Testicular germ tumor cells could be differentiated spontaneously or by some chemotherapeutic compounds. However, the mechanism by which the cells are differentiating from the stem cell remains unclear. The KU-MT cells, which were newly established from lung metastasis of testicular carcinoma, have been continuously producing alpha fetoprotein (AFP). Retinoic acids are well-known to induce cellular differentiation in culture and have already been applied for a clinical usage against leukemia. In the present study, all-trans-retionic acid (ATRA) elevated the level of AFP and inhibited the growth of KU-MT cells in vitro. ATRA also arrested the cell cycle in G1 and reduced the percentage of the S phase cell in terms of wild type p53, leading to apoptosis in part. Retinoids, especially retinoic acid receptor (RAR)-alpha specific agonists induced laminin production, a marker of endodermal differentiation; whereas arotinoid, a retinoid not bound to RAR-alpha, did not affect laminin expression. In summary, retinoic acids could mediate cell growth and differentiation of testicular tumor through RAR-alpha.

A 62-year-old man was found to have myelodysplastic syndrome (MDS) and gastric cancer. Serum studies revealed hypogammaglobulinemia, and positive reactions to rheumatoid test and anti-nuclear antibody. Chromosomal analysis of the bone marrow revealed deletions of No. 5 and 7 chromosomes and that of the stomach showed complex abnormalities. It may be hypothesized that an initial event which selects a clone of stem cells could manifest with this sort of immunological abnormalities. Subsequent deranged immunosurveillance may be responsible for the increased risk of cancer. Alternatively an increased chromosomal instability which seems to be associated with immunodeficiencies might be responsible for cancer development.

We report a 1-year-old boy with infantile lymphoblastic leukemia in first complete remission who received a cord blood stem cell transplantation (CBSCT) from an HLA identical sibling. We collected 120 ml of cord blood when his brother was born, which contained 4.2 x 10(8) mononuclear cells (4.2 x 10(7)/kg) and 3.1 x 10(5) CFU-GM (3.1 x 10(4)/kg). One month prior to transplantation, he showed persistent fever and liver dysfunction, and was finally diagnosed as having primary cytomegalovirus (CMV) infection which was demonstrated by elevation of serum anti-CMV-IgM. The administration of ganciclovir dramatically improved the clinical symptoms and abnormal laboratory findings, and was continued up to 1 month after transplantation to suppress the CMV reactivation. The preconditioning regimen consisted of busulfan (16 mg/kg/4 days) and cyclophosphamide (120 mg/kg/2 days), and cyclosporin A (CyA) alone was used for graft-versus-host disease (GVHD) prophylaxis. Fever suspicious of grade I GVHD developed on day 19, but subsided by increasing the dose of CyA. The WBC and platelet counts reached greater than 1,000/microliter and 50 x 10(3)/microliter on days 12 and 42, respectively. It is now at 13 months since transplantation, and he remains in a disease free state.

A 69-year-old woman with pure red cell aplasia and granular lymphocytic leukemia was reported. Because her granular lymphocyte count was in the normal range at the time of admission, we diagnosed the patient as primary pure red cell aplasia (PRCA). The granular lymphocyte count increased slowly, and we find monoclonal T cell receptor rearrangement, the case was diagnosed as granular lymphocytic leukemia accompanied with PRCA. Although single administration of cyclosporin or cyclophosphamide induced severe side effects obtained combined administration of low doses of these agents obtained good Hb increase. This case was granular lymphocytic leukemia with normal granular lymphocytic count at the time of diagnosis, the tumor cell suppressed BFU-E colony formation, and combined administration of low dose CPM and CyA yielded good effects.

Bone marrow transplantation was performed with a conditioning regimen including antithymocyte globulin (ATG) for 8 patients with HLA-compatible unrelated donors or HLA mismatched donor. Administration of ATG was halted due to side effects in only 1 case, but the other cases were had no adverse reaction. During administration of ATG, platelet counts did not decrease rapidly, but platelet infusion was not effective in some cases. As compared between patients with conventional allogeneic BMT, autologous BMT or peripheral blood stem cell transplantation and those with ATG administration, no obvious difference was seen between the two groups in lymphocyte counts, CD3, CD4, CD8 and CD20 positive cells. No patient with ATG saffered graft failure or acute GVHD. However, cytomegalovirus infection was observed more frequently than in patients without ATG. In hematological malignancy, relapse was more frequent than in patients without ATG.

