In 1954 Castleman et al reported a case of mediastinal lymph-node hyperplasia resembling thymoma, after that in 1956 they summarized similar cases histologically characterized by hyperplasia of lymph follicles, prominent vascular proliferation and hyalinization. But with increasing number of reports, cases with extrathoracic location or with systemic manifestation such as anemia, fever, hepatosplenomegaly, elevated ESR and hyperglobulinemia have been reported. In 1972 Keller et al suggested 2 histologic types: the hyaline-vascular type (H-V type), characterized by small hyaline-vascular follicles and interfollicular capillary proliferation ; the plasma cell type (P-C type), characterized by large follicles with inter-vening sheets of plasma cells.
The author analyzed, and reviewed 202 cases of Castleman's lymphoma in the literature.
1) Most of the cases are H-V type, and cases of P-C type and mixed type are few.
2) The age range of the cases are distributed in all ages, frequently from 10 to 40 years old (mean 30 years old). There is no sexual difference.
3) In most of cases swelling of the lymph-node is localized in a single lymph-node, and rarely systemic. In about half of cases the location of the lesion is in the thorax.
In cases of P-C type and mixed type systemic manifestation such as anemia, fever, hepatosplenomegaly, elevated ESR, hyperglobulinemia and hypoferremia are frequently found. Reports of cases with growth disturbance, amenorrhea, peripheral neuropathy, abnormal pigmentation and nephrotic syndrome are rare.

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Following the development of effective chemotherapy for producing remissions of acute lymphocytic leukemia (ALL), a new phenomenon has emerged in this disease-central nervous system (CNS) leukemia. CNS leukemia has become an increasingly frequent obstacle to prolongation of initial complete remission.
Prophylactic irradiation of the CNS concomitant with intrathecal administration of met-hotrexate (IT-MTX) has proved to be effective in the reduction of CNS involvement.
The purpose of this paper is to describe the results of irradiation for prevention of CNS leukemia and to discuss their implications.
The patients consisted of 32 children with acute leukemia, admitted to MAIZURU National Hospital from 1966 to 1980; 22 patients of them had ALL, the others ANLL (acute non-lymphocytic leukemia).
Preventive CNS therapy was started in 1974, (group A), but there was no prevention before 1974 (group B).
1. In group B, six patients was treated by therapeutic cranial irradiation, but all cases resulted in death.
2. In group A, seven patients was treated by prophylactic cranial irradiation combined with IT-MTX, and all of them have been alive without CNS relapse for 2 to 4 2/3 years after therapy.
3. In group A, none of 7 patients (0%) relapsed CNS leukemia initially as compared to 7 (50%) of 14 in group B, thus preventive efficacy was clear.
4. There were no severe complications attributable to the radiotherapy, with or without IT-MTX.

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In childhood leukemia, long-term complete remission has been achieved since the advent of modern combination chemotherapy.
In addition to the control of the disease in bone marrow (BM), the ability to prevent central nervous system (CNS) relapse has further extended clinical success.
However, a new form of extramedullary relapse involving testes has emerged as an important obstacle to the prolongation of bone marrow remission.
The present report describes our experiences at MAIZURU National Hospital with leukemic infiltration of the gonads seen in two males, and the role of radiotherapy in the treatment of this complication.
The age of case 1 was 10 yrs 3 mos old when the leukemia was diagnosed. He had remained well during the subsequent 18 months on and off therapy after 55 months of CCR on chemotherapy. But this boy suffered from subsequent bone marrow relapses and experienced simultaneous medullary and testicular relapses. The testicular relapse was treated by local irradiation with intensive chemotheapy.
This patient developed subsequent bone marrow relapses and died 16 months after the testicular episodes.
The age of case 2 was 4 yrs 7 mos old when the leukemia was diagnosed. The testis was the first site of relapse for this boy. The interval since the initial diagnosis was 98 months. He had received skull radiation for CNS prophylaxis. The testicular relapse was treated by local irradiation with intensive chemotherapy.
He has been alive for 6 months after the testicular episodes.

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Since April 1973, we have applied total body irradiation (TBI) for bone marrow trans-plantation (BMT) in leukemia which became resistant to conventional therapy. Prior to BMT, patients were conditioned for engraftment with cyclophosphamide, followed by 10 Gy TBI with 6 MV or 10 MV Linac X-ray. Bone marrow cells from donor were infused intravenously one day after TBI.
The longest survival time was 57 months after BMT and this patient was still alive with complete remission at the time of writing this paper.
The treatment was tolerated reasonably well, with acceptable side effect of irradation and graft versus host reaction.

