Plasmacytoma of the breast. An unusual case of recurrent myeloma.

An unusual case of multiple myeloma is presented in which recurrence of the disease after a four-year remission was heralded by an infiltrating plasmacytoma of the breast. The clinical and histologic features of this neoplasm are presented and compared with ten previously reported cases of plasmacytoma of the breast.

Skin metastases from transitional cell bladder cancer.

Three cases of transitional cell bladder cancer metastatic to skin are described. This manifestation of transitional cell uroepithelial malignancy was previously believed to be quite uncommon. The authors' experience suggests that this occurrence is not that rare and that it may reflect increased longevity in successfully treated patients, allowing previously unusual manifestations of metastatic disease to become evident. The role of aspiration skin biopsy is discussed.

IgA inhibitor to factor VIII/von Willebrand factor.

A 60-year-old Black female presented with a haemorrhagic diathesis and an acquired factor VIII/von Willebrand factor (VIII/vWf) inhibitor. This inhibitor was classified as an IgA immunoglobulin and was active not only against factor VIII coagulant (VIII:C) activity but also against plasma von Willebrand factor (vWf). The purified IgA also interacted with normal platelets to inhibit ristocetin-induced platelet aggregation (RIPA). In contrast, studies with haemophilia A plasma and platelets revealed that the inhibitor did not react significantly with these plasmas or platelets. The significant differences in the inhibition of vWf assay both of the plasma and the platelets of the haemophilia A patients suggests that part of the haemorrhagic diathesis may be related not only to the inhibition of VIII:C but also to interference with platelet function. In addition, these studies suggest that there may be significant differences in the factor VIII-related antigen (VIII R:Ag) on platelets in haemophilia A patients compared to normal.

Early-onset cyclophosphamide-induced interstitial pneumonitis.

This article describes three cases of biopsy-proved interstitial pneumonitis secondary to cyclophosphamide therapy. The pulmonary reactions developed after one to three courses of combination chemotherapy in three patients with diffuse histiocytic lymphoma. Resolution of the pulmonary infiltrates and blood gas value abnormalities followed discontinuation of use of this drug without recurrence when chemotherapy regimens excluding cyclophosphamide were subsequently used. Prednisone was given to all patients after the diagnosis was made, but its role in the resolution of the toxic changes is uncertain. The potential for early onset of cyclophosphamide-induced interstitial pneumonitis has not been previously stressed, but should lead to vigorous investigation of pulmonary reactions occurring at any time after initiation of therapy with this drug.

Radiotherapy results for nodular sclerosing Hodgkin's disease after clinical staging.

Certain features of nodular sclerosing Hodgkin's disease predispose toward achievement of excellent radiotherapeutic results using clinical staging rather than currently advocated surgical staging including laparatomy. These include a distinct pattern of contiguous lymphatic involvement and the infrequent dissemination of disease to extranodal sites in early stage patients. Only three of 58 consecutive Clinical Stage I-III patients initially treated with radiotherapy alone between 1965 and 1969 have died from Hodgkin's disease. The 10-year survival rates corrected for intercurrent deaths are 97%, 90%, and 86% for Stages I-IIA, IIB, and III respectively. The usual prognostic influence of "B" symptoms was not evident following extended prophylactic irradiation. Likewise, there was no discernible influence of the subtype (lymphocyte predominant, mixed cellularity, lymphocyte depletion) on survival with these nodular sclerosis patients. There was a single extension of disease to iliac nodes in 46 patients with supradiaphragmatic involvement for whom prophylactic irradiation did not extend below the aortic bifurcation, providing justification for modified total nodal irradiation. Development of extranodal dissemination was observed in only 4/58(7%) patients, indicating that adjuvant chemotherapy is not warranted or justified in the early stages of nodular sclerosing Hodgkin's disease.

Adriamycin and enhanced radiation reaction in normal esophagus and skin.

Clinical evaluation of 10 patients with small cell carcinoma of the lung treated with radiotherapy and periodic cycles of combination chemotherapy with cyclophosphamide, vincristine, and adriamycin showed frequent and occasionally severe esophageal and skin reactions. Eight of the 10 patients had esophagitis, four required supportive intravenous fluids, and two subsequently developed esophageal narrowing and stricture formation. Recurrent esophagitis with augmentation of injury in the recently irradiated esophagus was observed 11 times in eight of the 10 patients after cycles of chemotherapy, and contributed to the sustained toxicity seen in two patients. Dermatitis in the form of moist desquamation was observed in five of the patients at very low doses of supervoltage radiation therapy. Acute pulmonary reactions was notably absent. This combination of chemotherapy, particularly adriamycin, potentiates the effect of radiotherapy on the normal esophagus and skin, and further implicates the radiosensitizing property of adriamycin.

Ewing's sarcoma as a cause of the syndrome of inappropriate secretion of antidiuretic hormone.

A patient with Ewing's sarcoma presented with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) (1). Plasma values for vasopressin were found to be over four times the normal values expected for the plasma osmolality. At postmortem examination, the arginine vasopressin concentration in the tumor tissue was ten times that of the plasma. These data suggest that Ewing's sarcoma may cause SIADH.