Characterization of the mononuclear infiltrate in basal cell carcinoma: a predominantly T cell-mediated immune response with minor participation of Leu-7+ (natural killer) cells and Leu-14+ (B) cells.

We investigated the peritumoral inflammatory infiltrate in 22 basal cell carcinoma (BCC) from 18 patients using a series of monoclonal antibodies. In all the 22 BCC the infiltrate consisted mainly of T cells (55 +/- 15%) and only in three cases an invasion of the tumor nests by these cells was observed. The T helper (TH) subset predominated over the T suppressor/cytotoxic (TS/C) subset (TH/TS/C ratio of 1.9 +/- 0.8). In 8 of 22 BCC mild infiltrate was observed with 48 +/- 13% T cells and a TH/TS/C ratio of 1.5 +/- 0.6. In 14 of 22 BCC moderate to heavy infiltrate with 59 +/- 15% T cells and a TH/TS/C ratio of 2.0 +/- 1.0 was observed. There was a significant difference in the percentage of T cells in BCC with moderate to heavy infiltrate and that in BCC with mild infiltration. The mean percentage of HLA-DR+ cells was 54 +/- 11%; Langerhans cells (LC) 4 +/- 5%; and Leu-M5+ (monocytes and macrophages) 16 +/- 11%. Less than 2% Leu-14+(B) cells were seen in the infiltrate. The mean percentage of Leu-7+ (natural killer) cells was 4 +/- 4%, and only 1 of 22 BCC Leu-7+ cells invaded tumor nests, contacting with tumor cells. From these results we concluded that T cells play a major role in the defence against BCC proliferation. The main role of Langerhans cells and Leu-M5+ cells may be that of antigen presentation. B cells and NK cells probably play a minor role in the local defence against BCC proliferation.

Absence of cytokeratin 8 and inconsistent expression of cytokeratins 7 and 19 in human basal cell carcinoma.

The expression of the low molecular weight cytokeratins (K) 7, 8, 18, 19 and the high molecular weight cytokeratin 10 in 21 basal cell carcinoma (BCC) was studied using seven different monoclonal antibodies (MoAbs) with specific anti-cytokeratin activity. MoAbs RCK 105 (anti-K7), RPN 1164 (anti-low molecular weight cytokeratins of basic group), Ks 19.1 (anti-K19) and Cam 5.2 (anti-K8, K18, K19) reacted positively but inconsistently in the BCC that were examined. MoAbs 1166 (anti-K8) and RGE53 (anti-K18) did not react at all. MoAb RKSE 60 (anti-K10) did not react with the tumor cells. From the results of this study, it can be concluded that cytokeratins 7 and 19 are expressed in BCC (43% and 71%, respectively), whereas cytokeratin 8 is not expressed.

Immunoelectron microscopic studies on cytokeratins in human basal cell carcinoma.

Ultrastructural investigations into the location and the expression of the cytokeratins 7, 8, 10 and 19 were undertaken on ultrathin cryosections of 8 basal cell carcinomas (BCC) using a high resolution immunogold labeling method and five different monoclonal antibodies against specific cytokeratins. The results showed that cytokeratin 10 was expressed only in the differentiated keratinocytes. In contrast to the previously reported biochemical and immunohistochemical studies, in this study cytokeratin 19 was expressed not only in the tumor cells of BCC but also in the normal epidermal keratinocytes. The expression of cytokeratin 7 in BCC could not be confirmed but the lack of expression of cytokeratin 8 was confirmed, excluding its potential role as a specific histopathological marker for BCC.

[Acute perceptive hearing loss and metabolic acidosis as complications of the topical treatment of psoriasis with salicylic acid-containing ointment]. / Acute perceptieve slechthorendheid en metabole acidose als complicaties van externe behandeling van psoriasis met salicylzuurbevattende zalf.

A 36-year-old woman, hospitalized because of an exacerbation of psoriasis, developed fever, sudden deafness and severe metabolic acidosis after treatment with a 10% salicylic acid containing ointment for four days. The use of salicylic acid on large areas of inflamed skin enhances the risk of transcutaneous resorption and intoxication. High serum concentrations (> 300 mg/l) of salicylic acid deregulate the blood glucose metabolism and cause damage to the inner ear. After timely intervention such symptoms are largely reversible.

Diagnostic value of CT in the detection of brain metastasis in small cell lung cancer patients.

Fifty-seven patients with histologically proven small cell lung carcinoma were prospectively evaluated for signs of brain metastasis by neurological examination and computerized tomographic (CT) brain scanning. The reliability of demonstrating brain metastases by means of neurological examination was compared with that of CT. Three (5%) patients, two with cerebrovascular infarcts and one with leptomeningeal metastases, were excluded from the study. Four (7%) patients, all with extensive disease, showed neurological symptoms and signs of brain metastases, which were confirmed in three cases by brain CT. The fourth patient had neurological symptoms and signs pointing to cerebral metastasis, but no sign of this was detected on CT at the time of diagnosis. However, six months later, after completion of chemotherapy, CT revealed signs of brain metastasis. The other fifty neurologically asymptomatic patients had no brain metastases on CT. This clinical study suggests that routine CT of the brain is not useful in neurologically asymptomatic patients with small cell lung carcinoma.

Porphyria cutanea tarda in pre-existent lupus erythematosus--is there an association?

