From May 1975 until May 1980,128 operable breast cancer patients, clinical stage I-II, had a core bone marrow biopsy (BMB) from the posterior iliac crest as a part of the routine diagnostic work-up at the time of initial diagnosis. The mean age of the patients was 56 years, range 26-93. In a previous study on this material, 10 patients (7.8 per cent) were positive for tumor cells and 118 negative by conventional histopathology of BMB [1]. In 1996 we reexamined all BMB separately at two laboratories, using monoclonal antibodies against cytokeratins AE1-AE3, KL1, CAM 5-2 (DOP), and DC10, BA17 (MCI). The number of extrinsic cells in the bone marrow was graded positive for micrometastases when > or = 5 cells or suspicious when 1-4 cells per approximately 2 x 10(6) bone marrow cells were found, using high power field magnification. Micrometastases were detected in 17 patients (13.3 per cent) and another 8 patients were classified as suspicious. The presence of micrometastases was correlated to the axillary lymph node stage and primary tumor location. Median follow-up was 20 years. All 17 micrometastatic patients relapsed and died within 6 years of disease progression with evident osseous metastases. There was one disease-free survivor of the 8 patients with suspicious BMB after 17 years of follow-up. The median overall survival was significantly shorter in tumor-cell positive patients, being 1.9 years compared to 11.7 years in the BMB negative and BMB suspicious groups (p < 0.0001). Immunohistochemical analysis of core BMB taken postoperatively may be useful in predicting the prognosis in patients with breast cancer clinical stage I-II.

The effect of adjuvant combination chemotherapy when given to non-laparotomized patients in remission after radiotherapy in stage I or II non-Hodgkin's lymphoma was studied in a prospective randomized multicenter study. Locally extended field radiotherapy was given to a target absorbed dose of 40 Gy in 20 fractions. Fifty-five patients who were in complete remission 6 weeks after conclusion of radiotherapy were randomized to either no further therapy or to 9 cycles of CVP (cyclophosphamide + vincristine + prednisolone). The relapse-free survival at 30 months was 41% for patients without and 86% for patients with adjuvant chemotherapy (p = 0.02). The survival was the same for both treatment arms, being 90% at 30 months. Fifteen patients have relapsed, 14 of them with extensions and 1 with a recurrence within the radiation target volume. Analysis of subgroups showed that adjuvant chemotherapy in the present series significantly prolonged the relapse-free survival in diffuse histiocytic lymphoma.

Bone marrow biopsies (BMB) were performed on 622 women with a history of primary or metastatic breast cancer. In 332 of the patients bone scintigraphy (BSC) was also carried out at the time of initial diagnosis or during follow-up. The BMB revealed metastases in 22/88 patients (25%) in Stage I--III with positive BSC and in 39/111 patients (35%) in Stage IV with positive BSC, a total of 61/199 patients (31%). Moreover, the BMB was positive in 6/73 patients in Stage I--III with negative BSC, and in 5/37 patients in Stage IV with negative BSC, a total of 11/110 patients (10%). Statistical evaluation showed that the patients with BMB revealing tumor had a significantly higher death risk (P less than 0.0000001) than patients with BMB revealing tumor had a significantly higher death risk (P less than 0.0000001) than patients with negative BMB. No significant correlation was found in patients with positive or negative BSC. Similar results were also found for a subgroup of 207 patients who underwent BSC and BMB within five months. BMB may therefore be indicated for verification of metastases and prediction of prognosis in all patients with positive BSC and in BSC-negative patients Stage II--IV.

Bone marrow biopsies were taken from the posterior iliac crest in 532 women with unilateral breast cancer. Metastatic tumors were found in 10% of the biopsies. In a group with negative radiological examinations of the skeleton, the incidence of positive bone marrow biopsies was 1.6%. In a group with radiologically detectable metastases in the skeleton 28% of the biopsies were positive. In the latter group 43 out of 45 individuals with positive biopsies had negative x-rays of the pelvis. Histopathologically, 19% of the metastatic tumors were osteolytic, 65% were osteoblastic and 16% did not influence the bone structure. The fibrous reaction in and around the bone marrow tumors was similar to that found in the primary tumor. In 74% the morphological pattern was consistent throughout the biopsy, whereas in 26% the morphology was different in different parts of the biopsy. No specific histopathology was observed in the individuals with negative radiological examinations of the skeleton. Bone marrow biopsy of the posterior iliac crest does not seem to be helpful as a routine method in the initial staging of mammary carcinoma but may contribute to establish the degree of tumor spread in individuals with positive or suspicious x-ray of the skeleton.

Background. Patients with central nervous system (CNS) involvement by high grade non‐Hodgkin's lymphoma (NHL) have a poor prognosis. The roles of computed tomography, radiotherapy, and intrathecal and systemic chemotherapy still need to be defined. Methods. A patient with bulky cranial lymphoma mimicking brain involvement is reported. A 62‐year‐old man was admitted with a huge scalp lump, headache, fatigue, and focal and generalized neurologic symptoms. Computed tomography showed an abnormal mass in the frontoparietal region involving the subcutaneous scalp, osteolytic destruction of the cranial vault, and a bulky mass that was interpreted to be intracranial. A systemic survey also revealed bulky retroperitoneal involvement and focal involvement of the spleen. Biopsy revealed a B‐cell NHL of centroblastic type according to the Kiel classification. Results. The patient was treated with a modified combination of cyclophosphamide plus mitoxantrone plus vincristine plus prednisone (CNOP) and intrathecal methotrexate. The patient responded with complete remission, including partial bone restoration of the cranium. At the time of this writing, his relapse free survival lasted 5 years. Conclusions. The initial interpretation of this case indicated that systemic chemotherapy with modified CNOP plus intrathecal methotrexate would be useful in the management of NHL with CNS involvement. The clinical outcome with rapid neurologic repair and also bone restoration of the cranial vault within 5 years suggests that the lymphoma probably never penetrated the dura and a successful treatment was achieved with combination chemotherapy only.