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A 48-year-old man developed the infiltration of the leukemic cells in the central nervous system (including bilateral optic nerves) and cervical, brachial, and lumbar plexus one year and three months after the beginning of the therapy for acute leukemia (acute myelom-onocytic leukemia). Headache disappeared by the intrathecal administration of methotrexate, cytosine arabinoside and prednisolone, but the visual disturbance improved only partially, and the pain in the cervical, shoulder and lumbar area disappeared completely only by systemic chemotherapy (aclarubicin with cytosine arabinoside). The orbital CT scan showed the thickening of the optic nerve, but the autopsy findings revealed the leukemic cell infiltration in the optic nerve, and the visual disturbance was ascribed to the RochonDevigneand's syndrome of the orbital apex by the leukemic cell infiltration. On the other band, diffuse infiltration of leukemic cells was marked on the cervical, brachial and lumbar plexus. In order to prolong survival and to relieve pain from the nenuopathy by leukemic cell infiltration, we recommend intrathecal route of the prophylactic chemotherapy concomitant with skull radiation even in the early stage of therapy for acute nonlymphocytic leukemia.

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A 63-year-old female patient had been healthy until this admission. She was admitted to our hospital on April 15, 1979 with general malaise and splenomegaly. Blood examination revealed WBC count of 184, 000, RBC 293 × 10⁴, platelets 73×10⁴. Hemoanalysis showedall stages of granulocytes. Ph¹ chromosome was positive, NAP score was 30. The diagnosis of chronic myelogenous leukemia was made. Busulphan was administered and she showed complete remission and was discharged. Eleven months after discharge, she complained of high fever and vomiting and was re-admitted on July 13, 1981. Blood examina-tion revealed WBC count of 127, 000, hemoanalysis showed myeloblasts (32%) and immature basophils (39%). The results of bone marrow examination was as follows : NCC were 989, 000/cmm, myeloblasts 37%, immature basophils 31%. Immature basophils were 12-16μm in diameter, the color of its cytoplasma was light blue and the volume of the cytoplasma was reduced with many clear basophilic granules. These granules were positive by Peroxidase stain and PAS stain, and showed metachromasia by Toluidine-blue stain. Sch was treated by vincristin, 6MP and cytosine arabinoside. WBC count decreased to normal range and the numbers of myeloblasts, immature basophils were also decreased. But they soon increased again. She died on July 26, 1981 following hematemesis. During her admission persistant vomiting was characteristic in this case.

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A case of multiple myeloma was reported. The patient was a 60-year-old female with back pain, and her clinical symptoms and laboratory findings were aggravated by the administration of Vitamin D₃. The relationship between vitamin D₃ and hypercalcemia in multiple myeloma was also discussed.

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Hemolytic uremic syndrome has been recognized as a disease in infancy, but the reports of some adult cases have been increasing in these years. We have experienced a case of hemolytic uremic syndrome seen in a 20-year-old female patient who developed symptoms of upper respiratory tract infection, diarrhea, hemolytic jaundice and anemia as preceding manifestations and then renal insufficiency ensued. Peritoneal dialysis was effective to improve her clinical condition.
Clinical smyptoms and signs observed in this patient are considered to be typical as seen in infant patients with this syndrome and we think it important to describe in detail our observations of clinical findings of this patient.

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Anemia is frequently seen during pregnancy, however, it is very uncommon to see patients with special type of anemia during pregnancy.
We have experienced two cases of auto-immune hemolytic anemia during pregnancy. The first case was a 25-years-old primigravida, and the diagnosis of auto-immune hemolytic anemia was made at 10 weeks of gestation. She had twins and developed sepsis, which aggravated her symptoms and underwent C-section at 33 weeks of gestation. The second case was a 21-years-old primigravida. She had auto-immune hemolytic anemia with incom-plete abortion. On admission she looked like in the shock state because of ectopic preg-nancy. In these two cases, the disease state of hemolytic anemia became worse by pre-gnancies, but it improved after delivery and D&C. Both cases have been followed up at outpatient departmeut of hematology and have been given Prednisolone.

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The patient is a 61-years-old woman. Her family history and past history was nonsontributory. She was admitted to our hospital (from April to May, 1979) for the first time because of facial edema. The laboratory findings showed the following results : Uri-nary protein (+++), B-J protein (-), IgG (λ) M-protein in the serum 1.16 g/dl, and plasmacell count in the bone marrow 5.60. The facial edema was relieved by the administration of a diuretic agent. She was discharged and followed up as an outpatient. Since January 1981, however, nephrotic syndrome occurred, and B-J protein and increased serum Mprotein were observed. In addition, anemia occurred, and she was admitted again (from June 1981 to January 1982). She had macroglossia, hepatomegaly, splenomegaly, and hoarseness, but swelling of the lymph nodes was not found. Immediately after the admission, the biopsy of the labial gland was performed. The result indicated that a substance which could be specifically stained with H-E and Congo Red had deposited in the minor salivary gland. A diagnosis of amyloidosis was made. Furthermore, an open right kidney biopsy disclosed marked deposition of a substance which reacted positive with the same stain on the vascular walls of the glomerulus. DMSO, 40 mg/Kg was administered orally to the patient for primary amyloidosis parallel to the treatment of nephrotic syndrome.
However, IgG (λ) M-protein in the serum was unchanged, B-J (λ) M-protein in urine was elevated, and anemia and renal function were increasingly aggravated. In October 1981 plasma cell count in the bone marrow was 29% and the cells were atypical, and concomitant MP therapy was started for multiple myeloma. However, systemic edema incr-eased and she died on January 22, 1982 Major autopsy findings revealed the following findings. Edema was marked throughout the whole body including 1000 ml of bilateral pleural fluid and 3000 ml of light yellow cloudy ascites. Small foci of invasion were scattered here and there in the sternum and vertebrae, which showed a picture of multiple myeloma histologically, but extramedullary infiltration of tumor cells were not detected. The deposits of amyloid substance were found on the vascular walls of nearly the whole body ; there were deposits in the intercellular substance and muscle fibers in the heart, and highly diffuse ones on the glomerulus in the kidney which were nealy hyalinized. Deposition occurred almost diffusely in the red pulp, and the follicles were rather atrophic in the spleen. In addition, deposits were found in the intracellular substance and muscle fibers of the tongue, in the intracellular substance of the digestive tract and on the dermis of the skin. The present case was a generalized amyloidosis associated with multiple myeloma. As secondary lesions, pulmonary edema, congestion of the lung, liver and spleen, and nonspecfic acute colitis were observed.

