Large Cell Type Research Articles

Head and neck manifestations of non-Hodgkin's lymphoma in human immunodeficiency virus-infected patients

Non-Hodgkin's lymphoma is the 2nd most common malignancy in human immunodeficiency virus (HIV)-infected patients. However, limited information regarding head and neck manifestations of non-Hodgkin's lymphoma is present in the literature. The aim of this article is to describe the head and neck manifestations of non-Hodgkin's lymphoma in HIV-infected patients and compare it with that seen in noninfected patients. A case-control study was performed including 124 patients with non-Hodgkin's lymphoma presenting over a 5.5-year period to tertiary care center in a metropolitan location. Overall, the anatomic distribution of non-Hodgkin's lymphoma is not altered in the presence of HIV infection with the head and neck region (63%) most often involved overall. However, within the head and neck region, extralymphatic disease is significantly more common in HIV-infected patients (59%) than noninfected patients (33%; P = .001). Central nervous system (CNS) involvement accounts for 41% of head and neck non-Hodgkin's lymphoma in HIV-infected patients, in contrast to only 12% of noninfected patients. High-grade lymphoma (68%) are more common than intermediate (30%) or low-grade disease (2%) in the HIV-infected population, whereas low (24%) and intermediate (60%) grades are more common than high-grade lymphoma (16%) in noninfected patients (P < .001). The large cell immunoblastic type (48%) is the most common subtype in HIV-infected patients, whereas diffuse large-cell type (32%) was most common in HIV-negative patients (P < .05). Survival is significantly poor for HIV-infected patients (P < .05). The impact of HIV infection on survival remain significant even after controlling for the effects of confounding factors. Head and neck involvement with non-Hodgkin's lymphoma occurs in a significant number of HIV-infected patients. Our data show that the distribution and course of non-Hodgkin's lymphoma is unique in HIV-infected patients. A high level of suspicion for non-Hodgkin's lymphoma is required in all cases of head and neck lesions in patients with HIV infection to facilitate management.

Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms.

Atypical histologic variants of focal nodular hyperplasia have been reported and are sometimes difficult to recognize. To characterize the morphologic spectrum of focal nodular hyperplasia, we studied 305 lesions surgically resected from 168 patients. Clinicomorphologic correlations were established by statistical analyses. The patients included 150 women and 18 men (sex ratio, 8:1; median age, 38 years). One hundred twenty-eight (76.2%) patients had solitary lesions, and 40 (23.8%) had 2 to 30 lesions. All 305 lesions measured 1 mm to 19 cm in diameter. Only 49% of these lesions had one to three macroscopic scars. Histologically, 245 (80.3%) lesions were of classical form, and 60 (19.7%) lesions were nonclassical. The latter were classified as focal nodular hyperplasia of telangiectatic form (47 lesions), of mixed hyperplastic and adenomatous form (five lesions), and with atypia of large cell type (eight lesions). Several benign or malignant tumors were found in association with these lesions. This large retrospective series of focal nodular hyperplasia shows the relative incidence of its classical and nonclassical forms. The absence of a central scar could explain the difficult preoperative diagnosis of some of the cases. The morphologic diagnostic criteria in this study require further prospective evaluation.

Expression of p53 and retinoblastoma gene in high-grade nodal peripheral T-cell lymphomas: immunohistochemical and molecular findings suggesting different pathogenetic pathways and possible clinical implications

