Hepatic enzymes in Hodgkin's and non Hodgkin's lymphoma.

Serum alkaline phosphatase levels in patients with Hodgkin's and non-Hodgkin's lymphoma were studied. The findings were correlated with clinical stage, particularly hepatic involvement, and histologic findings. Serum levels of other hepatic enzymes (SGOT, 5,N and gamma GT) were also measured. The usefulness of these studies for clinical staging was described, as well as speculation on the observed differences in Hodgkin's and non-Hodgkin's patients.     

Argyrophilic nucleolar organiser region counts and prognosis in pharyngeal carcinoma.

The prognostic significance of argyrophilic nucleolar organiser regions (AgNORs) has been evaluated in biopsy specimens from 61 primary squamous and undifferentiated carcinomas of the pharynx prior to therapy. The univariate Kaplan-Meyer survival analysis showed a significant correlation between 3- and 5-year survival rates and the mean AgNOR number per tumour cell (P less than 0.001). No significant correlation was found between prognosis and patients age and sex, tumour location, clinical stage, histologic grade, extent of lymphocytic infiltration, HMFG-2 positivity of tumour cells and UCHL1, LN2, MB2 positivity of infiltrating lymphocytes. There was no significant association between AgNOR counts and tumour histologic grade or clinical stage. Multivariate survival analysis showed that only two variables were significantly correlated with prognosis: AgNOR counts (P less than 0.001) and the extent of lymphocytic infiltration (P less than 0.027). Our results indicate the prognostic value of AgNOR counts and suggest the use of this method as a significant parameter in the pretherapeutic assessment of the aggressiveness of pharyngeal carcinomas.     

Vincristine infusion in advanced non Hodgkin's lymphoma

Prognosis in cases of advanced Non Hodgkin's Lymphoma refractory to primary chemotherapy - continues to be poor. In search of suitable alternative we have recently treated six such patients with continuous, intravenous infusion of vincristine for five days. All patients had a variety of histological types and had received earlier primary combination chemotherapy including Vincristine by Intravenous bolus injection. A total of 21 courses (average 3.5) were given. Three patients (50%) achieved objective-partial response. Duration of response varied from two to nine months (mean 4.5 months). Toxicity was low with minimal myelosuppression and no increased neurotoxicity occurred. Vincristine infusion treatment may provide better palliation in advanced refractory Non Hodgkin's lymphoma and suggests the possibility of its use in combination chemotherapy protocols in untreated patients.     

Primary non Hodgkin's lymphoma of the vagina

The genital tract as a primary site of malignant lymphoma in women is extremely rare. This report concerns a 64 year old patient with a primary vaginal non-Hodgkin lymphoma (large cell B lineage according to the REAL classification--centroblastic type according to the Kiel classification--"G" according Working Formulation) with an unusual clinical presentation--pelvic discomfort accompanied by frequent ureteral-like colic. Due to gynecological onset symptoms and the rarity of this extranodal primary site misinterpretation of a primary vaginal lymphoma as a benign inflammatory disease or endometriosis may occur. We emphasize the importance of their recognition and also the differential diagnosis of cervical lymphoma from other neoplastic and non-neoplastic lesions.     

Treatment of relapses in aggressive non Hodgkin's lymphoma

In spite of considerable progress in the initial treatment of aggressive non Hodgkin's lymphoma, patients in relapse have poor prognosis. Patients with refractory disease have an even worse outcome. Current strategies and published reports of relapsing patients are presented. Intensification of chemosensitive relapse has yielded a number of continuous second remissions. However considerable efforts are required to define when transplantation should be performed, which type of graft should be used, and what type of post-intensification therapy can be proposed to improve the remission rate and duration.     

Second malignant neoplasms in patients with non Hodgkin's lymphoma

A retrospective review of the records of 3886 patients with non-Hodgkin's lymphoma registered at the Princess Margaret Hospital between 1970 and 1985 was undertaken to determine the incidence of second malignant tumours. Three thousand and twenty-one patients with a minimum documented follow-up of 6 months from referral were identified for analysis. The overall observed/expected ratio for all cancers in patients with malignant lymphoma was 1, suggesting no increased risk of developing a second malignant neoplasm compared to the general population. When the data were analyzed independently for each tumour site, statistically significant increased risk of developing acute non lymphocytic leukemia (ANLL) (p less than 0.001) and carcinoma of the tongue (p less than 0.05) were found. An increased risk of lung cancer following lymphoma was detected but was not statistically significant. Survival following diagnosis of ANLL and lung cancer was similar and significantly shorter than that following the diagnosis of other second malignancies. The risk of developing a second primary cancer was significantly related to increasing patient age.     

