[Small lymphocytic lymphoma/chronic lymphocytic leukemia with t(11;14)].

A 83-year-old woman was referred to our hospital because of swollen lymph nodes, marked splenomegaly, and bone marrow abnormality. Histological examination of the lymph nodes revealed characteristic findings for small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL). The immunophenotype of the tumor cells was CD5+, 10-, 19+, 20+, 23-, IgM+D+. Interphase fluorescent in situ hybridization (FISH) detected t(11;14), and immunohistochemical studies demonstrated cyclin D1 expression. In both SLL/CLL and mantle cell lymphoma (MCL), the normal counterpart of the tumor cells is thought to be CD5-positive B1 cells. The present case may therefore have been borderline between SLL/CLL and MCL.

Ectopic expression of MAFB gene in human myeloma cells carrying (14;20)(q32;q11) chromosomal translocations.

Chromosome 14q +, which represents a chromosomal rearrangement involving the immunoglobulin heavy chain gene (IgH) locus, is a genetic hallmark of human multiple myeloma (MM). Here, we report the identification of (14;20)(q32;q11) chromosomal translocations found in MM cells. Double color fluorescence in situ hybridization analyses pinpointed the breakpoints at the 20q11 locus in two MM cell lines within a length of at most 680 kb between the KIAA0823 and MAFB gene loci. Among the transcribed sequences in the vicinity of the breakpoints, an ectopic expression of the MAFB gene, which is located at 450 - 680 kb telomeric to one of the breakpoints and encodes a member of the MAF family basic region / leucine zipper transcription factor, was demonstrated to be associated with t(14;20). This finding, together with that of a previous study describing its transforming activity, suggests that the MAFB gene may be one of the targets deregulated by regulatory elements of the IgH gene as a result of t(14;20).

Multiple bone lesions after allogeneic bone marrow transplantation in a patient with relapsed adult acute lymphoblastic leukemia: minimal residual disease analysis may predict extramedullary relapse.

We describe a patient with acute lymphoblastic leukemia (ALL, L2) who relapsed with multiple bone lesions after allogeneic bone marrow transplantation (allo-BMT). Allo-BMT was performed from an HLA-identical sibling during the first hematological complete remission (CR). Minimal residual disease (MRD) assessed by polymerase chain reaction (PCR) with primers for T cell receptor delta (TCRdelta) gene became positive in the bone marrow sample on day 46 after allo-BMT. On day 113, the patient complained of a painful tumor at the right clavicle. The examination of biopsy specimen revealed infiltration of leukemic cells. After partial response was achieved by local radiotherapy, disseminated bone lesions were demonstrated by 99mTC scintigraphy scan, followed by bone marrow relapse on day 137. The patient died of cardiac tamponade on day 236 after Allo-BMT. MRD assessed by PCR assay for TCRdelta gene in the bone marrow is useful for the prediction of extramedullary as well as medullary relapse after BMT.

A novel human multiple myeloma-derived cell line, NCU-MM-1, carrying t(2;11)(q11;q23) and t(8;22)(q24;q11) chromosomal translocations with overexpression of c-Myc protein.

A novel cell line, designated as NCU-MM-1, was established from a 66-year-old female patient with multiple myeloma (MM) that had shown rapid progression from solitary plasmacytoma to plasma cell leukemia. Interestingly, cytogenetic analysis including fluorescence in situ hybridization analysis disclosed that this cell line carried 2 kinds of chromosomal translocations involving immunoglobulin light chain (IgL) gene loci without the presence of 14q32 translocations (14q+). The Ig lambda locus juxtaposed to the c-MYC locus at 8q24 on the derivative (8) chromosome and a concomitant overexpression of the c-Myc protein was observed. On the derivative (11) chromosome, the Ig kappa locus was also fused to the chromosome 11q23 locus, which is known to be a nonrandom translocation breakpoint in mature B-cell malignancies. The NCU-MM-1 cell line may thus be useful not only for the identification of the responsible proto-oncogene(s) mapped to 11q23, deregulated by the Ig kappa enhancer sequences, but also for clarification of the molecular origin of MM lacking 14q+ chromosomes because IgL rearrangements can physiologically begin to occur in the pre-B-cell stage.

Induction of chromosomal aberrations and growth-transformation of lymphoblastoid cell lines by inhibition of reactive oxygen species-induced apoptosis with interleukin-6.

