Cancer of unknown primary site. Deciding how far to carry evaluation.

Management of most patients who present with metastatic cancer from an unknown primary site is challenging. These patients often are debilitated from the onset of their disease, have symptoms that are hard to control, and respond poorly to systemic therapy. The decision regarding the extent of a frequently unrewarding diagnostic evaluation, especially in these days of cost containment, is difficult. Knowing that few will benefit from aggressive therapy, the treating physician should make quality of life the most important goal in caring for these patients.

[Gastric lymphomas. The role of echotomography]. / Linfomi gastrici. Ruolo dell'ecotomografia.

Even after the advent of endoscopic ultrasonography, conventional US can still be useful in the follow-up of advanced gastric lymphomas. Typical US pattern is (diffuse) hypoechoic thickening of the gastric wall. The conventional US findings, together with the barium examination, the endoscopic, histological and CT results were retrospectively (5 patients) and prospectively (5 patients) evaluated and compared of 10 patients with primary (n = 4) or secondary gastric lymphomas. Normal US gastric thickness was assessed as less than or equal to 7 mm. Four unresectable patients with secondary non-Hodgkin lymphomas underwent chemotherapy; their conventional US follow-up has been shown to correspond to CT findings and endoscopically-guided biopsies. Preliminary results show that increased echogenicity and reduced thickness in conventional US scans correspond to regression of the disease. The maximum gastric wall thickness found after chemotherapy was 10 mm, due to residual scarring.

Isolation and characterization of cortisol-sensitive and -resistant P1798 mouse lymphosarcoma cell lines.

Three cell lines have been isolated and characterized from the P1798 mouse lymphosarcoma. One line, derived from a glucocorticoid-resistant tumor, was glucocorticoid-resistant in vitro. The other two cell lines, derived from glucocorticoid-sensitive and -resistant parental tumors, respectively, were shown to be glucocorticoid-sensitive in vitro. The glucocorticoid receptor from all three cell lines bound glucocorticoid with similar affinity and capacity. However, based on Sephacryl S-300 gel filtration, the glucocorticoid receptor from the resistant cell line was smaller than that of the two sensitive cell lines. Moreover, the glucocorticoid receptor from the resistant cell line accumulated to a greater extent in the nucleus. This resistant cell line thus resembles the nti variant of the S49 lymphoma cell line. All three cell lines were tumorigenic and metastatic when reimplanted into mice, contained the normal mouse diploid complement of 40 chromosomes and exhibited the same responsiveness to cortisol in vivo as they did in vitro. It is concluded that the ready passage of these cell lines in vitro or in vivo and the presence of the small receptor in the resistant line should make them excellent model systems for the study of glucocorticoid resistance.

CT of peritoneal lymphomatosis.

The CT and clinical findings are presented in seven patients with diffuse peritoneal malignancy caused by non-Hodgkin lymphoma. All seven patients had CT evidence of ascites, omental infiltration, and peritoneal implants mimicking carcinomatosis. Bulky retroperitoneal or mesenteric adenopathy was present in only one patient. Four of the seven patients had documented AIDS. Paracentesis provided a diagnosis of lymphoma in only one of the seven patients. In the other six patients, the final diagnosis was established by surgery (three patients), by autopsy (one patient), by laparoscopy (one patient), and by guided needle aspiration (one patient). Although uncommon, lymphoma should be considered in patients who have diffuse peritoneal malignancy, particularly those who are at risk for AIDS.

[Effects of intravascular laser irradiation of blood on growth and metastasis of lymphosarcoma in rats]. / Vliianie vnutrisosudistogo oblucheniia krovi lazerom na rost i metastazirovanie limfosarkomy u krys.

The effect of intravenous blood radiation by low-intensity laser on tumour growth in Wistar rats with Pliss lymphosarcoma has been studied. As a result of single or double blood radiation by laser with wave-length of 510 and 633 nm both the tumour growth inhibition and metastases disappearance have been shown.

Primary lymphoma of the spleen. Clinical features and outcome after splenectomy.

A retrospective review was made of patients with primary splenic non-Hodgkin's lymphoma (PSL) diagnosed at surgery at Memorial Hospital between 1970 and 1981. Four patients had splenic involvement only (Group I), three patients had splenic and splenic hilar nodal involvement (Group II), and 14 had involvement of the spleen and other sites including liver (11 patients), bone marrow (eight patients), and distant abdominal lymph nodes (five patients) (Group III). Three of the seven Group I and II patients are alive without disease at 24, 42, and 144 months. There was a trend toward a longer survival for the Group I and II patients as compared with the Group III patients. Patients with truely localized PSL seem to have the same outlook as other Stage I non-Hodgkin's lymphoma patients.