The expression of p53 and the retinoblastoma gene has been investigated by immunohistochemical and molecular analysis in 45 cases of nodal peripheral T-cell lymphoma with high-grade histology. Most cases (73.3 per cent) were primary nodal lymphomas without any extra-nodal site involvement. Most of them (75.6 per cent) were histologically classified as pleomorphic, small, medium, and large cell type. Immunohistochemistry detected p53 in nine cases (20 per cent). In each of these cases, the polymerase chain reaction (PCR)/heteroduplex analysis did not show the presence of mutations, this finding being consistent with an alteration of the p53 functional pathway, in the presence of a wild-type protein. The retinoblastoma gene product was detected by immunohistochemistry in 35 cases (77.8 per cent) and not detected in ten cases (22.2 per cent). In the latter cases, the reverse transcription (RT)-PCR analysis showed the presence of a specific retinoblastoma gene transcript in six cases and was negative in the remaining four cases. The immunohistochemical and molecular findings seem to be consistent with abnormalities of retinoblastoma gene expression at either the transcriptional or the post-transcriptional level. Since all nine p53-positive cases by immunohistochemical analysis were also retinoblastoma gene product-positive, and all ten retinoblastoma gene product-negative cases were also p53-negative, two different and mutually exclusive pathways of possible pathogenetic significance may be suggested, the former involving abnormalities of the functional pathway of p53 in the absence of mutations and the latter abnormalities of retinoblastoma gene expression at the transcriptional and/or post-transcriptional level. Finally, the clinico-pathological correlations showed that p53 immunohistochemical expression is significantly associated with a poorer response to intensive chemotherapy.

Expression of p53 and retinoblastoma gene in high-grade nodal peripheral T-cell lymphomas: immunohistochemical and molecular findings suggesting different pathogenetic pathways and possible clinical implications.

The expression of p53 and the retinoblastoma gene has been investigated by immunohistochemical and molecular analysis in 45 cases of nodal peripheral T-cell lymphoma with high-grade histology. Most cases (73.3 per cent) were primary nodal lymphomas without any extra-nodal site involvement. Most of them (75.6 per cent) were histologically classified as pleomorphic, small, medium, and large cell type. Immunohistochemistry detected p53 in nine cases (20 per cent). In each of these cases, the polymerase chain reaction (PCR)/heteroduplex analysis did not show the presence of mutations, this finding being consistent with an alteration of the p53 functional pathway, in the presence of a wild-type protein. The retinoblastoma gene product was detected by immunohistochemistry in 35 cases (77.8 per cent) and not detected in ten cases (22.2 per cent). In the latter cases, the reverse transcription (RT)-PCR analysis showed the presence of a specific retinoblastoma gene transcript in six cases and was negative in the remaining four cases. The immunohistochemical and molecular findings seem to be consistent with abnormalities of retinoblastoma gene expression at either the transcriptional or the post-transcriptional level. Since all nine p53-positive cases by immunohistochemical analysis were also retinoblastoma gene product-positive, and all ten retinoblastoma gene product-negative cases were also p53-negative, two different and mutually exclusive pathways of possible pathogenetic significance may be suggested, the former involving abnormalities of the functional pathway of p53 in the absence of mutations and the latter abnormalities of retinoblastoma gene expression at the transcriptional and/or post-transcriptional level. Finally, the clinico-pathological correlations showed that p53 immunohistochemical expression is significantly associated with a poorer response to intensive chemotherapy.

Dedifferentiation occurring in adenoid cystic carcinoma of the tongue

A 61-year-old man came to the University of Granada School of Dentistry complaining of a mass involving his ventral tongue. Histopathologic examination of the excised specimen showed adenoid cystic carcinoma in which cribriform and tubular patterns were observed, juxtaposed with an undifferentiated carcinoma, large-cell type. No cervical lymph node metastasis was present, and the patient is alive and free of disease 5 years after treatment. To our knowledge, no similar cases have been reported thus far, though other salivary gland malignancies have been described in association with undifferentiated carcinoma, especially in the parotid gland. These neoplasms have been highly aggressive, and the adequacy of the primary surgical resection may be critical in determining the ultimate prognosis and survival. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:177-80)

Expression of cyclin D2 and D3 in lymphoid lesions.

