Biomedical subjects
J J Butler
Publications and source records attributed to J J Butler.
Adult neuroblastoma. Electron microscopic observations in nine cases.
Nine patients, whose ages ranged from 18 to 72, had small round cell neoplasms which were found on electron microscopy to have the ultrastructural features of neuroblastoma. The primary tumor was retroperitoneal in one patient. In another, liver and bone metastases were present and the primary site was not determined. The tumor presented in a peripheral location in the remaining seven patients (leg in two, buttock in one, head and neck in four), and all seven tumors metastasized to regional lymph nodes. One tumor that arose in the nasal cavity displayed olfactory differentiation. Two tumors recurred locally following excision. Although two patients have died from disseminated disease, the prognosis nevertheless appears more favorable than in childhood neuroblastoma. Adequate local excision of a peripheral lesion with close follow-up are indicated.
Malignant lymphoma with a high content of epitheloid histiocytes (Lennert's lymphoma).
Fifteen patients with a rare malignant lymphoma characterized by a high content of epithelioid histiocytes are reported. This lymphoma, referred to as "Lennert's lymphoma," was originally thought to be a variant of Hodgkin's disease, but has both histologic and clinical differences. Although the infiltrate is polymorphous, diagnostic Reed-Sternberg cells are difficult to find and involvement of tonsils relatively common. Lennert's lymphoma bears some resemblance to immunoblastic lymphadenopathy in that some patients have a history of allergies, polyclonal hyperglobulinemia, and all lymph nodes demonstrate variable proliferation of immunoblasts. However, both vascular proliferation and the amorphous eosinophilic interstitial material characteristic of immunoblastic lymphadenopathy are lacking. The clinical course in this series was unpredictable with rapid death in six cases, chiefly from sepsis, 1--18 months following diagnosis despite therapy as for Hodgkin's disease. The remaining eight patients for whom follow-up data are available are in apparent clinical remission. Further cases and investigations are needed to determine the precise behavior of Lennert's lymphoma and to learn its exact status in relation to other malignant lymphomas or immunoblastic proliferations.
Influence of staging celiotomy in localized presentations of Hodgkin's disease.
Staging celiotomy was performed in 139 previously untreated patients with lymphogram negative Stage I and II Hodgkin's disease. Sixteen additional patients received definitive radiotherapy for symptomatic relief of upper torso disease prior to abdominal exploration. The overall incidence of positive abdominal findings for these two groups was 34.5% and 31.2%, respectively. Further analysis of the 139 previously untreated cases revealed notable differences in incidence of positive abdominal findings for stage, presentation, and specific histology. Stage I patients with upper cervical or inguinal presentations or a lymphocytic predominance classification had negative celiotomies, as contrasted with a 43% incidence of positive abdominal findings in patients with supraclavicular presentations. In Stage II disease, the incidence of positive findings was related to the status of the mediastinum. For mediastinal presentations, the incidence was 33.3%, as compared to 48% for nonmediastinal presentations. To date, the number of relapses in celiotomy Stage I and II patients has been low regardless of whether or not prophylactic irradiation was administered to the major lymph-node-bearing regions of the upper and lower torso. Of 9 patients with progression, extranodal spread occurred as the first evidence of new disease in 4 patients. The implication of this finding is considered in a discussion on the influence of staging celiotomy in the management of Stage I and II patients with Hodgkin's disease.
Extranodal non-Hodgkin's lymphomas of the head and neck.
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A clinicopathological study of stages I and II non-Hodgkin's lymphomata using the Lukes-Collins classification.
A series of 226 patients with Stages I and II non-Hodgkin's lymphomata, treated with intensive irradiation to the involved regions, were studied using the Lukes-Collins classification. A statistically significant difference was found in the length of survival of patients with the follicular and the diffuse types of lymphoma. A difference in survival was also observed among those with the 3 subtypes of follicular lymphomata. The extent to which the follicular pattern could be recognized and whether or not lymphoma cells were confined to the follicular structures likewise had a bearing upon the survival of patients with follicular lymphomata. In this series, no significant difference in survival was found between the histological types of diffuse lymphoma. The relationship of the methods of staging to survival in this series, and the findings at staging laparotomy in other series suggest that the lymphangiogram is less valuable for detecting intra-abdominal disease in the non-Hodgkin's lymphomata than in Hodgkin's disease, probably because of the high incidence of involvement of mesenteric lymph nodes in the non-Hodgkin's lymphomata.
The natural history of non-Hodgkin's lymphomata stages I and II.
Progress in the management of non-Hodgkin's lymphomata has been impeded by lack of information on the natural history of these diseases. Confusion about the significance of histopathology, extranodal presentations and routes of spread renders much of previously published data relatively uninterpretable. To evaluate the relative prognostic significance of presentation, histopathology and lymphography, a retrospective study was undertaken on 226 patients with Stage I and II disease, who were treated with intensive irradiation to the involve regions. The slides on these patients were reviewed and reclassified in terms of the Rappaport system. The results of this study demonstrated that a nodular histopathological pattern was the most important prognostic factor. The significance of this finding and other factors are discussed in terms of possible new approaches to treatment.