Cancer Research and Treatment

Effect of Exogenous Exon 1 and Upstream Sequences on c-myc Expression in NIH3T3 Cells: Young Hwan Rhee, Tai Ju Hwang; J Korean Cancer Assoc. 1990;22(2):229-239.

Abstract PDF: Several mechanisms regarding activation of c-myc have been proposed. However, the molecular mechanism by which c-myc deregulation can occur remains obscure and no supparting evidence for a clearly defined regulation of c-myc expression has been provided. This research was designed to investigate the possible effect of exon 1 and its upstream sequences on c-myc expression. The transcriptional activities of exogenous plasmids and endogenous c-myc were studied for their expression after NIH3T3 cells were transiently transfected with plasmids containing exon 1 and upstream sequences of mouse c-myc that are putativelv regulatory sequences. The results of this research rule out a possible role of putatively regulatory sequences for transacting elements, an activator and a repressor, because the expressions of c-myc were not affected by the exogenous elements of exon 1 or upstream sequence in NIH3T3 fibroblast cells.

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Expression of Cellular Oncogene c-myc during HL-60 Cell Differentiation: Jong Suk Oh, In Chol Kang, Phil Youl Ryu, Jin Chuk Bae, Hyun Chul Lee; J Korean Cancer Assoc. 1990;22(2):239-251.

Abstract PDF: The effect of differentiation inducers alone or in combination on the degree of cellular differentiation and the level of c-nyc expression was assessed in human promyelocytic leukemia cell line HL-60. And the method of signal transduction in the cell was investigated in the same celL 1) TPA (12-0-tetradecanoyl phorbol-13-acetate)-treated HL-60 cells showed the morphological differentiation, while either calcium ionophore A231S7-, trifluoperazine-, or diltiazem-treated cells didn't. Among the three combinations of TPA and other agents, the calcium ionophore and TPA combination revealed the greatest effect on the cellular differentiation. Compared with control, the proliferation of cells treated with the inducers was suppressed. 2) Cells treated with the inducers, fixed onto nitrocellulose filter, and assessed by the method of dot blot hybridization showed that the c-myc RNA level of TPA-treated cells decreased and that of calcium ionophore-treated cells increased, while cells treated with the combination of these two agents produced a significant reduction in that level. And the c-myc RNA level of trifluoperazine- treated cells increased noticeably. 3) Poly (A+) mRNA was extracted from cells treat.ed with the inducers for 24 hours. Northern blot analysis showed that the c-myc expression of TPA-treated cell decreased and that of cells treated with the combination of calciuni ionophore and TPA decreased more, while the c-myc expression of trifluoperazine-treated cells increased significantly.

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Aberrant Expression of the K-ras Proto - oncogene in B - cell Malignascies: Jung Shin Lee, Kyoo Hyung Lee; J Korean Cancer Assoc. 1990;22(2):251-257.

Abstract PDF: The proto-oncogenes have the capacity for conversion to an oncogene that is capable of inducing or maintaining the transformed state when they are overly expressed or altered by mutation or rearrangement and crmsidered to play a central role in the pathogenesis of malignancv and also in nonnaf cellular growth and development. To study the possibie imolvement of these genes in the neoplastic transformation of S-cell malignancies, we evaluated expression of oncagenes in B cell malignancies using two DNA probes, c-k-ras and c-myc. A low-molecular weight c-k-ras transcript (1.2 kb) was detected in 9/18 fresh samples in addition to a high-molecular weight transcript (5.2 kb) which was detected in ail samples including normal lymphocytes. The level of expression of this low-molecular weight transcript was generaliy twofold higher than that of the high-molecular transcript. The low-molecular weight transcript was not detected in normal lymphocytes nor in cell lines we studied. There was no rearrangement nor amplification of c-k-ras gene on Southern blot analysis of fresh samples which have aberrant low molecular c-k-ras expressian. C-myc was expressed in all samples including normal lymphocytes without significant variation in the level of expression. Our study establishes certain oncogenes are aberrantiy expressed in some of fresh B-cell malig- nancies and suggests their role in the malignant transformation or normal cellular growth in a specific stage of hematopoietic differentiation.

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A Study on the Significance of Peripheral T-lymphocyte Subsets and Mitogen-induced Lymphocyte Prolicaraction in Acute Lymphoblastic Leukemia in Childhood: Sang Hyun Byun, Jong Jin Seo, Young Hun Chung; J Korean Cancer Assoc. 1990;22(2):257-267.

