutic effect in vivo of these agents.

Terpentecin and ECT4B, new family of topoisomerase II targeting antitumor antibiotics produced by Streptomyces: producing organism, fermentation and large scale purification

Terpentecin and UCT4B are new family of antitumor antibiotics with topoisomerase II mediated DNA cleavage activity. Based on the taxonomic studies, the producing strain S-464 was identified as Streptomyces sp. This strain is different from Kitasatosporia griseola which had been identified as the terpentecin-producing strain in 1988. Fermentation studies showed that natural nitrogen sources supported higher titer of terpentecin, and the synthetic medium with inorganic nitrogen sources supported selective production of UCT4B. An improved isolation method was developed for the large scale purification of terpentecin.

[Histopathological changes produced in organs by platelet activating factor]

This experiment was conducted to investigate the effect of platelet activating factor (PAF) on the pathological changes in organs using 10 mice (C3H/HeN). Ten mice were divided into two groups of acute and chronic experiment groups. In acute experiment, each mice received iv bolus injection of PAF 2.5 micrograms.kg-1 and in chronic experiment daily ip injection of PAF 7.5 micrograms.kg-1 for 7 days. Histopathology was observed with light microscopy after one hour or after 7 days by haematoxylin and eosin stain. In acute experiment, congestion of the lung, liver, kidney and spleen in all cases, right ventricular dilation in 2 cases and villous necrosis in the small intestine in 4 cases were observed. In chronic experiment, hyaline thrombus with congestion of the lung in 3 cases and congestion of the liver and kidney in all cases were observed. Splenomegaly with increased macrophage was observed, but no necrosis in the small intestine was observed. Marked findings were villous necrosis in the small intestine in acute experiment and hyaline thrombus in the lung as well as splenomegaly in chronic experiment.

Detection of human cytomegalovirus in pleural fluid of lymphoblastic lymphoma T-cell type

We report a case of T-lymphoblastic lymphoma in which lymphoma cells infected with cytomegalovirus were found in the pleural fluid. A 16-year-old boy with an anterior mediastinal mass developed pleural fluid accumulation. Immunoperoxidase staining of pathologic cells in the pleural fluid revealed them to be CD4+/-, CD7+, CD8-, CD34+, CD20- and HLA-DR+. The diagnosis of lymphoblastic lymphoma T-cell type was made. Electron microscopic examination revealed virus particles with an electron-dense core and capsid, late structures of virus, in the pleural fluid cells. Polymerase chain reaction (PCR) amplification was used to detect human cytomegalovirus (HCMV) DNA in pleural fluid cells. A pair of synthetic oligonucleotide primers from the CMV phosphoprotein 71, an early structural protein, coding region (HindIII fragments L, c and b of the Ad 169 strain) could amplify DNA from the pleural fluid cells from the patient. Immunoperoxidase staining of the pleural fluid cells with anti-HCMV positive sera also revealed a positive reaction. These findings suggest the entry of HCMV into lymphoma cells with positive PCR amplification of DNA encoding an early structural protein, and replication from the presence of late structures of virus, electron-dense core and capsid. Replication of lymphoid cell lines of B and T origin were reported in the literature but replication of HCMV in lymphoma cells in vivo has not been reported.

Sweet's syndrome during therapy with granulocyte colony-stimulating factor in a patient with aplastic anaemia

A patient with aplastic anaemia developed Sweet's syndrome (a febrile neutrophilic dermatosis) during granulocyte colony-stimulating factor (G-CSF) therapy. Three repeated episodes of appearance and disappearance of erythematous nodules after administration and withdrawal of G-CSF confirmed that G-CSF induced Sweet's syndrome in the patient. Sweet's syndrome has been reported in patients with myelodysplastic syndrome and acute leukemia, but not in patients with aplastic anaemia. This is the first report of a patient with aplastic anaemia who developed G-CSF-induced Sweet's syndrome.

