Sites of origin of primary intracerebral malignant lymphoma.

With the aim of finding characteristics pointing to the primary site, computed tomography examination from 9 patients with primary brain malignant lymphoma (non-Hodgkin's lymphoma originating in the central nervous system, NHL-CNS) (5 single, 4 multiple lesions) were analyzed. The tumors were usually situated in the basal ganglia, corpus callosum, or cerebellum and were always in contact with either the ependyma of the ventricles or the subarachnoid space. Tumors with widespread infiltration of white matter surrounding the ventricles were characteristic of NHL-CNS. Microscopic examination of 3 autopsy cases revealed infiltration of the subependymal layer of the lateral ventricles and the third and fourth ventricles by lymphoma cells. The entire extent of the choroid plexus was invaded by tumor cells. There were multiple foci of similar cells invading the periventricular white matter. The subarachnoid space was filled with lymphoma cells. In many areas the Virchow-Robin spaces and pial-glial membranes were disrupted, and invasion of the underlying gray matter by tumor cells was seen. The ultrastructure of the blood vessels of NHL-CNS was compared with those in glial, nonglial, and metastatic brain tumors. The essential feature in NHL-CNS was fenestrated vessels. They resembled the blood vessels found in nonglial and metastatic brain tumors, but were distinctly different from those seen in glial tumors with nonfenestrated vessels. Although the following scheme in proposed with reservations, it could account for the sites of origin of NHL-CNS: lymphocytes located in the choroid plexus stroma or the subarachnoid space are activated, caused to proliferate, and finally become neoplastic.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute mononeuropathy with angiotropic lymphoma.

Angiotropic lymphoma can present as a vascular disease in the central nervous system. The patient described in this report had a sudden pain in the region of the right superficial peroneal nerve and a nerve biopsy showed tumoral cells in the lumen of most small blood vessels. This pathology, first described in the skin as malignant angioendotheliomatosis, can be compared with the occurrence of multiple emboli in the vasa nervorum. In recent cases, tumoral markers have evidenced a lymphomatous origin, generally of the B type.

Lymph-node infarction and malignant lymphoma: a multicentre survey of European, English and American cases.

A multicentre study of 51 cases of lymph-node infarction seen in the 30-year period 1956 to 1985 was conducted in order to assess both the short- and long-term prognostic implications of the condition. In 14 cases malignant lymphoma was found synchronously with the infarct. Of the remaining 37 patients with apparently 'benign' lymph-node infarction only six showed manifestations of malignant lymphoma in the follow-up time studied (mean = 48 months; range 1-156 months). These subsequent malignant lymphomas all occurred within 2 years of the lymph-node infarction. A postal enquiry and collation of other cases in the medical literature indicates that a minority (26 of 81) have developed malignant lymphoma, and that these lymphomas, too, have all appeared within 2 years. Thorough examination of both the infarcted lymph nodes and others resected at the same time is mandatory in order to exclude concomitant or underlying malignant lymphoma. Two years after lymph-node infarction the risk of malignant lymphoma is negligible.

Site-related differences in the localization of the monoclonal antibody OX7 in SL2 and SL1 lymphomas.

The uptake of a monoclonal antibody (OX7) by murine lymphomas (SL1, SL2) growing in two sites in the mouse were compared. SL2 tumors grown in the subrenal site showed greater specific antibody uptake than did the same tumor grown in the subcutaneous site. Major differences in membrane bound antibody, in vitro antibody binding patterns, and gamma scintillation camera imaging were also observed between the two sites. These differences may be due to the greater blood flow measured in tumors growing in the subrenal capsule than those growing at the subcutaneous site. The differences observed in antibody uptake of the same tumor growing in two different sites raises questions concerning the choice of animal model systems that can be used to predict clinical utility.

Angiography of the internal mammary artery.

The anatomy and catheterization techniques of the internal mammary artery (i.m.a.) are described. The diagnostic criteria and importance of i.m.a. angiography in thymoma, lymphoma, carcinoma, parathyroid adenoma, diseases of the breast, and trauma are discussed. The role of i.m.a. catheterization for i.a. infusion therapy in lung carcinoma, mesothelioma and chest wall metastases of breast carcinoma and embolization of i.m.a. in bleeding following trauma or tumour ulceration are described. Transcatheter treatment of mediastinal parathyroid adenoma is also described.