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It is not uncommon that patients with malignant lymphoma show skin manifestation, but skin lesions are often non-specific and specific skin lesions are relatively few. In addition, most cases with specific skin lesions show general symptoms of malignant lymph-oma (stage IV), and relatively few cases show only tumor or nodule in the skin and subcutaneous tissues without lymphadenopathy (stage IE). The treatment of such cases should be carefully considered as the recurrence of the satellite lesions are not so infrequent.
We report a case of malignant lymphoma that started from the subcutaneous tissue as a single nodule in the left scapular region, was associated with frequent recurrences of satellite lesion and finally developed multiple tumors of the lung and the treatment of such cases is discussed.

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A case of male child with tumor formation in the pancreatic head and hepatic hilus asso-ciated with persistent mosquito hypersensitivity was reported. The patient has suffered from severe systemic reaction by mosquito bite since 2 years of age and developed lympho-reticular proliferation at the age of 10. He finally developed acute pancreatic necrosis. It was considered that this tumor showed the figure of rapidly growing fatal reticulosis, and that the histological findings demonstrated histiocytic medullary reticulosis with tumorous transformation. These findings might suggest the close correlation between basic mosquito allergy and tumor formation.

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Two cases are reported who complained of severe cancer pain due to malignant lymphomas in advanced stages. Case 1 is a 15-years-old girl with Hodgkin's lymphoma. She developed liver metastasis associated with severe right upper abdominal pain after 4 years of treatment. Case 2 is an 11-years-old boy with non-Hodgkin's lymphoma arising from bone. In this case the relapse occured as testicular invasion followed by systemic dissemination including the bone marrow involvement that caused systemic intractable pain.
In these two cases, cancer pain was so severe that any managements such as intrave-nous analgesics, epidural anesthesia and oral morphine were not completely effective.
Recently, marked advances have been made in the treatment of childhood cancer, and the prolongation of survival time has been achieved. But it should not mean that the patients might suffer from prolonged troubles caused by cancer.
It is necessary to have much more effective modalities including psychological approach in managing the cancer pain.

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With the increasing number of case reports of malignant lymphoma occurring subsequent to autoimmune diseases, a relationship between immuno-deficiencies as the background of autoimmune diseases and the development of malignant lymphoma has been noticed.
Two cases of malignant lymphoma occurring in the course of rheumatoid arthritis (RA) were reported. The two cases are as follows:
Case-1 is a 62-years-old housewife. In 1965 she suffered from pain in the joints of both hands and morning stiffness. RA-test showed strong positive, and was treated by non-steroid analgesics. In January 1982 she noticed the swelling of the lymphnodes in the right neck and both axilla. Examination of the lymphnodes showed malignant lymphoma (diffuse, large cell type). At this time RA-test was negative.
Case-2 is a 65-years-old housewife. Since 1974 she suffered from RA and was given non-steroid analgesics. In August 1982 she noticed swelling of the lymphnodes in the right neck. Pathological diagnosis of biopsied lymphnode was Hodgkin's lymphoma. At this time RA-test became negative.

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Using leukocyte migration inhibition test, the activity of serum immunosuppressive factor was determined in 50 patients with malignant lymphoma. The factor was observed in 40% of patients with malignant lymphoma. The percent blocking index (% BI) was -7.3% in four patients with stage I, +7.4% in seven patients with stage II, +12.8%6 in 15 patients with stage III, and +17.4% in 24 patients with stage IV. The activity in patients with localized disease was significantly higher than the activity in patients with extensive disease (p<0.01). Serial determination of % BI was correlated with the clinical course, and the % BI was inversely correlated with the skin test response to PPD. Serum immune complex was observed in 50% of patients with malignant lymphoma, and the percentage of positive cases was higher in patients with extensive disease than in patients with localized disease. Therefore, we may conclude that serum immunosuppressive factor appears to serve as a parameter for malignant lymphoma.

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