Midfacial T cell lymphoma: characterization by monoclonal antibodies.

Three cases of so-called lethal midline granuloma were studied immunologically, using monoclonal antibodies against T cell subsets, and electron microscopically. Immunofluorescence and immunoperoxidase studies of their surgical and autopsy specimens proved that the tumor cells showed positive stainings with anti-Leu 1 and anti-Leu 3a antibodies, and negative staining with anti-Leu 2a, anti-HLA-DR, and anti-immunoglobulin antibodies. These data might indicate that the tumor cells of the three cases had a similar surface antigen phenotype to that of peripheral helper-inducer T cells. The histopathological and ultrastructural examinations of the tumors showed general characteristics reported for T cell lymphomata derived from peripheral T cells.

Immunohistological study of tonsil. Distribution of T cell subsets.

Employing a series of monoclonal antibodies directed against T cell subsets and the ABC (avidin-biotin complex) method as the immunoperoxidase technique, we studied the distribution of T cell subsets in frozen tissue sections of tonsils in 8 cases with various tonsillar lesions. Anti-Leu 1 and anti-Leu 4 antibodies, which react with all peripheral T cells, stained a majority of interfollicular cells and mononuclear cells in the lymphoepithelial symbiosis (LES). Approximately 80% of Leu 1+ and Leu 4+ cells were reactive with anti-Leu 3a antibody, which defines the helper/inducer T cell subset. Small lymphocytes in the mantle zone of the tonsillar follicle had IgD and IgM on their surface, whereas the cells in the germinal center showed membrane and/or cytoplasmic staining with anti-IgM serum. In addition, Leu 3a+ cells were found in the germinal center, especially on the capsular side showing a linear distribution. On the other hand, anti-Leu 2a antibody, which defines the suppressor/cytotoxic T cell subset, stained only a minority of lymphocytes in the interfollicular area and in the LES. Leu 2a+ cells were rarely found in the germinal centers. Anti-HLA-DR-positive cells were found with two types of staining pattern, i.e., with membrane staining found in the small lymphocytes in the mantle zone and the germinal center and with membrane and/or cytoplasmic staining found in large cells with dendritic processes in the germinal center, in the LES, and in the interfollicular areas. These findings demonstrate the presence of intimate cellular interactions in T cells, B cells, and macrophages in the tonsil, and indicate that immunohistological study of the tonsil may provide new insights into the pathogenesis of tonsillar lesions.

Malignant melanoma in the maxillary sinus--a case successfully treated with radiotherapy.

In this paper, we present a case where radiotherapy was very effective against malignant melanoma. We performed a total maxillectomy as the primary treatment, but the tumor recurred rapidly in the operated wound. Then, the patient was treated with 50 Gy in twenty-five treatments. After that, the tumor disappeared remarkably. On the other hand, this malignant melanoma was of the amelanotic type. We carried out a Fontana's stain and electronic microscopy to provide the criteria for the diagnosis of malignant melanoma. The pathological character of this malignant melanoma was investigated.

Metastatic squamous cell carcinoma of the paranasal sinuses from a primary squamous cell carcinoma of the urinary bladder.

Metastatic tumours of the paranasal sinuses from primary lesions of the urogenital tract are rare, with about 50 cases so far being reported in the literature. The most frequent primary lesions is a renal carcinoma. We have experienced a case of paranasal sinus malignancy. There were no symptoms of urinary tract carcinoma preceding those in the paranasal sinuses. This case was later revealed at autopsy to be a metastasis from a diverticulum of the urinary bladder.

[Comparative study on cefmetazole and cefazolin in the treatment of suppurative otitis media].

Cefmetazole (CMZ) was compared to cefazolin (CEZ) for efficacy and safety in the treatment of suppurative otitis media (including acute otitis media and chronic otitis media in acute aggravating stage) under well controlled clinical trials. The therapeutic effects were analyzed statistically in 172 patients (82 administered CMZ, 90 administered CEZ). The adverse reactions were also analyzed statistically in 199 patients (CMZ 99, CEZ 100) in whom the judgement was possible. 1. The efficacy rate of CMZ (72.3% for good to excellent response) was assessed by physicians in charge to be similar to that of CEZ (59.3%). This was the same being assessed by the committee, too (CMZ 64.6%, CEZ 56.7%). 2. When patients were classified into 2 groups (acute otitis media, chronic otitis media in acute aggravating stage) with respect to diagnosis, statistically significant difference in clinical efficacy assessed by physicians in charge was observed in the cases with chronic otitis media (CMZ, CEZ). In addition, the improvements of flares on the drum membrane and the mucous membrane of eardrum were significantly better in the CMZ group than in the CEZ group. 3. Bacteriologically, 16 cases (19.8%) of S. aureus were resistant to CEZ, while only 1 case (1.2%) to CMZ. CMZ was judged to be effective in 5 of the 6 cases in which CEZ-resistant strains were detected. 4. Side effects were found in 2 cases (2.0%) treated with CMZ: one complained of retching and abdominal pain and the other developed skin eruption. On the other hand, only 1 case (1.0%) developed skin eruption in the CEZ group. These results suggest that CMZ is a new antibiotic agent which is highly valuable in the treatment of suppurative otitis media.

Conceptual understanding of pustulosis palmaris et plantaris as an immune complex disease due to focal tonsillar infections.

The relationship between pustulosis palmaris et plantaris (PPP) and immune complexes was studied in 17 patients who underwent tonsillectomy. By means of the Clq-binding test, immune complexes were detected in a considerable number of sera from these patients. Patients with a high serum level of immune complexes which decreased following tonsillectomy were found to benefit by a remarkable improvement in their skin lesions. There was a close association between the degree of improvement in skin lesions following tonsillectomy, and the changes in circulating immune complex levels after tonsillectomy. Immunofluorescence showed that all 6 patients with PPP tested had deposits of IgG, IgM, IgA or C3 in their skin lesions. These results suggest that PPP may be an immune complex disease, and that it may be closely associated with the tonsil as a focus for the release of antigens or immune complexes.

Non-Hodgkin's lymphoma of Waldeyer's ring and nasal cavity. Clinical and immunologic aspects.

Twenty-nine cases of non-Hodgkin's lymphoma of Waldeyer's ring (W-NHL) and nasal cavity or paranasal sinus (N-NHL) were studied for tumor-surface marker phenotype and histopathologic correlation with clinical features. Immunostaining procedures on tissue sections by using xenoantisera and monoclonal antibodies to human B- and T-cells enabled the authors to demonstrate precise surface marker phenotypes of tumor cells and, moreover, the histologic localization of normal or neoplastic B- and T-cells in preserving the original structure of lymphoid organs or tumor tissues. In 22 cases of W-NHL, 19 (86%) had B-cell markers and 3 (14%) had T-cell markers, whereas 6 of 7 cases (86%) of N-NHL had T-cell markers. Tumor cells in T-cell lymphomas in W-NHL and N-NHL reacted with antibodies to peripheral T-cells except one case of W-NHL. Rappaport "histiocytic" subtype was heterogeneous with respect to both surface marker characteristics and morphologic features, i.e., seven had B-cell markers and four had T-cell markers, and they were all subdivided into "large cell" or "large cell, immunoblastic" in Working Formulation and "large cell" or "pleomorphic" in Lymphoma Study Group classification. The actuarial survival curve for all T-cell lymphoma patients was characterized by a rapid initial decline and a subsequent plateau, which contained two of the long survivors. In contrast, the B-cell lymphoma group had a more graded decline. The median and actuarial survivals of the T-cell lymphoma group were far inferior to those for the lymphoma group that expressed B-cell markers.