A 27-year-old man with primary mediastinal choriocarcinoma was reported. He was admitted with complaint of right chest pain and dyspnea. Chest X-ray film and computed tomography of the chest revealed a bulky mass at anterior mediastinum and right pleural effusion. Physical examination revealed bilateral gynecomastia, and the serum beta-HCG level was cap at 500 ng/ml. The specimens obtained by percutaneous needle biopsy of the mediastinal mass showed cytotrophoblasts and syncytiotrophoblasts. He received 4 cycles of anti-cancer chemotherapy, and underwent resection for a residual mass, in which viable cancer cells remained in histological examination. In spite of additional chemotherapy, multiple lung metastasis developed rapidly. High dose chemotherapy, with carboplatine (200 mg/m2 x 4 days), etoposide (250 mg/m2 x 4 days) and cyclophosphamide (50 mg/kg x 2 days) was performed in combination with peripheral blood stem cell autotransplantation. However, brain metastasis set in and he died of respiratory failure 9 months after the onset of symptoms.

Thrombopoietin (TPO) is the critical regulator of proliferation and differentiation of megakaryocytic lineage. TPO has potent stimulatory effects on platelet production in patients with chemotherapy-induced thrombocytopenia. In addition to sustaining megakaryocytopoiesis, TPO may play an important role in regulating neutrophil activation and erythropoiesis. Furthermore, TPO induces proliferation of acute myeloblastic leukemia cells in vitro in some cases. These results suggest that TPO may be multifunctional factor. Recently osteosclerosis is observed in TPO transgenic mice. To determine whether TPO can modulate the osteoclastic differentiation from hematopoietic stem cells, we investigated the effect of TPO on in vitro osteogenesis. TPO inhibited the formation of osteoclastic cells and decreased the areas of bone resorption pits in a dose-dependent manner. We examined whether transforming growth factor-beta (TGF-beta) and platelet derived growth factor (PDGF), major cytokines produced by megakaryocytes, mediate the inhibitory effect of TPO. The addition of either anti-TGF-beta or anti-PDGF antibody to bone marrow cell cultures completely antagonized the effect of TPO on osteoclastogenesis. These data suggest that TPO inhibits osteoclastogenesis by stimulating thrombopoiesis and that TGF-beta and PDGF mediate the effect of TPO by impacting macrophage-lineage cells as osteoclast precursors.

We report a 85-year-old woman who died after one year history of convulsion, dementia, and consciousness disturbance. She was apparently well until January 6, 1995 when she was 85 year old; on that evening, she suddenly stated that some one was in her room and she became confused. A local MD gave her diazepam and she fell into sleep. At 3 o'clock in the following morning, she developed tonic-clonic convulsion in her right lower extremity which showed a march to her right upper extremity and the left lower extremity. She was admitted to our hospital. On admission, she was comatose with respiratory acidosis. She was intubated and placed on a ventilator. She was treated with intravenous phenytoin. She gradually gained consciousness and became alert. Respiration became normal. Her MRI revealed ventricular dilatation, fronto-parietal cortical atrophy, and a T1-low and T2-high signal intensity lesion in the left occipital lobe. She was discharged for out patient follow-up on February 4, 1995. Since then, she noted loss of memory and small step gait. A follow-up CT scan revealed a mass lesion which showed a ring-shaped enhancement in the left occipital lobe and was admitted again. On admission, she was alert but markedly demented. The optic fundi was unremarkable, but she appeared to have right homonymous hemianopsia. No motor weakness was noted. In Gd-DTPA enhanced MRI, the above tumor showed a ring enhancement. The diagnosis of glioblastoma was entertained, however, considering her age, she was treated with intravenous glycerol and intramuscular steroid. She was discharged for out-patient follow-up on July 15, 1995. Her gait disturbance had progressively become worse and she developed nausea and vomiting and was admitted again on October 2, 1995. On admission, she was somnolent and markedly demented. Brain stem responses were retained normally. She was unable to stand or walk. Deep tendon reflexes were slightly increased in the right upper extremity and the plantar response was extensor on the right. Her hospital course was complicated by respiratory tract infection and respiratory acidosis. She expired on November 2, 1995. The patient was discussed in a neurological CPC and the chief discussant arrived at the conclusion that she had a glioblastoma involving the left occipital lobe and the adjacent areas. Post-mortem examination revealed an infiltrating tumor in the left occipital lobe. On microscopic examination, the tumor was very cellular; nuclear atypism was marked and tumor cells undergoing mitosis were seen. In some areas, capillary proliferation was seen. Histologic characteristics were consistent with glioblastoma.

A 12-year-old girl presenting leukocytosis, anemia and thrombocytopenia was diagnosed as de nove acute myeloid leukemia (AML, M2) with concurrent myelodysplastic features in myeloid and erythroid cells. Her karyotype was defined as 47, XX, +8[20]. Though she was treated successfully with multi-drug chemotherapy, she relapsed after 2 years of remission. A bone marrow transplantation from HLA matched her brother was performed to induce hematological remission which persisted for one year. She again relapsed with AML with myelodysplasia, and an abnormal complex karyotype was newly detected. She eventually died without further chemotherapy. We performed FISH on the patient's stained bone marrow smears using DNA probes for chromosome 8 and Y to analyze the clonality. The results showed that the most of blasts and bone marrow cells except lymphoid cells were of trisomy 8 at onset, while in the 1st remission, trisomy 8 clone was slightly detected only in monocytes. At 1st and 2nd relapse, trisomy 8 clone was detected again in most of myeloid cells. Thus, in this case, it was considered that underlying stem cell disorder with trisomy 8 during the entire disease course contributed to leukemogenesis.