Lymphomatous polyarthritis in patients with peripheral T-cell lymphoma

Direct involvement of the joints is a rare complication of malignant lymphoma and lymphoma cells in synovium or synovial fluid have been characterized in only a very few cases. We report two cases of CD4-positive, HTLV-I-negative peripheral T-cell lymphomas that manifested polyarthritis infiltrated with lymphoma cells which we further characterized. Patient 1, with a prior 7-year history of cutaneous T-cell lymphoma (mycosis fungoides) and polyarthralgia, developed pain and swelling in the right knee joint and right femoral region. Patient 2 was initially diagnosed with immunoblastic lymphadenopathy, later rediagnosed as the prodromal stage of T zone lymphoma. Seven years later she developed skin eruptions, cervical lymph node swelling, polyarthritis, and pleural effusion. Synovial fluid analysis in both cases showed predominant CD3+ or cytoplasmic CD3+, CD4+, and CD8- atypical lymphoid cell infiltration. In both cases the T-cell receptor beta and gamma chains were rearranged in the synovial fluid mononuclear cells. Analysis of these two cases and a review of the literature suggest that lymphoma cell infiltration of synovium occurs preferentially in patients with CD4+ peripheral T-cell lymphoma.

[In vitro production of gamma/delta T cell clones and their characteristics]

Human TCR gamma/delta cell clones were produced from both CD2-depleted normal peripheral blood mononuclear cells (PBMC) and leukemia and lymphoma cell-predominant PBMC, effusion cells and lymph node cells in in vitro cultures with rIL-1 and rIL-2 and using limiting dilution techniques. These clones were then analyzed as to their cell morphology, phenotype and non-major histocompatibility-restricted cytotoxicity (NMRC) to K562. The results of the cloning from CD2-depleted PBMC showed 112 WT31+ gamma/delta-1- clones, 62 WT31- gamma/delta-1+ clones and 101 WT31- gamma/delta-1- clones. These were produced in 17 serial experiments. The addition of EBV-infected B cell line cells as feeder cells resulted in better production of gamma/delta-1+ and non-T cell clones than that of WT31+ clones. One typical example of the cloning from lymphoblastic lymphoma cell-predominant PBMC resulted in the production of 8 gamma/delta-1+ and 3 WT31+ clones. Most of the clones proven to be gamma/delta-1+ clones had the CD2+ CD3+ CD4(-)-+ CD8(-)-+ TCR delta-1+ beta F1- alpha F1- and delta TCS-1- phenotype, but few clones displayed CD2- or delta TCS-1+ phenotype. These gamma/delta-1+ clones were morphologically large granular lymphocytes, but functionally they did not have NMRC to K562. It is possible to say that TCR gamma/delta clones were rather easily produced from TCR alpha/beta cell-depleted PBMC and effusion cells, and can be used for the study of their nature and characteristics.

[Histological studies of thymomas from 17 myasthenia gravis and 1 pure red cell aplasia patients and the T cell subsets before and after in vitro culture with rIL-2]

A histological study of thymomas from 17 MG and 1 RCA patients was carried out, taking account of the clinical severity of the patients conditions. The cell surface markers of dispersed thymoma cells were studied before and after in vitro culture with rIL-2 using a panel of T cell monoclonal antibodies by FCM and the histostaining technique. The histological study of the 17 MG thymomas identified 2 invasive, 13 lymphoid hyperplasia, 1 epithelial cell hyperplasia and 1 mixed (lymphoid and epithelial) cell type. There was no clear correlation between the type of histology and the severity of the clinical stage of MG except in 2 patients with thymomas of the histologically invasive type who were in a clinically advanced stage of MG. One thymoma from the PRCA patient was of the histologically mixed cell type. A study of the subpopulations of each thymoma cell showed that the E-rosette-positive and the CD2-positive cells accounted for 77% and 78% of the total thymocytes on the average. There were far fewer mCD3-positive cells (36%) than CD2-positive (78%), CD4-positive (57%) or CD8-positive cells (57%) on the average. After in vitro culture with rIL-2, the percentage of mCD3-positive cells in each thymocyte increased to the level of CD2-positive cells, and the ratio of beta F1-positive cells also increased almost to the same level as mCD3-positive cells, but, in most cases, the percentage of WT31-positive cells was not increased by in vitro culture with rIL-2. Percoll density gradient separations of Case 18 and Case 19 thymoma cells showed that the precursors of CD3+WT31- cells were enriched in the intermediate density layers. These results indicate that rIL-2 induced mCD3-, cCD3+ and beta F1- immature thymocytes to mCD3+ and beta F1+ cells, but did not induce the expression of TCR beta gene product (WT31) on their cell surfaces.

