A case of upper gingiva carcinoma with chronic graft-versus-host disease after allogenic bone marrow transplantation

Oral squamous cell carcinoma (OSCC) is one of the most common solid tumours occurring after haematopoietic stem cell transplantation (HSCT), especially in patients with chronic graft-versus-host-disease (cGVHD). We describe a case of OSCC that developed in a 51-year-old male 22 years after he had received allogeneic HSCT from his human leukocyte antigen-identical sister as a treatment for acute myelocytic leukaemia. The patient had presented with multiple white patchy lesions on the palatal gingiva and mucosa 16 years after HSCT; these lesions were consistent with the clinical features of cGVHD. Six years later, oral examination and biopsy revealed upper gingival squamous cell carcinoma (SCC) in areas of cGVHD, and he underwent tumour excision. Follow-up examination at 2 years and 4 months after the operation revealed no evidence of recurrence of local SCC or metastasis of the cervical lymph node. The current case highlights the susceptibility of patients with cGVHD to the development of OSCC even two decades after HSCT. Therefore, we recommend careful long-term follow-up of the oral cavity for patients with cGVHD.

Expression and Regulation of Human CD275 on Endothelial Cells in Healthy and Inflamed Mucosal Tissues

The CD275-CD278 costimulatory pathway is a new pathway for CD28-B7 family molecules involved in the effector phase of T-cell-mediated immune responses. Expression of CD275 in oral mucosa at healthy and disease states has not been examined. We generated monoclonal antibodies against human CD275 and investigated its expression and regulation in cultured tissue cell lines and oral mucosal tissues. CD275 on monocytes was efficiently upregulated by interleukin-4, while interferon-gamma abrogated this effect. CD275 on cultured endothelial cells (EC) was rapidly enhanced by tumour necrosis factor-alpha. In healthy oral mucosa, CD275 was not detected on keratinocytes, Langerhans cells or intraepithelial lymphocytes within the epithelium or on interstitial dendritic cells or lymphocytes in the sub-epithelium. Constitutive expression of CD275 on EC in the connective tissues was observed in healthy mucosa, but CD275 expression on EC in oral lichen planus was either upregulated or down regulated. Approximately 20% of the T cells found within infiltrating mononuclear cells in the sub-epithelium expressed high levels of the CD278 receptor. CD275 on lymphoid and nonlymphoid cells is positively or negatively regulated by various cytokines. Our results suggest that CD275 on EC is involved in the recruitment or extravasation of receptor-positive effector T cells into inflamed tissues.

Fecal excretions of hydroxy fatty acid and bile acid in diabetic diarrheal patients

Thirteen normal subjects, 5 diarrheal controls (Group I) and 13 diabetics without peripheral neuropathy (Group II) were compared with 7 diabetic patients (Group III) with respect to fecal excretions of bile acids and hydroxy fatty acids for pathogenesis of diabetic diarrhea. The mean fecal excretions of bile acids per day were 304.9 mg for the normal controls, 297.8 mg for Group I, and 382.4 mg for Group II, while those of Group III were significantly higher (958.2 mg, p < 0.01) than the foregoing groups, and nearly three times as much as the controls. As to the fecal fatty acid excretion, there were no significant differences observed among these groups. The percentages of fecal hydroxy fatty acids were not significantly different in normal subjects (1.5%), Group I (2.0%), and Group II (1.2%). In contrast, the percentage of hydroxy fatty acid for Group III was greatly (p < 0.01) increased (13.2%). From the above results, the percentage of hydroxy fatty acid in diabetic diarrheal patients was high, suggesting that there is bacterial overgrowth. Meanwhile, the fecal bile acid level was increased about three times, indicative of poor absorption of bile acid from mild to moderate degree. Therefore, it is considered improbable that fecal hydroxy fatty acids and bile acids are the cause of diabetic diarrhea.