Engraftment of precursor lesions of human cutaneous neoplasms onto C.B-17 SCID mice: a useful in vivo experimental model of carcinogenesis in human skin

Using a full-thickness skin grafting technique, lesional skin from various human neoplastic and preneoplastic skin diseases was transplanted onto SCID (severe combined immunodeficiency) mice. Of 27 grafted lesions, 21 were successfully accepted by the mice and maintained in good condition. All these accepted grafts were finally excised 10-101 days after transplantation for histological examination. In most grafts, the characteristic histological configurations of each disease were well preserved. Immunohistochemical study using monoclonal antibodies to human blood group antigens ABH revealed that some elements of the grafts such as sweat glands were clearly positive, confirming that the tissue was from human skin. Neoplastic (atypical) cells were detected in 9 of 17 accepted grafts containing neoplastic cells from the beginning. The detection rates for neoplastic cells were very high (90%) in grafts from precursor lesions of squamous cell carcinomas such as Bowen's disease (5/5 specimens) and thermal keratosis (2/3). In contrast, no definite neoplastic cells were found in two grafts from extramammary Paget's disease and five grafts from the radial growth component of malignant melanoma. In most of the grafts from latter two diseases, characteristic histological configurations such as elongation of the rete ridges were maintained, suggesting that the neoplastic cells were selectively eliminated from the grafts. Split-thickness grafts of normal human skin were accepted and remained in a good condition for as long as 6 months. Engraftment of human lesional and non-lesional skin onto SCID mice therefore may well provide a useful in vivo experimental model of human skin diseases.

Immunoelectron microscopic localization of fibronectin in cultured human keratinocytes

We investigated the ultrastructural localization of fibronectin (FN) in cultured human keratinocytes using an improved method of peroxidase-immunoelectron microscopy. This method enabled us to visualize the precise localization of FN within the cells while preserving the morphology. FN was localized in the protein synthetic and secretory organelles, including the rough-surfaced endoplasmic reticulum, Golgi complex, multivesicular bodies and perinuclear space. It was also detected in the extracellular space, on small regions of the villous projections of cell membranes at the site of secretion and at cell-substratum contact sites. These findings confirm that human keratinocytes synthesize, secrete and deposit FN in the pericellular matrix.

Growth dynamics of acquired melanocytic nevi. Higher reactivity of proliferating cell nuclear antigen in junctional and compound nevi than intradermal nevi

BACKGROUND

The histogenesis of acquired melanocytic nevi is still a matter of debate.

OBJECTIVE

To provide data on the histogenesis, we investigated the lesional area of acquired melanocytic nevi and the proliferative activity of the nevus cells.

METHODS

Proliferative activity was examined with a monoclonal antibody against proliferating cell nuclear antigen (PCNA). The lesional area of the nevus was estimated in histologic sections.

RESULTS

Intradermal nevus was the largest of the acquired melanocytic nevi but had few PCNA-positive nevus cells. In contrast, junctional nevi were smallest and showed the highest PCNA positivity. Statistical analysis showed a significant inverse correlation between the largest lesional area and PCNA positivity.

CONCLUSION

The findings of the present study are in accordance with an epidermal melanocytic origin of acquired melanocytic nevi.

Primary cutaneous plasmacytosis: report of three cases and review of the literature

BACKGROUND

Cutaneous plasmacytosis is a rare disease characterized by peculiar multiple eruptions and hypergammaglobulinemia. More than 40 cases have been reported, mainly in Japan, although information concerning the disorder was limited to individual case reports.

OBJECTIVE AND METHODS

To clarify the clinicopathological and laboratory features, we reviewed 41 cases.

RESULTS

All patients were Japanese and the male-to-female ratio was 1:0.6. The onset ages ranged from 20 to 62 years, with a mean and median of 37 and 37 years. A superficial lymphadenopathy was detected in 58% (22/38), and polyclonal hypergammaglobulinemia was found in 93% (38/41). No cases were associated with any apparent underlying diseases. The course was chronic without spontaneous remission. Four patients died, 3 of whom succumbed to leukemia, respiratory failure or renal failure, respectively.

CONCLUSION

The results suggest that the condition appears to be a variant of reactive plasmacytic disorders of unknown origin.

Failure to transfer multiple sclerosis into severe combined immunodeficiency mice by mononuclear cells from CSF of patients

To confirm the reported transfer of multiple sclerosis (MS) by CSF cells, we injected CSF cells from six MS patients in the exacerbation stage into the cisterna magna of 18 severe combined immunodeficiency mice. No clinical neurologic abnormalities or light- or electron-microscopic pathologic changes were present in any transferred mice, and the reported results could not be reproduced.

Effective detection of plantar malignant melanoma

BACKGROUND

As the sole of the foot is the most prevalent site of malignant melanoma in non-Caucasians, early detection of the neoplasm at this anatomical site is very important. In our previous study, we proposed a clinical guideline that acquired melanocytic lesions on the sole larger than 7 mm in maximum diameter should be examined histologically.