The D-type cyclins, involved in the regulation of G1 progression of the cell cycle, are expressed in a lineage-specific manner. Normal hematopoietic cells express cyclin D2 and/or D3. In order to determine whether their expression pattern changes in lymphoid tumors, we examined cyclin D2 and D3 expression in non-neoplastic and neoplastic lymphoid lesions, using a sensitive immunohistochemical amplification method. Centroblasts in lymphoid follicles of reactive lymph nodes expressed exclusively cyclin D3 and no D2. Interfollicular areas contained scattered cyclin D3 and D2 positive cells. By double staining, cyclin D3 was detected in CD79a positive B cells, CD3 positive T cells and CD68 positive macrophages. Cyclin D2 was present only in CD3 positive T cells. Neoplastic lymphoid lesions included 33 B cell lymphomas, 9 T cell lymphomas and 12 Hodgkin's lymphomas. The B cell lymphomas comprised 9 follicular lymphomas (FL), 1 Burkitt lymphoma (BL), 22 diffuse large cell lymphomas (DL) and 1 chronic lymphocytic leukemia (CLL). All 9 FLs and the single BL expressed exclusively cyclin D3, similarly to germinal center B cells, that represent their cells of origin. Six DLs expressed both cyclin D2 and D3, while 6 expressed only D3. Among the 9 pleomorphic T cell lymphomas, medium and large cell type, 5 expressed cyclin D2. Cyclin D3 was also detected in scattered cells in 4 of 9 cases and was highly expressed in 2 of 9 T cell lymphomas. The majority of Hodgkin's lymphomas expressed both cyclin D2 and D3 in Hodgkin/Reed-Sternberg (HRS) cells. The high frequency of positive cells indicates that both cyclins were expressed in the same cells.

Author reply

We read with great interest the letter by Imashuku et al. regarding our recent description of hemophagocytic syndrome with Epstein–Barr virus (EBV) negative B-cell lymphomas.1 Although we could not differentiate the pattern of hypercytokinemia among the data in our hands, Imashuku et al. observed significantly higher levels of serum interferon-γ (IFN-γ) concentrations in T-cell lymphoma-associated hemophagocytic syndrome (T-LAHS) when compared with B-cell lymphoma-associated hemophagocytic syndrome (B-LAHS). The result was extracted from the huge accumulation of their data regarding hemophagocytic syndrome (HPS).2-4 The majority of their T-LAHS cases were EBV-related, whereas B-LAHS cases were not. Although we should be careful concerning the age difference, their observation provides an important clue in understanding the difference in the pathogenesis of HPS between T-LAHS and B-LAHS. In B-LAHS cases, as well as angioimmunoblastic lymphadenopathy with dysproteinemia and pleomorphic T-cell lymphoma of angioinvasive type in T-LAHS, a histologic predisposition may exist. The majority of histologically proven cases are intravascular lymphomatosis.1, 5 These are followed by T-cell rich B-cell lymphomas and those simply documented as diffuse large cell type. Thus, nearly all B-LAHS cases are considered to constitute a unique subtype of diffuse large B-cell lymphomas. It is interesting to note that, in this subtype, many reactive cells, including lymphocytes, histiocytes, and endothelial cells, are intermingled with systemically disseminated but relatively few neoplastic cells. In such a case, hypercytokinemia in B-LAHS may not be ascribed to the neoplastic cells themselves. Conversely, interleukin (IL)-2 and IL-6 are well known to be B-cell helper factors that also are elaborated by B cells themselves. Although INF-γ may exhibit some helper activity and delay apoptosis of CD5 positive chronic lymphocytic leukemia cells, evidence that B cells produce IFN-γ has not been accumulated.6, 7 Thus, we assume that intervening, reactively activated, nonneoplastic T cells may be responsible for the induction of B-LAHS, in which the magnitude of increased INF-γ is relatively low compared with T-LAHS, as Imashuku et al. have described. Tatsuharu Ohno M.D.*, * Division of Hematology and Immunology Department of Internal Medicine Ohtsu Red Cross Hospital Shiga, Japan

Gastric Lymphoma.

