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Genetic mechanisms in cancer predisposition: report of a cancer family.

A family is described in which four children developed cancer affecting different organs:lymphoma, meningeal sarcoma, osteogenic sarcoma, and adenocarcinoma of the cecum. Since there was only one other case of cancer in previous generations of this family, an hypothesis is put forth to explain this unusual aggregation on the basis of recombination of common genes. It is postulated that each parent carried a different combination of genes which, though not associated with increased cancer predisposition in the combinations in which they were present in the parents, due to independent assortment resulted in a combination producing cancer susceptibility in half of the offspring. Such genetic loci could include factors similar to an oncogene which is normally held in control by genes at another locus; thus the dominant oncogene without the dominant controlling genes would make for cancer susceptibility, while the controlling genes without the oncogene would be associated with cancer resistance since two mutations would then be required for malignant development. To explain the occurrence of lymphoma in one of the children in this family, a third set of genes is included in this model--genes affecting immunocompetence, in which the normal allele is dominant. This three locus model has the advantage of being able to explain not only the occasional cancer family, but also the distribution of cancer susceptibility and resistance in the general population.

Adenocarcinoma

Nuclear DNA polymerases of human carcinomas.

Comparisons have been made of the DNA polymerases of normal human lung and cecum, primary carcinomas of human lung, breast, and cecum, and resting and regeneration rat liver. The picture for the normal human tissues is similar to the one for unstimulated rat liver, that for the human carcinomas resembles regenerating rat liver. The human tissues contain two polymerases with sedimentation coefficients of about 3 and 7 S, the enzymes are restricted to the nucleus, and the specific activities of the 7 S polymerase, but not of the 3 S enzyme, are elevated in the cancers. Just as with the regenerating rat liver polymerases, the 3 S activity of a bronchogenic carcinoma is unaffected by cytosine arabinoside 5'-triphosphate and only little reduced by novobiocin, whereas DNA synthesis by the 7 S enzyme is abolished by both compounds. A variety of other inhibitory agents have similar effects on the 7 S polymerases of the human carcinomas and regenerating rat liver.

Animals

Metastatic tumors of the foot.

Four metastatic tumors of the foot, of colonic, renal and humeral origin, are described. They involved three calcanei and two tali. All four patients died within a few months after the appearance of metastasis to the foot. Bony destruction, pain, and swelling can closely resemble the clinical signs and symptoms of osteomyelitis. Diagnostic roentgenograms must be obtained to rule out the possibility of metastatic disease, and biopsies are usually required for accurate diagnosis.

Adenocarcinoma

Ileocecal masses discovered unexpectedly at surgery for appendicitis.

During the past five years we have encountered 15 patients who were found to have an ileocecal mass of undetermined etiology when explored through a right lower quadrant incision for presumed appendicitis. Diverticulitis of the ileocecal region accounted for almost one-half of these lesions. There are many possible etiologies for mass lesions in this location, but beacuse malignancy cannot be excluded at operation, a right hemicolectomy is advised. We found that this procedure could be done with relative safety in unprepared bowel under emergency conditions.

Adolescent

Carcinoembryonic antigen concentrations in undiagnosed patients.

Serum carcinoembryonic antigen (C.E.A.) levels were measured in 381 undiagnosed patients who presented with clinical problems commonly associated with gastrointestinal malignancy. The results were compared with the final diagnosis after follow-up for up to 5 years to see whether C.E.A.-testing added any useful information. Of 307 patients presenting with upper gastrointestinal symptoms, lower gastrointestinal symptoms, or irom deficiency anaemia, C.E.A. levels greater than 20 ng/ml indicated malignancy in 5 but in 3 of these malignancy was also diagnosed after routine investigation. Of 74 patients presenting with obstructive jaundice, hepatomegaly, or abnormal liver function, malignancy was diagnosed in 38. In 9 of these patients the diagnosis of malignancy could otherwise have been reached only by laparotomy. The serum-C.E.A. thus reached only by laparotomy. The serum-C.E.A. thus seems to be of value in the assessment of liver disease but not in patients with gastric or colonic symptoms or iron-deficiency anaemia.

Anemia, Hypochromic

Pseudolymphoma presenting as a cecal tumor.

A 7-yr-old with abdominal pain and melena had a barium enema which revealed a cecal lesion that proved to be a pseudolymphoma of the cecum and appendix--a site not previously reported.

Appendiceal Neoplasms

Investigation of a family suspected of being at high risk for cancer.

The investigation of the family of a patient with bilateral breast cancer is described. By means of interviews and the checking of hospital records and death certificates, information was obtained on 199 family members over five generations, 19 of whom had cancer. Comparison with expected numbers of cases showed an excess in only one generation. The interpretation of these findings and the advice given to family members are discussed.

Adult

Transhepatic percutaneous cholangiography.

Transhepatic percutaneous cholangiography continues to be a significant tool in the diagnosis of jaundice. It allows direct, easily achieved graphic delineation of the biliary system. Although specific diagnosis may not be possible, the site and extent of obstruction and the differentiation from intrahepatic parenchymal disease may be determined with a high degree of success.

Adenocarcinoma

Mantle zone lymphoma in a gastric glomus tumor.

A 61-year-old man had an ileocolectomy for resection of an obstructing lesion of the terminal ileum, which proved to be a mantle zone variant of intermediate lymphocytic lymphoma. At laparotomy, an intramural nodule in the gastric antrum was observed; on resection, this was found to be a typical gastric glomus tumor, focally infiltrated by lymphoma. This combined tumor has not been described previously, to the knowledge of the authors, and could be misdiagnosed easily, although both components should be considered in the differential diagnosis of small cell gastric neoplasms and can be identified readily by immunohistochemical studies.

Actins

Arteriography in malignant neoplasms of the bowel.

Eighty patients with gastrointestinal bleeding were investigated by angiography over a four-year period. Nine had malignant neoplasms of the bowel. Inconspicuous neovascularity was the most constant finding, best seen in leiomyosarcoma of the small bowel and adenocarcinoma of the colon. Neovascularity was not seen in a patient with reticulum cell sarcoma of colon detected by extravasation. When other studies including endoscopy and barium examinations have failed to explain acute or chronic bleeding, an appreciable number of intestinal neoplasms may be demonstrated by arteriography.

Adenocarcinoma