Microangiopathic hemolytic anemia and thrombocytopenia secondary to disseminated intravascular coagulation is a well-described complication of widely metastatic carcinoma. The authors report four cases of gastric carcinoma, one case of colon cancer, and one case of adenocarcinoma of unknown primary in which the patient developed a syndrome analagous to thrombotic thrombocytopenic purpura, consisting of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure without definite evidence of disseminated intravascular coagulation. In contrast to previous reports, postmortem examination in three of the cases revealed no recurrence or only microscopic foci of residual tumor. In the remaining three, there was clinical and pathologic evidence of grossly disseminated carcinoma. Also in contrast to previous cases, all patients evidenced azotemia and proteinuria at the onset of the syndrome and ultimately uremia was a contributing cause of death. Coagulation profiles showed prolonged thrombin times and elevated fibrin degradation products in four instances and did not distinguish the patients with grossly metastatic disease from those with no tumor or only microscopic residua. Circulating immune complexes containing carcinoembryonic antigen were found in the patient with metastatic colon carcinoma. The syndrohe was clinically identical whether or not grossly metastatic tumor was present, and it should not be attributed to advanced disease without definite clinical or pathologic evidence of a recurrence. Cancer 48:1738-1745. 1981. I(ROAN(iIOPA1 H I (H t M O L Y I I (A N t : M I A iS a M w el I-d oc 11 me n t e d co m p I ic a t i on of met as t a t i c carcinoma.'.2 The anemia is thought to be caused by a fragmentation of erythrocytes on fibrin strands that From the * H em at o I og y-0 n c o I og y. W a I t e r Reed Arm y Medical C e nt e r ,
First Bite Syndrome (FBS) is a painful condition which classically presents as severe pain in the pre‐auricular region, initiated on the first bite of a meal. It is usually associated with a history of upper neck surgery or tumour of the parotid salivary gland or parapharyngeal space (PPS). Some propose that FBS arises from damage to, or resection of, the cervical sympathetic trunk resulting in loss of sympathetic innervation to the parotid salivary gland. Idiopathic FBS has been reported only a handful of times in the literature. We present the case of a 51‐year‐old male, urgently referred to the Department of Oral Medicine, with a 3‐week history of severe, sharp, unilateral pain from the right angle of mandible, intensity described as ‘20/10', occurring only on the first bite of eating. This would diminish over 2 min. Clinical examination revealed tenderness over the right condylar neck and angle of mandible only. FBS was suspected and the patient immediately started on carbamazepine. An urgent MRI displayed no abnormalities of the temporomandibular joints, PPS, trigeminal nerve or parotid gland. Restorative Dentistry review confirmed no odontogenic or occlusal cause and on review, 4 months later the patient reported complete resolution of symptoms on 200 mg of carbamazepine three times daily. This case highlights the importance of taking a thorough pain history. Patients with symptoms of FBS and no history of surgery to the neck should have an MRI to rule out parotid gland or PPS tumour. Carbamazepine can be successful in treating idiopathic FBS and can resolve symptoms completely.
Detection of specific tumor sites was studied with scintigraphy and radiolabeled human IgM monoclonal antibodies (MoAbs). Ten patients with metastatic breast cancer received an infusion of one of three indium-111-labeled anti-breast carcinoma MoAbs. The time of infusion ranged from 30 minutes to 2 hours. Three patients received YBB-190 at total doses of 2, 4.25, or 11 mg, four patients received YBM-209 at total doses of 1 mg (n = 1) or 20 mg (n = 3), and three patients each received 22 mg of YBY-088. Imaging was performed immediately after infusion and at 4, 24, 48, 72, 120, and 144 hours. Many presumed sites of metastatic disease were imaged in three of the four patients who received 20 mg of YBM-209 and in two of the three patients who received YBY-088. Tumor was not detected in any of the patients who received YBB-190, in the patient who received a 1-mg dose of YBM-209, or in the patient who received YBY-088 and in whom a biopsy of tumor tissue failed to demonstrate target antigen. The authors conclude that In-111-labeled human IgM MoAbs can target human breast cancer, but antigen expression and antibody dose determine successful immunoscintigraphy.
We undertook a retrospective study of all lung cancer patients diagnosed between 1978 to 1982 and seen at the University of California San Diego affiliated hospitals. There were 390 evaluable patients; the vast majority were men. Overall median survival was 8 months and was similar for all histologic types. Completely asymptomatic patients had a median survival of 20.1 months while symptomatic patients had a median survival of 5-8 months. Retrospective application of the new clinical staging system for lung cancer increased the survival distinction between clinical Stage I and Stage II disease. Median survival for small cell carcinoma of the lung was 10 months: 16.6 months for disease limited to the chest, and 5.8 months for metastatic disease. Median survival for Stage III nonsmall cell lung cancer patients was only 5 months. Only those asymptomatic patients with small lesions which were detected incidentally or by screening chest x-ray had any likelihood of long-term, disease-free survival with more than 60% alive two years after diagnosis. This study suggests that screening and early detection programs in existence during the period of observation were not effective in detecting early disease, and that no therapy of advanced diseases [Stages II through IV] was sufficiently efficacious to be considered standard.
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