Kanata Miyakawa

Systemic and local immunological features of atopic dermatitis patients with ocular complications

AIMS Clinical factors and data from recent cases of atopic dermatitis (AD) (with or without ocular complications) and non-AD cases were examined to evaluate the mechanism of atopic ocular complications. METHODS IgE-RAST for eight allergens including rice, egg, and mite and serum total IgE were measured in 216 patients with AD (70 ocular type, 146 non-ocular type) and 69 non-AD individuals. Tear histamine and leukotriene B4(LTB4) levels were also measured. RESULTS The serum levels of IgE were significantly increased in AD patients with ocular complications compared with those without ocular complications. The positive rates of IgE-RAST for rice and wheat were significantly higher in ocular type AD than in non-ocular type AD. In ocular type AD, serum IgE was significantly increased in patients with cataract compared with that in those without cataract. Tear histamine and LTB4 levels in AD patients with ocular complications showed significant elevations compared with those in patients with pure AD and controls. CONCLUSIONS These results suggest that ocular type AD belongs to the most severe end of the spectrum of AD, and that some food antigens may contribute to the pathogenesis of severe AD resulting in ocular complications.

AgNOR (Nucleolar Organizer Regions) Staining in Malignant Melanoma

Nucleolar organizer regions (NORs) are loops of ribosomal DNA seen in nuclei, which are demonstrable as black dots (AgNOR) in tissue sections by silver (Ag) colloid staining. The number of such AgNORs is correlated with cellular activity and is an indicator of the degree of malignancy. In this study, 76 melanocytic lesions were analyzed by AgNOR staining, and the clinical and histopathological characteristics of malignant melanoma and melanocytic nevi were considered. Although the AgNOR counts for melanocytic nevi were significantly different from those in malignant melanoma, an obvious overlap between them was detected. The number of AgNORs in melanocytic nevi per cell was usually 1 or 2. On the other hand, the number of AgNORs per malignant melanoma cell was variable. Morphologically, malignant melanoma cells often showed dispersal of AgNORs throughout the nucleus as well as multiple nucleoli containing clustered AgNORs, whereas melanocytic nevus cells tended to have a regular nucleolus with tightly clustered AgNORs. The correlation between AgNOR count and pathological staging was uncertain, but a slight correlation between AgNOR count and thickness of the primary lesion was obtained. However, the AgNOR count in malignant melanoma was not a prognostic factor for the disease. Therefore, the AgNOR method is difficult to use for differential diagnosis between benign pigmented lesions and malignant melanoma. Nonetheless, an AgNOR count of more than two per cell favors a diagnosis of malignant melanoma.

Successful Treatment of Adult T‐cell Leukemia/Lymphoma with MACOP‐B, M‐FEPA and VEPP‐B Combination Chemotherapy

A 45‐year‐old man was referred to our department in March of 1989. Physical examination showed erythroderma, palmo‐plantar hyperkeratosis, generalized lymphadenopathy, hepatosplenomegaly, and leukemic manifestation. The lymphocyte count in the peripheral blood before treatment was 1.7 × 104 cells/mm3. Atypical lymphocytes such as flower cells and lobulated cells were seen in the peripheral blood. A sample excised from a lymph node showed immunoblastic, pleomorphic T cells by a modified classification scheme of the Working Formulation. A high level of serum LDH was detected (2.1 times the upper normal limit). Anti HTLV‐1 antibody was also detected in the serum. The atypical lymphocytes were positive for CD3, CD4, CD5, CD7 and HLA‐DR, and negative for CD8. Thus, the clinical, pathologic and immunologic features were those of typical acute‐type ATL.

Malignant melanoma treated with natural interferons alfa and beta and DAV

The S-year survival of patients with stage III malignant melanoma excluding N2 treated with DAV plus IFN-B is better than that of patients treated with BCG plus DAV, picibanil (OK432) plus DAV, DAV alone or dacarbazine alone. The 5year survival of patients treated with IFN-P plus DAV or dacarbazine was 84%, whereas that of patients treated with BCG plus DAV or dacarbazine, and picibanil plus DAV or dacarbaxine was 58 and 56%, respectively.

Statistical observation of epithelium malignant tumors.Statistical observation of epithelium malignant tumors in the Yokohama City Univ. medical school dermatology.

横浜市立大学皮膚科における最近10年間の上皮系悪性腫瘍について統計的観察を行った。上皮系皮膚悪性腫瘍は合計403例 (光線角化症, 放射線角化症, 砒素角化症を除くと314例) で, 外来新患総数の約0.6% (同じく0.5%) であった。最近10年間に増減傾向はないが, 当科における前回10年間の統計と比較すると基底細胞上皮腫, 光線角化症, Paget病, 付属器系悪性腫瘍の増加がみられた。性別では, 有棘細胞癌, Paget病, 毛包脂腺系腫瘍は男性に多かった。年齢では有棘細胞癌, Paget病, 転移性皮膚腫瘍は60～70歳代, 基底細胞上皮腫, Bowen病は50～70歳代, 光線角化症は60～80歳代に多かった。有棘細胞癌では前回の10年間に比べ高齢化傾向がみられた。発生部位は有棘細胞癌, 基底細胞上皮腫, 光線角化症は顔面, Bowen病は下肢・体幹に多くみられた。死亡例は有棘細胞癌7例, Paget病2例, 皮膚付属器系悪性腫瘍2例, 転移性皮膚腫瘍8例であった。