Interferon (IFN) has anti-cell-proliferative activities. Some of the interferon-stimulated gene (ISGs) products have important roles for controlling cell proliferation and cell differentiation. Candidates for that kind of ISGs involve PKR, IRF-1, IRF-2, 2'5' OAS, RNaseL, and ICSBP. The PKR phosphorylate eIF2 alpha that leads to blocking of protein synthesis, mediates signal transduction via NF-kappa B and/or probably IRF-1, and is also involved in apoptosis. IRF-1 leads to apoptosis to prevent malignant transformation when a cell undergoes initial oncogene activation, and controls cell proliferation by balancing with IRF-2. 2'5' OAS and RNaseL system also has possibilities to have those roles. ICSBP, one of the IRF family, has new findings from the knock-out mouse. The mouse developed a hematopoietic abnormality which looks very similar to human chronic myelogenous leukemia, indicating ICSBP has important roles in proliferation and differentiation of hematopoietic stem cells.

A 24-year-old male was admitted to our hospital, complaining of right back pain, in May 1995. Chest X-ray films showed an abnormal mass in the mediastinum. Computed tomography revealed massive effusion in the pleural and pericardial space. A biopsy specimen of the pleural lesion demonstrated lymphoblastic lymphoma of T cell type. After the completion of intensive chemotherapy by our original protocol, he entered into partial remission. Peripheral blood stem cells (PBSC) were harvested using a high-dose cytarabine (Ara-C) followed by granulocyte-colony stimulating factor (G-CSF) mobilization regimen. The total number of collected PBSC was enough to perform two courses of PBSCT. In January 1996, following the conditioning regimen of nimustine hydrochloride, etoposide (VP-16), Ara-C, thiotepa, he received PBSCT. Complete remission was achieved after the 1st PBSCT. In March 1996, he received the 2nd PBSCT following the conditioning regimen of carboplatin, VP-16, ifosfamide. No regimen-related toxity or delayed engrafment was observed. Subsequently, he received irradiation to his neck and mediastinum, the primary site of the disease. As of February 1997, he has no evidence of the disease.

We examined the number and phenotype of mast cells, and the localization of stem cell factor (SCF) as a growth factor of mast cells in the excised tissue of 38 cases of pterygium. In histopathology with toluidine blue stain and immunohistochemistry with a monoclonal antibody to tryptase, the mean mast cell count in pterygium specimens was twice as high as in normal conjunctiva. In pterygium specimens more than 94% of tryptase-positive mast cells were found to express chymase and c-kit. There was no phenotypic difference between mast cells in pterygium and normal conjunctiva. In all immunohistochemical specimens in which we could examine the head of the pterygium, SCF was expressed in subepithelial fibroblasts at the central edge of pterygium. The results suggest that overexpression of SCF was accompanied with the augmentation of mast cells in the pterygium.

Leukoencephalopathy probably caused by tacrolimus hydrate after stem cell transplantation in a girl with MDS 7 monosomy is reported. The conditioning regimen consisted of thiotepa (150 mg/m2 x 4), melphalan (70 mg/m2 x 2) and 12 Gy total body irradiation. She received peripheral blood CD34 positive cells (4.17 x 10(6)/kg) from her HLA-mismatched father and tacrolimus hydrate was used for GVHD prophylaxis. Engraftment was rapid and grade 1 acute GVHD of the skin responded well to pulse therapy. From day 27 she became irritable and sleepless, and right facial convulsions developed on day 37. No abnormality was found in the cerebrospinal fluid. Cranial CT findings showed no abnormalities except for low density lesions around the bilateral ventricle. Leukoencephalopathy was suspected and tacrolimus hydrate was discontinued. Thereafter psychosomatic symptoms improved, temporarily however, similar symptoms again developed following cyclosporine administration. Therefore we had to halt the administration of both tacrolimus and cyclosporine. She died on day 104 because of GVHD and fungal infection without recovering from leukoencephalopathy.