[A case of Sjögren's syndrome at the age of 91 with a lymphoepithelial lesion]

A 91 year old woman with Sjögren's syndrome who developed a lymphoepithelial lesion and showed an active state of the disease is described. Since June, 1990, the patient had been complaining of dry eyes and mouth and a left submandibular tumor (1.0 x 1.5 cm in diameter). A biopsy of the tumor revealed lymphoepithelial lesions in the salivary gland. Mild anemia (Hb 9.6 g/dl) and an elevated erythrocyte sedimentation rate (80 mm/hr) were noted. The gamma-globulin level was 2.7 g/dl, IgG 2789 mg/dl, IgA 469 mg/dl, RAHA x80, antinuclear antibody x20, anti-SS-A x256, thyroid test x400 and microsome test x102400. The Schirmer's test showed decreased tear secretion (Lt. 3mm, Rt. 9mm) and keratoconjunctivitis sicca were noticed by an ophthalmologist. Salivary scintigraphy revealed decreased uptake and slow excretion of the isotope (grade II). A biopsy of a minor salivary gland showed periductal lymphocytic infiltration and acinar cell destruction. Immunohistochemical analyses revealed the cross-reactive idiotype of a monoclonal rheumatoid factor which is associated with a patient with Sjögren's syndrome, in the infiltrating lymphocytes and plasma cells of the minor salivary glands, but not in the lymphoepithelial lesions of the left submandibular gland. This was a rare case concerning a 91-year old patient with Sjögren's syndrome who developed a lymphoepithelial lesion and showed high activity in the serum and gives us valuable information on the relationship between aging and autoimmunity.

Establishment of a CD4-positive plasmacytoma cell line (AMO1)

A human plasmacytoma cell line (AMO1) was established. The AMO1 cells had the light and electron microscopic characteristics typical of plasmacytoma cells and did not harbor Epstein-Barr virus. These cells expressed cytoplasmic immunoglobulin A kappa and the immunoglobulin heavy-chain gene (JH) and kappa light-chain gene (C kappa) were rearranged. Coexpression of a CD4 antigen and plasma cell antigens (CD38 and PCA-1) was an unusual and sustained feature. Neither the T-cell receptor beta nor the gamma chain gene displayed the rearranged form. Other lineage-specific surface antigens, namely T, B, monocytoid, and myeloid antigens, were all negative in AMO1. In accordance with the surface CD4 expression, polymerase chain reaction analysis indicated constitutive expression of CD4 mRNA, and the cytogenetic findings revealed that AMO1 cells had a derivative chromosome 12, which had a structural abnormality of the short arm carrying the CD4 gene locus. These findings provide strong evidence for the presence of CD4-positive malignant plasma cells and raise the possibility that the CD4 expression in the AMO1 cell line is closely associated with the derivative chromosome.

[Malignant lymphoma developing from the wall of chronic empyema following artificial pneumothorax]

A 60-year-old man who had had chronic empyema following an artificial pneumothorax for pulmonary tuberculosis when he was 26 years old developed malignant lymphoma of the chest wall. The patient was admitted because of right pyothorax as a result of pseudomonas aeruginosa infection and underwent right thoracotomy. During lavage of the right thoracic cavity a tumor was found arising from the empyematic wall. Pathologic examination revealed that it was malignant lymphoma (diffuse large, immunoblastic, B cell type). Treatment with VEAP-Bleomycin elicited a good response. Seven months after chemotherapy, the patient underwent thoracoplasty in addition to packing the cavity with the latissimus dorsi and the greater omentum. Following this, the patient received chemotherapy once a month for one and a half years, after which he was kept under close observation without treatment. Complete remission has now lasted for 49 months since the initial treatment. This is the first reported lymphoma case with closure of the empyematic wall and is remarkable since this patient has remained in complete remission for the last two years without any treatment.

Interleukin-7 (IL-7)-induced proliferation of CD8+ T-chronic lymphocytic leukemia cells

Interleukin-7 (IL-7) is a growth factor for pro-B cells, pre-B cells, and thymocytes and is known to induce the proliferation of normal human peripheral T cells. Moreover, human B and T acute leukemia cells with immature surface markers proliferate in response to IL-7. Here we describe a case of T-chronic lymphocytic leukemia, in which the leukemic cells showed a proliferative response to human recombinant IL-7 in vitro. The patient was a 74-year-old woman with anemia and thrombocytopenia, whose bone marrow was fibrosed and infiltrated with pathologic cells. Surface markers of the leukemic cells were CD2(+), CD3(+), CD5(+), CD7(+), CD8(+), and CD4(-). Both T-cell receptor beta-chain and gamma-chain genes were found to be rearranged by immunogenotypic analysis. The leukemic cells proliferated in response to IL-7 dose dependently. The DNA synthesis of CLL cells was stimulated by not only IL-7 but also IL-2 and IL-4. The IL-7-induced proliferation was not inhibited by antibodies to IL-2 receptors or the anti-IL-4 antibody. These findings indicate that IL-7 may induce the proliferation of peripheral CD8+ T cells, even on its pathological counterpart.