Central nervous system metastases from non-Hodgkin's lymphoma: treatment and prophylaxis.

Central nervous system (CNS) lymphoma was identified in 96 patients treated for non-Hodgkin's lymphoma at Memorial Sloan-Kettering Cancer Center between 1975 and 1981. During the same period, 68 other patients with non-Hodgkin's lymphoma but no CNS disease received prophylactic CNS chemotherapy. In the 156 total patients, the lymphomas were diffuse in 96 percent, and 67 percent were stage IV at diagnosis. CNS involvement was present at initial diagnosis in 27 percent, at relapse in 26 percent, and during the course of progressive systemic disease in 47 percent. CNS involvement was asymptomatic in 10 percent. Cytologic study of the cerebrospinal fluid was the most sensitive and specific laboratory test, but often (22 percent) more than one lumbar puncture was required to identify malignant cells. CNS lymphoma was treated in 85 patients, 46 by intracerebroventricular cannulae; 81 percent improved. Although median survival after the diagnosis of CNS disease was four months, there were seven long-term disease-free survivors and the CNS disease contributed to death in only 14 percent. In 52 percent of treated patients, there was no CNS lymphoma at autopsy. CNS prophylaxis was with methotrexate or cytosine arabinoside, usually by lumbar puncture; an intraventricular cannula was used in seven patients. Although this group of high-risk patients with non-Hodgkin's lymphoma had a high systemic response rate and the median projected survival was greater than five years, CNS lymphoma developed in eight patients (12 percent). In five, CNS lymphoma occurred as an apparently isolated relapse site. The role of CNS chemoprophylaxis in high-risk patients with non-Hodgkin's lymphoma is still uncertain.

Development of lymphosarcoma lines with high metastatic ability to lymph nodes and visceral organs in BALB/c mice.

A metastatic tumor population was isolated in BALB/c mice during routine s.c. passage of the colon 26 adenocarcinoma. The tumor metastasized to lymph nodes, liver, spleen, ovary and kidney. A primary culture established from the s.c. growing tumor was composed of both adherent and nonadherent cells. These two cell types were successfully separated from the primary culture and designated CMS (suspension cells) and CMA (adherent cells). The CMS and CMA cell lines are morphologically distinct in culture; however both formed similar histopathologic tumors when inoculated s.c. Furthermore, both tumor lines showed identical metastatic patterns in BALB/c mice with involvement of lymph node, liver, spleen, ovary and kidney. CMS and CMA expressed T-antigen as revealed by FITC-labeled-anti-Thy 1.2 antibody. Chromosome analysis and morphologic studies by light and electron microscopy indicated that the present metastatic lines have no relationship with the colon 26 adenocarcinoma and seem to be non-thymic T-cell lymphosarcomas which developed spontaneously in BALB/c mice.

[Spinal lymphosarcoma in a foal]. / Spinales Lymphosarkom bei einem Fohlen.

The present report describes the clinical and pathological findings of a one year old foal presented with paralysis of the hind legs. Macroscopically and histologically, a lymphosarcoma in the vertebral body and the adjacent epidural space of T 16, in the spleen and the mesenterial lymph nodes was observed. The adjacent spinal cord showed focal degenerative changes characterized by dilatation of myelin sheaths, swollen axons and few macrophages.

[Action of doxorubicin and a doxorubicin-heparin complex on the growth and metastasis of experimental tumors and the hemostatic system indices]. / Deistvie doksorubitsina i kompleksa doksorubitsin--geparin na rost i metastazirovanie éksperimental'nykh opukholei i nekotorye pokazateli sistemy gemostaza.

The electrophoretic and spectral analyses have been used to show the possibility to form a complex consisting of doxorubicin and adriamycin with heparin, the molar ratio being 6:1 and pH 4.8-7.4. Doxorubicin and adriamycin had procoagulant properties but the doxorubicin-heparin complex showed an anticoagulant activity. In experiments on rats with the Pliss lymphosarcoma and sarcoma 45 the doxorubicin-heparin complex depressed more efficiently the tumour growth and metastasis spreading. The combination of doxorubicin and the doxorubicin heparin complex with the trypsin-heparin complex which imitate the hyperfunction of anticoagulative system markedly increased the antitumour effects.

Temporal bone pathology of metastatic T-cell lymphoma.

Metastatic lymphoma involving the temporal bone is a rare tumour. A review of the English literature revealed only 13 reported cases. The common metastatic sites within the temporal bone are bone marrow and the internal auditory canal (IAC). Non-Hodgkin lymphoma has a tendency to infiltrate to the inner ear and middle ear, with bone marrow involvement. Recent advances in immunology have redefined the malignant lymphoma as a neoplasm of the immune system that has involved T and B cells. We present a case of non-Hodgkin T-cell lymphoma that metastasized to the temporal bone and central nervous system.