Chromosome 1p abnormalities in B non Hodgkin's lymphoma

Thirteen patients with B-non Hodgkin's lymphoma and abnormalities of the short arm of chromosome 1 were evaluated, to see if this cytogenetic anomaly was associated with a particular subgroup of lymphomas. Large cell lymphoma was found in seven patients (with an immunoblastic component in four cases). Six patients with diffuse small cleaved cell lymphoma of non follicle centre cell origin formed a second group. The chromosome 1 breakpoints in the second group were located between p34 and p36, suggesting that genes located here may be important in the initiation or progression of these lymphomas.     

非霍奇金淋巴瘤935例临床分析

目的研究提高非霍奇金淋巴瘤（ＮＨＬ）的治疗水平。方法对９３５例有计划治疗且资料完整的病例进行分析。结果（１）病理分类与远期生存：以中度恶性偏优,与其他类型比,Ｐ＜０．０５。（２）临床分期与远期生存：表现为分期早、预后好的规律,Ⅰ期与Ⅱ、Ⅲ、Ⅳ期相比,Ｐ均＜０．００１。（３）近期疗效与远期生存：ＣＲ者预后最佳,ＣＲ与ＰＲ、Ｓ、Ｐ相比,Ｐ＜０．００１。（４）按不同治疗手段比较：化疗＋放疗（综合治疗）比单一放疗（单放）或单一化疗（单化）的远期生存率似略优,但Ｐ均＞０．０５。（５）１９８３～１９８８年与１９８９～１９９３年修改治疗计划后两阶段比较,后者５年生存率明显高于前者,Ｐ值多有意义。结论ＮＨＬ疗后远期生存与病理分类、临床分期、近期疗效等关系密切;由于ＮＨＬ有跳跃性播散的生物学行为,故更要重视全身治疗     

Silver-stained nucleolar organiser region counts are of no prognostic value in primary breast cancer.

The assessment of nucleolar organising regions have been reported to be of prognostic value both in a number of haematological and solid tumours. We have examined the relationship between the number of nucleolar organising regions (NORs) present in 75 primary breast cancers and various clinical and pathological features known to be associated with prognosis in patients with breast cancer. Formalin-fixed, paraffin-embedded tumour tissue was sectioned and stained by a one-stage argyrophil (AgNOR) method. Using light microscopy the mean number of AgNORs per cell was calculated. No correlation was observed between AgNOR counts and any of the prognostic variables studied, including oestrogen receptor (ER) status, histological grade of malignancy, lymph node stage or site of initial metastatic disease. Similarly there was no correlation between AgNOR counts and disease-free interval or survival. AgNOR counts do not appear to be a prognostic factor in primary breast cancer.     

Hypoglycaemia and lactic acidosis in a MALT non Hodgkin's lymphoma

Hypoglycaemia associated with lactic acidosis is a rare complication of lymphomas; only four cases have been previously reported. Recent studies provide evidence of direct consumption of glucose by the tumour cells, leading to lactic acidosis. We report the case of a 64-year-old patient with a gastric diffuse large B cell non-Hodgkin's lymphoma transformed from an indolent mucosa associated lymphoid tissue (MALT) lymphoma, admitted to our department for acute renal failure due to a tumour lysis syndrome. After recovery from renal failure, she developed severe hypoglycaemia and lactic acidosis refractory to therapy. She died after the onset of shock and coma.     

Intermediate and high grade non Hodgkin's lymphoma in the elderly

Many malignant tumors develop in the later years of life. One of malignancies that frequently occurs in older patients is non Hodgkin's lymphoma (NHL) with a median age at diagnosis over 60 years. The overall incidence of NHL has increased over the past decade and is expected to continue to rise in developed countries. So NHL will be diagnosed more in the future. In this review we discuss epidemiology, etiology, possible differences in tumor characteristics compared with younger NHL patients, treatment and treatment results in elderly NHL patients.     

Follicular non Hodgkin's lymphoma in adenolymphoma: report of a case

A case of centroblastic centrocytic follicular lymphoma arising within a bilateral adenolymphoma of the parotid glands with involvement of the adjacent lymph nodes is reported. The patient was treated with combination chemotherapy and three years after the first cycle of therapy there was no evidence of disease. The occurrence of primary malignant lymphomas in the lymphoid stroma of an adenolymphoma has seldom been discussed in literature. All cases reported of follicular centre cell type were characterized by an indolent clinical course.     

