In order to detect monoclonal gammopathy in its early stage from a large number of serum samples four-item screening was very useful. It consists of 1) serum protein over 10Gm/100ml, 2) abnormal TTT/ZTT ratio (i.e., both TTT and ZTT below 1 or TTT below 1 and ZTT over 11), 3) abnormal band (s) in the serum protein electrophoresis (by orders from the attending physicians) and 4) discrepancy in the positivity of urinary protein by Albustix and sulfosalicylic acid test, i.e., negative or weakly positive Albustix test with a large amount of protein detected by sulfosalicylic acid method. The last frequently means the positive Bence Jones proteinuria.
By this four-item screening method 47 new cases with monoclonal gammopathy were detected from the sera of the out- and inpatients of Toranomon Hospital within one and a half years. After the application of so-called protein fraction screening method, where all the sera were tested by the simple paper elctrophoresis the detection rate increased up to more than 50 cases a year.
Cases of “premyeloma,” “indolent” myeloma and association of other malignant tumor (s) were presented and discussed.

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The features of the initial stage of chronic myelocytic leukemia (CML) were investigated. 16 (33.3%) of 48 cases (25 males; 23 females) were found to have peptic ulcer. These patients were characteristically male with a mean age that was greater at the time of diagnoses of CML than the mean age reported for those with CML alone. Of these 16 cases, 6 had underwent surgery. Measurement of hematological parameters following confirmation of the diagnosis of CML demonstrated unusually high levels for whole blood histamine, serum histamine, serum β-thromboglobulin, and platelet factor 4. After confirmation of the diagnosis, however, only two cases were found to suffer from peptic ulcer. Repeated radiographic examinations for peptic ulcer have been implicated as a possible causal factor in CML. For 9 of the cases that were examined hematologically prior to confirmation of the diagnosis of CML, white blood cell counts were maintained at the 10,000∼level for approximately 3.5 to 5.9 months and then climbed to the 30,000 -level over a period of 1.5 to 5.7 months. The white blood cell counts for several of these cases increased gradually with intermittent fluctuations. For these cases, it is suspected that white cell counts were approximately normal for 0.5 to 1 year prior to the hematological changes. In addition, white cell counts of peripheral blood increased slightly along with an increase in the basophil level in the absence of juvenile granulocytes.

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During the induction treatment of 47 cases with acute leukemia, incidence of infection was studied as the effectiveness of laminar air flow rooms (LAF). Twenty-one cases were treated in LAF, and 26 cases in conventional rooms (C). Both groups were kept under our routine nursing, i.e. with heated food, not sterilized cloths and linens, oral antibiotics administration, without any gown technique.
Times of fever wer 1.7 in LAF, 3.4 in C (p>0.01), and days of fever were 11.5 in LAF, 26.2 in C (p>0.05). Incidence of infections complicated with induction therapy. especially pneumonia, were lower in LAF than in C, even under our routine nursing procedure without any special clean technique.

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A 57-year-old male first sought medical assistance for general malaise and weight loss. Physical examination revealed generalized lymphadenopathy. Peripheral blood examination revealed only mild anemia and leucocytosis with a normal differential. Serum protein study revealed monoclonal gammopathy with IgM-κ type, although myelogram showed no lymphoplasmacytic proliferation. Furthermore both cryo-and pyroglobulin were found in the serum, and they were shown to consist mainly of M protein. The excised lymph nodes revealed histological characteristics of angio-immunoblastic lymphadenopathy. Peripheral lymphocyte examination showed the slight decrease of B cell and Tγ cell population.
Polyclonal hyperglobulinemia frequently accompanies angioimmunoblastic lymphadenopathy. However it seems rare that macroglobulinemia appears with the histology of angio-immunoblastic lymphadenopathy. This case could be an example of monoclonal immunoblastosis.

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A 63-year-old male was admitted on May 8. 1978, because of paraplegia. This symptom was due to spinal cord compression caused by myeloma of IgG, κ type and improved by radiation therapy even 3 months after its oncet. This effectiveness was also confirmed with laboratory examinations such as lumbar puncture and computed tomography. The total doses of ⁶⁰Co was 4,928 rad. Thereafter, the patient has been recieving cyclophosphamide and prednisolone.
The incidence of spinal cord compression is to 10 to 20% of patients with myeloma, and the radiation therapy for these cases has hardly been reported in Japan, while they were usually treated with surgery. But radiation is also useful for inoperable patiens, since myeloma is a high radiosensitive tumor and radiation therapy is not so invasive.
It has been indicated in some reports that paraplegia due to myeloma would be curable despite prolonged symptoms, and spinal cord compression progresses slowly in some cases. Therefore, it will be highly recommended to treat a patient with prolonged paraplegia due to myeloma by radiation as well as surgery.