METHODS

Eighty-one Japanese patients with the complaint of plantar pigmented lesions were screened at our dermatology clinic during 3 years using the 7-mm criterion.

RESULTS

Of the total 80 melanocytic lesions on the sole, 14 lesions were larger than 7 mm in maximum diameter, excluding congenital lesions. Diagnoses of the 14 "large" lesions were as follows: advanced malignant melanoma, 8 lesions; early malignant melanoma (malignant melanoma in situ), 1 lesion; acquired melanocytic nevus, 4 lesions, and volar melanotic macule, 1 lesion.

CONCLUSIONS

The present study confirmed the validity of the 7-mm criterion for the early effective detection of plantar malignant melanoma.

FK506 and cyclosporin a regulate proliferation and proto-oncogene expression in HTLV-1-associated myelopathy/tropical-spastic-paraparesis-derived T cells

Human T-cell-leukemia-virus-type-1 (HTLV-1) infection is associated with adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP). The T-cell-targeting immunosuppressants, FK506 and cyclosporin A (CsA), suppressed proliferation of the HAM/TSP-derived T-cell lines, H89-59, H89-79 and H109. FK506 and CsA also reduced expression of the proto-oncogenes, c-myc and c-fos, but not c-jun and interleukin-2-receptor-alpha (IL-2R alpha) gene in H109 cells. The growth-inhibitory effects of FK506 and CsA were not abrogated by interleukin 2 (IL-2). These results suggest that the inhibitory effects of FK506 and CsA are independent of IL-2, and are associated with the reduction of c-myc and c-fos gene expression.

Campylobacter jejuni strains from patients with Guillain-Barré syndrome belong mostly to Penner serogroup 19 and contain beta-N-acetylglucosamine residues

Campylobacter jejuni was isolated from stool cultures from 14 (30%) of 46 patients with Guillain-Barré syndrome and from 6 (1.2%) of 503 healthy persons, and the difference was highly significant (p < 0.0001). In addition, serological evidence of recent C. jejuni infection was found in 5 of 29 patients with negative stool cultures. Therefore, 41% of patients were associated with C. jejuni infection. Ten of 12 (83%) isolates from patients with Guillain-Barré syndrome belonged to Penner serogroup 19, which is a rare serogroup in sporadic patients with C. jejuni enteritis. In the lectin typing study, all serogroup 19 strains from patients with Guillain-Barré syndrome were shown to contain terminal beta-N-acetylglucosamine residues on their cell surface, but serogroup 19 strains from patients with enteritis were not.

Detection of early lesions of "ungual" malignant melanoma

BACKGROUND

The nail area is commonly affected by malignant melanoma. The prognosis of malignant melanoma of the nail is poor, because at the time of diagnosis most lesions are in the advanced stage. Correct diagnosis of early lesions could improve the prognosis.

METHODS

For 3 years, all patients with nail pigmentation at the dermatology clinic were screened for five specific criteria for the diagnosis of early lesions of malignant melanoma. Histologic examination was performed on 10 of 29 lesions.

RESULTS

Five of the 29 lesions were advanced malignant melanoma, easily diagnosed clinically. Two of the remaining 24 lesions fulfilled most of our clinical criteria of early malignant melanoma of the nail apparatus; that is, they appeared as melanonychia striata during adulthood, were wide in breadth measuring 9 and 11 mm, and showed variegated shades of brown. Periungual pigmented macule (Hutchinson's sign) was observed in one of the two cases. Total resection of the lesions was performed, followed by skin grafting.

CONCLUSIONS

Histologically, an increased number of atypical melanocytes, mainly arranged as solitary units, were observed only in the epithelia of the nail matrix and of the nail-bed, confirming that these lesions were "ungual" malignant melanoma in situ. Such an early lesion of malignant melanoma of the nail apparatus can be completely cured with conservative excision, and the phalanx of the affected digit can be preserved.

Lethal posttransfusion graft-versus-host disease. Report of four cases

Four cases of posttransfusion graft-versus-host disease are reported. Three were caused by high-dose transfusion of non-irradiated fresh blood during open-heart surgery and 1 by the contaminated lymphocytes in packed red blood cells transfused for renal injury. In 1 patient, change of HLA type of peripheral lymphocytes was demonstrated.

Proliferative activity of cutaneous melanocytic neoplasms defined by a proliferating cell nuclear antigen labelling index

To evaluate the proliferative activity of benign, borderline and malignant cutaneous melanocytic neoplasms, 30 cases of malignant melanoma (MM) and 41 cases of naevi were studied by immunostaining using a monoclonal antibody against proliferating cell nuclear antigen (PCNA). PCNA is a nuclear antigen expressed in the late G1 and S phase and serves as a marker of proliferating cells. Invasive MM and MM in situ showed much higher PCNA positivity rates than melanocytic naevi (invasive MM, 18.0%; MM in situ, 11.3%; ordinary melanocytic naevi, 2.6%). The PCNA positivity rate did not increase significantly with the thickness of MM. Among ordinary melanocytic naevi, junctional naevi had a higher PCNA positivity rate than compound or intradermal naevi. Mean PCNA positivity rates for Spitz's naevi and sporadic dysplastic naevi were within the range for ordinary melanocytic naevi, indicating the benign nature of both types of naevus. Contrary to some previous studies, MM in situ showed high proliferative activity, indicating that cells of MM in situ are actively proliferating. This study clearly demonstrates that MM and various types of naevi can be separated according to differences in proliferative activity defined by the PCNA labeling index.

