Imprint cytology of Gaucher's disease presenting as a splenic mass. A case report with molecular approaches.

BACKGROUND: Gaucher's disease is an autosomally transmitted lysosomal storage disease caused by a defect in the lysosomal enzyme, beta-glucosidase. CASE: A 43-year-old male presented with splenomegaly and anemia. Magnetic resonance imaging examination of the abdomen revealed huge, round masses in the spleen. Intraoperative cytology of the spleen showed Gaucher cells that resembled macrophages, with eccentric, small, oval nuclei, but distinguished by their abundant cytoplasm with the characteristic "wrinkled tissue paper" appearance. The cytologic features of the smears correlated well with the histologic sections from the splenectomized specimen. The DNA from this patient was examined for seven glucocerebrosidase mutations that are known to cause Gaucher's disease. The patient was heterozygous for the 754 mutation. Diagnosis was confirmed by a deficiency of beta-glucosidase. The residual activity was 15% of control values. CONCLUSION: Diagnosis of Gaucher's disease was made cytologically and subsequently confirmed by the polymerase chain reaction. Imprint cytology is a sensitive diagnostic test, and the combined use of histology and molecular techniques offers the highest probability of identifying this common lysosomal storage disorder.

Safety and efficacy of intraperitoneal injection of etoposide in oil suspension in mice with peritoneal carcinomatosis.

We compared the safety and efficacy in mice with peritoneal carcinomatosis of two etoposide formulations: an aqueous solution (Etp-sol) and particles suspended in oil (the addition products of iodine and the ethyl esters of the fatty acids obtained from poppy-seed oil (Lipiodol) or sesame oil; Etp-oil). We also investigated tissue distribution of etoposide in rats treated with Etp-oil and Etp-sol. Etoposide was injected intraperitoneally at concentrations ranging from 52 to 392 mg/kg (increasing geometrically by a factor of 1.4). The 50% lethal dose (LD50), determined over a 2-week period of observation, was 135 mg/kg for Etp-oil and 108 mg/kg for Etp-sol. Autopsy findings included macroscopic intestinal bleeding, necrosis of the intestinal mucosa, and pulmonary congestion in mice from both treatment groups. In the efficacy trials. 10(6) P388 leukemia cells were transplanted into CDF1 male mice, and Etp-oil and Etp-sol were injected at doses of 20 mg/kg and 80 mg/kg. In the groups receiving the 20 mg/kg dose, 11 of 19 mice in the Etp-oil group survived to day 60 compared with 3 of 20 mice in the Etp-sol group. Toxicity-related deaths occurred in 1 of 20 mice treated with 80 mg/kg Etp-oil and in 8 of 20 mice treated with 80 mg/kg Etp-sol. No cancer-related deaths were associated with the 80 mg/kg dose in either treatment group. Our findings showed that the Etp-oil was associated with a lower toxicity and a higher efficacy than the Etp-sol. To evaluate tissue distribution, rats were injected intraperitoneally with 5 mg/kg body weight of Etp-sol or Etp-oil. The tissue distribution of etoposide was subsequently analyzed by high performance liquid chromatography. Compared with Etp-sol, Etp-oil delivered significantly greater amounts of etoposide and for a longer period to the omentum, taken as representative of the intraperitoneal tissue, and the etoposide concentration in blood plasma was increased more slowly and decreased more gradually.

Resection margin in patients with gastric cancer associated with esophageal invasion: clinicopathological study.

We investigated the correlations between resection margin involvement by carcinoma and a number of clinicopathological features in patients with gastric cancer and esophageal invasion. From January 1968 to December 1988, 1,040 patients with carcinoma of the stomach underwent gastric resection. Thirty-nine patients had tumor infiltration of the esophagus on histological examination of the resected specimens. The patients were divided into two groups on microscopic examination: those in whom the resection margin was less than 5 mm wide, and those in whom it exceeded 5 mm microscopically. There were 6 and 33 patients in the narrow and wide margin groups, respectively. There were statistically significant differences in tumor size, depth of cancer invasion, and macroscopic appearance between the two groups. The risk of resection margin involvement was high in tumors with the following features: large Borrmann type 4 tumor (macroscopic appearance and size) and infiltrative carcinoma (depth of invasion).

