Immunologic, Clinicopathologic and Prognostic Features of Lymphoma of the Gastrointestinal Tract

The lymphoma cells of 32 patients with histopathologically provenmalignant lymphomas with gastrointestinal (G-I) tract involvementwere examined for their surface marker characteristics. Twelvecases were diagnosed as primary lymphoma of the G-I tract and20 cases as secondary lymphoma of the G-I tract according toclinical and autopsy findings. Only one of the primary G-I tractlymphomas was identified as T-cell type, seven as B-cell typeand four as surface immunoglobulin (S-Ig)-negative non-T type(defective B-cell type). Ten of the 11 cases of non-T cell typewere histopathologically diagnosed as diffuse large lymphoidlymphoma, and one as diffuse medium-sized or poorly differentiatedlymphocytic lymphoma. This suggests that most primary G-I tractlymphoma would be large lymphoid lymphoma, even if it couldbe found at an early stage. The histopathological diagnosisof one case of T-cell type was controversial lymphocyte depletionof Hodgkin's disease or pleomorphic lymphoma is most probable. Three of the 20 secondary G-I tract lymphomas were identifiedas T-cell type, eight as B-cell type, five as defective B-celltype and four as S-Ig-undetermined non-T cell type. In contrastwith the primary G-I tract lymphomas, all histologic types wereincluded in the secondary G-I tract lymphomas. The period fromonset to G-I tract involvement ranged from four to 88 mo withan average of 32.6 mo. The tumor mass in the G-I tract in B-celllymphoma was usually large enough to be able to be detectedclinically, while a large proportion of the G-I tract lesionsin defective B-cell lymphoma and T-cell lymphoma were so smallthat they were detected only at autopsy. These results suggestthat B-cell lymphoma has a higher incidence of G-I tract involvementand a more pronounced capacity to proliferate in the G-I tractthan defective B-cell lymphoma and T-cell lymphoma. The prognosis for the patients with G-I tract lymphoma variedaccording to the stage at the time of the first examination.All three patients with stage I primary lymphoma of the G-Itract are surviving, while only three of nine patients withstage II or higher are still alive. In the case of secondaryG-I tract lymphoma, although the median survival time of stageI patients was fairly long (66 mo). more than 80% of the patientsdied of the disease. Half of the patients with stage I diseasedied within 6 mo and about 40% of the patients died within 1mo after G-I tract involvement. This indicates that secondaryG-I tract involvement of lynaphoma is a poorer risk factor forprognosis than is primary G-I tract lymphoma.     

Adenosine Deaminase and Purine Nucleoside Phosphorylase Activities of Various Cultured Cell Lines Derived from Human Hematologic Malignancies

The activities of adenosine deaminase (ADA) and purine nucleosidephosphorylase (PNP) in the cytoplasmic fraction of various culturedcell lines derived from human leukemias and malignant lymphomaswere measured and compared in terms of cell lineage and differentiationof these cultured cell lines as based on cell surface markers.Generally, T-cell lines had higher ADA activity. Above all,two lines (P12/1chikawa and MOLT-3) which had the same differentiationmarkers as common thymocyte showed the highest ADA activity.There were no differences in the ADA activity among five non-Tnon-B cell lines, five B-cell lines and five normal B-cell lines.The ADA activity was lower in myeloid cell lines. No significantdifferences in PNP activity among all these cell lines wereobserved. ADA activity may be useful as a differentiation marker of T-celllineage.     

Anti-ATLA (Antibody to the Adult T-Cell Leukemia Cell-Associated Antigen)-Positive Hematologic Malignancies in the Kanto District

Serum or plasma specimens from 278 patients having various hematologicmalignancies or some other diseases were screened for reactivitywith adult T-cell leukemia cell-associated antigen (ATLA). Antibodiesagainst ATLA in cultured MT-1 cells, a line derived from adultT-cell leukemia (ATL), were found in 18 (6.5%) of the total278 patients, but in 10 (34.5%) of 29 patients born in the ATL-endemicarea. The antibodies were also detected in eight (80%) of 10patients with ATL or adult T-cell leukemia/lymphoma (ATLL),and most of them were born in the ATL-endemic area. The antibodies were detected in only eight (3.2%) of 249 patients whowere born in an ATL nonendemic area, but six of the eight patientswere ones with acute leukemia, and they were found to have hadmassive blood transfusions in cluding platelet or granulocytetransfusions. Generally, the patients who received transfusionswere found to have a higher incidence of anti-ATLA than thosewithout transfusions. In particular, in acute leukemia in anATL-nonendemic area, the antibodies were detected in six (21.4%)of the 28 patients who had previous transfusions, but in noneof the 16 not given transfusions. Further more, ATLA reactivityof the sera from the two patients was found to change from negativeto positive in one to three months. During that period, bothpatients had massive platelet or granulocyte transfusions. Theseresults not only confirm Hinuma's initial report on anti-ATLA,but also indicate the rare existence of anti-ATLA-negative patientswho have ATL or ATLL. These facts also suggest that massiveblood transfusions are one of the possible causes of the generationof anti-ATLA in the patients. However, direct evidence to provethis possibility must be sought.     

Inoculation of Rhesus Monkeys with Human Helicobacter pylori: A Long-term Investigation on Gastric Mucosa by Endoscopy

Abstract: To study the pathogenetic role of Helicobacter pylori, colonization of this organism was attempted in conventional rhesus monkeys. After inoculation of human H. pylori to the gastric mucosa of four 10-year-old monkeys, endoscopical and histological examinations were repeated for 10 weeks. The organisms were recovered bacteriologically from all 4 monkeys at the first week, from 3 animals at the 2nd, and from 2 animals at the 6th to 10th week. The endoscopical examination showed only minimum changes in the mucosal appearance such as erythema and erosion due to H. pylori colonization throughout the study. In contrast, the histological examination revealed prominent polymorphonuclear cell infiltration, edema of the mucosa and dissected epithelium at the earlier periods and mononuclear cell infiltration afterwards. The maximum lymphocyte reaction such as clusters or the formation of a thick layer at the bottom of the lamina propria was observed at the 8th week. These results indicated that rhesus monkeys can be infected by human H. pylori resulting in similar pathologic changes in the human stomach, and that this animal model may be useful for future studies.     

