Primary central nervous system lymphoma as a secondary malignancy

Article Abstract:

Patients with cancer are at increased risk for the development of some other cancer later in life. These secondary neoplasms are often leukemias or lymphomas, but it is not known to what degree these conditions arise as a response to the treatment of the first cancer, or to what degree they represent a predisposition towards cancer. Lymphoma that arises as a secondary neoplasm, the primary lymphoma of the central nervous system is considered uncommon. The author reports the cases of seven patients who developed a primary lymphoma of the central nervous system as a secondary tumor. The lymphoma occurred an average of 10 years after the diagnosis of the original tumor, and an average of six years after the last evidence of disease in the original tumor. Alkylating agents are chemotherapeutic drugs that are associated with a high rate of secondary cancers. However, four of the seven patients did not receive any chemotherapy, and two did not receive either chemotherapy or radiotherapy. Therefore, the brain lymphomas cannot be attributed to previous treatment in all cases. Review of these cases revealed that there tends to be a delay in the diagnosis of brain lymphoma due to confusion of the lymphoma with a brain metastasis of the original cancer. In one case, the patient's history suggested that the primary central nervous system lymphoma actually had begun at least five years prior to its diagnosis. Since brain lymphoma is more readily treatable before dissemination, such delays may have unfortunate clinical consequences. In the present series, three patients were alive at the time of this report, and of these, two have no evidence of disease 12 and 75 months after diagnosis of lymphoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Tumors, Nervous system tumors

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Novel tumor necrosis factor toxic effects: pulmonary hemorrhage and severe hepatic dysfunction

Article Abstract:

Tumor necrosis factor (TNF) has been found to stop the growth of some cancer cells, and in some cases kill the cancer cells. The substance is currently undergoing evaluation as a possible treatment for some forms of cancer, including malignant melanoma. TNF is a naturally occurring substance which is elaborated by immune system cells in response to infection. The administration of synthetic TNF to patients often results in serious side effects, believed in general to result from a disturbance of the normal physiological balances within the immune system. However, two cases have now been seen in which the administration of TNF to cancer patients has resulted in extreme toxic effects involving the liver and lungs. In one patient, TNF was associated with a massive hemorrhage in the lungs and in the other with a serious disturbance of liver function. It should be emphasized that the organs involved in the complications in these two patients were not directly affected by the presence of metastatic cancer. In previous cases, TNF has been reported to mildly interfere with the pulmonary function and a mild increase in liver enzymes has been observed. In the present cases, however, a metastatic melanoma patient developed a massive hemorrhage in the lungs four hours after the administration of TNF. The other patient, suffering recurrent breast cancer, developed extreme elevations of liver enzymes and bilirubin within 14 hours of TNF treatment. Fortunately, the liver dysfunction returned to normal within a few days and did not require treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Liver diseases, Tumor necrosis factor

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Pancoast syndrome in a patient with malignant lymphoma

Article Abstract:

Pancoast's syndrome consists of neuritic pain in the arm, atrophy of the muscles of the arm and hand, along with Horner's syndrome, which includes sinking of the eyeball, ptosis of the upper eyelid, and constriction of the pupil. Pancoast's syndrome is often associated with a density in the apex of the lung as seen on X-ray; the neurologic symptoms are due to the pressure of this mass on the brachial nerve plexus. The majority of cases of Pancoast's syndrome are due to lung cancer; large cell, squamous cell, and adenocarcinomas are likely causes, while small cell carcinoma is an infrequent cause. The syndrome may also result from myeloma, metastatic tumors, and infections such as aspergillosis. However, in a recent case, Pancoast's syndrome in an 86-year-old man was found to be the result of malignant lymphoma. The patient responded to chemotherapy, but Horner's syndrome remained despite great resolution of the tumor masses. This case demonstrates the importance of histology in establishing proper diagnosis and treatment. Had the mass been assumed to be lung cancer, as is usually the case, the patient would probably have undergone major surgery without significant benefit. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Horner's syndrome

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