Abstract PDF: To evaluate the relationship between peripheral blood T-lymphocyte subsets, mitogen-induced lymphocyte proliferation and the outcome of acute lymphoblastic leukemia in childhood, the authors studied 15 cases of acute Iymphoblastic leukemia in childhood. The results were as follows: 1 I Percent peripheral lymphocyte and percent CDS+ cells showed no significant difference between total patient group and control group, while percent CD4+ cells was significantly decreased in total patient group compared to control group. But no significant difference was found between patient subgroups 2) Total counts of CD4+ cells and CD8+cells showed no significant difference between patient subgroups. 3) The ratio of CD4+cells and CDB+ cells showed no significant difference between patient subgroups, but more cases with the ratio less than 1.0 were found among total patient group compared to control group. 4) The stimulation indices of PHA and Con-A were significantly decreased in total patient group (p<0.05, p<0.005) compared to control group, but no significant difference was observed between patient subgroups. 5) The unstimulated 3[H]-thymidine uptake showed no significant relationship between patient subgroups. 6) The distribution of T-lymphocyte subsets showed no significant relationship with the stimula- tion index of PHA and Con-A. These results showed that the children with acute lymphoblastic leukemia have depressed cellular immune functions tested with T-lymphocvte subsets and mitagen-induced lymphocyte proliferation assay. But these results can not be regarded as one of prognostic factors of acute lymphoblastic leukemia in childhood unless there are additional longterm data indicating the T-cell mediated immune functions are related to the outcome of acute lymphoblastic leukemia in childhood.

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Effects of Drugs on Angiogenesis: Yeon Woong Chung, Sang Choon Lee, Sung Soo Yoon, Wook Dong Kim, Dong Il Park, Soo Jung Lee, Min Chul Chim, Koing Bo Kwun; J Korean Cancer Assoc. 1990;22(2):267-274.

Abstract PDF: Angiogenesis, a process of new blood vessel formation, is an essential biological phenomenon that occurs in normal growth, wound healing, inflammation, and even in a malignant tumor growth. It is now well known that unrestricted growth of tumor is dependent upon angiogenesis and a tumor itself release angiogenic factors which stimulate migration and proliferation of capillaries toward the tumor from neighboring blood vessels. A numorous study has been going on to find out a strong angiogenic inhibitor which could be used to comabat tumor angiogenesis and achieve tumor regression. In order to investigate angiogenic properties of several medicines author utilized a chick chorioallantoic membrane assay technique. Protamine sulfate (50 ug), picibanil (0.6 uKE), heparin (6 ug) and prostaglandidn E1, (1 ug) were tested, and normal saline was used for control. Each test medicine was absorbed into a small piece of cottonoid disk and then it was placed at the edge of the chorioallantoic membrane of 4 days old chick embryo, and angiogenesis was evaluated after 48 hours incubation. According to the degree of vascular growing by the naked eyes, the responses were subdivided into 3 groups as no response, the inhibited and the increased. Control group, heparin and picibanil groups revealed no response on angiogenesis Prostaglandin E, demonstrated increased vascular reponse, protamine sulfate showed a strong inhibition of angiogenesis. In conclusion, test chemicals showd different angiogenic responses. Only protamine sulfate demon- strated a strong angiogenic inhibition. Por the clinical application of this inhibitor, Further evaluation may be required.

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Immunohistochemical Study of Laminin in Mucinous Tumors and Metastatic Adenocarcinoma of the Ovary: Seung Ho Lee, Nam Hee Won, Seung Yong Paik, Ju Hie Lee, Moon Ho Yang; J Korean Cancer Assoc. 1990;22(2):274-281.

Abstract PDF: The distribution of laminin in the basement membranes of 20 mucinous tumors and 5 metastatic adenocarcinomas to the ovary was studied using immunoperoxidase techniques to check for invasive carcinoma. Lymph nodes with ovarian tumor metastasis were also studied in 2 cases. Nine cases af 11 mucinous tumors of boderline malignancy revealed linear continuous staining for laminin along the basement membranes around the glands. Only 2 cases showed focal distruption in the laminin staining, accompanied by mucus release or inflammation. Laminin expression of mucinous cystadenocarcinomas was variable and similar to those of boderline malignancy, except areas of stromal invasion. Thick and discontinuous staining of the basement membranes were observed in 4 cases of mucinous cystadenocarcinoma; fragmentary staining in 4 cases; and unrecognizable basement membrane staining in the remaining one case. Laminin stainings were campletely negative in 2 cases of metastatic lymph nodes of ovarian cystadenocarcinoma. Krukenberg tumors were all negative for laminin except only one. The cases of metastatic adenocarcinoma from the large intestine to ovary revealed irregular and fragmentary staining related to the histologic differentiation, the cellular atypism of tumor cells, abnormal glandular architecture of the tumor and the degree of inflammatory cell infiltration.