Intratemporal facial nerve neurinoma without facial paralysis

A 38-year-old man was referred by his general practitioner to our department on 28 October 1991, with a 2-week history of vertigo. A left aural polyp was identified. The audiogram showed a moderate conductive loss on the left side. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of the expanding lesion in the descending portion of the facial nerve. However, there was no seventh nerve paresis. At operation, the neurinoma (Schwannoma) filled the middle ear cleft and extended from the genu to the stylomastoid foramen. The floor of the middle ear had been eroded, exposing the jugular bulb. Facial nerve paresis is the usual presenting feature of a facial neurinoma. The case is presented for the reason that the absence of facial palsy as a presenting feature is rather rare, especially in the cases with large tumor and extensive bone erosion.

Endoscopic resection of early-stage esophageal cancer

Early-stage esophageal cancerous lesions in four clinical cases were endoscopically resected via a newly developed procedure, endoscopic esophageal mucosal resection using a transparent tube (EMRT). In the complete resection of cancer-bearing mucosa, more than half of the circumferential mucosal resections did not involve major complications such as perforation or massive bleeding. Large ulcers artificially induced by this procedure disappeared within 3 weeks, exhibiting no stenotic changes. Resected specimens contributed well to microscopic examination for histological classification and determination of the depth of cancer invasion and possible vascular involvement. No signs of recurrence were observed during the 15-month follow-up period. We conclude that EMRT is a safe and minimally invasive local treatment for early-stage esophageal cancer that also provides specimens that are suitable for accurate histopathological diagnosis.

Enzyme histochemical, immuno histochemical and electron microscopic studies of two cases of leukemic malignant histiocytosis

Two cases of leukemic malignant histiocytosis had similar morphologic and enzyme histochemical findings. Large blasts with low nuclear/cytoplasmic ratios, occasional azurophilic granules, and immature nuclei with nucleoli were seen in peripheral blood and bone marrow smears. Case 1 had occasional erythrophagocytosis, while in Case 2 it was rare. They were peroxidase negative, and very strongly positive by alpha-naphthyl butyrate esterase stain, the latter being inhibited by sodium fluoride. Acid phosphatase stains were also very strongly positive and were inhibited with tartaric acid. They were also stained granularly with PAS. Surface marker analysis revealed myeloid surface antigens, CD11+, CD13+ and HLA-DR+ in Case 1, and CD11+, CD13+, CD33+ and HLA-DR+ in Case 2. Immunoperoxidase stains of bone marrow biopsies revealed that lysozyme was positive in both cases. S-100 protein was strongly positive in Case 1, but weakly so in the skin tumor and negative in the bone marrow of Case 2. Electron microscopy showed both cases to be myeloperoxidase negative and rich in cytoplasmic organelles, such as lysosomes, mitochondria, and endoplasmic reticuli. Nuclei were irregularly shaped and nucleoli were present in virtually all the cells. These findings suggest that the malignant histiocytes in these two cases derive from bone marrow macrophages, and S-100 protein can also be detected in monocyte-macrophage derived histiocytes.

Results of damped-rotation tests in brain damaged infants and children

We studied the relation between vestibular functions and neurological diagnosis in 477 brain damaged infants and children who had delayed gross motor functions. They were divided into two groups. Group 1 consisted of 319 infants with cerebral palsy in the first year of life, and Group 2 consisted of 158 brain damaged children up to 4 years of age. The damped-rotation test was used to evaluate vestibular function and the number of perrotatory nystagmus were measured. In Group 1 there were 24 infants with no vestibular responses, including two who were deaf. Five of those in Group 1 showed no responses at the first year of life but normal responses as they developed. In Group 2, all had normal vestibular responses. These results show that the incidence of no vestibular response is very high in infants with spastic cerebral palsy.

