Malignant lymphoma of mucosa-associated lymphoid tissue arising in the thymus of a patient with Sjögren's syndrome. A morphologic, phenotypic, and genotypic study.

A 59-year-old woman with Sjögren's syndrome had an anterior mediastinal tumor. The tumor had epithelium-lined thymic cysts. Histologically, centrocyte-like (CCL) cells were present as clusters intermingling with small lymphocytes and plasma cells, invaded the epithelium, and formed characteristic lymphoepithelial lesions; the tumor was identified as malignant lymphoma arising in mucosa-associated lymphoid tissue (MALT). Within the tumor, trapped Hassall's corpuscles were recognized. Immunohistochemical staining demonstrated monotypic cytoplasmic kappa light chains in a small portion of the CCL cells. Furthermore, Southern blot hybridization studies showed rearrangements of immunoglobulin heavy chain, immunoglobulin kappa light chain, and T-cell receptor beta genes. The findings are consistent with thymic low-grade B-cell MALT lymphoma.

[Study of surgical treatment of advanced small lung cancer].

We analyzed 15 patients with small but advanced primary lung cancer operated from 1965 to 1988. The size of tumors were less than 2.0 cm in largest dimension and their pathological stages III A, III B and IV. The histological types were adenocarcinoma in 13 cases and squamous cell carcinoma in 2 cases. Nine patients (69%) had elevated levels of preoperative serum CEA. The prognosis of patients with intrapulmonary metastases was better than that of those with pleural dissemination. In adenocarcinoma patients with mediastinal lymph node metastases, the survival rate of cases with small cancer less than 2.0 cm in diameter was higher than those with large cancer more than 5.0 cm in diameter.

An unusual case of bronchial carcinoid predominantly consisting of large cells.

A 58-year-old woman presented an unusual variant of bronchial carcinoid. A tumor measuring 20 x 25 mm was recognized upon gross examination in the upper lobe of the right lung. Microscopically, the tumor consisted of large polyhedral cells with a pseudoglandular arrangement similar to pheochromocytoma cells. Immunohistochemically, the tumor cells contained serotonin, S-100 protein and neuron-specific enolase. Thus, we consider this neoplasm to be a large cell variant of bronchial carcinoid which, to our knowledge, has not been described in the literature.

[Postoperative therapy of recurrent esophageal squamous cell carcinoma].

Some 218 resected cases and 43 autopsied cases after resection during the last 13 years were analyzed with regard to the mode of recurrence and survival. Several factors were investigated with the following results. 1) Extensive clearance of upper mediastinal lymph nodes during radical surgery may reduce the incidence of tumor recurrence. It is preferable to remove the cervical lymph node, however, after positive metastasis to cervical lymph node. 2) Beginning in 1981, interstitial brachytherapy of 192Ir seed assemblies using afterloading techniques was administered to two patients with esophageal carcinoma infiltrating the aorta and four patients infiltrating the trachea and main bronchus which were not completely resected in either case due to invasion of adjacent organs. No significant difference in life-prolongation was observed, but it may have been effective for prevention of localized recurrence in cases with aortic infiltration and with infiltration of the trachea and bronchus. 3) From 1984, eleven patients with recurrent squamous cell esophageal carcinoma were treated with combination chemotherapy sandwiched with irradiation (CDDP/5FU-RT-CDDP/5FU). Eight patients (73%) had complete or partial response, and six patients survived over one year after combination chemotherapy sandwiched with irradiation. Combination chemotherapy sandwiched with irradiation appears to be effective in the treatment of patients with recurrent squamous cell carcinoma of the esophagus. Toxic effects are moderate and manageable.

A case-control study of lung cancer in nonsmoking women.

A case-control study of Japanese women in Nagoya was conducted to investigate the significance of passive smoking and other factors in relation to the etiology of female lung cancer. A total of 90 nonsmoking patients with primary lung cancer and their age- and hospital-matched female controls were asked to fill in a questionnaire in the hospital. Elevated relative risk (RR) of lung cancer was observed for passive smoking from mother (RR = 4.0; p less than 0.05) and from husband's father (RR = 3.2; p less than 0.05). No association was observed between the risk of lung cancer and smoking of husband or passive smoke exposure at work. Occupational exposure to iron or other metals also showed high risk (RR = 4.8; p less than 0.05). No appreciable differences in food intakes were observed between cases and controls.