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GASTRIC CARCINOMA AND EARLY PERNICIOUS ANEMIA
909 cancer is frequently impalpable, often because it thin sheet of cancer, or because there are several tiny
ulceration could heal in the presence of continuing widespread
underlying
gastritis.
is
think there is no good evidence for accentuat the expense of, for example, pepsin(s) or any other component of gastic secretion. Mucosal resistance to autodigestion has been ably discussed by Montagu.12 We therefore believe that the evidence from both clinical and experimental work 13 precludes at present the dissociation of gastric secretion and vascular factors, and the accentuation of one or other of them, in the ætiology of gastric ulcer. We also wonder to what extent a " normal " gastric secretion is a desirable accompaniment to therapy, and also whether wholesale attempts completely to eliminate or neutralise components of gastric secretion are enlightened. Department of Pharmacy, W. ANDERSON University of Strathclyde, P. D. SOMAN. Glasgow C.1.
At present
we
ating the role of acid
CARCINOMA AND EARLY PERNICIOUS ANEMIA SIR,-Accepting Dr. Morson’s evidence that intestinal metaplasia may be premalignant (Oct. 1, p. 753), one still asks oneself what it is about this microscopic appearance that predisposes to cancer of the stomach. As one measure of turnover of gastric surface cells my co-workers and I 14 performed mitosis-counts in normal and abnormal gastric biopsies. Of the five highest mitosis-counts, four were in areas of intestinal metaplasia, as shown by the following results:
GASTRIC
a
cancers
St.
fairly
near
together. H. S. SHUCKSMITH J. A. DOSSETT.
James’s Hospital, Leeds 9.
REOVIRUS 3 AND LYMPHOBLASTIC LYMPHOMAS SIR,-The closing remark of one of your leading articles on the lymphoblastic lymphomas of childhood1 prompts me to communicate to you some of the recent developments in St. Louis, Missouri. I should like first to comment on the recent observations of Achong and Epstein.2 After a study of the fine structure of the Burkitt tumour, in biopsy material from Uganda, they reported the presence of nuclear projections in the tumour cells, which they regard as lymphoblasts. These projections of the nuclear envelope corresponded to those of cultured lymphoblasts of established in-vitro stains, and were thus interpreted as an inherent attribute of the Burkitt tumour and not the result of cultivation in vitro. Similar nuclear projections were noted by Stanley3 and his collaborators in lymphoblasts from a murine lymphoma induced by neonatal infection with reovirus 3. In April, 1966, laparotomy was performed on a two-year-old boy (from St. Louis, Missouri) with an abdominal tumour. ’A frozen-section diagnosis of malignant lymphoma, with a starry-sky pattern " was made on biopsy of a tumour nodule in the omentum. Electron microscopic examination of this tissue revealed the presence of lymphoblasts with nuclear projections identical to those described by Achong and Epstein (fig. 1). The initial manifestations of the disease in this child, "
This suggests, but does not prove, that there may be parturnover in these areas; the notably abnormal turnover, which appears to be even higher than in atrophic gastritis, could be an important factor linking intestinal metanlasia and gastric cancer. St. Thomas’s Hospital, D. N. CROFT. London S.E.1.
ticularly high
MAMMARY LIPOMA AND CARCINOMA SIR,-Dr. Behan (Oct. 1, p. 753) asks whether the findings in 4 women of a lipoma and an underlying cancer are fortuitous. Korner 15 described the association of a fatty tumour, which he called a pseudolipoma, with cancer of the breast in 4 patients in 1956. We 16 were not aware of Korner’s paper when we independently used the term pseudolipoma for the fatty tumour found in association with cancer of the breast in our description of 18 examples of pseudolipoma in 1965; we considered that such a fatty tumour was not a true lipoma, for there is no overgrowth of adipose tissue. The pseudolipoma is nearly always produced by compression of the fat lying superficial to the breast disc when the fibrous septa, which connect the breast disc to the skin, are drawn together by the contraction of underlying cancer or cancers; less commonly the pseudolipoma is produced by oedema of the fatty tissue overlying a cancer surrounded by an inflammatory reaction. The finding of a pseudolipoma is fairly common, and we now have 8 further examples, making a total of 26 (13%) in 201 consecutive breast cancers; of these 26, 11 (42%) contained multiple cancers. Duct ectasia produced a pseudolipoma by contraction of postinflammatory periductal collagenous tissue in 3 further examples, and a true lipoma was found with no underlying breast lesion in 2 other patients. The fact that a pseudolipoma is commonly associated with an underlying cancer is of particular importance, for the 12. 13. 14. 15. 16.
