Case report 761. Acute lymphocytic leukemia.
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Biomedical subjects
Publications and source records attributed to S C Aisner.
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An adamantinoma of the tibia is presented, for which the CT and MRI characteristics are described. Both imaging modalities were excellent in providing information as to the extent and invasiveness of the tumor, although MRI had the advantage of providing immediate high quality sagittal visualization. Comparison is made briefly between adamantinoma and both fibrous dysplasia and osteofibrous dysplasia.
This paper describes a tissue culture and exfoliative cell culture system that enables one to (1) evaluate the adequacy of primary lung carcinoma cultures for cytogenetic analysis, and (2) predict the likelihood of viable cells and type of differentiation present in the primary lung tumor cultures used for cytogenetics. Primary lung carcinomas were established from explant outgrowths and maintained in serum supplemented or serum free media on plastic or basement membrane associated protein coated dishes in order to obtain cells for karyotypic analysis (Miura et al., 1990). The media from these cultures that would ordinarily have been discarded was aspirated at each media change and used to prepare cytocentrifuge cytology preparations. Papanicolaou stained cells from the preparations were evaluated by cytotechnologists in order to assess (1) the cellularity and presence of cancer cells in the sample, (2) cytology preparations of cell and explant outgrowth cultures from primary lung tumors are reliable method for screening and evaluating the suitability of primary lung carcinoma cultures for cytogenetic analysis.
A patient with a history of angioblastic meningioma 7 years previously developed lytic metastatic disease to the femur at two separate sites. The controversy in terminology of angioblastic meningioma and hemangiopericytoma and the similarity in radiological and pathological appearance of primary and metastatic hemangiopericytoma of bone illustrate the need for an accurate clinical history to arrive at a correct diagnosis.
A case of destructive osseous sarcoidosis involving the lower lumbar spine, sacrum, and pelvis has been presented. The pattern of multiple small lytic lesions without sclerosis in this distribution has not been described previously. Identification of these lesions was only possible by computed tomography and differentiation from metastatic disease required open biopsy.
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The present randomized, prospective study was designed to assess whether alternating induction cyclophosphamide, doxorubicin, vincristine-altretamine (hexamethylmelamine), etoposide, and methotrexate (CAV-HEM) chemotherapy is better than standard chemotherapy (CAV) in improving response, survival, and remission time in 577 evaluable patients having extensive-disease small-cell lung cancer (SCLC). In addition, the study was designed to assess the impact of maintenance chemotherapy following a complete response (CR) on the time to progression and survival. The response rates (CR plus partial response [PR]) for CAV-HEM and CAV were 64% and 61%, respectively, but 23% of the patients on CAV-HEM achieved a CR compared with 16% for CAV alone (P = .03). Among complete responders, the continuation of therapy significantly increased the remission time for patients on CAV, while maintenance therapy for patients on CAV-HEM had no significant impact on remission time. However, the increased remission had little effect on survival. Patients on CAV maintenance therapy survived marginally longer than those patients on no maintenance therapy, whereas patients who received CAV-HEM and no maintenance therapy survived longer than those on maintenance therapy. CAV-HEM was associated with significantly higher severity of complications (ie, mainly myelosuppression) than CAV (P = .01). Maintenance chemotherapy was associated with significantly more complications than no maintenance therapy. Patients on CAV-HEM lived significantly longer than those on CAV alone (45.9 weeks v 42.7 weeks; P = .002). Ten percent of patients treated on CAV-HEM survived at least 2 years, compared with 4% on CAV alone. In our study involving patients with extensive-disease SCLC, the alternating induction chemotherapy significantly increased the CR rates and had a small impact on long-term survival compared with the results achieved with standard induction chemotherapy. Moreover, when the alternating induction chemotherapy was used, long-term maintenance chemotherapy was not needed.
Past attempts to subclassify small-cell lung cancer (SCCL) histology (oat cell, fusiform, polygonal, intermediate, etc) have not been useful because of interrater variability and a lack of clinical significance. A review of outcome in a previous series suggested that a different histologic subtype, small-cell/large-cell (SC/LC) conferred an inferior response and survival analogous to the relative chemotherapy and radiation resistance seen in the variant-morphology (SC/LC) cultured cell lines. To evaluate the clinical impact of SC/LC we applied the proposed International Association for the study of Lung Cancer (IASLC) histology subclassification that incorporates the SC/LC category for patients with extensive-disease SCCL entering Eastern Cooperative Oncology Group (ECOG) protocol 1582. All cases were reviewed for eligibility by one pathologist, and all possible SC/LC (variant) plus 10% of all cases were reviewed together with a second pathologist; 577 of the 628 patients who entered were eligible, of whom 550 had histologic material submitted for review and are considered for this analysis. Initial review disclosed 24 cases with SC/LC (4.4%) and 526 with "classic" histology. The second review showed 100% agreement for classic form, but only 11 SC/LC cases with concordance between the reviewing pathologists. Eight of 24 (33%) cases from first review and three of 11 (27%) with concordance on second review achieved complete response (CR) compared with 101 of 526 (19%) for "classic" SCCL (P = .11 and .45, respectively, for the first and second review groups).(ABSTRACT TRUNCATED AT 250 WORDS)
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Desmoplastic fibroma of bone is a rare benign tumor, first described by Jaffe in 1958. Since then approximately 80 cases have been reported in the long bones, although the tumor also involves the jaw bones, particularly the mandible. The plain film features consist of a lytic, expansile lesion, usually in the metaphysis of bone, sometimes extending into the soft tissues. We present two cases involving the long bones in which the correct diagnosis was suggested by computed tomography (CT). The CT appearance of the lesions is described.
Granular cell tumors are uncommon and generally benign lesions that are commonly accepted to be of Schwann cell origin. These tumors occur most frequently in the skin and oral cavity and are generally asymptomatic. However, when signs and symptoms occur, they are relative to the organ or site involved. The histological features are distinct. Surgical resection is curative in almost all cases, with only rare local recurrences. We report a case of symptomatic bilateral granular cell tumors arising in the posterior mediastinum.
Interstitial pneumonitis in sarcoidosis is rare. When present, it confined to areas of active granuloma formation. We report finding widespread interstitial pneumonitis and fibrosis in a patient with sarcoidosis. Due to the focal sampling of pulmonary tissue by transbronchial biopsy, a finding of interstitial pneumonitis does not exclude a diagnosis of sarcoidosis.
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Acquired toxoplasmosis usually is diagnosed serologically. Specific histologic criteria allow for the recognition of this disease in lymph node sections. However, Toxoplasma cysts are rarely seen in nodes. The lymph node from a 15-year-old male with asymptomatic lymphadenopathy was found to have typical histologic features of toxoplasmic lymphadenitis. Toxoplasma cysts were identified and specific serology was confirmatory.
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Granular cell tumors are benign lesions that usually appear in the skin, oral activity, and mucous membrane. Occasionally, they will appear in visceral organs, and cause signs and symptoms similar to those of other organ-related diseases. We studied a patient with granular cell tumors of the common bile duct whose clinical appearance mimicked that of cholecystitis with cholelithiasis. Recognition of granular cell tumors on frozen section will allow surgical resection with probable cure.
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