Analysis of the expression of Hanganutziu-Deicher (HD) antigen in human malignant melanoma

Hanganutziu-Deicher (HD) antigen is classified as a heterophile antigen and chemically defined as a ganglioside and/or glycoprotein containing N-glycolylneuraminic acid (NeuGc). HD antigen is absent from normal tissues in humans and chickens but can be expressed in human malignant neoplasms including melanoma. We analysed HD antigen expression in ganglioside and glycoprotein fractions of human melanoma tissues by means of TLC enzyme-immunostaining and Western blotting with biotinylated affinity-purified chicken anti-NeuGc-lactosylceramide (anti-HD3) antibody. No HD-antigenic gangliosides were detected in 11 specimens of human melanoma. In the glycoprotein fractions, however, a strong HD-positive band of 58 kD was detected in 3 of 10 specimens and several minor bands (37 kD, 13.5 kD, etc.) were also found in 5 specimens. The positive bands completely disappeared after treatment with neuraminidase. These results suggest that HD antigen is expressed on the carbohydrate chains of glycoproteins but not on those of gangliosides in human melanoma.

HLAs and genes in Japanese patients with multiple sclerosis: evidence for increased frequencies of HLA-Cw3, HLA-DR2, and HLA-DQB1*0602

The distribution of HLA-A, B, C, DR and DRB1, DQB1, DPB1 alleles was studied in 60 Japanese patients with clinically definite multiple sclerosis (MS) using serologic and genomic analysis. We found significant associations with HLA-Cw3 (p = 0.002, pc = 0.012, RR = 3.2), DR2 (p = 0.007, RR = 2.6), and DQB1*0602 (p = 0.04, RR = 4.0) in Japanese patients for the first time. The combined presence of Cw3 and DR2 gave a higher risk than each antigen alone. The reported increase in the frequency of DPw4 in Japanese MS patients [12] could not be confirmed by our genomic study. The frequencies of all of the residues in each variable region of the amino acid sequences of DQ beta and DP beta chains were not different between the MS patients and the controls. These results suggest that MS susceptibility may result from polygenic influences and from the presence of environmental factors.

Distribution patterns and frequency of proliferating cells in cutaneous keratinocytic neoplasms. Immunohistochemical study with a monoclonal antibody (TOB7) used against proliferating cell nuclear antigen

BACKGROUND

Almost all markers for proliferating cells need freshly frozen tissues for evaluation; therefore retrospective study is impossible.

OBJECTIVE

In the present study, a murine monoclonal antibody (TOB7) against the proliferating cell nuclear antigen (PCNA) was used for the analysis of cell kinetics of cutaneous keratinocytic neoplasms. The antibody is applicable to formalin-fixed, paraffin-embedded tissues.

METHODS

The frequency of PCNA-positive cells and their distribution patterns were immunohistochemically investigated in various cutaneous keratinocytic neoplasms.

RESULTS

Squamous cell carcinoma and Bowen's disease showed significantly increased numbers of PCNA-positive cells when compared with other keratinocytic neoplasms. A characteristic marginal or random distribution pattern of PCNA-positive cells was observed in the lesions of each disease category.

CONCLUSION

Important information on the growth dynamics of keratinocytic neoplasms was obtained in this retrospective immunohistochemical study.

Immunohistochemical studies of blood group antigens ABH in cutaneous angiosarcoma

Eight angiosarcomas were clinicopathologically and immunohistochemically investigated. Four of the angiosarcomas originated in the scalp of the elderly, and four cases were angiosarcomas associated with chronic lymphedema after hysterectomy for uterine carcinoma or after mastectomy for breast carcinoma. Six of the angiosarcomas showed conventional histopathology, whereas the remaining two cases were considered cutaneous epithelioid angiosarcoma. Immunohistochemical studies for blood group antigens ABH were carried out. Three of the conventional angiosarcomas were weakly positive and three were moderately positive with antigens ABH. The antigens were strongly positive in the two epithelioid angiosarcomas. The biologic course of the two epithelioid angiosarcomas was longer than that of the other six cases. This study suggested that the strong positivity of blood group antigens may be one of the characteristics of epithelioid angiosarcoma.