Lymph nodal vital staining with newer carbon particle suspensions compared with India ink: experimental and clinical observations.

CH40 and CH1500AA are newly prepared carbon suspensions which were examined as vital staining dyes for their usefulness in visualizing lymphatics at operation and to blacken lymph nodes. In mice, these carbon suspensions at 0.001 ml/g of body weight and India ink were injected subcutaneously into the footpad of the right hindpaw. Regional lymph nodes were visualized and were examined stereomicroscopically to determine how intensely these nodes blackened with carbon suspensions. Compared with India ink, CH40 and CH1500AA blackened the regional lymph nodes much faster and more vividly (1-8 min. after subcutaneous injection). As analyzed by centrifugal particle size distribution, CH40 and CH1500AA are narrowly distributed with a small particle size (150 and 167 nm, respectively, in mean diameter). By contrast, India ink is comprised of widely distributed and relatively large particles in suspension (mean diameter--254 nm). In 10 patients undergoing radical gastrectomy for treatment of stomach cancer, CH40 blackened 69% of regional lymph nodes with metastases (38 of 55) and 76% of those nodes without metastases (387 of 512).

A new dosage form comprising a suspension of activated carbon particles adsorbing aclarubicin: toxicity in mice.

A new dosage form (ACR-CH), a suspension of small activated carbon particles adsorbing aclarubicin, was studied for its toxicity and histopathological effects on organs in mice. The 50% lethal subcutaneous dose of ACR-CH was 83.5 mg/kg, a value 2.42 times that (34.5 mg/kg) of the aclarubicin aqueous solution. The duration of the toxic effects of ACR-CH was prolonged compared with that of the aclarubicin aqueous solution. On autopsy there was no remarkable difference in macroscopic and microscopic examinations between the two dosage forms.

[Toxic reduction and superior therapeutic effects on peritoneal carcinomatosis of etoposide particles suspended in oil in mice].

Two dosage forms of etoposide diluted by saline solution (Etp-sol) and etoposide particles suspended in oil (Etp-oil) were examined for the toxicity and therapeutic effects when injected intraperitoneally (ip) in mice. The 50% lethal dose (LD50) values for two weeks observation were 135 mg/kg in Etp-oil and 108 mg/kg in Etp-sol. Two days after intraperitoneal transplantation of 10(6) cells/mouse of P388 leukemia to CDF1 male mice, etoposide was injected intraperitoneally in the form of Etp-oil or Etp-sol. In the mice receiving 20mg/kg of etoposide, 11 of 19 mice given Etp-oil and 3 of 20 given Etp-sol survived to day 60. In the mice receiving 80 mg/kg of etoposide, 1 in 20 treated with Etp-oil and 8 of 20 treated with Etp-sol died from by the toxicity.

Enhanced anti-cancer efficacy on lymph node metastasis using peplomycin adsorbed on small activated carbon particles.

A new dosage form (PEP-CH) of peplomycin was tested for therapeutic efficacy against lymph node metastasis in mice. PEP-CH is a suspension comprising 4 mg/ml of activated carbon, 2 mg/ml of peplomycin and 1.6 mg/ml of polyvinylpyrrolidone in saline. Mice were subcutaneously inoculated with 3 x 10(5) MH134 tumor cells into the left hind paw. Drugs were given on day 10 when cancer had been metastasized in the left popliteal lymph node. Mice were killed on day 17 and the left popliteal lymph node and the left deep inguinal lymph node were extirpated. Since the degree of the metastatic lesion and the lymph node weight correlated with a statistically high probability with each other, the degree of metastatic lesion was evaluated through comparison of lymph node weight. The left popliteal lymph node and the deep inguinal lymph node were 10.5 mg and 4.5 mg in average weight, respectively, in the mice given PEP-CH containing 0.1 mg of peplomycin subcutaneously into the left hind foot-pad. The weights were significantly smaller than those in the mice given an identical dose of peplomycin aqueous solution subcutaneously into the left hind foot-pad or intraperitoneally.

Selective distribution of aclarubicin to regional lymph nodes with a new dosage form: aclarubicin adsorbed on activated carbon particles.