Short-term thymidine uptake in normal and neoplastic tissues: studies for PET.

Uptake of H-3 thymidine was studied in mice, both normal and with spontaneous lymphoma, and in the organs and tumors of dogs with spontaneous tumors. Uptake was compared with relative blood flow as measured by the distribution of C-14 iodoantipyrine. Initial distribution of thymidine in normal mice measured 20 sec after injection, correlated with the relative perfusion measurements; however, all measurements of thymidine uptake made between 1 and 60 min after injection showed no correlation with perfusion. This indicates that the distribution more than 1 min after injection is primarily dependent on subsequent redistribution and/or metabolism of thymidine. A time-course study demonstrated that normal mouse organs with high rates of proliferation retained all the labeled thymidine initially taken up. Organs with low rates of proliferation lost their label in a nearly exponential washout. These studies provide further evidence of the feasibility of using C-11 thymidine for positron emission tomography (PET).

Radiation-induced changes in regional blood flow in human tumors.

In 43 patients the blood flow in 48 superficial metastatic tumors was measured with the 133xenon wash-out method. In all cases the blood flow was measured before the start of radiotherapy and then one week later during radiotherapy. In 36 cases the blood flow was measured after 2 weeks during radiotherapy, and in six patients the follow-up lasted 5-6 weeks. The blood flow increased during the first week of radiotherapy in the whole series from 20.1 +/- 18.0 ml/min/100g to 31.3 +/- 24.9 ml/min/100g. The increase during the first week was significant (p less than 0.001). During the second week of radiotherapy the blood flow decreased to 27.0 +/- 19.3 ml/min/100g; the decrease was also significant (p less than 0.05). The changes in the different tumor groups during radiotherapy seemed to be in the same direction. In a longer follow-up the gradual decrease in the blood flow seemed to continue.

Malignant lymphoma with primary manifestation in the gonad: a clinicopathologic study of 38 patients.

This study is based on 38 patients, each of whom had a malignant lymphoma in which the gonad was the site of the main tumor mass at the time of diagnosis. Histiocytic lymphoma was the predominant type in the 27 male patients; in the 11 female patients, poorly differentiated lymphocytic lymphoma was the most frequent type (36%). All of the neoplasms in the males were diffuse, whereas two of the females had neoplasms that were nodular and diffuse. A striking feature was the high frequency of vascular invasion (41%) in the testicular lymphomas, which was reflected in a high incidence (86%) of noncontiguous lung involvement at autopsy, suggesting hematogenous spread. Clinically occult disease is probably responsible for the short interval between the discovery of a gonadal mass and the appearance of generalized disease. A poor prognosis may be expected if there is evidence of generalized disease within one year after diagnosis. Only 2 patients had disseminated disease after a year, whereas all those who died of disseminated disease manifested it within six months after diagnosis. Disease-freee survival times in excess of 60 months in 3 patients who were treated only by orchiectomy or oophorectomy indicate that the gonads may be the primary site of a malignant lymphoma.

Regional blood flow in human tumors.

Blood flow in 97 human tumor nodules, of which 31 were lymphomas, 31 were anaplastic carcinomas, and 35 were differentiated cancers, was measured using the 133Xe clearance method. The lymphomas showed statistically higher blood flow [34.6 +/- 21 (S.D.) ml/min/100 g] than did the anaplastic carcinomas (15.4 +/- 11.4 ml/min/100 g; p less than 0.001) and the differentiated cancers (22.8 +/- 14.9 ml/min/100 g; p less than 0.05). The size of the tumors did not correlate with the blood flow. In the group of differentiated cancers, the blood flow in nodules in areas of earlier irradiation was lower (9.0 +/- 6.3 ml/min/100 g) than in nodules in intact regions (25.0 +/- 14.5 ml/min/100 g; p less than 0.05). Nodules in cicatricial areas after surgical operation had lower blood flow than did nodules in the intact areas, but the difference is not statistically significant. It is obvious that most human tumors have a considerably lower blood flow than what one would expect to find in the surrounding normal tissue.

Tumour detection by ultrasonic Doppler blood-flow signals.

