“Early” tongue carcinoma

This is a retrospective study done in 89 patients who were treated for stage I lingual carcinoma, to determine the local control and 5-year salvage rate and the site and frequency of recurrences with salvage rate with a second modality.     

Exploratory thoracotomy on a patient with previous malignancy—“metastasis” or “new primary” or “unrelated lesion”

Surgical resection of a solitary pulmonary metastasis is an established procedure. A medical generation ago when such a shadow appeared on chest roentgenogram of a patient who had known cancer elsewhere in body, it was assumed to be “metastasis” from an extrathoracic site. With increasing advances in knowledge, the occurrence of second primary or new lesion is now no more curiosity in clinical practice. To one's surprise, the lesions that are assumed to be metastatic have often turned out to be “fresh” lesion or even unrelated benign, granulomatous, inflammatory, or parasitic lesion. This paper analyses 66 patients during a period of 20 years who underwent thoracotomy for such solitary pulmonary lesions, and emphasizes the role of diagnostic-cum-therapeutic-thoracotomy in such a clinical situation where in prethoracotomy tissue diagnosis is not forthcoming.     

Melanoma metastatic to “lipomata”

Three patients presented with solitary melanoma metastases that mimicked a simple “lipomata.” On further investigation each patient had a discrete fatty tissue tumor mass surrounding a melanoma metastasis. The presence of an enlarging mass in patients with a history of melanoma should be viewed with suspicion and a biopsy should be performed.     

Superselective catheterisation with the “Explorer” catheter

An Australian-manufactured, superselective catheter is available for deep catheterisation of target vessels using a coaxial technique. The catheter is compatible with standard micro coils and is able to deliver embolic particles of appropriate size.     

Solitary lung nodule due to dirofilaria immitis (dog “heartworm”)

The filarial parasite Dirofilaria immitis (dog “heartworm”) is the cause of a progressive zoonosis among canine species in the United States; it is rarely transmitted to man, in whom it can present as a solitary lung nodule. There are currently no reliable clinical or radiologic features to distinguish it from other solitary necrotizing granulomas, and thoracotomy is currently the only means of establishing the diagnosis. D. immitis can be identified and properly classified by routine light microscopy despite being immature and partially necrotic. Canine Dirofilariasis may well assume even greater medical importance because of its expanding geographic range and the concomitant increase in the number of cases observed among humans.     

Does “Black” Brain Mean Doom? Computed Tomography in the Prediction of Outcome in Children with Severe Head Injuries: “Benign” vs “Malignant” Brain Swelling

A retrospective review of initial and subsequent CT scans of 179 children who has suffered severe head injury requiring admission to intensive care was performed. The aim was to define the CT appearance which was always associated with a poor outcome. The children whose brain showed poor definition of basal ganglia and grey-white differentiation overall, together with sufficient swelling to obliterate the ambient cistern and third ventricle always died or remained in a vegetative state. Over half of these had reduced brain density, and several had small focal high densities consistent with contusions or petechial haemorrhages. A typical appearance showed homogeneous scans at the levels of the ambient cistern and thalami with no normal internal brain detail. Conversely obliteration of the ambient cistern associated with a large surface collection was compatible with complete recovery if grey-white definition remained normal and treatment was prompt.     

Characteristics of cell lines established from human gastric carcinoma

We report the establishment and characterization of four continuous cell lines derived from human primary and metastatic gastric carcinomas, and we compare their properties with a panel of colorectal carcinoma cell lines previously established and reported by us. Our success rate in culturing gastric carcinomas was relatively low, especially from primary tumors, compared to colorectal carcinoma. These observations may reflect the relatively modest number of gastric carcinoma cell lines established (mainly from Japan), compared to the abundance of colorectal carcinoma lines established worldwide. All four gastric lines expressed the surface glycoproteins carcinoembryonic antigen and TAG-72 and three lines expressed CA 19-9. Two of the lines expressed aromatic amino acid decarboxylase but lacked other markers for neuroendocrine differentiation. All four lines were positive for vasoactive intestinal peptide receptors but lacked gastrin receptors. In addition, two lines expressed receptors for muscarinic/cholinergic receptors but not beta-adrenergic receptors. Cytogenetic evidence for gene amplification was present in the cell lines. All four lines contained varying numbers of double-minute chromosomes. One line, SNU-16, was amplified for the c-myc proto-oncogene and contained four homogeneously staining regions. While c-myc and c-erb-B-2 RNA were expressed by all lines, there was no evidence of amplification or overexpression of several other proto-oncogenes and growth factors. The multiple properties we have described in our gastric carcinoma cell lines are remarkably similar to those found in the panel of colorectal carcinoma cell lines. These properties include morphology, growth characteristics, expression of surface glycoproteins, partial expression of neuroendocrine cell markers, frequent chromosomal evidence of gene amplification, and occasional amplification of the c-myc proto-oncogene. Our four well characterized cell lines should provide useful additions to the modest number currently available for in vitro studies of gastric carcinoma.     

Direct “Metrizamide” Myelocystography in Syringohydromyelia

Metrizamide myelography, followed by CT examination, demonstrated features consistent with syringohydromelia in three patients. One was an adult, male, of 23 years and two were females of 5 and 6 years respectively. Subsequently, metrizamide was introduced into the syrinx by direct needle puncture in each patient. The anatomical details of the syrinx are well demonstrated, continuity of the myelocyst is easily established, and the possibility of communication with the fourth ventricle is readily assessed. The technique is simple and was without complication in these cases. The myelo-graphic and CT findings are also presented. The Arnold-Chiari Type I malformation was present in two patients. The myelocyst did not communicate with the fourth ventricle in two patients. Poor communication was demonstrated in one patient by CT examination immediately after the myelocystogram.     

Macrophage Expression of Interleukin-1 in Lymphoepithelioid Cell (“Lennert's”) Lymphoma

Macrophage activation was studied in three cases of a genuine form of T cell non-Hodgkin's lymphoma particularly rich in epithelioid histiocytes, the so-called “lymphoepithelioid cell lymphoma” or “Lennert's lymphoma”. Host tumor infiltrating macrophages actively produced Interleukin-1 as demonstrated by immunocytochemistry. The activated histiocytes also contained intracytoplasmic tumor cells which were either intact or at various stages of apoptosis. We postulate that in Lennert's lymphoma, tumor cells are capable of activating host macrophages. Initial macrophage activation is followed by IL-1 production with recruitment of additional macrophages accounting for the characteristic histological appearance of this tumor. The activated macrophages are also engaged in a phagocytic antitumoral response. Future studies should investigate if this host response can be potentiated.