Jules M. Elias

Histologic studies of chronic idiopathic urticaria

Skin biopsy specimens were obtained from 43 consecutive patients with chronic idiopathic urticaria and from seven normal controls. Of 43 patients, 42 had a non-necrotizing perivascular infiltrate composed primarily of mononuclear cells. There was no evidence of damage to vessel walls, of nuclear debris, or of extravasation of red blood cells, and most cells were seen around vessels rather than within the vessel wall. One patient had vasculitis with a neutrophilic infiltrate, nuclear debris, and positive immunofluorescence. Quantitative cell counts revealed four times the number of mononuclear cells and 10 times the number of mast cells in urticaria biopsy sites vs normal skin. Thus chronic urticaria is characterized by an accumulation of mononuclear cells and mast cells with mast cell degranulation presumably associated with hive formation. In our series, the characteristic lesion is not vasculitic. The stimulus responsible for the infiltration of skin with these cells is unknown.

Studies of the cellular infiltrate of chronic idiopathic urticaria: Prominence of T-lymphocytes, monocytes, and mast cells

We have used a panel of monoclonal antibodies and enzyme histochemistry in order to characterize further the perivascular mononuclear cell infiltrate found in chronic idiopathic urticaria. Biotinylated anti-mouse immunoglobulin was exposed to avidin-biotin-peroxidase-labeled complex followed by peroxidase development in order to detect binding of monoclonal antibodies. The mean percent staining obtained for 12 patients with chronic urticaria was 47% T-lymphocytes, 22% monocytes (14% by alpha-naphthyl acid esterase), and 11% mast cells. B-lymphocytes were not detectable, and approximately 20% of cells could not be identified. Although patients varied greatly in the ratio of Leu 3a positive helper-inducer T cells to T8 positive cytotoxic-suppressor cells, the average of all patients was not significantly different from the T4/T8 ratio in plasma. Our results suggest that the infiltrate resembles that observed in cellular immune reactions (although no antigen has been identified) and that interaction of T-lymphocytes and/or monocytes with mast cells to cause mediator release appears likely.

Cell Proliferation Indexes: a Biomarker in Solid Tumors

Clinical studies have shown that carcinogenesis is linked to the development of proliferative abnormalities. Proliferative activity has been found to have prognostic significance in a variety of human tumors. Because proliferative abnormalities can precede the occurrence of morphological abnormalities, their measurement could also serve as useful biomarkers for chemoprevention trials. The variety of techniques for measuring cell proliferation in routine sections include mitosis counting, AgNORs, DNA precursor uptake (bromodeoxyuridine), and immunohistochemical detection of cell cycle proteins (PCNA, Ki-67/MIB-1). It is essential that the virtues and limitations of these methods be examined to ensure collection of meaningful clinical data.

Hepatitis B surface antigen and hepatocellular carcinoma in the people's Republic of China

Eighteen cases of hepatocellular carcinoma from the Peoples Republic of China were investigated for the presence of hepatitis B surface antigen (HBsAg) in the cytoplasm of hepatocytes and tumor cells. The Sternberger‐PAP immunoperoxidase technique utilizing monospecific antibody to HBsAg and a modified orcein method demonstrated cytoplasmic HBsAg in hepatocytes of 15 cases (83.3%) and tumor cells of 3 cases (16.7%). Thirteen of these cases were also investigated for HBs antigenemia and of these 11 were positive (84.6%). These hepatomas were often associated with macronodular cirrhosis and/or a persistent inflammatory process in the hepatic parenchyma. The high association of HBsAg and hepatoma indicates that the hepatitis B virus plays an important role in the pathogenesis of this malignancy in China. It is concluded that a major public health effort to eradicate endemic hepatitis B infection is the most reasonable way to decrease the incidence of this cancer, which is common in China.

Application of immunologic probes for contractile proteins to tissue sections

Abstract Employing antisera produced in rabbits against actin, smooth and skeletal muscle myosin, α-actinin, tropomyosin, and tubulin, we have been able to demonstrate the presence of these antigens in tissue sections. The antisera were prepared against well-characterized, relatively pure antigens and had been previously studied in isolated cells. This permitted reliable confirmation and extension of studies demonstrating contractile proteins in non-muscle cells. Of particular interest was the visualization of a unique banding pattern in small vessels with sera directed against actin, smooth muscle myosin, tropomyosin, and actinin. An unexplained observation was the presence of significant amounts of tubulin in endomysial cells. The relationship of our observations to those recently appearing in the literature is discussed.

Soft tissue T cell lymphoma of the forearm: a case report.

A patient with a soft tissue T cell lymphoma with symptoms of de Quervains tenosynovitis and a forearm mass in the area of the abductor pollicis longus and extensor pollicis brevis is described. Previously excised soft tissue masses from other locations had presented a diagnostic dilemma in this patient. This report clarifies the histopathology of soft tissue T cell lymphomas of the extremities. After surgical debulking and local radiotherapy, there has been no evidence of recurrence at 1 year.