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Natural Killer Cell Activity in Patients with Liver Cirrhosis and Primary Hepatocellular Carcinoma: Sung Gye Lee, Sung Sook Lee, Ja Young Koo, Byung Chae Park; J Korean Cancer Assoc. 1990;22(2):281-286.

Abstract PDF: To evaluate the possibility that depressed natural killer (NK) cell activity observed in chronic liver diseases might be related to the development of primary hepatocellular carcinoma (PHC), we studied NK cell activity by using 4-hr 51Cr releasing assay in patients with chronic liver diseases caused by chronic B virus infection. The subjects were consisted of hepatitis B virus (HBV) healthy carrier (n=35), chronic active hepatitis (CAH, n=40), liver cirrhosis (LC, n=28), PHC (n=35) and normal control (n=40). The results were as follows: 1) NK cell activity obtained in patients with CAH (51.04+-10.42%,) was similar to that of control group (50.73+7.77%). 2) NK cell activity in HBV carrier (55.07+-11.35%) was some what higher than that of control, but there was no significant difference between the two groups. 3) NK cell act.ivity observed in both groups of patients with LC (40.60+-12.26%) and with PHC (41. 00+-12.20%) were significantly (p<0.005) depressed as compared to those of CAH and control. There was no significant difference in NK cell activity between groups of LC and PHC. These findings might be a suggestion that depressed natural immune surveillance as measured by NK cell activity might be one of several factors which may enhance the development of PHC form cirrhotic liver.

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Antitumor Activity of Lymphokine Activated Killer Cells ( LAK ) and Interleukin-2 Activated Tumor Infiltrating Lymphocytes ( TIL ) to the Cell Lines of Human Renal cell carcinom: Chong Wook Lee, Eun Sik Lee, Dae Seog Heo, Jae Gahb Park; J Korean Cancer Assoc. 1990;22(2):286-298.

Abstract PDF: We analysed the antitumor activity of lymphokine activated killer cells (LAK) induced from peripheral bloods of normal, renai cells carcinoma and transitional cell carcinoma patients and interleukin-2 (IL-2) activated tumor infiltrating lymphocytes (TIL) from human renal cell carcinoma and transitional cell carcinoma of the bladder. An establidhed human renal cell carcinoma (Caki-1l and transitiunai cell carcinoma cell lines (T-24) were used as target cell. Cytotoxicity was checked by MTT assay. As a pilot study, concentration of IL-2 produced by KAIST was measured using IL-2 dependent CTLL cell compared with Cetus standard unit and optimun conditions for LAK generation were evaiuated. The concentration of IL-2 was 2 x 10(6) Cetus units/mg. The optimum target cell number was 5 x 10(3) cells in Caki-1 and 2.5 x 10(3) cells in T-24 cell line. Most active LAK cells were induced by 1,000 units,' m1 of IL-2 concentration and 5 days incubation period. The LAK activity of 10 normal adults (group 1), 10 renal celi carcinoma (group 2) and 9 transitional cell carcinoma patients lgroup 3) ta the target cells were compared. More than 50% of target cells were killed when effector; target cell ratio was 10 or more. The killing activities against the T-24 and Caki-1 cell lines were not different in all three groups. The tunwr infiltrating lymphocytes from 10 renal cell and 9 transitional cell carcinomas were activated with 1,000 units/ml of IL-2. TIL was activated in 7 of 19 tumor tissues. TIL from renal cell carcinoma showed good proliferating potential and nonspecific killing activity to the T-24 and Caki-l. The killing activity of TIL appeared to be somewhat stronger than LAK. Adoptive immunotherapy using LAK and TIL cauid provide a good therapeutic modality in the patients with advanced renai cell carcinoma and transitional cell carcinoma of the bladder.