The approach to the management of gastric lymphoma must begin with a precise pathologic diagnosis based on histologic examination and immunophenotyping, at a minimum. This should be followed by detailed staging procedures that include endoscopic ultrasonography (EUS). Most primary gastric lymphomas are low-grade Mucosa-Associated Lymphoid Tissue (MALT) or large-cell (high-grade) types. The treatments for these differ. For low-grade MALT lymphomas confined to the stomach, an attempt at eradication of Helicobater pylori is the first choice. If the patient does not have H. pylori, if eradication is unsuccessful, or if the disease stage is II1(E), radiation therapy is the next approach. Chemotherapy is the best option for disease that is stage II2(E) or higher and for disease that does not respond to antibiotics and radiation. Surgery should be reserved for patients with localized disease who do not respond to these other therapies. In patients with clinical stage I(E) large-cell lymphomas, there are valid arguments for and against the use of both surgery and stomach-sparing therapy. Surgery alone (if disease is pathologic stage I(E)) or surgery followed by chemotherapy (for disease that is pathologic stage II or higher) has more data defining expected outcomes. Recently published experience indicates that chemotherapy plus radiation therapy may be an acceptable alternative to surgery. The entire clinical picture and the patient's preferences must play a role in this difficult management decision. Chemotherapy is the clear first option in patients with disease that is stage II or higher. Local radiation therapy should be added in selected cases with residual local disease or bulky tumor.

Malignant lymphoma of the gastrointestinal tract

AimsThe gastrointestinal tract (GIT) is the most common site of extra-nodal lymphoma. Most of these lymphomas arise from mucosa associated lymphoid tissue (MALT). We attempt in this study to define the natural history and treatment outcome of this type of lymphoma.MethodsWe carried out a retrospective study of patients presenting at our centre with histopathological diagnosis of primary GIT lymphoma between 1990 and 1994.ResultsEqual numbers of cases of stomach and small bowel lymphoma were found. Vomiting and feeling of fullness were the two most common presenting symptoms. Large cell type and high grade tumours were found to be the commonest histological types. All the patients were treated with surgery followed by chemotherapy. A 5-year disease-free survival (DFS) rate of 73% was observed with a confidence interval of 0.65–1.35. Survival in stomach cancer was 73.5% (95% CI 0.26–1.74) while it was 76.4% in small bowel tumours (95% CI 0.54–1.46). The difference in survival was not statistically significant.ConclusionsAlthough there is no consensus regarding treatment of primary GI lymphoma, surgery and adjuvant chemotherapy yield good survival.

A Family of the Super High Frequency of ATL

P140 We report a very rare case of a family with acute adult T-cell leukemia (ATL) in all six siblings. Sibling I; 77 yr. female. She developed lymphadenopathy and skin lesion in November, 1989. Anti-HTLV-I (+). Her white blood cell (WBC) count was 100,000/μl, and 95% of them were ATL cells (CD3+4+8−) with convoluted nuclei. Pathology of the lymph node (LN) revealed non-Hodgkin's lymphoma (NHL), diffuse, pleomorphic type. Sibling II; 72 yr. female. She noticed lymphadenopathy in July, 1988. Anti-HTLV-I (+). Her WBC count was 3,200/μl and 10% were ATL cells with indented nuclei. Pathology of the LN showed NHL, diffuse, pleomorphic type (T cell). Sibling III; 60 yr. female. She had lymphadenopathy in 1982. Test for anti-HTLV-I antibodies was not done. A large number of abnormal lymphocytes with convoluted nuclei appeared in the blood. Pathology of the LN revealed NHL, diffuse, medium type. Sibling IV; 64 yr. female. She had lymphadenopathy in Feburary, 1988, and multiple skin tumor occurred in her clinical course. Anti-HTLV-I (+). Her WBC count was 7,700/μl, and 33% were ATL cells with convoluted nuclei. Pathology of the skin tumor revealed NHL, diffuse, pleomorphic type (CD2+3−4+25+30+). Sibling V; 62 yr. male. He had lymphadenopathy in the abdominal cavity and ascites. Test for anti-HTLV-I antibodies was not done. His WBC count was 68,700/μl, and 84% were abnormal lymphocytes. Pathology of the LN was NHL, diffuse, large cell type (T cell). Sibling VI; 48 yr. male. He was admitted to hospital because of cough and dyspnea in 1978. He had lymphadenopathy. His WBC count was 49,600/μl and 90% were abnormal lymphocytes with convoluted nuclei. Other examinations about ATL were not tested. Although examinations about HTLV-I in III, V and VI were not tested, these three cases were highly suspected of acute ATL due to their clinical manifestations and blood pictures. The super high frequency of ATL in the siblings may show this family members have disposition of ATL.

Frequency of CD43 expression in non-Hodgkin lymphoma. A survey of 742 cases and further characterization of rare CD43+ follicular lymphomas.