[Analysis of surface membrane antigens, cytoskeletal proteins and N-myc oncogene in pediatric solid malignant tumors, their diagnostic usefulness and relevant problems]

Neuroblastoma (NB), primitive neuroectodermal tumor (PNET), Ewing's sarcoma and rhabdomyosarcoma (RMS) are solid malignant tumors in childhood. Microscopically these tumors are grouped as small-round-cell tumors, and a different diagnosis is sometimes difficult. Cell surface membrane antigen, cytoskeletal protein and N-myc amplification and over-expression were analyzed in these cell lines and tumor tissues for the accurate diagnosis. NB and PNET could be distinguished from Ewing's sarcoma and RMS by the panel of monoclonal antibodies against cell surface membrane antigens. The cytoskeletal protein analysis is useful for the diagnosis of RMS and leiomyosarcoma. Alpha-smooth muscle actin and/or desmin were demonstrated in the S-type (epithelial-like) cells in 3 NB cell lines, suggesting the differentiation pathway of NB into smooth muscle cells. N-myc amplification and over-expression were observed in NB cell lines as well as one RMS cell line. The occurrence of N-myc amplification and over-expression in the RMS cell line cautions us against using N-myc as a distinguishable marker for NB.

Increased susceptibility of human fetal astrocytes to human T-lymphotropic virus type I in culture

Human T-lymphotropic virus type I (HTLV-I) has been considered as an agent responsible for tropical spastic paraparesis and HTLV-I associated myelopathy. However, the pathogenesis of the diseases remains unclear. In a previous study we demonstrated that HTLV-I could infect adult human astrocytes and oligodendrocytes in vitro, although the rates of infected cells were low, at a rate of 0.1% and 0.01-0.05% respectively. Since mother-to-child transmission has been proposed as one of the major pathways for the prevalence of HTLV-I endemic, in the present study we investigated the susceptibility of human fetal astrocytes to HTLV-I in culture. After two days of co-culturing fetal brain cells with irradiated MT-2 cells (an HTLV-I-producing T-cell line), immunofluorescence staining revealed many positive astrocytes for HTLV-I p19 antigen. Multinucleated giant cells doubly immunoreactive to glial fibrillary acidic protein and HTLV-I antigen were frequently observed and showed a characteristic feature of hairy or fluffy external appearance. The percentage of infected astrocytes became as high as 19.4% at Day 21 of co-culture and then decreased. Electron microscopic examination revealed type C virus-like particles in astrocytes. These results indicate that human fetal astrocytes are more susceptible to HTLV-I infection than adult human astrocytes in tissue culture.

Long-term effects of mass screening for neuroblastoma in infancy

Eighty-four neuroblastoma patients were treated at the Department of Pediatrics, Kyoto Prefectural University of Medicine, during the 27 years from 1962 to 1988. They were divided into three groups: 35 cases in phase 1, the 12 years before mass screening from 1962 to 1974; 22 in phase 2, the 8 years after the onset of mass screening by a qualitative vanillylmandelic acid (VMA) test from 1974 to 1982; and 27 in phase 3, the recent 6 years from 1983 to 1988, after the introduction of mass screening by quantitative assay for VMA and homovanillic acid using high performance liquid chromatography. The clinical findings of these patients were compared for each phase. In Kyoto, the number of annual neuroblastoma cases diagnosed under 1 year of age increased from 0.58 in phase 1 to 1.50 in phase 2 and 3.17 in phase 3. The number of cases over 2 years of age decreased from 2.00 in phase 1 to 0.88 in phase 2 and 1.00 in phase 3. Survival rates increased from 17.1% (six of 35) in phase 1 to 54.5% (12 of 22) in phase 2 and 85.2% (23 of 27) in phase 3. The annual number of neuroblastoma deaths decreased from 2.42 in phase 1 to 1.25 in phase 2 and 0.67 in phase 3. Mass screening for neuroblastoma in infancy has increased the long-term survival rates of neuroblastoma cases treated at this hospital.

Clinical guidelines for the early detection of plantar malignant melanoma

Of 144 pigmented lesions excised from the soles of Japanese patients, 140 were melanocytic. Apart from congenital melanocytic nevi, only a few benign acquired melanocytic nevi on the sole were more than 7 mm in maximum diameter and none exceeded 9 mm. In contrast, all plantar malignant melanomas, including malignant melanoma in situ, were 9 mm or more in maximum diameter. In addition, the majority of plantar melanocytic lesions excised from patients who were older than 50 years of age were malignant melanoma. On the basis of these data, we propose clinical guidelines for the early detection of plantar malignant melanoma.