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An autopsy case of macroglobulinemia with cryoglobulinemia complicated by a syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) was reported.
A 55-year-old man had been subjected to subtotal gastrectomy due to the finding suspect of stomach cancer in Sept. 1970. Histological diagnosis was reactive lymphoreticular hyperplasia of stomach. He was consulted to our clinic in May 1975 because of general fatijue and generalized lymphnode swelling. On admission, physical and laboratory examination disclosed generalized lymphadenopathy, hepatosplenomegaly, moderate anemia, thrombocytopenia, leukocytosis, and accelerated blood sedimentation rate, and cryoglobulin and M-component of IgM-kappa type in the serum. Many atypical lymphocytes were found in bone marrow. He was diagnosed as macroglobulinemia and treated with Chlorambucil. After a transient recovery, he expired in July 1977 because of recurrent pulmonary infections and hyponatremia due to SIADH. Autopsy findings showed systemic lymphnodes swelling and hepatosplenomegaly. Variety of the abnormal cells in which cytoplasmic immunoglobulin of IgM-kappa was demonstrated, infiltrated in the lymphnodes, spleen, bone marrow and gastro-intestinal tract.
From the close similarity of the histological findings between autopsy and resected stomach in 1970, it was suspected that the disease originated primarily from the stomach and extended to systemic lymphoreticular tissue. The patient could survive about 6 years and ten months from the onset.

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A 63-year-old male patient developed productive cough and fever in 1972, and was treated successfully with cyclophosphamide and then chlorambucil under a diagnosis of macroglobulinemia. In 1978, he was adimtted to our hospital with chief complaints of productive cough, fever, cervical lymphadenopathy and hepatosplenomegaly.
Hematological findings were as follows: hemoglobin 10.2g/dl, white blood cell count 6,700 with 42% lymphocytes and 6% abnormal plasmacytoid cells and rouleau formation in the blood. Examinations of bone marrow aspiration and lymph node biopsy showed a proliferation of lymphoblastoid and plasmacytoid cell series with different maturation stages.
Serum total protein was 8.7g/dl with hypergammaglobulinemia of two M components. Quantitation of the serum immunoglobulins revealed the increase in IgA and IgG, 2,220mg/dl and 1,485mg/dl respectively, and the decrease in IgM of 40mg/dl. Immunoelectrophoresis of the serum showed M-bows in IgG-λ and IgA-λ. Bence Jones protein was 341mg/dl in urine.
From these results, this patient was diagnosed as a peculiar disorder simulating macroglobulinemia, which had both IgG and IgA M-proteins.

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Myeloblastoma with chronic myelogenous leukemia (CML) has been well documented in Japanese literatures, but only few cases with non-myeloblastomatous tumor have been discribed. Recently, a 26-year-old male with developed painful lymphadenopathy and lytic bone lesion was observed in spite of well control of the chronic phase of CML with no splenomegaly, low score of neutrophil alkaline phosphatase (NAP) and mild increase of white blood cell count (WBC) without hiatus leukemicus.
His diagnosis of CML was made in September 1972, and his WBC was well controlled with busulfan and pipobroman over the following 4 years. On March 10. 1977, he was sufferred from severe pain on the left inguinal region, on March 26, lymphadenopathy and painful soft swelling developed on the same region. ^99mTc scintigram proved hot and cold area on the left iliac bone. Open biopsy of lymph node and lytic bone lesion revealed leukemic infiltration with immature and mature granulocytes.
Local irradiation was evaluated to be effective to tumor, but following hematological blastic crisis did not respond to combinated chemotherapy. He died on June 23. 1977.

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We experienced a patient associated with plasma cells having spindle-shaped inclusions, hypogammaglobulinemia and reduction of cellular immunity. Autopsy revealed marked atrophy of the spleen and peritonitis due to perforated Meckel's diverticulum.
To study the properties of these inclusion bodies, electron microscopic, histochemical and immunological observations were performed. The electron microscopic observation showed that these inclusion bodies were composed of fibrous material, 200∼250 A in diameter and 0.5∼1.5 μm in length, and surrounded by a unit membrane. By special stainings, acid phosphatase and beta-glucuronidase activities were positive but peroxidase, PAS and alkaline phosphatase were negative in them. Furthermore, in the immunological observation, they did not have the properties of immunoglobulins and amyloid fibrils. Therefore, seems it that the inclusion bodies were composed of fibrous material containing lysosomal enzymes.
Furthermore, hypogammaglobulinemia and reduction of cellular immunity appear to be the concomitant phenomena caused by atrophy of the spleen and lymph nodes, because it is difficult to interpret that hypogammaglobulinemia and reduction of cellular immunity were induced by abnomal plasma cells.

