No abstract

We studied the clinical and pathological features of six cases of non-Hodgkin's lymphoma (diffuse undifferentiated in four cases and diffuse histiocytic in two cases) occuring in patients treated for Hodgkin's disease. All six patients had received both radiation and chemotherapy. Abdominal or gastrointestinal involvement was present in five of the six cases. None of the patients had evidence of Hodgkin's disease when the diagnosis of non-Hodgkin's lymphoma was made. Five of the six patients were among a study group of 579 patients with Hodgkin's disease, prospectively followed since diagnosis. At 10 years the actuarial risk of development of non-Hodgkin's lymphoma in this study group is 4.4 per cent (1.2 to 15.0) (per cent probability with 95 per cent confidence limits) and is similar to that of developing acute leukemia: 2.0 per cent (0.3 to 12.9). Non-Hodgkin's lymphoma is a second tumor that may occur late in the course of patients treated for Hodgkin's disease--particularly in patients who have received both radiation therapy and chemotherapy. Like acute leukemia, non-Hodgkin's lymphoma may be another cancer that represents a substantial late risk of combined-modality therapy.

Seven previously untreated patients and two previously treated patients with advanced non-Hodgkin's lymphoma (Stages III and IV) and favorable histologic subtypes had spontaneous regression of their lymphomas. Regressions were either complete or partial and were frequently durable. Six of the seven patients who had spontaneous regression of their lymphomas prior to any therapy have yet to require treatment. Seven of the nine spontaneous regressions occurred in a group of 44 patients who were followed with initial therapy deferred. Six patients had regression of their lymphomas prior to any therapy and one patient had previously received a small field of radiation therapy. Temporary spontaneous regression of lymphoma may be common in selected patients with favorable histologies and advanced disease in whom initial therapy is deferred.

The diagnosis of lymphangitic spread of carcinoma in the lungs is sometimes difficult. We studied the cytologic characteristics of blood drawn through a wedged pulmonary-artery catheter from eight patients in whom lymphangitic carcinomatosis was confirmed by subsequent autopsy, lung biopsy, or clinical evaluation. The sites of the primary tumors were the prostate, breast, esophagus, and lung. Malignant cells were found in seven of the eight patients. Cytologic findings were normal in 16 of 17 patients with cancer but without pulmonary metastases and in 22 of 23 patients with nonmalignant pulmonary disorders. In a patient with cancer with tumor embolism to the lungs, the findings were positive, probably because of extensive intravascular tumor in large hepatic veins. One false positive finding occurred in a patient with extensive pulmonary infarction. Megakaryocytes, which are present in large numbers in the pulmonary capillary bed, are the hallmark of a satisfactory pulmonary vascular blood sample for pulmonary microvascular cytologic study. Familiarity with the cytologic characteristics of these cells in Papanicolaou preparations is essential to avoid mistakenly identifying them as malignant. Although transbronchial lung biopsy remains the diagnostic procedure of choice in this disorder, our findings suggest that the presence of malignant cells in pulmonary microvascular-cytology preparations in patients with cancer and unexplained dyspnea constitutes presumptive evidence of lymphangitic carcinomatosis. Pulmonary microvascular cytology may be particularly valuable when lung biopsy is refused or is thought to be too hazardous.

Between Jan 6, 1968, and April 11, 1977, 124 patients underwent cardiac transplantation at Stanford University Medical Center, with a mean and median period of follow-up of 18.3 and 9.7 months, respectively. Malignant neoplasms developed in seven patients--three lymphoproliferative neoplasms, two skin cancers, one acute leukemia, and one colon carcinoma. Visceral tumors were often fatal and caused 11% of deaths after three months following transplantation. The incidence and spectrum of malignant neoplasms in this population are similar to those observed in recipients of renal homografts.