Cellular immunoregulatory mechanisms in the central nervous system: characterization of noninflammatory and inflammatory cerebrospinal fluid lymphocytes

Dual-label flow cytometric analysis of cerebrospinal fluid (CSF) and blood lymphocytes with combinations of monoclonal antibodies such as CD4 plus CD45R or Leu8, and CD8 plus CD11b was performed in 37 patients with noninflammatory neurological diseases (NINDs) to clarify the differences in cellular immunoregulatory mechanisms present in the central nervous system (CNS) and in the systemic circulation. In the CSF of patients with NINDs, the paucity of CD4+CD45R+ and CD8+CD11b+ cells was striking, whereas the same subsets accounted for substantial proportions in the blood. CD4+CD45R- and CD4+Leu8- cells as well as CD8+CD11b- cells increased in the CSF when compared with those in the blood. Seven patients with active multiple sclerosis (MS) and 10 patients with other inflammatory diseases in the CNS (CNS-infl) were also studied. Patients with active MS were characterized by a consistent increase in percentage of CD4+CD45R- cells in the CSF, whereas an increase of CD4- CD45R+ cells in the CSF was a feature of the patients with CNS-infl, when compared with patients with NINDs. These findings indicate that the CNS is routinely surveyed by particular subsets of lymphocytes different from those in the blood, and cellular immune reaction in the CNS varies according to the types of CNS inflammatory conditions.

Immunohistochemical detection of heterophile Hanganutziu-Deicher antigen in human malignant melanoma

The Hanganutziu-Deicher (HD) antigen is a heterophile antigen whose immunodominant molecule is N-glycolylneuraminic acid, a sialic acid that cannot be found in normal tissues of either humans or chickens. Using biotinylated chicken anti-HD antibody purified with affinity chromatography, expression of HD antigen was immunohistochemically investigated in formalin-fixed tissues of human malignant melanoma. HD antigen-positive melanoma cells were clearly demonstrated in 7 of 11 lesions of malignant melanoma. No HD antigen-positive cells were found in 8 lesions of melanocytic nevus, and no components of normal human skin including epidermal melanocytes were stained with the antibody. This study is the first that immunohistochemically demonstrates HD antigen in tissue sections of human malignant melanoma. The expression of the HD antigen in transformed human melanocytes may have great immunological significance because the antigen is absent from normal human tissues and is immunogenic in humans.

Detection of Epstein-Barr virus DNA in Reed-Sternberg cells of Hodgkin's disease using the polymerase chain reaction and in situ hybridization

Thirty-one cases of Hodgkin's disease were examined for the occurrence of Epstein-Barr virus (EBV) genome by using the polymerase chain reaction (PCR) of DNA in formalin-fixed paraffin-embedded tissues and in situ hybridization technique. The cases were subdivided into 17 cases of nodular sclerosis (NS), nine cases of mixed cellularity (MC), four cases of lymphocyte predominance (LP), and one case of lymphocyte depletion (LD). EBV DNA was detected in eight cases including four cases of NS, three cases of MC and one case of LP. The sensitivity of PCR was higher than that of Southern blot hybridization of DNA from fresh frozen tissue, because Southern blot hybridization using the BamHI-W fragment of EBV detected virus DNA only in two of three cases which were positive by PCR. The results of in situ hybridization studies confirmed that EBV genome was localized within the nuclei of Reed-Sternberg (RS) cells and their mononuclear variants. Furthermore, double-labeling studies combining in situ hybridization and immunocytochemistry using CD30 (BerH2) and CD15 (LeuM1) as markers of RS cells, as well as pan B-marker (L26) and pan T-marker, CD45RO (UCHL1), were performed to demonstrate the phenotype of EBV DNA-positive cells, confirming that EBV DNA was present in RS cells but not in lymphocytes. The results of this study indicate a significant association between EBV and some cases of Hodgkin's disease.

HLA-DP antigens and HTLV-1 antibody status among Japanese with multiple sclerosis: evidence for an increased frequency of HLA-DPw4

Previously, an association between multiple sclerosis (MS) and HLA-DPw4 has been reported in Scandinavians. In the present study, the distribution of HLA-DP antigens was studied in 34 Japanese MS patients, all of whom fulfilled the criteria for definite MS. HLA-DP typings for DPw1 through w6 and the local specificity, CDP-HEI, were performed using the primed lymphocyte typing (PLT) technique. In addition, the patients were typed for a DR2+, Dw2+/Dw12- related, PLT defined specificity. The distribution of DPw1-w5 in 121 healthy, unrelated Japanese controls were from Nishimura et al., 1984; Nishimura, personal communication). Sera from all 34 patients and 38 controls (both from the HTLV-1 nonendemic, Kyoto region) were examined for the presence of HTLV-1 reacting antibodies by a highly sensitive radioimmuno assay (RIA) using two sources of HTLV-1 antigens, namely total crude protein preparations from disrupted HTLV-1 virions and affinity purified p24 HTLV-1 core proteins. The frequency of DPw4 was significantly increased to 35.3% in Japanese MS patients compared to 16.5% in controls (Relative Risk, RR = 2.8, p = 1.9 x 10(-2)). 41.6% of the MS patients gave clear typing responses with a PLT reagent which recognized a Dw2+ related specificity, which is higher than the frequency of Dw2 (6.8%) in Japanese. Fourteen of the 34 patient sera contrasting to none of the sera from 38 controls contained antibodies of IgG and/or IgM subclasses reacting with the HTLV-1 derived antigens. This difference is highly significant (P less than 1 x 10(-5)).(ABSTRACT TRUNCATED AT 250 WORDS)