Ultrasonic Doppler blood-flow signals which seem to be associated with malignant tumour neovascularization have been detected in the female breast. No such signals have been detected from cysts. This discovery may lead to the development of a highspeed ultrasonic Doppler scanner which might make breast screening for cancer practicable.

Angiography of the liver in lymphoma.

Three cases of lymphocytic lymphoma are reported. The diagnosis of liver involvement is critical since it may be a determining factor in the selection of chemo- or radiotherapy. Angiographic diagnosis of liver lymphoma is frequently unsuccessful. Though liver lymphomas usually display a hypovascular pattern, the hypervascular pattern should be considered in the differential diagnosis of hepatic lesions.

Malignant lymphoma of the skin: a clinicopathologic study of lymphoma other than mycosis fungoides.

The clinical and histopathologic findings in 25 cases of malignant lymphoma of the skin other than mycosis fungoides were reviewed. All patients had skin lesions as a primary manifestation of the disorder, and none had histopathologic evidence of extracutaneous involvement at the time of skin biopsy. The majority of patients had solitary nodules involving the skin of the head and neck region. Twenty-two of the skin biopsy specimens were interpreted as lymphocytic lymphoma, well or poorly differentiated, nodular or diffuse. Only three cases of histiocytic lymphoma (reticulum cell sarcoma) were encountered, and there were no cases of Hodgkin's disease of the skin. Twenty-two patients (88%) subsequently developed extracutaneous lymphoma: the interval from the occurrence of apparently localized skin lesions to involvement of lymph nodes and/or viscera ranged from 6 months of 5 years (mean duration of 21 months). Sixteen patients (64%) died of disseminated lymphoma, with survivals that ranged from 8 months to 12 years (mean survival of 3.7 years). Only three patients survived without disease for greater than 1 year. There was no definite relationship between either the histologic subtype of the tumor or the mode of therapy and prognosis. The patholoic findings indicate that a definite diagnosis of malignant lymphoma can be made by skin biopsy in patients with disease apparently confimed to the skin. Careful, detailed examination of the skin biopsy specimen provides a basis for distinguishing malignant lymphoma from cutaneous lymphoid hyperplasia. The clinical findings and survival data support the conclusion that malignant lymphoma with skin lesions as a primary manifestation almost invariably disseminates to extracutaneous organs and usually has a fatal outcome.

Regional blood flow in human tumours with special reference to the effect of radiotherapy.

Blood flow in 41 superficial tumour nodules, of which nine were lymphomas, nine anaplastic carcinomas and 23 differentiated malignomas was measured using the 133Xe-clearance method. The lymphomas showed statistically higher blood flow (38-4 ml./min/100 g) than anaplastic (11-4 ml./min/100 g) and differentiated tumours (13-7 ml./min/100 g). After one week of radiation treatment the mean blood flow in anaplastic carcinomas was higher than the initial value. After an interval following the end of the radiation treatment the circulation diminished significantly compared with that observed immediately at the end of radiotherapy. The size of the tumours did not correlate with the blood flow.

Histologic identification of malignant lymphoma cutis.

Sections of 47 skin biopsies diagnosed during 1960-1970 as suggestive of or diagnostic of malignant lymphoma were retrospectively analyzed. Thirteen with monomorphous cutaneous infiltrates of reticulum cells or poorly differentiated lymphocytes were encountered; all were from patients who had extracutaneous manifestations of reticulum-cell sarcoma, poorly differentiated lymphosarcoma, or leukemia at the time of biopsy or within a year after biopsy. Diagnosis of well-differentiated lymphosarcoma or leukemia cutis is more tenuous, since mature lymphocytic infiltrates were encountered in patients with or without evidence of extracutaneous lymphoma. These are designated "unclassified" lymphocytic infiltrates of skin, requiring careful clinical exclusion of these types of malignant lymphoma. Other purported histopathologic discriminants of malignant lymphoma and pseudolymphoma, the latter term utilized to designate banal disorders characterized by a polymorphous infiltrate with or without atypical reticulum cells, are of little value for their distinction. These diagnostic criteria for malignant lymphoma cutis should clarify much of the pathologic and clinical uncertainty attendant upon the so-called "lymphoreticular" infiltrates of the skin.