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Treatment Results and Prognostic Factors of Radical Radiotherapy in FIGO Stage 3B Cervical Cnacer: Hyung Sik Lee, Sun Rock Moon, Byung Soo Kim, Chang Ok Suh, Gwi Eon Kim, Jun Kyu Loh, Dong Won Kim; J Korean Cancer Assoc. 1990;22(2):298-307.

Abstract PDF: From January 1979 to December 1981, One hundred and sixty-one patients with stage IIIB car- cinoma of the cervix according to the International Federation of Gynecology and Obstetrics (FIGO) received radical radiation treatment consisting of external irradiation with intracavitary brachytherapy in our institute. Radiation treatment was delivered in a similar fashion in all patients in terms of the dosage and the technique. Complete response rate of 63.9% and overall 5 year survival rate of 49.6% for stage IIIB carcinoma of cervix were obtained in the study. One hundred and sixty one patients were retrospectively analyzed with respect to two variables: the extent of pelvic wall involvement and the presence of hydronephrosis. The extent of pelve wall involvement proved to be a strong prognostic factor, that is, the patients with unilateral involvement had a 5 year survival rate of 58.7% and bilateral ones of 34.3%;, whereas in those with fixation of pelvic wall involvement (frozen pelvis) it was only 23.5% (p= 0.000). The presence of nonfunctioning kidney or hydronephrosis proved to be statistically insignificant factors as far as the survival rates are concerned (p=0.87). We can, therefore, conclude that subsets of the patient with Stage IIIB cervical cancer with bilateral pelvic wall involvement or pelvic wall fixation carries unfavorable prognostic factors as compare to those of unilateral subset and these should be kept in mind when designing treatment plan.

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Antiemetic effects of Metoclopramide and Motilium Suppository in Patients Peceiving Cisplatin - Based Chemotherapy : A Randomized Crossover Trial: Joong Jik Cha, Seok Kyun Kim, In Young Hyun, Weon Seon Hong, Jhin Oh Lee; J Korean Cancer Assoc. 1990;22(2):307-316.

Abstract PDF: Twenty patients with advanced stomach cancer receiving combination chemotherapy with 5- fluorouracil and cisplatin were entered into an antiemetic randomized crossover trial. All patients had previously untreated adenocarcinoma of the stomach with metastasis beyond surgical resection, but no pyloric obstruction. Thirteen patients (Group A) have received 1,000 mg/m of -fluarouracil on day 1-5 and 80 mg/m of cisplatin on day 1. Fourteen patients (Group B) have received 1,000 mg/m of 5-fluorouracil and 20 mg/m of cisplatin on day 1-5. Seven patients (A-1) of group A have treated with metoclopramide (2 mg/kg i. v. bid. on day 1) and no antiemetics on day 2-5. Six patients (A-2) of group A have treated with metoclopramide (2 mg/kg i. v, bid. on day 1) and Motilium suppository (1 capsule = 60 mg of domperidone, bid. on day 2-5). Eight patients (B-1) of group B have treated with metoclopramide alone (I mg/kg i. v. bid. on day 1-5). Six patients (B-2) of group B have treated with Motilium suppository (I capsule per rectal. bid. on day 2-5). Response of vomiting was determined as the percentage of patients with less than two times of vomiting per day to all patients studied. Nausea was classified into four groups; no nausea, mild degree, moderate degree and severe degree. Response of nausea was determined as the percentage of patients with no and mild degree of nausea to all patients studied. Response rate on day #1 was similar between A-1 (43%) and A-2 (50%). Response rates of vomiting and nausea on day 2-5 in A-2 (95% and 54%, respectively) were not significantly different from those of A-l(89% and 64%). Response rate of vomiting was not significantly different between S-l and B-2 (85% and 90% in B-1 and B-2, respectively). Response rate of nausea, however, in B-2 was superior to that in B-l (48% and 63% in B-1 and B-2, respectivelyl. When the patients were asked for their opinion of the two regimen (A-1 or A-2 in group A and B-1 or B-2 in group E), 679; in group A and 1009o in group B prefered A-2 and B-2 regimens, respectively. There was no major side effects associated with antiemetic treatement. These results demonstrating that motilium suppository is cansiderably effective for low dose of 5-fluorouracil and cisplatin-induced emesis warrant a further trial to determine the optimal dose and schedule for clinical usage of Motilium suppository as antiemetics.

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Effect of Low Dose Cyclophosphamide and Polysaccharide K ( Copolang ) Combination Therapy on the Cell - Mediated Immunity in Cancer Patients and Primary Hepatocellular Carcino: Cheol Shin Park, Jong Wan Kim, Jun Young Kil, Sam Yong Kim; J Korean Cancer Assoc. 1990;22(2):316-323.