Montagu, K. Nature, Lond. 1966, 209, 1206. Anderson, W., Soman, P. D. ibid. 1966, 18, 58. Croft, D. N., Pollock, D. J., Coghill, N. F. Gut, 1966, 7, 333. Korner, W. Zentbl. Chir. 1956, 81, 31. Shucksmith, H. S., Dossett, J. A. Br. med. J. 1965, ii, 1495.
Fig. 1-Electron micrograph of biopsy material from child with lymphoblastic lymphoma showing nuclear projection in lymphoblast ( x 41,800). appearances of the tumour, and the fine strucof the tumour cells were typical of Burkitt’s lymphoma. Subsequently, however, the child developed hepatosplenomegaly, mediastinal lymphadenopathy, pleural effusions, involvement of the small bowel, symptoms referable to the central nervous system, and terminally lymphoblastic leuksemia. Lymphoblasts in peripheral blood and bone-marrow smears contained cytoplasmic vacuoles identical to those described by Wright in tumour cells of the Burkitt lymphoma.4 Necropsy confirmed widespread involvement of the central nervous system, associated with perivascular demyelination in the white matter of the brain. A detailed report of the fine structure of this tumour has been submitted elsewhere for publication. Two weeks ago a four-year-old girl died in St. Louis Children’s Hospital after a stormy and fulminating disease lasting ten weeks from onset of symptoms to death. There was
the
microscopic
ture
1. 2.
Lancet, 1966, i, 965. Achong, B. G., Epstein, M. A. J. natn. Cancer Inst. 1966, 36, 877. 3. Stanley, N. F. Lancet, 1966, i, 961. 4. Wright, D. Br. J. Cancer, 1963, 17, 50.
ulceration could heal in the presence of continuing widespread
underlying
gastritis.
is
think there is no good evidence for accentuat the expense of, for example, pepsin(s) or any other component of gastic secretion. Mucosal resistance to autodigestion has been ably discussed by Montagu.12 We therefore believe that the evidence from both clinical and experimental work 13 precludes at present the dissociation of gastric secretion and vascular factors, and the accentuation of one or other of them, in the ætiology of gastric ulcer. We also wonder to what extent a " normal " gastric secretion is a desirable accompaniment to therapy, and also whether wholesale attempts completely to eliminate or neutralise components of gastric secretion are enlightened. Department of Pharmacy, W. ANDERSON University of Strathclyde, P. D. SOMAN. Glasgow C.1.
At present
we
ating the role of acid
CARCINOMA AND EARLY PERNICIOUS ANEMIA SIR,-Accepting Dr. Morson’s evidence that intestinal metaplasia may be premalignant (Oct. 1, p. 753), one still asks oneself what it is about this microscopic appearance that predisposes to cancer of the stomach. As one measure of turnover of gastric surface cells my co-workers and I 14 performed mitosis-counts in normal and abnormal gastric biopsies. Of the five highest mitosis-counts, four were in areas of intestinal metaplasia, as shown by the following results:
GASTRIC
a
cancers
St.
fairly
near
together. H. S. SHUCKSMITH J. A. DOSSETT.
James’s Hospital, Leeds 9.
