314 Radiation Oncology 0 Biology 0 Physics

TREATMENT OF LYMPHOCYTIC INFILTRATIVE ULCERS OF THE FACE BY MINIMAL DDSE IRRADIATION

OF THE SPLEEN

To the Editor: A 51 year-old male was admitted with Stage IV chronic lymphocytic leukemia (CLL). He had 180,000 lymphocytes per cmm and large lymphnodes. His spleen was 18 cm below the left costal margin. On the left side of his face and the base of his nose, there were deep ulcerative lesions (Fig. 1).

angina1 pain accompanied by ventricular tachycardia and fibrillations. A week after the irradiation, the infiltration on his face disappeared and did not recur till his death eight weeks later (Fig. 2).

It is well known that lymph nodes shrink and the number of lymphocytes diminishes following irradiation of the spleen. The same happens with any extranodal lymphocyte infiltration. This indirect method of treatment of the face has the additional benefit that the irradiation does not damage adjacent normal tissue.

As these ulcerations were thought to be of infective origin, they were DAVID KOHN, M.D. treated with systemic antibiotics and antimycotics, but to no avail. The EDITH FLATAU, M.D. cultures remained sterile, the biopsy and the tissue imprint showed pure DAN SCHILLER, M.D. lymphocytes only. The patient had severe pains on his left flank, which Dept. of Internal Medicine ‘B’, Afula, Israel. suggested recurrent infarctions of the spleen. MIRIAN STEINFELD, M.D.

An irradiation of the spleen was considered. After an initial given Dept. of Dermatology, Afula. Israel. dose of 100 rad on the anterior abdominal field 18 x 15 cm with cobalt ABRAHAM KUTEN, M.D. 60 X rays, the treatment had to be stopped because of an attack of Dept. of Oncology, Rambam Medical Center, Haifa, Israel.

February 1982, Volume 8, Number 2

Figure 1 Figure 2