A case of bilateral renal metastases from non Hodgkin's malignant lymphoma

A patient with bilateral renal metastases from non Hodgkin's malignant lymphoma originating in the aortocaval abdominal lymph nodes was treated with chemotherapy. Initially, methotrexate (20 mg/m2), vincristine (0.6 mg/m2), cyclophosphamide (500 mg/m2), adriamycin (20 mg/m2), and bleomycin (30 mg/m2) were given on day 1, cisplatinum (50 mg/m2) was given on day 2, and prednisolone (20 mg/body) was given from day 1 to 3 (MVP-CAB regimen). Since the patient was 74 years old and had slight renal dysfunction, for the first and second courses of this therapy, methotrexate and cisplatinum were administered at 60% of the usual dose and the other 4 anticancer agents at 70% of the usual dose. Only prednisolone was given at the full dose. From the third course the 6 anticancer agents were used at 70% of the normal dose. Administration was performed every 4 weeks until the third course, and every 8 weeks after the fourth course (total number of cycles of MVP-CAB: 8 cycles). A marked improvement of the general state and a reduction of the tumor size were noted following treatment. Since regrowth of the residual tumor occurred, as second line chemotherapy cytosine arabinoside (100 mg/m2) on day 1, ifosfamide (1 g/m2) on day 1 to 2, etoposide (100 mg/m2) plus prednisolone (20 mg/body) on day 1 to 3 were administered (AraC-VIP regimen). The timing of administration was similar to that of the MVP-CAB regimen. More than 50% tumor reduction was obtained with this regimen. The total survival time since the beginning of chemotherapy is 2 years to date.     

鼻咽癌患者血T淋巴细胞核仁形成区嗜银蛋白检测的价值

目的 探讨外周血T淋巴细胞核仁形成区嗜银蛋白（Ag-NORs）的检测在鼻咽癌诊治中的临床价值。方法 对36例正常人、73例初治、11例复发和（或）转移及32例放射治疗后随诊鼻咽癌患者进行外周血T淋巴细胞Ag-NORs检测，并对部分初治患者放射治疗前、期间及后的Ag-NORs含量进行动态观察，结果以核仁银染面积与细胞核面积的比值（I.S%）表达。结果 各组鼻咽癌患者外周血T淋巴细胞Ag-NORs含量均明显低于正常人（P＜0.01），复发与初治和随诊患者间也有显著差异（P＜0.01）。Ⅲ、Ⅳ期患者Ag-NORs含量低于Ⅰ、Ⅱ期患者，差异无显著性（P＞0.05）。放射治疗期间Ag-NORs含量较放射治疗前明显降低（P＜0.01），放射治疗后与放射治疗前比较无显著差异（P＞0.05）。结论 外周血T淋巴细胞Ag-NORs检测在鼻咽癌患者的疗效观察、预后判断甚至诊断和分期中均具有一定的临床价值。     

Breakpoints of 11q25 in three similar cases of B non Hodgkin's lymphoma

We report three cases of small B cell non Hodgkins lymphoma, two with plasmacytoid differentiation, presenting with a similar clinical picture and identical immunophenotype, who cytogenetically had breakpoints involving band 11q25. We suggest that this breakpoint may define a group of lymphomas closely related to the diffuse small cleaved cell lymphomas with t(11;14)(q13;q32).     

小细胞癌与小淋巴细胞性非何杰金淋巴瘤的形态计量学初探

目的　初步探讨小细胞癌与小淋巴细胞性非何杰金淋巴瘤鉴别的体视学参数。方法　运用MPIAS- 500 多媒体病理图文分析系统, 对30 例小细胞癌及20 例小淋巴细胞性非何杰金淋巴瘤进行定量分析研究。结果　两者的细胞核面积、面积体积、等效直径和最小直径的差异有显著性( P< 0-05) 。结论　这些参数对两者的鉴别诊断有重要的参考价值     

Multicentre combined chemotherapy protocol for large cell advanced non Hodgkin's lymphoma.