A new dosage form (ACR-CH) comprising aclarubicin adsorbed on activated carbon particles was designed to sustain release of aclarubicin. ACR-CH or aclarubicin aqueous solution (ACR-sol) was injected subcutaneously into the fore foot-pads of rats. ACR-CH distributed a statistically significantly higher level of aclarubicin to the axillary lymph nodes (detectable up to 7 days after injection) than aclarubicin distributed in an ACR-sol (not detectable after 48 h). To other tissues, ACR-CH distributed statistically significantly low levels of aclarubicin, as compared with ACR-sol.

[Adsorption and desorption of aclarubicin into and from activated carbon particles as drug carrier--an in vitro study].

A new dosage form (ACR-CH), aclarubicin(ACR) adsorbed on activated carbon particles (CH), was studied for adsorption and desorption onto and from CH. The adsorption isotherm at 37 degrees C in saline and phosphate buffer (pH 7.4-7.5) were shown as M = 175 Co.15 and M = 207 Co.24, respectively (M = ACR amount adsorbed on CH, microgram/mg; C = ACR concentration in a free state, microgram/ml). In both fluids, CH adsorbed more than 100-1,000 times more amount of ACR than ACR in a free state. ACR-CH was lavaged 7 times and the released ACR in a free state was measured. The results showed that ACR-CH desorbed constantly a small amount of ACR, namely, 1.5-8 percent of initial concentration of ACR in a free state in saline, 0.1-10% in phosphate buffer, and 0.5-4.0% in Ringer's solution. Under the same conditions, desorption of ACR-CH was measured in dog's blood plasma. The first lavage made ACR-CH desorb at 25.7 +/- 0.85 percent of ACR initial concentration in a free state, and two times' to 7 times' lavage made 1-3%. Overall, 43.3 +/- 0.99% of ACR were desorbed from the activated carbon. It was concluded that ACR-CH slowly released a constant amount of ACR for a long period.

Affinity of intraperitoneally injected activated carbon particles adsorbing mitomycin C to tumor surface of Yoshida sarcoma.

A new dosage form of mitomycin C (MMC-CH) comprising 0.75 mg/ml of activated carbon particles adsorbing mitomycin C at 124 micrograms/mg and 7 micrograms/ml of mitomycin C in a free state was injected intraperitoneally to male rats of Donryu strain transplanted intraperitoneally with 10(7) cells/rat of Yoshida sarcoma 4 days before injection. The rats were subjected to autopsy within 60 min after injection. MMC-CH adhered selectively to the tumor surface of Yoshida sarcoma growing intraperitoneally rather than to the surface of organs such as small intestines which the surface cancer did not affect. Within 120 min after injection, mitomycin C concentration in the tissue samples was bioassayed. Intraperitoneally injected MMC-CH distributed high levels of mitomycin C to the tumor rather than to the unaffected organ located intraperitoneally. Animals killed by cancer after the treatment of MMC-CH were autopsied. Histological effects of MMC-CH were studied microscopically. Mitomycin C adsorbed on activated carbon particles induced degenerative changes in the tissues of tumors to which the activated carbon particles had adhered.

[Intracavitary microspheres incorporating cisplatinum in the treatment of malignant effusions--clinical trials].

A new dosage form of cisplatinum (CDDP), lactic acid oligomer microspheres incorporating cisplatinum (CDDP-ms), is designed to slowly release 70% of contained CDDP. CDDP-ms's acute toxicity is as low as 57% of the toxicity of CDDP aqueous solution, and its therapeutic efficacy is statistically significantly strong as compared with that of CDDP aqueous solution, when examined with experimental peritoneal carcinomatosis induced by mouse M5076 ovarian sarcoma. Clinical trials were carried out in 10 patients with malignant ascites (gastric cancer 6, pseudomyxoma peritonei 2, colon cancer 1, pancreas cancer 1) and in one patient with pleural effusion (lung cancer). CDDP-ms at 100 mg/person in terms of CDDP was injected at bolus into the affected cavity. In the 10 patients with ascites, 7 responded completely, two partially and one did not respond. The patient with pleural effusion responded partially. The response rate was 91%. Five of the 11 patients complained of temporary nausea or vomiting. In 5 patients fever higher than 38 degrees C was seen. No other side effect such as kidney, nor liver-damage or blood cell count abnormality was noted.