CD43 expression on B cells is an immunophenotypic feature suggestive of malignancy. In the light of its diagnostic importance, we performed a comprehensive survey of CD43 expression in various types of non-Hodgkin lymphoma (NHL) and determined the frequency of its expression in routinely fixed paraffin-embedded tissues. Tissue sections in 742 cases of NHL, pretreated by the heat-induced epitope retrieval technique, were immunostained using an anti-CD43 antibody. Three categories of CD43 positivity were found: (1) more than 90% of T-cell lymphoma, mantle cell lymphoma, B-cell small lymphocytic lymphoma, and Burkitt lymphoma cases were positive; (2) 20% to 40% of nodal and extranodal marginal zone lymphoma (MZL), diffuse large B-cell lymphoma, Burkitt-like B-cell lymphoma, and lymphoplasmacytoid lymphoma cases were positive; and (3) 0% to 6% of primary splenic MZL and various types of follicular lymphoma cases were positive. Most CD43+ follicular lymphomas were predominantly large cell type with focally diffuse areas; their follicular center cell origin in 4 of 8 cases was supported by the presence of CD10 immunoreactivity and/or t(14;18) fusion gene product. CD43 is frequently detectable in a subset of B-NHL, and, thus, it seems to be a highly sensitive marker for these tumors. CD43 also may be a useful marker for classifying B-cell NHLs by virtue of its differential expression in these tumors.

Lymphoma presenting as a solitary bone lesion.

Primary lymphoma of bone has characteristic clinical and radiologic manifestations; however, its histologic features and clinical outcome show considerable variability. The histologic and immunophenotypic features of 13 adult patients with lymphoma as a solitary bone lesion were compared with clinical outcome. All tumors studied were non-Hodgkin lymphoma of anaplastic or large cell type and included B-cell (9 cases), T-cell (3 cases), and null cell (1 case) phenotypes. All patients responded well initially to systemic chemotherapy (with or without radiotherapy); however, disease in 6 patients progressed or recurred, and 5 patients died of disease. Local disease progression was seen in 2 patients, with 4 patients experiencing relapse at distant sites. Expression of CD30, present in 7 cases, was associated with an anaplastic or large noncleaved histologic appearance. Absence of CD30 expression characterized 6 cases, including 4 with multilobate or cleaved morphologic features. Five of 6 cases that recurred were associated with CD30 expression, including 3 with anaplastic features. The 4 tumors with cleaved or multilobate nuclear morphologic features were associated with long disease-free survivals and may represent a distinct lymphoma subtype with a good prognosis.

Diagnosis and prognosis of neuroendocrine tumours of the lung by means of high resolution image analysis.

Neuroendocrine tumours (NET) of the lung are divided in subtypes with different malignant potential. The first is the benign or low‐grade malignant tumours, well‐differentiated, called typical carcinoids (TC) and the second is the high‐grade malignant tumours, poorly differentiated of small (SCLC) or large cell type (LCLC). Between these tumour types lies the well‐differentiated carcinoma with a lower grade of malignancy (WDNEC). In clinical routine it is very important with regard to prognosis to distinguish patients with low malignant potential from those with higher ones. In this study 32 cases of SCLC, 13 of WDNEC and 14 of TC with a follow‐up time up to 7 years were collected. Sections 4 μm thick from paraffin embedded tissue were Feulgen stained. By means of high resolution image analysis 100 nuclei per case were randomly gathered to extract morphometric, densitometric and textural quantitative features. To investigate the ploidy status of the tumour the corrected DNA distribution was calculated. Stepwise linear discriminant analysis to differentiate the classes and Cox regression analysis for the survival time analysis were applied. Using chromatin textural and morphometric features in two two‐class discriminations, 11 of the 14 TC cases and 8 of the 13 WDNEC cases were correctly classified and 11/13 WDNEC cases and 28/32 SCLC cases, respectively. The WDNEC cases are more similar in chromatin structure to TC than to SCLC. For the survival analysis, only chromatin features were selected to differentiate patients with better and worse prognosis independent of staging and tumour type.