Between October 1985 and October 1989, 75 previously untreated patients with stage III and IV non Hodgkin's lymphoma, large cell type, were treated with an alternating weekly chemotherapy regimen including the following drugs: week 1: Doxorubicin, vincristine, cyclophosphamide, bleomycin, and intrathecal (i.th.) methotrexate and cytarabine; week 2: Methotrexate with leucovorin rescue; week 3: Doxorubicin, ifosfamide with mesna, etoposide, and i.th. methotrexate and cytarabine; week 4: Methotrexate with leucovorin rescue. Complete responders after three cycles according to this schedule (12 weeks) were given 18 gys cranial irradiation and randomized between one additional cycle or three monthly CHOP (consolidation treatment). Among 66 evaluable patients, 53 achieved a complete remission (CR 80 per cent) and seven a partial remission (11 per cent). There were six failures, and nine early deaths during the initial phase, mostly due to septic problems. Forty-one of the 53 CR patients (77.3 per cent) have remained free of disease with a median follow-up of 15 months (1-49). Eight of the 12 relapses occurred during the first year, the four others at 13, 14, 16 and 38 months respectively. The 2-year survival was 63 per cent for the whole group, and 77 per cent for the CR group. No difference has been observed up until now between the two groups with different consolidation treatment. Therefore, this protocol seems to be able to produce a high rate of complete and durable remission. The analysis of prognostic factors suggests that some high-risk patients should be considered for intensification therapy with the support of autologous bone marrow transplantation.     

Silver stained nucleolar organizer region proteins and Helix pomatia agglutinin immunostaining in esophageal carcinoma: Correlated prognostic factors

The number of nucleolar organizer region proteins identified by silver staining (AgNORs) and alterations in cell surface glycoproteins identified by Helix pomatia agglutinin (HPA) immunostaining were studied in 96 primary esophageal carcinomas. The number of AgNORs increased with increasing depth of cancer invasion, venous involvement, lymphatic invasion, and tumor stage. Positivity of HPA staining correlated significantly with increasing depth of cancer invasion, venous invasion, and tumor stage. Forty of 42 HPA negative cases had low AgNORs numbers (<4), while 39 of 54 HPA positive cases had high AgNORs numbers (?4) (P = 0.0001). The survival rate of patients with stage III and IV disease was significantly poorer for those with a high AgNORs score and HPA positivity than in those with a low AgNORs score and HPA negativity. The present study indicates that the AgNORs score is positively correlated with positive HPA staining and that tumors having both factors represent a subgroup of esophageal carcinomas with poor prognosis. © 1994 Wiley-Liss, Inc.     

Cytophotometric DNA content and argyrophilic nucleolar organiser regions of oesophageal carcinoma.

The cytophotometric DNA content and the argyrophilic nucleolar organiser regions (AgNORs) of biopsy specimens taken before undergoing any treatment were examined in 91 surgically treated oesophageal carcinoma cases. There was a significant linear dependence between the mean DNA content and the number of AgNOR per nucleus (AgNOR number) (r = 0.615, P < 0.001). The DNA distribution pattern and the range of the AgNOR number also showed a significant correlation (P < 0.01). Twenty three of 28 cases with a low AgNOR number (< 4) were then determined to have a diploid pattern (type II), while 17 out of 22 cases with a high AgNOR number (> or = 6) had high ploidy values (type IV). The patients with a type II DNA distribution pattern and a low AgNOR number thus showed a good post-operative course with a 5 year survival rate of 55.2%, whereas no patients survived over 4 years among the 17 cases with both a type IV DNA pattern and a high AgNOR number (P < 0.001). These data thus demonstrate the close relationship between cytophotometric DNA content and AgNOR number and suggest that the combined detection of these two parameters, using biopsy specimens, should be of benefit in making an accurate preoperative evaluation of prognosis for patients with oesophageal carcinoma.     

Secondary acute non lymphoid leukemia in patients treated for non Hodgkin's lymphoma: no risk of therapy-related ANLL after PROVECIP schedule

The present study was undertaken to evaluate the frequency, characteristics and actuarial risk of secondary acute non lymphoid leukemia (s-ANLL) in 141 patients treated for non Hodgkin's lymphoma with different modalities. One hundred and twenty-four patients received chemotherapy according to PROVECIP protocol. Of these, 15 also received as induction treatment a local nodal irradiation and 33 an extended field radiotherapy. Seventeen out of 141 were treated by total body irradiation. Of these, 15 relapsed and received salvage chemotherapy. Sixteen of the 124 patients treated with PROVECIP also underwent different chemotherapeutic programs as salvage treatment. Of the entire population studied, 2 patients developed an s-ANLL, 45 and 63 months after diagnosis of NHL. The type of treatment significantly affected the occurrence of s-ANLL, since both leukemias occurred in patients treated with total body irradiation, given alone or followed by chemotherapy. The actuarial risk at 8 years was 5.24% in the whole group, whereas it greatly increased in the group of patients treated with total body irradiation (24%). Conversely, no risk was found in the group treated with PROVECIP, alone, with additional chemotherapy, or with associated local or extended field radiotherapy.