Four Cases of T-Cell Malignancy in Childhood

Four cases of T-cell malignancy in childhood are reported. Inthe two older boys (seven [Case 1] and eight [Case 2] yearsold) the disease began as leukemia without a clinically detectablemediastinal mass. However, thymic involvement was found at autopsyin Case 1. Tumor cells of both patients had a rosetteformingcapacity with sheep erythrocytes (ERFC), high terminal deoxynucleotidyltransferase (TdT) activity and a positive acid phosphatase (AcPase)reaction. These findings suggest that the tumor cells of Cases1 and 2 originated from thymic T lymphocytes. The two younger patients (two [Case 3] and three [Case 4] yearsold) had cervical lymphadenopathy with mediastinal mass at onset,followed by leukemic change. The youngest patient (Case 3) lackedERFC and the AcPase reaction, but had C3 Receptor (C3-R), humanT-lymphocyte antigen (HLTA) and TdT activity. These findingsindicate that the tumor cells of Case 3 are compatible withearly thymic T lymphocytes. Tumor cells of Case 4 had ERFC,C3-R, HTLA, and slightly increased TdT activity. These findingssuggest that the tumor cells of Case 4 originated from thymicT lymphocytes. Only one patient has maintained an initial complete remissionfor more than one year. The three others relapsed or had a leukemicconversion within 12 months of the initial remission and twodied within 13 months. This indicates that childhood T-cellmalignancies have a poor prognosis.     

Gastric lipoma successfully treated by endoscopic unroofing

A 64‐year‐old Japanese man was diagnosed with a tumor of the stomach. From the findings of an upper gastrointestinal endoscopy, computed tomography scan and endoscopic ultrasonography, the tumor was suggestive of a gastric lipoma. He was successfully treated by an endoscopic unroofing technique. There remained residual tumor just after unroofing, but it disappeared a month later. There remained only a scar and there has been no recurrence.     

Factors Influencing Transfused Platelet Recovery and Survival, With Special Reference to Antiplatelet Antibody

Factors influencing platelet increment, recovery and survivalwere analyzed in 103 transfusions given to 33 thrombocytopenicpatients, with special reference to the antiplatelet antibodywhich was examined by the mixed passive hemoagglutination methodrecently developed by Shibata et al., (1976). The results demonstratedthat platelet increment, recovery and survival were significantlyreduced in the patients with post-transfusion fever or antiplateletantibody. Platelet recovery seemed to decrease with the increasein the number of HLA mismatched antigens, but the changes inpercent recovery among every HLA mismatched grades were notstatistically significant. The presence of the antiplateletantibody rather than the lymphocytotoxic antibody, HLA mismatchedgrades or post-transfusion fever established the presence ofthe poorer platelet recovery and survival and the more refractorystate. Post-transfusion fever was significantly associated withthe presence of antibodies against platelets and/or lymphocytes.Hemorrhage was arrested after transfusion in 81.1% out of the33 patients that had clinical hemorrhage prior to transfusion,but not in six cases (18.2%), all which had poor platelet recoveryand post-transfusion fever. The detection of antiplatelet antibodyand platelet cross-match test using the mixed passive hemoagglutinationmethod was of primary importance for selecting the adequatedonor for platelet transfusion. Platelet typing must be donein the near future.     

Oil-Depot Type Bleomycin in the Treatment of Malignant Lymphoma in Comparison with Regular Bleomycin

Oil-depot type bleomycin was originally intended to take advantageof not only concentration-dependent action, but also the time-dependentaction of bleomycin to obtain more efficient tumor cell kill.In this study, the effects of oil-depot type bleomycin and regularbleomycin on 81 patients with malignant lymphoma were compared.Both oil-depot type bleomycin and regular bleomycin were equallyeffective against Hodgkin's disease, with a complete remissionrate of 60% (6/10) and 54.5% (6/11), respectively. Non-Hodgkin's lymphoma in advanced stages responded better tooil-depot type bleomycin [complete remission (CR); 35.2% (6/17)]than to regular bleomycin [CR: 10.5% (2/19)]. In addition, thepatients were more responsive to smaller doses of oil-depottype bleomycin than regular bleomycin. Eleven out of 12 (91.6%)patients who responded to oil-depot type bleomycin, went intocomplete remission before receiving 45 mg in total dosage ofbleomycin, while five out of 10 (50%) patients who respondedto regular bleomycin reached complete remission after 60 mgin total dosage was administered. The toxic manifestations of oil-depot type bleomycin were almostthe same in quality and quantity as regular bleomycin. However,the average total dose of oil-depot type bleomycin used wasalmost half of that of regular bleomycin. ^* Present address: Cancer Chemotherapy Center, Cancer ResearchInstitute, Tokyo, Japan. ^** Present address: National Nagoya Hospital, Nagoya, Japan.     

A Case of Heavy Chain Disease

The symptoms and clinical course in a patient suggested malignantlymphoma who was considered to be the tenth case of heavy chaindisease. Postmortem examination revealed that Hodgkin's diseaseof granulomatous type was the most likely diagnosis. Immunochemicaland pathological findings have been described. And the possibilityof the case being a secondary heavy chain disease was discussed.