Vimentin-positive squamous cell carcinoma arising in a burn scar. A highly malignant neoplasm composed of acantholytic round keratinocytes

Two patients had unusual squamous cell carcinoma (SCC) arising in a burn scar. The SCCs rapidly recurred and metastasized after radical operation, and the patients died of disseminated metastases. Histopathologically, the SCC was poorly differentiated and consisted of acantholytic round cells that diffusely proliferated into the deep dermis. However, small, solid nests composed of squamoid cells were focally observed. Immunohistochemical studies revealed that the acantholytic round neoplastic cells expressed not only keratin but also vimentin, and the coexpression was substantiated with double immunostaining. Vimentin-positive SCC composed of acantholytic round neoplastic cells may be a highly malignant subset of cutaneous SCC.

Human and simian glial cells infected by human T-lymphotropic virus type I in culture

Although human T-lymphotropic virus type I (HTLV-I) has been implicated in the etiology of tropical spastic paraparesis (TSP) and HTLV-I associated myelopathy (HAM), the direct infectivity of the virus against constituent cells in the central nervous system remains undetermined. To investigate the neurotropism of HTLV-I, we exposed cultured human and simian glial cells to HTLV-I. Primary mixed glial cell cultures of astrocytes and oligodendrocytes were obtained from adult human and cynomolgus monkey (Macaca fascicularis) brains by an enzyme digestion-Percoll gradient method. After two weeks in vitro, the cells were co-cultured with irradiated MT-2 cells, an HTLV-I-producing T-cell line. Cultures were double stained with antibodies against cell-type specific markers and anti-HTLV-I p19 (gag) monoclonal antibody. The HTLV-I antigen was demonstrated in small numbers of glial fibrillary acidic protein-positive cells (astrocytes) and galactocerebroside-positive cells (oligodendrocytes) in both the human and simian cultures. Electron microscopy demonstrated the presence of type C virus-like particles in the cytoplasm of astrocytes. These results indicate that HTLV-I is capable of infecting human and simian glial cells in vitro.

[Relation of maximum diameters of plantar malignant melanoma to various prognostic factors and prognosis of patients]

The following factors were investigated in 43 cases of plantar malignant melanoma: maximum diameters of primary lesions, Clark's subtypes, clinical stages, UICC's stages, Clark's levels of invasion, Breslow's tumor thickness, and prognosis of patients. Relation of maximum diameter of primary lesions to various prognostic factors and prognosis of the patients was analysed. It was revealed that there were no statistically significant relationships between maximum diameters and other various factors. In our series, however, all patients with plantar malignant melanoma less than 14 mm in diameter are alive without metastasis. Judging from our previous and present studies, the following two points are the most important for improving the prognosis of patients with plantar malignant melanoma: 1) Catching all pigmented lesions on the sole that are more than 7 mm in diameter and examining them histologically, if they have no possibility of being congenital melanocytic nevus or black heel. 2) Treating plantar malignant melanomas adequately before they become 14 mm in maximum diameter.

Establishment of a human dermatofibrosarcoma protuberans cell line: cytological characteristics

We established a dermatofibrosarcoma protuberans (DFSP) cell line derived from a DFSP tumor from a 69-year-old female. The population doubling time of the cells was about 45 hours. The cells were mostly round, although a few triangular or spindle-shaped cells were also found. They could not be transplanted into nude mice. These cells had some histiocyte characteristics which are not observed in fibroblasts: 1) Electron microscopically, there were more lysosomes and phagolysosomes than in fibroblasts. Dense bodies and myelin figures derived from lysosomes were also observed. 2) Staining with acid phosphatase (ACPase), esterase, and alpha-1-antitrypsin was positive. 3) The cells had C3 receptors but no Fc receptors. However, there were two differences between DFSP cells in the established line and those in the early stages: in the former, the capacity for immunophagocytosis (Fc receptors and phagocytosis of Candida albicans) and collagen synthesis were almost entirely absent.

Bowen's disease with invasive carcinoma showing sweat gland differentiation

A 75-year-old Japanese woman presented an erythematous macular lesion on the flexor aspect of her left wrist. A reddish nodule, 4 mm in diameter, was observed at the medial portion of the macule. The macular lesion was histologically confirmed to be a typical Bowen's disease. The nodular lesion was composed of intradermal solid nests of bowenoid neoplastic cells, and in some areas of the dermal component, prominent gland-like structures were observed. Immunohistochemically, most neoplastic cells of the intradermal solid nests were positive with S-100 protein, and the cells lining the gland-like structures along with amorphous material within the lumens were positive with carcinoembryonic antigen. Judging from these findings, this case was diagnosed as Bowen's disease with invasive carcinoma, whose dermal component showed sweat gland differentiation not only morphologically but also immunohistochemically.