Sapurimycin, new antitumor antibiotic produced by Streptomyces. Producing organism, fermentation, isolation and biological properties

In screening actinomycetes for antitumor compounds, Streptomyces sp. DO-116 was found to produce a new antitumor antibiotic sapurimycin. It is structurally related to, but distinct from, kapurimycins. The antibiotic was produced in a fermentation medium supplemented with high porous polymer resin which adsorbs antibiotic in the culture and results in an increase of titer. Active material was separated from the polymer resin by a solvent extraction procedure and isolated by repeated solvent extraction, adsorption chromatography and HPLC. Sapurimycin was active against bacteria, particularly Gram-positive organisms. It exhibited antitumor activity against leukemia P388 and sarcoma 180 in mice. Sapurimycin caused single strand breaks in supercoiled plasmid DNA in vitro. These results are discussed in comparison with data for kapurimycins.

Light and electron microscopic study of vacuolated cells in immunoblastic lymphadenopathy-like T-cell lymphoma

Three cases of immunoblastic lymphadenopathy (IBL)-like T-cell lymphoma were analyzed immunologically, and the ultrastructure of mononuclear cells in the lymph nodes and peripheral blood was examined. In the peripheral blood, light microscopic examination revealed vacuolated lymphocytes. These vacuolated lymphocytes formed rosettes with sheep erythrocytes, and they were CD3- and CD4-positive using the avidin-biotin method in cases 1 and 2. Electron microscopic examination revealed two kinds of abnormal lymphocytes. One kind was of B-cell nature with rich lamellated rough-surfaced endoplasmic reticulum and mitochondria. The other kind had a large cytoplasm, in which Golgi apparatus, some endoplasmic reticulum, some mitochondria and a few vacuoles were seen. Some of these vacuoles had remnants of mitochondrial cristae or were enlarged endoplasmic reticulum. The vacuolated T lymphocytes and activated lymphocytes of B-cell nature disappeared with chemotherapy but reappeared with relapse of the disease. These observations suggest that vacuolated cells are related to pale cells in lymph node sections. In other words when these vacuolated cells are found in the peripheral blood of patients with lymphoid malignancies, IBL-like T-cell lymphoma can be suspected.

Studies of the antibacterial activity of plant extracts and their constituents against periodontopathic bacteria

Plant extracts and their constituents were tested for antibacterial activity against periodontopathic bacteria, including Actinobacillus, Capnocytophaga, Fusobacterium, Eikenella and Bacteroides species. The essential oils of two labiatae plants, Mosla chinensis Maxim. and Pogostemon cablin Benth., and five terpenoids, hinokitiol, thymol, carvacrol, patchoulialcohol and pogostone, showed antibacterial activity. The terpenoids were especially effective against Bacteroides species.

Topographical anatomy of the bronchomediastinal lymph vessels: their relationships and formation of the collecting trunks

This article aims to clarify the topographical relationships of the bronchomediastinal collecting lymph vessels to other structures, in particular the great vessels, the trachea, the esophagus and the mediastinal pleura. Minute dissection was performed on eight cadavers with special reference to the converging collecting lymph vessels which form the bronchomediastinal trunks. On the right side, the trunks were consistently observed on both the right brachiocephalic vein and the subserous surface of the mediastinal pleura (anterior and posterior mediastinal trunks). The pathway from the right recurrent chain nodes ran laterally behind the carotid sheath and led either into the deep cervical nodes situated on the scalenus anterior or directly into the right venous angle. On the left side, the trunks showed varying courses. The nodes from which the trunks arose were constant, and classifiable into three groups: the uppermost paratracheal nodes near the recurrent chain nodes, the anterior mediastinal nodes (the left phrenic nodes) surrounding the phrenic nerve in front of and inferior to the aortic arch (the origin of the superior mediastinal trunk), and the left tracheobronchial nodes (the origin of the inferior mediastinal trunk). The large transverse superficial communicating vessel between the right and left sides was usually found in front of the trachea above the aortic arch; it was often connected to the nodes of the brachiocephalic angle. Deep communications were also found in front of the carina and behind the trachea. These findings allow the collecting vessels from the thoracic viscera to be divided into two pathways on each side: the anterior and posterior mediastinal trunks on the right side, and the superior and inferior mediastinal trunks on the left side. In addition to the four trunks, the superficial communicating vessel between the right and left sides is also drained from the superior mediastinum. The internal mammary lymph chain, which often emptied directly into the venous angle or into the deep cervical nodes, occasionally joined with the right anterior mediastinal trunk or the left superior mediastinal trunk.