Two Cases of Gastric metastasis from Small Cell Lung Cancer

This is a report of gastric metastases secondary from a primary small cell carcinoma of the lung in two men. Blood-borne metastatic involvement of the stomach by cancer is a rare entity. According to the reports in the literature the prevalence of metastasis to the stomach occurs in 0.4% and the most common cell type of the primary lung carcinoma is large cell type(3.7%) followed by adenocarcinoma(2.4%), small cell carcinoma(1.7%) and squamous cell carcinoma(0.7%). The most common tumors that spread to the stomach through the blood stream are malignant melanoma, breast carcinoma and lung carcinoma. Most of the gastrointestinal tract metastases had no specific symptoms because of its submucosal involvement. The prognosis was poor and the mean survival period from the onset of symptoms was 49 days. The first patient was a 56-year-old man who had primary lung carcinoma with brain metastasis. Gastroscopic findings showed two elevated mass lesions in the anterior wall of the mid body with central ulcer and the posterior wall of the fundus with intact surface mucosa. Pathologic examination of stomach tissue revealed small cell type tumor cells infiltrate in the stomach wall segmentally without destruction of the glands. The second patient was a 67-year-old man who had no other evidence of the distant metastasis. Gastroscopic findings showed a huge, oval shaped, ulcerofungating mass with deep penetrating central ulcer coated with dirty exudate in the anterior wall from mid to upper body of the stomach, and thickened elevated rugal folds in the posterior wall of the fundus. Pathologic examination of stomach tissues revealed the small cell type tumor cells showing small smudged nucleus infiltrate into the mucosa of the stomach and the architecture of mucosa intact. We report the two cases of metastatic gastric cancer from the primary small cell lung carcinoma with the literature review.

皮膚Ｂ細胞リンパ腫の１例

We report a case of cutaneous B cell lymphoma in a 29-year-old male. About one and half years before consultation, he noticed firm and red colored nodules on his left knee.Histopathological examination revealed a dense infiltrate of large lymphoid cells with mitotic figures in the dermis. In an immunohistochemical study, most of these cells were found to be positive for CD20. Southern blot analysis demonstrated rearranged bands in the immunoglobulin heavy-chain gene. On physical examination lymph node swelling was not noted. CT and Ga scintigraphy showed no evidence of metastasis. The patient was diagnosed as having malignant lymphoma of the diffuse, large cell type by REAL classification associated with cutaneous B cell lymphoma, stage 1A, by Burg's staging.Excision of the lesion with a 2cm margin was performed followed by local irradiation with a total dose of 30Gy.

Fast quadratic increase of multiport-storage-cell area with port number

It is shown that the space required for wordline/bitline routing leads to a quadratic multiport-storage-cell area increase with port number N, dominating from as little as N = 2, N = 6 for small ROM and large SRAM cell types, respectively. Larger N results in enormous area increases (e.g. by a factor of 80 for a 32-port SRAM), making conventional multiport memories unacceptable for most practical applications.

Nasal Lymphomas in Japan: A High Prevalence of Epstein-Barr Virus Type A and Deletion Within the Latent Membrane Protein Gene

The majority of nasal lymphomas are of the natural killer (NK)/T cell lineage. We analyzed 33 specimens of nasal lymphoma from Japanese patients for Epstein-Barr virus (EBV). Phenotypic and genetic analyses showed 28 cases with NK/T cell type and 5 cases with B cell type. All NK/T lymphomas were of pleomorphic cell type except 2 large cell (centroblastoid) and one lymphoblastic lymphoma. All cases with nasal B cell lymphoma were of large (centroblastoid) cell type. EBV was detected in all cases of NK/T cell type with the exception of one lymphoblastic case, and was monoclonally integrated in all cases examined (14/14 cases). All but one case had subtype A of EBV infection with 30-base paired deleted LMP-1 gene. One case of B cell lymphoma showed the presence of EBV infection with subtype A and deletion of LMP-1. Our results indicate that the majority of nasal lymphomas in Japanese patients are of the nasal NK/T cell type, have pleomorphic morphology, a high prevalence of EBV with a monoclonal integration, subtype A and deleted LMP-1 gene. In contrast, nasal B cell lymphoma showed monomorphic appearance and rare EBV infection.

