Duodenal lymphangitis carcinomatosa: Endoscopic characteristics and clinical significance

Background and Aim: Duodenal lymphangitis carcinomatosa has been sporadically described, but so far little attention has been paid to duodenal lymphangitis carcinomatosa. Methods: Four cases with duodenal lymphangitis carcinomatosa were endoscopically and histologically examined. Results: The four cases exhibited multiple polypoid lesions along the Kerckring's folds and/or were covered by characteristically granular, non‐ulcerated mucosa upon thickening. The granularity seems to been caused by dilated lymph vessels containing the carcinoma cells. The lesions were microscopically characterized by: (i) involvement of lymph vessels located in the upper portion of the lamina propria; (ii) no inflammatory changes; and (iii) no desmoplastic changes. Primary sites were thought to be the stomach in case 1, the pancreas in cases 2 and 4, and unknown in case 3. All patients died within 6 months after admission or endoscopic examination. Conclusions: As duodenal lymphangitis carcinomatosis shows characteristic endoscopic appearance, endoscopic diagnosis is not difficult. We should realize that the lesion represents extremely poor prognosis, and it should be distinguished from ordinary metastatic duodenal carcinoma.     

消肿乳糜清系列制剂治疗乳糜尿和淋巴水肿的临床研究

目的探索乳糜尿、淋巴水肿和慢性淋巴管／结炎等疑难疾病的最佳治疗药物。方法研制应用消肿乳糜清口服液、生药片剂、较大剂量生药片剂和浸膏胶囊剂治疗丝虫性和其它病因的乳糜尿、乳糜血尿315例,研制应用消肿乳糜清注射液、口服液、生药片剂和浸膏胶囊剂治疗各种病因的淋巴水肿（象皮肿）和淋巴水肿合并淋巴管／结炎者分别为341例、313例。结果经1～7个月治疗后总有效率为93．48％～100％,其中乳糜尿、淋巴水肿和淋巴管／结炎的治愈率（淋巴水肿为基本治愈和显效率）分别为98．11％、73．91％和95．85％。治疗期间和疗毕后1～5年观察,95％以上的患者疗效稳定,亦未发现明显的毒副反应。而对照组（乙胺嗪治疗组）治疗前后无显著统计学差异（P〉0．05）。结论该药是目前乳糜尿、乳糜血尿、肢体淋巴水肿（象皮肿）和慢性淋巴管／结炎患者理想的天然治疗药物。     

四种方法治疗慢性淋巴水肿、淋巴管（结）炎的比较研究

目的应用四种常用方法,比较治疗慢性淋巴水肿和淋巴管（结）炎的疗效。方法采用音频电疗结合绑扎、桑叶注射液结合绑扎、香豆素、消肿乳糜清制剂分组治疗。结果音频电疗结合绑扎、桑叶注射液结合绑扎、香豆素、消肿乳糜清制剂组对慢性淋巴水肿疗后基本治愈和显效率分别为36．36％、68．75％、41．07％和61．78％,对慢性淋巴管结炎的治愈率分别为54．17％、83．33％、69．64％、95．85％。结论消肿乳糜清制剂是慢性淋巴水肿、淋巴管（结）炎患者最理想的天然治疗药物。     

七种方法治疗淋巴水肿和淋巴管（结）炎疗效的对比观察

目的探讨慢性淋巴水肿合并淋巴管（结）炎保守治疗的最佳方法。方法采用音频电疗和桑叶注射液结合绑扎患肢分别治疗56和37例；应用香豆素与消肿乳糜清注射液、口服液、片剂、浸膏胶囊制剂在不结合绑扎患肢及其它任何辅助疗法的情况下，分别治疗56、49、116、131和45例。结果在2种结合绑扎患肢的疗法中，以桑叶注射液结合绑扎患肢疗法效果更好；在不结合绑扎患肢的后5种疗法中，以消肿乳糜清片荆和消肿乳糜清浸膏胶囊疗效最佳。结论消肿乳糜清系列制剂，尤其是浸膏胶囊制剂是目前慢性淋巴水肿合并淋巴管（结）炎患者的更理想的治疗药物。     

Blue Lymphangitis of the Breast after Breast Cancer: Case Report

Carcinomatous lymphangitis accounts for 5% of all skin metastases, but blue lymphangitis of the breast has never been described. We report a case of blue lymphangitis of the breast in a patient 11 years after treatment for ipsilateral breast cancer that was in full remission. Breast examination and imaging showed no other abnormalities. Skin biopsy revealed a carcinomatous‐pigmented infiltration corresponding to melanoma metastasis, which helped highlight a primitive right flank injury. This case report emphasizes that a full body exam should always be performed with unusual presentation of breast cancer and reiterates the indispensable place of histology before any diagnosis.     