Cisplatin combination chemotherapy in squamous cell carcinoma and adenoid cystic carcinoma of the skin

Seven patients with skin cancers, six with squamous cell carcinoma (SCC) and one with adenoid cystic carcinoma, were treated with cisplatin in combination with vindesine or adriamycin. Partial response was observed in three patients with squamous cell carcinomas: two cases with metastatic lung lesions and one with a primary skin lesion and lymph node metastasis. Two of the responding SCC had been resistant to previous chemotherapy, including peplomycin and mitomycin C. Multiple metastatic lesions of adenoid cystic carcinoma of the skin completely regressed after two courses of the combination chemotherapy with cisplatin and adriamycin. This report showed that cisplatin combination chemotherapy may be useful for the treatment of cutaneous squamous cell carcinoma, which is resistant to peplomycin, and adenoid cystic carcinoma of the skin.

Malignant melanoma in situ on the sole of the foot. Its clinical and histopathologic characteristics

This clinical and histologic study of 122 macular melanocytic lesions on the soles of the feet of Japanese subjects revealed ten in situ malignant melanomas. Clinically, the lesions were broad pigmented macules or patches with asymmetric, angular, irregular shapes, and notched borders. The lesions appeared brownish black, and most were variegated from tan to black. The largest diameters were greater than or equal to 9 mm. The demargination of most lesions was not even; that is, one part of the lesion border was vague while another part was sharp. Histologically, an increased number of atypical melanocytes, mainly arranged as solitary units, were observed within the epidermis. Intraepidermal nests of melanocytes were found in five cases. The great majority of malignant melanomas in non-Caucasians affect acral regions--especially the sole of the foot--so, to improve their prognosis, the characteristics of malignant melanoma in situ on the sole must be elucidated.

[Intraepidermal distribution patterns of melanocytes in the melanocytic lesions on the sole: proposed criteria for histopathologic diagnosis of plantar malignant melanoma in situ]

Eighty-eight melanocytic lesions on the soles of Japanese were histologically investigated. Increased numbers of solitary melanocytes above the basal layer of the epidermis were often found in the benign melanocytic nevi on the sole: in 5 lesions of 9 congenital melanocytic nevi, 22 of 65 acquired melanocytic nevi, and 1 of 5 dysplastic nevi. In addition, a moderate degree of nuclear atypia of proliferating melanocytes was frequently observed in the benign melanocytic nevi on the sole: in 3 lesions of 9 congenital melanocytic nevi, 17 of 65 acquired melanocytic nevi, and 2 of 5 dysplastic nevi. Therefore it cannot be said that increased numbers of solitary atypical melanocytes above the basal layer is a characteristic histologic feature of early malignant melanoma in situ. Combining the intraepidermal distribution patterns of melanocytes and maximum diameter of the lesion, we propose criteria for histopathologic diagnosis of plantar malignant melanoma in situ.

[Clinical and histopathologic analyses of pigmented macular lesions on the soles of Japanese--proposal of a clinical guideline for detection of early malignant melanoma on the sole]

Of 92 pigmented macular lesions on the soles of Japanese, 88 lesions were histologically confirmed to be melanocytic: 65 ordinary acquired melanocytic nevi, 9 congenital melanocytic nevi, 5 dysplastic nevi, and 5 possible and 4 definite lesions of early malignant melanomas. None of the ordinary acquired melanocytic nevi were more than 7 mm in maximum diameter. Excluding congenital melanocytic nevi, there were 8 lesions whose greatest diameters were more than 7 mm: 2 dysplastic nevi, and 2 possible and 4 definite lesions of early malignant melanoma. Judging from the data obtained in this study, we propose the following clinical guideline for the detection of early lesions of malignant melanoma on the sole. If the pigmented lesions have no possibility of being congenital melanocytic nevus, black heel, lesions of Peutz-Jeghers syndrome, or 5-FU induced lesions, measure the maximum diameters. 1) Lesions with a diameter of more than 7 mm should be excised for histological evaluation. 2) Lesions with a diameter between 6 and 7 mm should be examined histologically when they show conspicuous irregularity in shape, color and/or border or are observed on the soles of a patient older than 50.

A case of mosaic Down's syndrome concomitant with ganglioneuroma

We present the case of a 6-year-old boy with concomitant mosaic Down's syndrome and ganglioneuroma. To our knowledge, this is the first case report illustrating this association.

Clinical and histopathologic characteristics of early lesions of subungual malignant melanoma

Twenty-one Japanese cases of subungual malignant melanoma were investigated clinically and histologically. In the majority of the cases, the initial sign of the disease was confirmed to be melanonychia striata. Five cases of Clark's Level I melanoma were found in the series. Melanonychia striata had appeared as the initial sign in these five cases. Melanonychia striata is frequently observed in persons who are not white and is attributed to various local and systemic causes. Detailed clinical analysis of the five cases of early subungual melanoma showed that melanonychia striata with the following characteristics may increase the risk of early subungual melanoma developing: it is noticed during adulthood, it is broader than 6 mm, it is brownish with variegated shades or homogenously black, and it is accompanied by periungual pigmentation (Hutchinson's sign). Detection of early lesions of subungual melanoma is beneficial not only for the improvement of prognosis, but also for the preservation of the affected phalanx.