[Toxicity of cis-platinum loaded with lactic acid oligomer microspheres in mice].

We have evaluated the acute toxicity of an experimental new dosage form administered intraperitoneally in mice, consisting of cis-platinum loaded with lactic acid oligomer microspheres (CDDP-ms). The LD50 value of the CDDP-ms was 23.8 mg/kg, which amounted to 176% of the LD50 of the cis-platinum solution (13.5 mg/kg). Autopsy findings revealed no additional toxicity due to this dosage form.

[Intraoperative chemotherapy with intraperitoneal activated carbon particles adsorbing mitomycin C against peritoneal dissemination of gastric cancer].

A new form of dosage (MMC-CH) was composed of activated carbon particles adsorbing mitomycin C. Intraperitoneal administration of MMC-CH was tested clinically for prophylactic and therapeutic effects on peritoneal carcinomatosis of gastric cancer. The criteria of MMC-CH's administration were equal or less than 70 years old, more than 40 kg in body weight, no disfunction of liver and kidney, no particular findings in electrocardiography, S2 or S3 in the grade of serosal invasion, P0, P1, P2 or P3 in the grade of peritoneal dissemination, according to the General Rules for the Gastric Cancer Study in Surgery and Pathology by the Japanese Research Society for Gastric Cancer. MMC-CH was given to 44 patients undergoing gastrectomy for gastric cancer in our department from 1985 to 1988. The 44 patients were composed of 12 patients with P0 findings (P0 patients), 8 patients with P1 findings (P1 patients), 12 patients with P2 findings (P2 patients), and 12 patients with P3 findings (P3 patients). MMC-CH at 50 mg/person in terms of mitomycin C was administered intraperitoneally before the operation wound was closed. Fifty-seven patients in our department from 1983 to 1987 for whom the same criteria were applicable and did not receive MMC-CH therapy, served as the control group. The 57 patients were composed of 23 P0 patients, 21 P1 patients, 10 P2 patients, and 3 P3 patients. There was statistically with chi 2 test no significant difference of age, sex, depth of infiltration macroscopically and microscopically defined progression of lymph-nodal metastases between the MMC-CH group and the control group. Survival rate was calculated with Kaplan-Meier's method in the overall patients in each of the MMC-CH group or the control group. The overall survival rate in the MMC-CH group was statistically significantly (p less than 0.01-0.05) higher from day 460 to day 552 and from day 736 to day 800 than that in the control group. Next, the patients were classified into two subgroups, namely the subgroup composed of P0 patients and the subgroup composed of P1, P2, and P3 patients, in order to examine each of the MMC-CH's prophylactic effects on subsequent dissemination or its therapeutic effects on established dissemination. Survival rate was calculated with Kaplan-Meier's method in the two subgroups through the same procedures used for the overall survival rate.(ABSTRACT TRUNCATED AT 400 WORDS)

[Intraoperative chemotherapy against peritoneal dissemination of gastric cancer with intraperitoneal activated carbon particles adsorbing mitomycin C].

For prevention and therapy of peritoneal dissemination, a new dosage from (MMC-CH) comprising carbon particles adsorbing mitomycin C was given to 44 patients (the MMC-CH group) undergoing gastrectomy for gastric cancer, of which advancing stage was classified into the category of H0, and S2 or S3, and P0, P1, P2 or P3 according to the General Rules for the Gastric Cancer Study. MMC-CH, principally at 50 mg person in terms of mitomycin C was administered intraperitoneally before the surgical wound was closed. Historical control group was composed of 53 patients not given MMC-CH, who underwent gastrectomy for gastric cancer in the same advancing stage as those of the 44 patients. There was statistically no significant difference of age, sex, depth of infiltration, macroscopically and microscopically defined progression of lymph-nodal metastases, between the MMC-CH group and the historical control group. The survival rate of the overall patients, and each group of the patients with the lesion defined as P0, P1, P2, or P3 was compared with Kaplan-Meier's method between the MMC-CH group and the historical control group. In the MMC-CH group, the survival rates of the overall patients and the patients with P0, P1, or P2 lesion were statistically significantly higher than those in the historical control group. However, the rate of the P3 patients in the MMC-CH group was statistically significantly lower than in the historical control group.