A five-year-old girl with Diamond-Blackfan syndrome received cord blood transplantation from an HLA-identical sibling. The patient showed pale face at birth, and was diagnosed to have Diamond-Blackfan syndrome. She had been treated with prednisolone (PSL), high dose of methylprednisolone, erythropoietin, and anti-lymphocyte globulin. Despite of these intensive therapies, erythropoiesis did not entirely improve, and transfusion of red blood cells had been required every third or fourth week until cord blood transplantation. Conditioning regimen consisted of thoraco-abdominal irradiation (TAI; 8 Gy), cyclophosphamide (CY; 50 mg/kg x 4), and anti-thymocyte globulin (ATG; 2.5 mg/kg x 4), Cyclosporin (CyA 3 mg/kg) was administered for the prophylaxis of graft-versus-host disease (GVHD). 4.14 x 10 (7)/kg of cord blood mononuclear cells were infused to the patient. White blood cell (WBC) and reticulocyte counts increased promptly, but recovery of platelet count was delayed. Skin GVHD (grade I) appeared on day +9, which responded to the administration of PSL (2 mg/kg). Chromosomal analyses of bone marrow cells for sex mismatch revealed complete chimerism on day +14, on day +28 and thereafter. Umbilical cord blood cells can be an alternative source of hematopoietic stem cells for allogeneic transplantation.

A 68 year old woman was hospitalized because of cervical lymphadenopathy. Hematological data on admission showed anemia, leukopenia with a normal platelet count. Serum serological studies revealed polyclonal hypergammaglobulinemia, a positive microsome and thyroid test, and positive reaction to antithyroglobulin antibody. Microscopic examination of a cervical lymph node revealed malignant lymphoma, diffuse large cells of B cell phenotype. The bone marrow smears revealed hypercellularity with dysplastic features including pseudo-Pelger and other nuclear abnormalities of neutrophils, micromegakaryocytes, dyserythropoiesis with megalobastic changes, 60% ring sideroblast and with no increase in proportion of blast cells (3.6%). A diagnosis of myelodysplastic syndrome (MDS, refractory anemia with ring sideroblast (RARS)) was made. Remission of ML obtained with radiation and subsequent systemic chemotherapy with CHOP-Bleo regimen, although she died 2.5 yr after the diagnosis due to relapse of ML without leukemic transformation of MDS. Although basic disturbances in these three conditions are not clear, it is evident that treatment was not concerned with the pathogenesis in this case, because the three conditions existed without treatment. It may be hypothesized that an initial event which selects a clone of stem cells that retains the capacity to differentiate into myeloid and lymphoid line would manifest with the features of RARS in the myeloid line and with the sort of immunological abnormalities reported in this case. Subsequent events select subclones and these progressively lose terminal differentiation, culminating as B-cell lymphoma.

In chronic myelogenous leukemia (CML), abnormalities develop in hematopoietic stem cells, affecting three hematopoietic cell series, including leukocytes, erythrocytes, and platelets. The occurrence of the Philadelphia (Ph1) chromosome and BCR/ABL fused genes are involved in its pathophysiology. Methods of treating CML consist of bone marrow transplantation, and administration of interferon (IFN) and other antineoplastic drugs. Bone marrow transplantation is strongly recommended when the patient is young (usually aged 45 years or younger) and a donor with identical human leukocyte antigens (HLA) is available. When bone marrow transplantation is impossible, administration of IFN is the treatment of choice. IFN administration may induce disappearance or a decrease in the Ph1 chromosome. IFN administration has been demonstrated to significantly increase the survival rate over conventional chemotherapy (hydroxyurea or busulfan).

An autopsy case of multiple myeloma (IgD lambda type) with pineal body and spinal cord dura mater infiltration is reported. The 63-year-old man was diagnosed as multiple myeloma (IgD lambda type). He was treated with melphalan and prednisolone. Extra bone marrow masses developed 1 year after the onset. He died with renal failure. At autopsy there were many extra bone marrow masses including pineal body and dura mater of the thoracic cord. Microscopic examination revealed that those mass lesions consisted of neoplastic plasma cells. Myeloma cells also infiltrated perivascular space near the pineal body, subdural space of the cerebrum and brain stem. The cells were labeled VS 38 c immunohistochemically. We discussed routes of the metastasis to the central nervous system of the multiple myeloma. This case suggests that the way of myeloma cells infiltration to the pineal body is hematogenous metastasis, because pineal body have no blood brain barrier.

In two cases with adenosquamous cell carcinoma of advanced cervical cancer, carboplatin-based chemotherapy was given intraarterially from the internal iliac artery as neoadjuvant chemotherapy, and peripheral blood stem cells (PBSCs) were harvested. After the operation, conventional intravenous chemotherapy with PBSC autotransplant was performed. PBSCs were mobilized by neoadjuvant chemotherapy and G-CSF administration. By the apheresis procedures, 0.7-2.6 x 10(6)/kg CD34 positive cells were obtained. They had no severe side effects from intravenous chemotherapy with PBSCT, and they were free of disease 20 months. Neoadjuvant chemotherapy and G-CSF administration may be capable of mobilization of PBSCs, and chemotherapy with PBSCT may be useful in radioresistant advanced adenosquamous carcinoma of the cervical cancer.