Etiological evidence, indicating the relationships between the onset of malignant lymphoma and pre-existing chronic inflammation, has been accumulated. For the autonomous growth of malignant tumor, genetic lesions, such as chromosomal aberrations, amplification of oncogenes, and mutations of genes involved in the cell cycle regulation, must be essential. However, how the inflammation promotes the accumulation of genetic lesions and induces the autonomous growth of lymphoid cells remains unclear. Reactive oxygen species released by polymorphonuclear leukocytes and macrophages are factors causing DNA damage in the foci of inflammation, and thus could play a role in lymphomagenesis. The xanthine/xanthine oxidase (X/XOD) system produces a mixture of hydrogen peroxide and superoxide anion extracellularly, and thus serves as an in vitro source of reactive oxygen species. Cell death of lymphoblastoid cell lines (LCLs) was induced with X/XOD treatment in a dose-dependent manner. DNA fragmentation, which is the characteristic feature of apoptosis, was observed in LCLs at 4-8 hours after X/XOD treatment. Among cytokines such as interleukin-6 (IL-6), IL-10, and interferon-gamma, only pretreatment with IL-6 gave LCLs the resistance to X/XOD-induced cell death in a dose-dependent manner. The proportion of apoptotic cells in X/XOD-treated LCL culture was decreased with IL-6 pretreatment by quantification with flow cytometric analysis. Treatment of LCLs with IL-6 for 48 hours up-regulated bcl-2 mRNA expression. Furthermore, the LCLs repeatedly treated with X/XOD and cultured with or without IL-6 showed many more structural abnormalities of chromosomes than those without X/XOD treatment. Colony forming efficiency of X/XOD-treated LCLs with IL-6 was significantly higher than those without IL-6, and even relatively higher than LCLs without X/XOD treatment. IL-6 could support the survival of non-neoplastic B cells and accelerate the malignant transformation of B lineage cells in inflammatory lesions.

Parkinsonism due to chronic subdural hematoma.

A 75-year-old male presented with bilateral parkinsonism due to chronic subdural hematoma. The hematoma was removed through a small craniotomy. The parkinsonism rapidly improved following operation, suggesting a strong relationship between the hematoma and parkinsonism. We recommend surgical intervention in such cases.

Local multicystic encephalopathy: case report.

A case of local multicystic encephalopathy is presented. CT scan showed a low-density area with a string-like structure of iso-density in the left frontal lobe. Angiogram demonstrated no abnormality. Magnetic resonance imaging (MRI) demonstrated multiple cystic lesions, and we diagnosed the case as local multicystic encephalopathy. This disease generally occurs diffusely, and local occurrence is very rare. MRI was very useful for diagnosis and delineating the details.

Spontaneous spinal subarachnoid hematoma--case report.

BACKGROUND: Spinal subarachnoid hemorrhage is unusual, and rarely results in spinal subarachnoid hematoma because the cerebrospinal fluid tends to dilute the blood and prevent the formation of clots. We describe a patient with spinal subarachnoid hematoma of unusual spontaneous origin. CASE: A 66-year-old female presented with sudden onset of intense back pain with paraplegia. Magnetic resonance imaging demonstrated a mass lesion between T2 and T6, compressing the spinal cord anteriorly. Emergency osteoplastic laminotomy exposed a hematoma in the subarachnoid space from T2 to T6, but no source of the hemorrhage was found. The patient was able to walk by herself about 20 days after the operation. CONCLUSION: The outcome is significantly influenced by the duration between onset and operation, preoperative neurologic status, and rapidity of symptom progression. Therefore, we emphasize the importance of early diagnosis, and rapid and complete operative removal of spinal subarachnoid hematoma in order to achieve the best outcome.

Migration of a subduroperitoneal shunt catheter into the subdural space--case report.

An 82-year-old male with intractable bilateral chronic subdural hematomas was treated by emplacement of bilateral subduroperitoneal shunts on the left in 1990 and on the right in 1991. Chronic subdural hematoma recurred in 1992 due to an unusual migration of a shunt catheter into the subdural space. This migration was probably due to inadequate fixation of the shunt. Shunt replacement and fixation with an anchoring wing has resulted in no further complications for 2 years.

[Application of the finite element method to craniofacial growth analysis. 4. Three-dimensional application of tensor analysis].

The purpose of this study is the 3-dimensional application of finite element method to analyze the craniofacial growth. In our previous studies, 2-dimensional finite element method was applied to analyze and to predict the craniofacial growth. In case of 2-dimensional application, the normal and shear strains were given by the displacements u, v that were linear functions of coordinates x, y. In the 3-dimensional case, six strain components are required to obtain the extension ratio and the directions of three-principal axes. In this study, for the 3-dimensional application, four-noded, pyramidal elements were used and twelve 3-dimensional elements were constructed. Materials were longitudinal frontal and lateral cephalometric X-rays of 4 males and 4 females from 7 to 10 years with normal occlusions. 3-dimensional coordinates of each nodal points were calculated by transforming 2-dimensional coordinates on the frontal and lateral cephalometric X-ray films. Coordinates of the nodal points at 7 years were standards against that results of the finite element method from 8 to 10 years were obtained. They were subjects of the analysis that elements equivalent to the cranial base, the maxillary portion, the maxillary alveolar portion and the posterior pharyngeal portion. Summarized results were as follows. 1. It was observed that the similar figured extension of the anterior cranial base element. 2. The posterior cranial base element extended to right, anterior and upwards direction. 3. On the maxillaly elements, especially, lateral extensions appeared. 4. The element of the posterior pharyngeal portion extended to left and downwards direction. 5. The elements of the maxillary alveolar portion extended to downwards directions. From the above, the directions of transformation of the elements that are selected with voluntary nodal points can be observed. Therefore, 3-dimensional tensor analysis is a method of great significance for obtaining new findings of the craniofacial growth.