Abstract PDF: To evaluate the combined therapeutic effect of Polysaccharide K and low dose cyclophosphamide, cyclophosphamide 300 mg/m IV Day 1 and PSK (Copolang 3 gm/Day, po, Day 4-17) were adminis- tered every 4 weeks in 16 patients with cancer including 10 patients with gastric cancer after surgery, 1 patient with duodenal cancer, 2 patients with pancreatic cancer, 1 patient with nasopharyngeal cancer, and 2 patients with bladder cancer. Peripheral blood T-cell subsets were measured by indirect fluorescent staining of peripheral lymphocytes with specific monoclonal antibodies against CD3, CD4 and CD8. The results are summerized as follows: 1) The mean value of percentage of CD4+ and CD4+/CD8+ ratio was increased, and the percentage of CDS+ was decreased after therapy, with statistical significance. 2) For durg toxicity, nausea & indigestion (grade 1 gastrointestinal toxicity) were complained in 3 patients (18%), and mild pruritus in 1 patient (9%). 3) There was no disease progression or disease recurrence during the period of this study. Duration of follow up was; median 8 months, range 4-16 months. In conclusion, copolang and low dose cyclophosphamide combination immunotherapy seems a useful modality in the therapy of a selected group of patients with cancer such as low risk surgical adjuvant setting, though longer follow up is needed to verify its effect on patient survival.

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Non - Hodgkin's Lymphoma of the Central Nervous System: Chang In Suh, Heung Tae Kim, Young Hyuk Im, Young Suk Park, Won Ki Kang, Dae Seog Heo, Yung Jue Bang, Byoung Kook Kim, Noe Kyeong Kim; J Korean Cancer Assoc. 1990;22(2):323-329.

Abstract PDF: Thirty one patients with Non-Hodgkin's lymphoma of the central nervous system (CNS) were treated at the Seoul National University Hospital between Jan. 1978 and Mar. 1989. Clinical records of these patients were analyzed in order to define disease characteristics. clinical course, and risk factors for CNS involvement Six patients had primary CNS lymphoma and twenty five patients had secondary involvement of CNS. 5.3% of non-Hodgkin's lymphoma patients had secondary CNS involvement. Patients less than 30 years of age had increased risk for CNS involvement. Patients who had stage IV lymphoma had CNS invalvement more frequently than expected but without statistical significance. Median survival time was 14 months for primary CNS lymphoma and 4 months for secondary CNS lynsphoma. Cranial irradiation and intrathecal chemotherapy prolonged the survival but standard treatment should be established.

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The Efficacy of 5-Fluorouracil and Low Dose Oral Leucovorin in Advanced GI Malignancies: Han Lim Moon, Hoon Kyo Kim, Kyung Shik Lee, Jin Woo Jung, Chang Don Lee, Boo Sung Kim, Dong Jip Kim, Kyu Ho Choi, Keung Eup Choi; J Korean Cancer Assoc. 1990;22(2):329-334.

Abstract PDF: Eighteen patients with GI malignancies (9 gastric, 3 colorectal, 3 pancreatic and 3 hepatobiliary cancer) were treated with oral leucovorin 15 mg administered every 6 hrs and IV 5-fluorouracil (5-FU) 500 mg/m started 1 hr after oral leucovorin for 5 consecutive days. The cycle was repeated every 3 weeks. When grade III or IV toxicities appeared, dose of 5-FU was reduced to 80% of initial one. Eight of 18 patients had previous experience of 5-FU containing chemotherapy. The results of study showed no objective responder of 16 evaluable patients. Eleven of 16 (69%) had stable disease and 5 (31%) Progressed initially. The overall survival of the study group was 9-65+ weeks (median: 36 wks). Survival of patients with stable disease and those with initial progression were 9+-65+ weeks (median: 41 weeks) and 9-21 (median: 13) weeks retrospectively (p<0.05). Toxicities were mild and tolerable. The most common and dose limiting toxicity was mucositis (83.3%). We concluded low dose oral leucovorin and 5-FU was tolerable, but not effective in GI malignancies.

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A Clinical Study on 140 Cases of Early Gastric Cancer: Man Seok Heo, Nam Sun Paik, Nan Mo Moon; J Korean Cancer Assoc. 1990;22(2):334-341.