REOVIRUS 3 AND LYMPHOBLASTIC LYMPHOMAS SIR,-The closing remark of one of your leading articles on the lymphoblastic lymphomas of childhood1 prompts me to communicate to you some of the recent developments in St. Louis, Missouri. I should like first to comment on the recent observations of Achong and Epstein.2 After a study of the fine structure of the Burkitt tumour, in biopsy material from Uganda, they reported the presence of nuclear projections in the tumour cells, which they regard as lymphoblasts. These projections of the nuclear envelope corresponded to those of cultured lymphoblasts of established in-vitro stains, and were thus interpreted as an inherent attribute of the Burkitt tumour and not the result of cultivation in vitro. Similar nuclear projections were noted by Stanley3 and his collaborators in lymphoblasts from a murine lymphoma induced by neonatal infection with reovirus 3. In April, 1966, laparotomy was performed on a two-year-old boy (from St. Louis, Missouri) with an abdominal tumour. ’A frozen-section diagnosis of malignant lymphoma, with a starry-sky pattern " was made on biopsy of a tumour nodule in the omentum. Electron microscopic examination of this tissue revealed the presence of lymphoblasts with nuclear projections identical to those described by Achong and Epstein (fig. 1). The initial manifestations of the disease in this child, "
This suggests, but does not prove, that there may be parturnover in these areas; the notably abnormal turnover, which appears to be even higher than in atrophic gastritis, could be an important factor linking intestinal metanlasia and gastric cancer. St. Thomas’s Hospital, D. N. CROFT. London S.E.1.
ticularly high
MAMMARY LIPOMA AND CARCINOMA SIR,-Dr. Behan (Oct. 1, p. 753) asks whether the findings in 4 women of a lipoma and an underlying cancer are fortuitous. Korner 15 described the association of a fatty tumour, which he called a pseudolipoma, with cancer of the breast in 4 patients in 1956. We 16 were not aware of Korner’s paper when we independently used the term pseudolipoma for the fatty tumour found in association with cancer of the breast in our description of 18 examples of pseudolipoma in 1965; we considered that such a fatty tumour was not a true lipoma, for there is no overgrowth of adipose tissue. The pseudolipoma is nearly always produced by compression of the fat lying superficial to the breast disc when the fibrous septa, which connect the breast disc to the skin, are drawn together by the contraction of underlying cancer or cancers; less commonly the pseudolipoma is produced by oedema of the fatty tissue overlying a cancer surrounded by an inflammatory reaction. The finding of a pseudolipoma is fairly common, and we now have 8 further examples, making a total of 26 (13%) in 201 consecutive breast cancers; of these 26, 11 (42%) contained multiple cancers. Duct ectasia produced a pseudolipoma by contraction of postinflammatory periductal collagenous tissue in 3 further examples, and a true lipoma was found with no underlying breast lesion in 2 other patients. The fact that a pseudolipoma is commonly associated with an underlying cancer is of particular importance, for the 12. 13. 14. 15. 16.
Montagu, K. Nature, Lond. 1966, 209, 1206. Anderson, W., Soman, P. D. ibid. 1966, 18, 58. Croft, D. N., Pollock, D. J., Coghill, N. F. Gut, 1966, 7, 333. Korner, W. Zentbl. Chir. 1956, 81, 31. Shucksmith, H. S., Dossett, J. A. Br. med. J. 1965, ii, 1495.
Fig. 1-Electron micrograph of biopsy material from child with lymphoblastic lymphoma showing nuclear projection in lymphoblast ( x 41,800). appearances of the tumour, and the fine strucof the tumour cells were typical of Burkitt’s lymphoma. Subsequently, however, the child developed hepatosplenomegaly, mediastinal lymphadenopathy, pleural effusions, involvement of the small bowel, symptoms referable to the central nervous system, and terminally lymphoblastic leuksemia. Lymphoblasts in peripheral blood and bone-marrow smears contained cytoplasmic vacuoles identical to those described by Wright in tumour cells of the Burkitt lymphoma.4 Necropsy confirmed widespread involvement of the central nervous system, associated with perivascular demyelination in the white matter of the brain. A detailed report of the fine structure of this tumour has been submitted elsewhere for publication. Two weeks ago a four-year-old girl died in St. Louis Children’s Hospital after a stormy and fulminating disease lasting ten weeks from onset of symptoms to death. There was
the
microscopic
ture
1. 2.
Lancet, 1966, i, 965. Achong, B. G., Epstein, M. A. J. natn. Cancer Inst. 1966, 36, 877. 3. Stanley, N. F. Lancet, 1966, i, 961. 4. Wright, D. Br. J. Cancer, 1963, 17, 50.