[Cerebral localizations of non-Hodgkin's malignant lymphoma. Contribution of x-ray computed tomography]. / Localisations cérébrales des lymphomes malins non hodgkiniens. Apport de la tomodensitométrie.

At the present time, CT scan imaging occupies an essential place in the diagnostic approach and course of cerebral non-Hodgkin's malignant lymphoma. Results of CT scan investigations are reported in 17 patients, 8 with primary and 9 with secondary lymphoma. The lesions observed, hypo-, iso- or faintly hyper-dense, took-up contrast almost constantly in an intense and well limited homogeneous manner. The subependymal infiltration noted was suggestive of the disease particularly since it was often associated with a paraventricular localization in the white substance, corpus callosum or central gray nuclei. However, no correlation existed with the primary or secondary nature or histologic type of lymphoma, and histopathologic confirmation was necessary from surgical biopsy specimen. Appearances of primary and secondary lymphoma are superimposable, apart from certain cases with co-existing secondary lymphoma and bone lysis or a contiguous endocranial tumor. Follow-up CT scan imaging confirms clinical remission, or recurrence raising the problem of radionecrosis.

Treatment and prophylaxis of experimental liver metastases of M5076 reticulosarcoma with cis-bis-neodecanoato-trans-R,R-1,2-diaminocyclohexaneplatinum (II) encapsulated in multilamellar vesicles.

cis-Bis-neodecanoato-trans-R,R-1,2-diaminocyclohexaneplatinum++ +-(II) (NDDP) was encapsulated in multilamellar vesicles composed of dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol at a 7:3 molar ratio. Compared with cisplatin, i.v. administration of an equimolar dose of liposome-encapsulated NDDP (L-NDDP) resulted in 15-fold higher peak platinum levels in the spleen (204.7 versus 13.3 micrograms/g dry tissue), 5-fold higher in the lungs (116.4 versus 21.0 micrograms/g dry tissue), 3-fold higher in the liver (71.6 versus 23.9 micrograms/g dry tissue), and 4-fold higher in the blood (14.8 versus 3.9 micrograms/ml). At the optimal dose and schedule, L-NDDP administered i.p. in mice bearing peritoneal L1210 leukemia resulted in the percentage of median survival time of treated mice divided by median survival time of control mice (%T/C) of 312 versus 225 for cisplatin and free NDDP. When administered i.v., L-NDDP was also more active than cisplatin against L1210 leukemia inoculated i.v. (%T/C 186 versus 142). L-NDDP was markedly active against L1210 leukemia resistant to cisplatin (%T/C, 200 versus 112 for cisplatin). In mice bearing liver metastases of M5076 reticulosarcoma, L-NDDP was significatnly more effective than cisplatin at equimolar doses (mean survival time, 57 +/- 9 (SD) days for L-NDDP versus 42 +/- 3 days for cisplatin, P less than 0.05). L-NDDP was also effective in preventing liver metastases of M5076 when administered up to 24 h prior to tumor inoculation (mean survival, 28 +/- 2 days for L-NDDP versus 22 +/- 2 days for cisplatin, P less than 0.05). L-NDDP is significantly non-cross-resistant with cisplatin and more effective against phagocytic and nonphagocytic murine tumors.

Progressive loss of vision in patients with high-grade non-Hodgkin's lymphoma.

Three cases of double-sided neuritis of the optic nerve in patients with lymphomas are described. Two patients with lymphoblastic lymphoma had no other signs of central nervous system (CNS) relapse. All three cases responded to high doses of corticosteroids and/or radiotherapy, suggesting a lymphomatous cause of the papillitis. Optic nerve involvement is reported to be rare in lymphomas, but may become more prominent with aggressive systemic therapy controlling manifestations outside the CNS. Possible causes of optic neuritis in patients with lymphoma are discussed and therapeutic measures are suggested.

T-immunoblastic lymphoma mimicking B-immunoblastic lymphoma.

A T-cell immunoblastic lymphoma having plasmacytoid features that mimic B-cell immunoblastic lymphoma, is described. The lesion was composed of sheets of pleomorphic plasmacytoid cells that displayed a helper T-cell immunophenotype (Leu-1+, Leu-3+, Leu-4+, Leu-5+, Leu-9-, Leu-2-). Ultrastructural features were consistent with a T-cell lymphoma. Flow cytometric analysis revealed that the cells were DNA triploid and had a high proliferative activity. Although the histology of immunoblastic lymphomas alone may suggest either a T- or B-cell phenotype, immunophenotyping is essential in making this distinction.