Leinamycin, a new antitumor antibiotic from Streptomyces: producing organism, fermentation and isolation

Leinamycin (DC 107) is newly discovered antitumor antibiotic with an unusual 1,3-dioxo-1,2-dithiolane structure. Five different producing strains were isolated from soils collected in Japan during 1985-1988 and were taxonomically assigned as Streptomyces. Fermentation studies indicate: Leinamycin was unstable in culture broth. A chemically defined medium could be designed for a preferable production. Streptomyces sp. S-140 grew on medium supplemented with Zn2+ and high porus polymer resin and accumulated 32 micrograms/ml of leinamycin. Improved isolation methods are described along with identification of mikamycin A co-produced with leinamycin by the strain S-140.

[Evaluation of the extended operation in stage 4 esophageal cancer]

For the last four years, 174 cases of thoracic esophageal cancer have been resected in our department. Stage 4 cancer cases were encountered in 73 cases (42%) of total resected cancer cases. As the location of lesion, 1m was most frequent in 52%, followed by Ei in 23%. The 2-year and 3-year survival rate were 25% and 17% respectively. Analyzing 73 cases of stage 4 cancer, a0-2n3,4 was found in 52 cases (71%), a3n0-2 12(16%), a3n3,4 7(10%) and M1 2(3%). Invasion to the trachea and bronchi was seen in 11 and that to the aorta was in 7. As for surgical procedures, the combined resection of the aorta was performed in two cases. The postoperative course was smooth, however, the prolonged survival was not obtained due to the recurrence of cancer. The lymph node metastasis was widely observed in the cervical region, mediastinum and abdominal cavity. The thoracic paratracheal lymph node metastasis was the most frequent. The lymph node dissection was necessary in these three regions. Especially the sufficient dissection in the upper mediastinal lymph nodes, that is, the right recurrent nerve nodes, the left recurrent nodes and the infraaortic arch nodes, was very important.

[HTLV-I carriers in ATL/L-nonendemic area--with reference to blood transfusions]

Sera from 5,705 persons were tested for antibodies to human T-cell leukemia virus type 1 (HTLV-I) by gelatin particle agglutination test (PA) and enzyme immunoassay (EIA) as screening methods, and the antibodies were confirmed by indirect immunofluorescence assay (IF) and Western blotting method (WB). The antibodies were detected in 30 (1.34%) of 2,239 patients who had received blood transfusions, 3 (0.29%) of 1,022 healthy blood donors, all 18 adult T-cell leukemia/lymphoma (ATL/L) patients, 23 (47%) of 49 family members of the ATL/L patients and 10 (0.53%) of the other 1,898 persons. Before the introduction of the mass screening of healthy blood donors by the Japan Red Cross Blood Center, 17 (2.29%) of 743 recipients tested were positive for the antibodies by PA and most of them were confirmed by IF and WB. Ten of these 17 recipients tested were negative for the antibodies before the blood transfusions. After the introduction of mass screening, 13 (0.87%) of 1,496 recipients tested were positive for the antibodies by PA, but the seroconversion of the antibodies by blood transfusions could not be confirmed clearly. In persons with low titers (1:16-1:64) in PA, the coincident rate of positive reaction with EIA, IF and WB was only 9.5%, 0.0% and 23.8%, respectively, and most of the immunoglobulin (Ig) class was IgM. On the other hand, in those with titers of 1:128 or greater in PA, the coincident rate was 72.7%, 81.8% and 90.9%, respectively, and the Ig class was IgG or IgG + IgM.

[Diagnosis and surgical treatment of early esophageal cancer]

144 cases of the superficial esophageal cancer, of which invasion was limited to the submucosa, have been resected for the last 23 years. 94 cases (65%) were early cancer, and 50 cases (35%) were superficial cancer with metastasis. The 5-year survival rate of early cancer cases was 65%, otherwise, that of superficial cancer cases with metastasis was 24%. There was a significant difference between these two groups. As for the depth of cancerous invasion, the 5-year survival rate of mucosal cancer cases was 100%. That of submucosal cancer cases was 70% even in cases without nodal involvement. Analyzing the cancerous depth of the superficial cancer and its nodal involvement and its vascular invasion, the lymph node metastasis and the vascular invasion were not observed in 90% of mucosal cancer cases, otherwise these were negative only in 30% of submucosal cancer cases. So to obtain the remarkable improvement of the long term results of esophageal cancer, the diagnosis and the treatment of mucosal cancer of the esophagus are essential. The endoscopic examination have come to play a large role for the diagnosis of mucosal cancer of the esophagus. Moreover, the endoscopic dyeing with Lugol's solution is important in the diagnosis of flat type of esophageal lesions, that is mucosal cancer and epithelial cancer. At present time, the treatment of early esophageal cancer is in principle surgery. And the operative mortality was low, 1.4%. However, the non-invasive treatments; endoscopic LASER therapy, radiation, endoscopic strip-biopsy etc., will be performed more frequently in minute mucosal cancer.

