Summary. Involvement of the central nervous system (CNS) by multiple myeloma, as defined by the detection of malignant plasma cells in the cerebrospinal fluid in the presence of suggestive symptoms, is considered extremely rare. We report on the characteristics of 18 such patients diagnosed and treated at the University of Arkansas over the last 10 years for an overall incidence of approximately 1%. Their evaluation revealed association of CNS involvement with unfavourable cytogenetic abnormalities (especially translocations and deletion of the chromosome 13), high tumour mass, plasmablastic morphology, additional extramedullary myeloma manifestations and circulating plasma cells. The presence of these features should alert clinicians to the possibility of CNS involvement. The outcome of these patients was extremely poor despite the use of aggressive local and systemic treatment including autologous stem cell transplants. Given this universally poor prognosis, the application of allogeneic transplants should be studied in this clinical setting.

No abstract

This study was undertaken to determine whether the cells of the fibrocartilaginous meniscal substance are capable of proliferation and matrix synthesis. Cells were isolated from the fibrocartilaginous menisci of young New Zealand white rabbits, and grown in two alternative culture regimens differing only in the basal nutrient medium used to initiate primary monolayer growth. Under each culture regimen, the cells attached and proliferated both initially and after passage into secondary (2 degrees) culture. Differences were noted in cell morphology and time to reach confluence in primary (1 degrees) culture. Upon passage into 2 degrees culture, the fibrochondrocytes assumed two distinct morphologies depending upon the type of medium used for 1 degree culture. These morphological changes were accompanied by differences in the population doubling time and incorporation of 35SO4 into sulfated proteoglycans. The proliferation of both fibrochondrocyte subtypes was stimulated by the addition of either pituitary fibroblast growth factor (FGF) or human platelet lysate in a dose-dependent manner. Both FGF (10 ng/ml) and ascorbate (40 micrograms/ml) decreased 35-sulfate incorporation, whereas only ascorbate was found to alter the amount of sulfated glycosaminoglycan in the pericellular coat. We conclude that the fibrochondrocytes of the meniscal substance are capable of replication and synthesis of matrix macromolecules if given the proper stimuli. Additionally, there may be two subpopulations of fibrochondrocytes that can be distinguished by their in vitro behavior.

Little is known about the incidence of clinically occult AL amyloid in patients with multiple myeloma and its impact on prognosis of these patients. To address these issues, subcutaneous fat pad aspirates (SAFA) and bone marrow biopsies were evaluated for the presence of amyloid in a cohort of newly diagnosed patients with multiple myeloma prior to enrollment on a phase II study including tandem transplants. Organ directed biopsies were performed when clinically indicated. Presence of amyloid at > or = 1 site was noted in 32 patients (38%). SAFA was positive in 25 (31%), bone marrow in 8 patients (10%) and other organ sites in 7 patients. Patients with and without amyloid did not differ in disease characteristics, in particular no lambda predominance was observed in patients with amyloid. Event free survival (59+ vs 52 months; p = .9) and overall survival (59+ vs 66+ months; p = .9) were similar in both groups. Even the seven patients with symptomatic organ involvement with AL amyloid had a median overall survival of 38+ months. In conclusion, AL amyloidosis occurs more often than previously reported, but its presence does not influence the outcome of these patients after transplantation.

Morphologic features (abnormal mitoses, necrosis, vascular and capsular invasion, broad fibrous bands, cellular pleomorphism, size) previously suggested to be predictors of malignant behavior in adrenal cortical tumors were assessed individually in 23 (17 benign, 6 malignant) pediatric and 42 (29 benign, 13 malignant) adult tumors. Of these features, size was the only predictor of malignancy in pediatric tumors. All pediatric tumors weighing more than 500 g were malignant and all but one weighing less than 500 g were benign. The remaining features were present in both benign and malignant pediatric tumors, and pediatric benign tumors were significantly more likely to have mitoses (P < 0.01), necrosis (P < 0.001), broad fibrous bands (P < 0.005), and moderate to severe pleomorphism (P < 0.01) than were adult benign tumors. The authors conclude that pediatric tumors are more likely to be benign than previously thought, and that size is the only morphologic predictor of their biologic behavior.Cancer 57:2235-2237, 1986.OST STUDIES of the morphologic criteria for malig-M nancy in adrenal cortical tumors have not separated pediatric from adult tumors. As a result, the literature often advocates using the same morphologic criteria for malignancy for both,'-3 and there remains a persistent tendency for the majority of pediatric adrenal cortical tumors to be classified as We undertook a retrospective multi-institutional study to determine long-term prognosis in a series of pediatric adrenal cortical tumors. Morphologic features suggested in the literature as predictors of malignant behavior in adrenal cortical t u m~r s~,~-l were assessed individually in the childhood tumors and in a control series of adult tumors. Reliability of these features as criteria for biologic behavior was then compared between the two series. Materials and MethodsThe original hematoxylin and eosin (H & E) histologic sections of 23 cases of childhood adrenal cortical tumors resected between 1953 and 1983 were collected from the collaborating centers. The slides were examined, without prior knowledge of the outcome of the patient, for his- The authors thank Mrs. Lillian ONeil for her secretarial support. Accepted for publication August 19, 1985. tologic features that have been suggested to predict malignancy in such tumors. The presence or absence of the following features was noted in each case: necrosis, calcifications, broad fibrous bands, abnormal mitoses, vascular invasion, and capsular invasion. Cytologic pleomorphism was graded as absent, mild, moderate, and severe. Mitoses were considered significant when they numbered more than one per high-power field.3The age and sex of the patient, the symptoms at presentation, the subsequent clinical history, the original pathologic diagnosis, and the weight of each tumor at the time of resection were obtained from the clinical records and pathology reports. Malignant tumors were defined clinically as those producing metastases and/or resulting in death from direct effects of tumor. The relations...

No abstract

No abstract

No abstract