In vivo CNS demyelination mediated by anti-galactocerebroside antibody

The mechanism of antibody-mediated central nervous system (CNS) demyelination in vivo was studied using rabbit eyes. Injection of anti-galactocerebroside (Gal C) antiserum alone into the normal rabbit vitreous body induced demyelination in the epiretinal myelinated fibers. This activity of the antiserum disappeared after heat treatment at 56 degrees C for 30 min and was restored by supplement of normal fresh serum, suggesting the complement dependency of the activity. Heated anti-Gal C antiserum could induce demyelination, however, when macrophages were introduced by injecting lymphocyte supernatants together with antiserum. Electron microscopic study revealed penetration of macrophage process between the myelin lamella. These findings suggest that the cooperation of anti-Gal C antibody and macrophage can result in the antibody-dependent cell-mediated demyelination in the absence of complement. Because oligodendrocyte generally appeared normal, myelin, not oligodendrocyte is suspected to be the primary target by anti-Gal C antiserum. In contrast, neither anti-MBP nor anti-gangliosides antiserum had the in vivo-demyelinating activity. In CNS demyelination by anti-Gal C antibody, complement-mediated and macrophage-mediated mechanisms may cooperate in varying degrees.

Two major subgroups of human T-cell leukemia virus-1 in Japan

T lymphocytes of patients with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy (HAM) were cultured. After cultivating for several months, HAM-derived cell lines were tested for the presence of HTLV-1 proviral genome. We have found two major subgroups, the SacI type and the PstI type, of HTLV-1 by the restriction map analysis. They were almost equally distributed among HAM patients. We have also found two types of the provirus in DNA derived from fresh peripheral blood lymphocytes (PBL) or lymph node cells of adult T-cell leukemia/lymphoma (ATL) patients. The PstI type proviruses were predominant in ATL patients. It was concluded that two major subgroups of HTLV-1 exist in Japan and both types have an ability to cause either of two diseases, ATL or HAM.

The imbalance in CSF T cell subsets in active multiple sclerosis

We determined the percentage of each lymphocyte subpopulation in the cerebrospinal fluid (CSF) and the peripheral blood of 7 patients with active multiple sclerosis (MS), 7 with inactive MS, 5 with other inflammatory diseases in the central nervous system, and 12 with non-inflammatory neurological diseases, using fluorescein-labelled monoclonal antibodies (anti-Leu7, anti-HLA-DR, and those that recognize such surface antigens as CD3, CD4, CD8, and CD19), and by laser flow cytometry to clarify the clinical usefulness of their measurement in the assessment of disease activity in MS. In CSF, a significant increase in the percentage of CD4+ cells and a significant decrease in the percentage of CD8+ cells were observed in the active MS group compared with the other 3 groups, while none of the percentages of the 6 subsets studied in the peripheral blood were significantly different among these groups. Our preliminary study indicated that evaluation of the percentages of CD4+ and CD8+ cells in CSF by flow cytometry could be a useful indicator of disease activity in MS.

Diagnosis of neuroblastoma metastasis in bone marrow with a panel of monoclonal antibodies

Neuroblastoma, along with rhabdomyosarcoma, Ewing's sarcoma, and acute lymphoblastic leukemia/lymphoma, is one of the small, round-cell tumors of childhood. All of these malignancies show a propensity to metastasize to bone marrow. Occasionally when the clinical picture is unclear and the tumor is particularly anaplastic, it can be difficult to arrive at a diagnosis by conventional histological and biochemical procedures. In the present study, a panel of nine monoclonal antibodies was used to undertake a detailed analysis of seven bone marrows contaminated with tumor cells: six cases of stage IV neuroblastoma, and one case of stage IV-S neuroblastoma. The antibody profiles obtained were compared with those deduced from the studies of over 20 marrows from patients with acute lymphoblastic leukemia. A comparison of these data with those obtained from the studies of rhabdomyosarcoma and Ewing's sarcoma cell lines and tissues suggests that when high levels of tumor cells are present in the marrow, it is possible to obtain a confident diagnosis of either neuroblastoma or acute lymphoblastic leukemia. In addition, the immunocytological identification of neuroblasts in bone marrow enables accurate staging without histological examination.

Heterophile Hanganutziu-Deicher antigen in ganglioside fractions of human melanoma tissues

Gangliosides were purified from melanoma tissue extracts obtained from 5 patients. GM3 and GD3 were identified as the major components in ganglioside fractions of the melanoma tissues. Following thin-layer chromatography, enzyme immunostaining with Hanganutziu-Deicher (H-D) antigen-specific chicken antisera demonstrated the presence of NeuGc-neolactotetraosylceramide (H-D5) and NeuGc-lacto-N-norhexa-osylceramide (H-D7) in all 5 melanoma extracts.