Cytotoxic-mediated spontaneous regression of inflammatory cutaneous metastases of breast carcinoma

Spontaneous regression (SR) of cancer is a rare but well-documented biological phenomenon, which is even rarer in the context of metastatic breast carcinoma. Different mechanisms of SR are still under debate, including immune-mediated response. We herein report a case of the SR of intralymphatic cutaneous metastases of a breast carcinoma with spontaneously-induced T-cell-mediated cytotoxic response. An 86-year-old female was diagnosed with locally advanced right breast carcinoma and axillary lymph node metastases, without distant metastases The patient refused any therapy. Six months afterwards, she developed multiple, asymptomatic purpura-like plaques with prominent teleangectasias on her right chest wall, continuous to the previous surgical scar and on her ipsilateral abdomen. Skin biopsy showed aggregates of atypical cells admixed with erythrocyte thrombi within dilated dermal lymphatic vessels. SR of the cutaneous lesions occurred within 6 months and persisted at the 15 months follow-up in the absence of therapy, whilst no signs of internal relapse were observed. Immunohistochemically, the estrogen-negative, CK7-positive, C-erb B2-positive intralymphatic metastases were associated with extensive infiltration of CD8-positive cytototoxic T lymphocytes. Factors that may have precluded the implantation of intralymphatic metastases leading to SR are discussed, with local immune surveillance being one major hypothesis.     

Rickettsia mongolotimonae infection in South Africa

We report the first laboratory-confirmed case of Rickettsia mongolotimonae infection in Africa. The patient sought treatment for an eschar on his toe; lymphangitis, severe headaches, and fever subsequently developed. After a regimen of doxycycline, symptoms rapidly resolved. R. mongolotimonae infection was diagnosed retrospectively by serologic tests and molecular-based detection of the organism in biopsy specimens of eschar material.     

Establishment of highly metastatic tumor clones derived from a skin squamous cell carcinoma (SqC-NH), D-1 and F-3, with distinct features of pulmonary metastases

We have established two highly metastatic tumor clones, D-1 and F-3, which have the distinct features of undergoing pulmonary metastases. Both clones were derived from a skin squamous cell carcinoma (SqC-NH), which had spontaneously occurred in DS-Nh mice. F-3 was morphologically spindle-shaped in tumor mass and adherent in culture, while D-1 was round and non-adherent. In in vitro growth, there was no significant difference between them. When the clonal tumor cells were implanted intradermally into syngeneic mice, however, the growth of D-1 was slower than that of F-3. As for the metastasic ability, both D-1 and F-3 were highly metastatic compared with the original tumor. Interestingly, the pulmonary metastases of these two clones were apparently different. In F-3-bearing mice, some round nodules were detected and no tumor cells were seen in the surrounding area around the nodules (nodule-type). In contrast, D-1 cells had initially grown from the periphery of lobes, and interstitially infiltrated the lung parenchyma area without forming nodules (diffuse-type) and the appearance was similar to lymphangitis carcinomatosa. Histologically, a remarkably smaller number of metastatic foci formed around the blood vessel for D-1 as compared with F-3. It should also be noted that some localized nodules (nodule-type both visually and histologically) were seen in the lung, when D-1 cells were inoculated in the tail vein. In addition, D-1 showed markedly higher lymphatic metastasis than F-3. These observations show that the pulmonary metastases of D-1 and F-3 differ in the mechanisms underlying the processes of tumor dissemination. We suppose a possibility that D-1 may preferentially metastasize via the lymphatics and F-3 may metastasize via the bloodstream.     

山东省基本消灭丝虫病后晚期丝虫病发病情况调查

1984～1988年,在原丝虫病严重流行的滕县、邹县等6个县(市)的252个村庄,发现的丝虫病人1038例中,象皮肿383例,乳糜尿357例,鞘膜积液298例。1983年前发病902例(86.9％);1984年后发病136例(13.1％),其中新发现乳糜尿患者125例,占新发病人的91.9％。结果表明,山东省基本消灭丝虫病后,已基本控制了象皮肿和鞘膜积液的发生,但仍继续出现乳糜尿新病人.因此在基本消灭班氏丝虫病的地区,应重点研究控制新病人和治愈原有病人的有效方法。