The `Inka cell' and its associated cells: ultrastructure of the epitracheal glands in the gypsy moth, Lymantria dispar

The epitracheal glands in pharate and young pupae of Lymantria dispar are located at the base of ventrolateral tracheal trunks in the prothoracic and first through eighth abdominal segments. Each gland is composed of four cells the ultrastructure of which is described in this paper. One large cell and one smaller cell have an endocrine function, while a third cell is exocrine. A fourth cell forms a canal running from the exocrine cell into the trachea. The large endocrine cell, but not the smaller endocrine cell has released its secretions in freshly moulted pupae. The exocrine cell is assumed to be involved in the pupal moult events as well. The physiological role of the different cell types is discussed: The large endocrine cell (type I endocrine cell) is supposedly homologous with the `Inka cell', which produces ecdysis triggering hormone (ETH) and was previously described in Manduca sexta; the functions of the smaller endocrine cell (type II endocrine cell) and the exocrine cell remain unknown.

MALIGNANT T-CELL LYMPHOMA OF THE BREAST-REPORT OF A CASE-

A 45-year-old woman was seen at the hospital because of a left breast tumor. A 3×2cm elastic hard, sharply demarcated, and well movable tumor with smooth surface was confirmed in the C area of the left breast. With mammography and ultrasonography, breast cancer was suspected and a biopsy was performed. Histopathological examination and immunohistologic stainings revealed malignant lymphoma, diffuse, large cell and T-cell type. A modified radical mastectomy (Patey method) was performed and one positive node was confirmed in the axillary lymph nodes. About 2.5 months after the operation, the patient experienced recurrence in the mediastinum and after a temporary remission with CHOP-Bleo regimen, she died of leukemic change one year and 7 months later. This case was thought to be lymphoma type of ATL because of positive response to anti-HTLV-1 antibody. But most cases of T-cell malignant lymphoma of the breast are anti-HTLV-1 antibody positive and have a poor prognosis. These cases might be preferable to be considered as lymphoma type ATL which formed a breast tumor rather than T cell malignant lymphoma arisen in the breast, and hence potent chemotherapy would be mandatary.

Limited Stage I and II Follicular Non-Hodgkin's Lymphoma: The Nebraska Lymphoma Study Group Experience

The purpose of this study was to evaluate the outcome and prognostic factors of patients with limited stage follicular non-Hodgkin's lymphoma treated prospectively by the Nebraska Lymphoma Study Group (NLSG). Forty previously untreated patients, median age 64 years, with limited stage follicular lymphoma were prospectively treated according to the protocols of the NLSG between January 1980 and December 1990. The follicular large cell type represents 75% of the cases, and 14 of the biopsies also had a diffuse component (composite lymphoma). The initial treatment was radiation therapy (RT) to the involved field in 15 patients, anthracycline-containing combination chemotherapy (CT) in 20, and combined RT and CT in 5. Thirty-seven patients (92.5%) achieved a complete remission (CR). The median follow-up is 120 months (range, 20 to 214). Of the 37 patients achieving a CR, 7 patients are alive in first CR, one died due to sepsis, another because of a myeloproliferative disorder at 77 months following chemotherapy, 6 died because of unrelated causes in first CR. Twenty-two patients relapsed between 1 to 128 months following a CR. The estimated 10-year event-free survival is 21% (95% C1: 7 to 35). Two patients received no or palliative therapy after relapse and both died of progressive disease. Nineteen patients received salvage therapy and 15 achieved a second remission. The median survival after first relapse is 55 months. The estimated 10-year overall survival is 44% (95% C1: 28 to 60). Various factors including sex, his-tologic subtype, stage, and degree of follicularity do not influence the overall survival or event-free survival. CT with or without RT resulted in a better trend for 10-year event-free survival in stage IA patients compared to RT alone but estimated 10-year overall survival is no different. The overall survival is worse in the 60 age group but this difference is not evident if data is adjusted for cause specific death. In conclusion, limited stage follicular lymphoma has an excellent initial response to radiation therapy or chemotherapy; however the recurrence rate is high and cure is limited.