Abstract PDF: Carcinoma of the stomach is the most prevalent malignancy in Korea and usually has poor prognosis. But, the prognosis for the early gastric cancer has been reported very excellent. Authors analyzed 140 cases of EGC operated on from January 1980 to December 1988 at KCCH in the view of the incidence, ABO blood types, age distribution, depth of invasion, pathological classification, lymph node metastases and progno#sis. The results were as follows. 1) The incidence of EGC was 12.6% of all stomach cancer during the same period. The overall male to female sex ratio was 1.8:1 (male:female=90:50). 2) The most frequent age group was the 6the decade (34%), followed by the 5th decade (27.9%) and the 7th decade (20.7%) in order. 3) The major blood type of EGC patients was type A(42.1%). 4) The preoperative diagnostic accuracy was 40.3% by double contrast study and 62.0% by endoscopy with biopsy. 5) The most common site was antrum, followed by incisura angularis. 6) The most common type of EGC was type II, (57.9%), followed by type II,+III(17.9%). 7) In 43 cases the lesion was limited to mucosa only, and nintyseven cases invaded to submucosa, and the metastases to regional lymph nodes were zero in mucosa type and 16.4% (23 cases) in submucosa type. B) Histologic type revealed 20 cases of well differentiated type, 38 cases of moderated differentiated type, 62 cases of poorly differentiated type, 20 cases of signet ring cell type. 9) Radical operations were performed in all cases and adjuvant chemotherapy was done in the cases with lymph node metastases only. 10) Overall 5-year survival rate for the entire group was 96.0%.

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Surgical Treatment of Malignant Melanoma: Seong Yeoll Kim, Yeo Kyu Youn, Kuk Jin Choe; J Korean Cancer Assoc. 1990;22(2):341-352.

Abstract PDF: Twenty-eight cases of malignant melanoma were treated at this hospital during the period from 1978 to 1987. An analysis of this clinical material revealed the followings. 1) The incidence of this cancer was far less common than in the west, comprising only 0.4% of all registered cancer patients at Department of GerneraI Surgery in SNVH. 2) The sex ratio was almost equal, and the disease was most often diagnosed in the sixth decade of life. 3) Twenty-six cases were cutaneous melanoma, and two cases were mucosal melanoma. 4) Main clinical symptoms were change in size or contour of nevus and unhealed ulcer. 5) Most freuqent primary site was lower extremity. 6) Almost all patients symptom duration was less than one year. 7) Most frequently used treatment modality was combination on wide excision, regional lymph node dissection, and adjuvant therapy. 8) Frquently metastatic sites of malignant melanoma were regional lymph node (17), Liver (5), lung (4), bone (4), other site of skin (2), and brain (1). 9) The determinate survivai af cutaneous melanoma was 36.1 months and mucosal melanoma was 31.5 months. 1(l) The determinate survivai of malienant melanoma, according to clinical stage were stage I cases 44.6 months, stage II cases 36.1 months and stage Ill cases 15.6 months. 11) The disease free interval of malignant melanoma, were cutaneous melanoma 19.4 months and mucosal melanoma 24 montha 12) The disease free interval of malignant melanoma according to clinical stage were stage I cases 26.5 months, stage II cases 22.1 months and stage III cases 6.4 months. 13) Those factors like stage I and II, less than 0.76 mm, thick and below Clark level II revealed good prognostic indicators.

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A Case of Herpes Zoster Duplex in Patient with Malignant Lymphoma: Jong Youl Jin, Suk Joon Park, Seok Joong Yoon, Sung No Yun, Han Lim Moon, Hoon Kyo Kim, Moon Won Kang, Kyung Shik Lee, Dong Jip Kim; J Korean Cancer Assoc. 1990;22(2):352-355.

Abstract PDF: Herpes zoster occurs frequently in lymphoproliferative malignancy. In the majority, lesions confine to the skin in one or more adjacent dermatomes (localized zoster). But double dermatomes involve- ment (zoster duplex) occurs 0.15 to 0.5 percent of unselected patients with herpes zoster. A 59 years old female patient with malignant lymphoma showed multiple vesicles on right chest (T, dermatome area) and left arm (C, dermatome areal. The distribution of vesicles along nerve distribu- tion was characteristic pattern of herpes zoster. The patient was treated with topical application of calamin lotion, analgesics and acyclovir for 7 days. On the 7th hospital day, vesicle had changed to crust and discharged with improvement of pain.

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