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A case of chronic myelomonocytic leukemia complicated by myelofibrosis and polycythemia is presented.
A 73-year-old woman was hospitalized in November 1979 for the examination of an abdominal tumor which she noticed 4 years previously. On admission her spleen and liver were palpable 12 cm and 3 cm below the costal margins, respectively. The peripheral blood showed Hb 11.7 g/dl, RBC 402×10⁴/mm³, WBC 27,900/mm³, and platelets 20×10⁴/mm³. WBC differential count demonstrated a marked leucoerytroblastic picture with blasts 2%, promyelocytes 4%, myelocytes 7%, metamyelocytes 8%, neutrophils 47%, eosinophils 2%, basophils 2%, monocyotoid cells 18%, lymphocytes 10% and 5 erythroblasts per 100 WBC. A bone marrow aspirate, obtained with some difficulty, revealed marked granulocytic hyperplasia with an increase in both all stages of granulocytic cells and monocytoid cells. Trephine biopsy of bone marrow showed typical change of myelofibrosis with an increase in collagen and reticulin. NAP score was high and the serum muramidase level was elevated. Cytogenetic study of bone marrow showed normal chromosome karyotype of 46 XX without Ph¹ chromosome. The circulating red cell mass was 1887 ml by ⁵¹Cr method, giving a volume of 41.9 ml/kg. The in vitro colony counts of CFU-C and BFU-E from both of bone marrow aspirate and circulating blood were greatly increased, while the bone marrow CFU-E colony count was markedly reduced. Because of progressive enlargement of the spleen, a short course of dibromomannitol (100 mg daily) was given, with a fall in the WBC count and a regression of the spleen size.
Thus our case was characterized by an association of myelomonocytic malignant proliforation with erythrocytosis and myelofibrosis. It is known that clinically and hematologically transitional or hybrid cases are not infrequent among chronic myeloproliferative disorders. Our case, who had proliferative changes in more than two series of blood cells, will support the concept that chronic myelomonocytic leukemia is a proliferative disorder involving all marrow cells derived from malignant proliferation of a multipotent stem cell, representing a distinct clinical entity which belongs to the so-called chronic myeloproliferative disorders.

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Chronic lymphocytic leukemia (CLL) has been known to have a higher incidence of cancer than other types of leukemia and relationship between CLL and cancer has been emphasized. In Japan, however, reports of such cases are few.
We have recently encountered two cases of CLL associated with cancer.
The first case, 60-year-old woman, has developed to cancer of the pancreas after 12 years course of CLL.
The second case, 76 year-old-woman, has been discovered CLL and cancer of the left breast simulataneously.
Case reports of CLL associated with cancer from the literature were reviewed and discussed.

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A 29-year-old woman was admitted to the hospital becouse of cervical lymphnode swellings and developed dyspnea. Chest X-ray showed a mediastinal mass, and bone marrow aspiration revealed 66.7% pathological cells.
Diagnosis of malignant lymphoma, diffuse poorly differentiated lymphocytic was established by the cervical lymphnode biopsy. She obtained complete remission with CVP combination chemotherapy. However, she developed CNS involvement in 12th month, skin infiltration in 18th month and leukemic change in 20th month, and died in 38th month after diagnosis.
The pathological cells had convoluted nuclei, a lot of vacuoles in cytoplasma and showed strong focal acid phosphatase activity. Their surface marker study revealed cold E rosette, hot E rosette and EAC rosette, but negative surface immunoglobulin.

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We experienced a patient with adult T cell leukemia which has been proposed as a new clinical entity of diseases by it's immunological and histopathological features.
A 57-year-old man from the southern coast of Kii peninsula was admitted to our hospital because of fever and general fatigue. On laboratory examinations, it was found that there were many lymphocytoid leukemic cells with convoluted or lobulated nuclei in peripheral blood and bone marrow. These cells were confirmed to have the property to form rosettes with sheep red cells and completely unresponsive to the plant-lectins such as PHA, PWM and Con A, in vitro. The elevation of serum Ca and P levels was noted during the course of illness, and metastatic calcification mainly at the systemic vessels was found at autopsy.
Hypercalcemia and hyperphosphatemia, which might be due to the destruction of bone by infiltrated leukemic cells, seemed to play an important role in the development of metastatic calcification, and a discussion was made against this unusual complication.
The geographic distribution of a few cases of adult T cell leukemia at the south-west of Kii peninsula was presented. It was reconfirmed that the birthplaces of all patients were closely situated at the see.

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