[Ga-67 citrate accumulation in heart in malignant lymphoma of B-cell type accompanied with repeated ECG abnormalities which were normalized with chemotherapy--report of an autopsy case]

A 37y/o male developed mass formation in right tibia in Oct. 1986. He had generalized lymphadenopathy. Diagnosis of malignant lymphoma of B cell type (follicular, large cell type) stage IV B was made because of bone marrow involvement. Surface marker analysis of pathologic cells in the peripheral blood, bone marrow, lymph nodes revealed that they were of B cell type with positive EA gamma rosette formation, positive surface immunoglobulin with IgM-kappa and cytoplasmic immunoglobulin with IgM-kappa and positive responses to monoclonal antibodies of OKIal and B1. He responded partially to VEPAM therapy but in Jan. 1987 he developed Ga accumulation in heart and ECG abnormalities such as depression of ST and inverted T in II, III, AVF, V1-V6 leads. After treatment with VEP, ECG abnormalities disappeared in a month. The same ECG abnormalities recurred once more and disappeared again. Autopsy findings revealed accumulation of lymphoma cells in epicardium and myocardial degeneration in right ventricle. Ga scan appears to be a valuable method for detection of early cardiac involvement by malignant lymphoma.

Hypergammaglobulinemic purpura in patients with Sjögren's syndrome: a report of nine cases and a review of the Japanese literature

Nine patients with hypergammaglobulinemic purpura associated with primary Sjögren's syndrome were presented. All patients were female (mean age 45.6) and showed recurrent purpura on the lower extremities and typical findings of Sjögren's syndrome with high gammaglobulin and IgG levels, rheumatoid factors, anti-SSA/SSB antibodies (5/5) and anti-nuclear antibodies (6/9). Vasculitis was seen in 6 patients, 4 were of the mononuclear cell type and 2 of the neutrophilic cell type. Six patients had intermediate complexes between 7S and 19S shown by serum ultracentrifugation. Immunofluorescent staining showed immunoglobulin deposition along the blood vessel walls of the skin in these patients. These data suggest that hypergammaglobulinemic purpura in Sjögren's syndrome is vasculitis caused by immunologic processes.

[Nutritional management following resection of esophageal cancer--effect of early postoperative enteral hyperalimentation]

We studied the effect of early postoperative enteral hyperalimentation on the nutritional state and hormones in digestive organs in twenty patients who underwent resection of thoracic esophageal carcinoma and reconstruction of new esophagus. Following results were obtained. 1. Although enteral hyperalimentation was started in the early postoperative period (postoperative 3 day), the incidence of complications including diarrhea was decreased dramatically and satisfactory nutritional effect was obtained due to the development of many excellent chemically defined enteral nutrients. 2. Gut hormones including CCK showed the same response as in the preoperative period to the loading of enteral nutrients. And that, it is suggested that the response of CCK is affected by the lipid content in the nutrients and that this response was effective to prevent the postoperative biliary stasis. 3. Enteral nutrition made it possible to self-regulate water absorption from digestive organs, to control body fluid volume and to prevent over hydration or hypovolemia to comparison with parenteral nutrition.

[A case of preoperative esophageal cancer developing lobar pneumonia due to MRSA infection of the catheter]

The 65-year-old male patient of esophageal cancer before operation suffered from lobar pneumonia. Bacteriological examination identified MRSA in his sputum and catheter tip. None of the cefem type antibiotics were effective, but CLDM and MINO were so much effective against that. We studied 47 cases of esophageal cancer which received operation last year. In many bacteria which were identified in the sputum and pus, MRSA occupied 30% as well as Pseud. aeruginosa. In the preoperative period enteral nutrition (ED) may be acceptable, if possible, as nutritional support alternative to TPN.