In lupus erythematosus (LE), vesicles and bullae are only rarely seen. However, in some instances such efflorescences might suggest an association with distinct cutaneous diseases, including erythema multiforme, toxic epidermal necrolysis or autoimmune blistering disorders such as bullous pemphigoid, pemphigus vulgaris, and dermatitis herpetiformis Duhring. Another blistering disease that has been described in association with cutaneous and systemic LE is porphyria cutanea tarda (PCT). PCT is a metabolic disorder caused by a deficiency of the fifth enzyme in heme biosynthesis, uroporphyrinogen decarboxylase. Here, we report on a 57-year-old Caucasian woman of Dutch origin with a medical history of mild cutaneous LE who developed skin fragility, blistering skin lesions, milia, and facial hypertrichosis. Subsequent porphyrin analysis in urine and feces confirmed the suspected simultaneous manifestation of LE and PCT.

Characterization of the mononuclear infiltrate in Bowen's disease (squamous cell carcinoma in situ). Evidence for a T cell-mediated anti-tumour immune response.

We investigated the dermal inflammatory infiltrate and the expression of HLA-DR and beta 2-microglobulin on the tumour cells in 8 Bowen's disease (BD) using a series of monoclonal antibodies. The inflammatory infiltrate was classified as mild, moderate or heavy. The infiltrate in all cases consisted mainly of T cells (55 +/- 21%) and where the T helper (TH) subset predominated over the T suppressor/cytotoxic (TS/C) subset (TH/TS/C ratio of 2.4 +/- 1.0). The mean percentage of HLA-DR positive cells was 58 +/- 18%, Langerhans cells (LC) 4 +/- 1% and Leu-M5 positive cells (monocytes/macrophages) 9 +/- 2%. The mean percentage of B cells and natural killer (NK) cells was 4 +/- 5% and 1 +/- 2% respectively. B cells and NK cells did not invade any of the tumours. In the 5 BD with moderate or heavy infiltrate, TH cells, TS/C cells and Leu-M5 positive cells did invade the tumour. In the tumour area where there was invasion, the number of LC was increased and HLA-DR was expressed on the cells. beta 2-microglobulin was generally expressed on the tumour cells of BD. We concluded that there is evidence for a T cell-mediated anti-tumour immune response which may account for the infrequent invasive growth in BD.

An absence of human leukocyte antigen-DR and a decreased expression of beta 2-microglobulin on tumor cells of basal cell carcinoma: no influence on the peritumoral immune infiltrate.

The expression of human leukocyte antigen-DR (HLA-DR) and beta 2-microglobulin on the tumor cells and their correlation (if any) to the degree and the composition of the peritumoral mononuclear infiltrate were studied in 37 basal cell carcinomas from 32 patients with an indirect immunoperoxidase technique. In 36 of 37 basal cell carcinomas (97%) there was no expression of HLA-DR on tumor cells of basal cell carcinoma. In 13 of 37 basal cell carcinomas (35%) beta 2-microglobulin was expressed on the tumor cells. Both a diffuse cytoplasmic and a membrane staining were observed in only six of these 13 basal a diffuse cytoplasmic and a membrane staining were observed in only six of these 13 basal cell carcinomas; in the other seven basal cell carcinomas only a diffuse cytoplasmic staining was observed. In all 37 basal cell carcinomas there was membrane staining for beta 2-microglobulin in the normal epidermis. The intensity of staining in the normal epidermis was always stronger than that in the tumor nests. There was a varying degree of peritumoral immune infiltrate in all basal cell carcinomas. It comprised mainly T cells (mean percentage 57 +/- 15). In the group of patients with basal cell carcinoma with moderate to heavy infiltrate the mean percentage of T cells was 63 +/- 13, which was significantly higher than the mean percentage of T cells (46% +/- 14%) in the group of patients with basal cell carcinoma with a mild infiltrate. This difference was mainly the result of an increase in T helper cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Intralesional treatment of basal cell carcinoma with low-dose recombinant interferon gamma.

In this pilot clinical trail the efficacy of intralesional low-dose human recombinant interferon-gamma was investigated in seven outpatients with nodular basal cell carcinoma. There was no antitumor response in any case. Toxic side effects were minimal. All tumors were excised surgically 8 weeks after completion of therapy.

Sensitization to sodium hypochlorite causing hand dermatitis.

2 patients are reported with chronic hand dermatitis related to sensitization to sodium hypochlorite, as the active component in a bleaching product. To avoid irritant reactions in patch testing, a sodium hypochlorite concentration of 1.0% appeared to be useful. It is concluded that with regard to the frequent use of bleaching agents, allergy to sodium hypochlorite must be considered in certain cases of unidentified chronic allergic hand dermatitis.

The detection of basal cell determinants in human basal cell carcinomas using two different monoclonal antibodies.

This report deals with the reaction pattern(s) of two monoclonal antibodies (MoAbs) with normal skin and basal cell carcinomas (BCC). Using indirect immunoperoxidase (IIP) and indirect immunofluorescence (IIF) techniques, MoAb 12 G7 was observed to react with a determinant related to the cell membrane of the epidermal basal cells. In the IIP technique MoAb 12 G7 showed a positive reaction with 32 out of 34 BCC (94%), while in IIF all the 14 BCC that were studied were positive. In most cases only the cells at the periphery of the tumour nests were stained. MoAb 253 B7 reacted with cytoplasmic determinant(s) of the epidermal basal cells both in the IIF as well as in the IIP techniques. Using the IIP technique only 5 out of 34 BCC (15%) showed a positive reaction with this MoAb. Four of the 5 positively staining tumours showed aggressive histological features. Using IIF technique only 2 out of 14 BCC were positive. The results presented in this communication are discussed with regard to the possible expression of selective differentiation and tumor-associated determinant(s) in BCC.