Monoclonal gammopathies in patients with Sjögren's syndrome

We studied 18 sera of Sjögren's syndrome (SS) with monoclonal gammopathy. Monoclonality was established by typical immunoelectrophoretic findings in all patients and confirmed by idiotypic (Id) studies in 12 patients. Four of the monoclonal gammopathies were of the IgG class, 8 were of the IgA class and 4 were of the IgM class, and 2 patients had 2 M proteins (IgMK/IgGK and IgAK/IgGK). The monoclonal rheumatoid factor (RF) was found in 6 patients (4 IgA and 2 IgM). A review of the literature revealed additional 19 monoclonal gammopathies (2 IgG, 9 IgA, 7 IgM and one Bence Jones protein) in Japanese SS patients. In non-Japanese SS patients, 27 monoclonal gammopathies (4 IgG, 2 IgA, 20 IgM and once Bence Jones protein) were reported. Both Japanese and non-Japanese patients showed a higher incidence of monoclonal gammopathies in primary than in secondary SS. The non-IgM class monoclonal gammopathies were predominant in Japanese SS patients, whereas monoclonal gammopathies were mostly confined to the IgM class in non-Japanese SS patients. These results indicate that monoclonal gammopathy is another significant complication of SS.

An established CD4+ T lymphoma cell line derived from a patient with so-called Lennert's lymphoma: possible roles of cytokines in histopathogenesis

A T lymphoma cell line, KT-3, was established from the peripheral blood of a patient with so-called Lennert's lymphoma when the patient developed leukemic lymphoma. The KT-3 cells stain positively for alpha-naphthyl acetate esterase, PAS, and acid phosphatase. The surface phenotype is E rosette-positive, CD1-, CD2+, CD3-, CD4+, CD5+, CD8-, CD11-, CD20-, CD25 (anti-Tac)+, OKla-1+, HNK-1-, J-5-, and My9-, and the surface membrane immunoglobulin is negative, which is almost the same phenotype as the leukemic cells studied when the culture was started. Southern blot analysis showed rearrangement in both beta and gamma T cell receptor genes. Although KT-3 cells proliferate spontaneously and form clusters, they cease proliferating when they are cultured at low cell densities. They proliferate vigorously in response to macrophages, macrophage-derived factor, or recombinant interleukin 2 (rIL-2) added to the culture. Furthermore, they secrete interferon-gamma (IFN-gamma) spontaneously, and the secretion is augmented when they are stimulated with macrophage-derived factor. The macrophage-derived factor enhancing KT-3 cell growth is different from IL-1 alpha, IL-1 beta, IL-2, or IFN-gamma. To our knowledge, this is the first tumor cell line established from a patient with Lennert's lymphoma. The results conclusively confirmed that, at the least, Lennert's lymphoma included CD4+ T lymphoma and also suggested that cytokines or factors secreted by T lymphoma cells and epithelioid histiocytes play an important role in the histopathogenesis of Lennert's lymphoma.

Malignant lymphomas in patients with autoimmune diseases: a report of 6 cases and a review of the Japanese literature

Six patients with malignant lymphomas in autoimmune diseases are described. Four patients who had Sjögren's syndrome (SS) alone or with progressive systemic sclerosis (PSS) or rheumatoid arthritis (RA) developed non-Hodgkin's lymphomas of the B cell type. One patient who had systemic lupus erythematosus (SLE) developed a B cell lymphoma. Another patient with chronic thyroiditis (ChTD) and idiopathic thrombocytopenic purpura (ITP) had a T cell (OKT3/T4) lymphoma. In 5 patients, the autoimmune diseases (2SS, SS/PSS, SS/RA and SLE) preceded B cell lymphomas by one to 11 years. In the patient with ChTD/ITP, ChTD and a malignant lymphoma were found simultaneously. A review of Japanese reports on lymphoproliferative disorders associated with these autoimmune diseases is given. This report offers the suggestion that disorders in the immunoregulatory system caused by autoimmune diseases may predispose lymphoproliferative disorders.

Serum monoclonal IgM undetectable by cellulose acetate membrane electrophoresis in four patients with B cell malignant lymphoma

A small amount of monoclonal IgM was demonstrated in the serum of four B cell malignant lymphoma patients in whom electrophoretically homogeneous protein bands were not detected by either cellulose acetate membrane electrophoresis or immunoelectrophoresis. By using anti-idiotypic (Id) antisera prepared against serum IgM, the M proteins were detected and identified as the products of malignant cells. These findings suggest that the use of more sensitive technics than the usual serum electrophoresis shows that the incidence of M proteins in B cell malignant lymphomas is higher than has been previously reported.