Minoru Ishida

Non-Hodgkin's malignant lymphoma of the sinonasal tract--treatment outcome for 53 patients according to REAL classification.

OBJECTIVE Although the Working Formulation is commonly used to classify NHL in Japan, it has been recognized as imperfect for primary extranodal lymphoma, especially for patients with sinonasal disease because of their histological characteristics. The present study investigated the clinical characteristics and the prognosis of sinonasal lymphomas according to REAL classification. METHODS Fifty-three patients with non-Hodgkins malignant lymphoma (NHL) of the sinonasal tract were treated between 1981 and 1997. The age at clinical presentation was from 10 to 84 years (mean, 52.4 years). According to the Ann Arbor system, there were 30 patients with Stage IE, 13 with Stage IIE, 4 with Stage IIIE, and 6 with Stage IVE lymphomas. Twenty-two patients (41.5%) had B symptoms. The primary sites were the nasal cavity (67.8%), maxillary sinus (20.8%), ethmoidal sinus (9.4%), and frontal sinus (1.9%). The survival data was calculated by Kaplan-Meier method. Statistical analysis was performed with a generalized Wilcoxon method. RESULTS All of the lymphomas showed a diffuse growth pattern. Based on the origin of the tumor cells, the authors classified NHL of the sinonasal tract into five groups with the REAL classification of Japan: diffuse large B-cell lymphoma (22.6%), peripheral T-cell lymphomas (15.1%), angiocentric lymphoma (35.9%), other lymphomas and unclassified types. Of 53 patients, 39 (73.6%) received chemotherapy and radiotherapy, eight patients received chemotherapy alone, and four patients received radiotherapy alone. The cumulative 5-year survival rates were 28.5% for all of the types, 55.0% for diffuse large B-cell lymphoma, 33.3% for peripheral T-cell lymphoma, and 19.7% for angiocentric lymphoma. Results suggest that conventional combined treatment (CHOP chemotherapy+radiotherapy) is ineffective for NHL of the sinonasal tract, and especially so for NHL in the nasal cavity, NHL with tumor cells with positive T-cell markers, NHL further than Stage IIE and NHL with B symptoms. CONCLUSION (1) In light of this ineffectiveness, new therapies must be developed to improve patient outcome instead of the conventional combined treatment; (2) REAL classification is clear and useful for sinonasal lymphomas in Japan.

Five Cases of Mucormycosis in Paranasal Sinuses

Five cases of mucormycosis are reported, 2 of them suffered from immunosuppression, the other 3 did not. We conclude that a combination of CT and bacteriological findings is useful for the diagnosis of mucormycosis differentially from other diseases. Therapy consisted of paranasal debridement and administration of amphotericin B.

Studies of Ldh Activity Concerning Malignant Transformation from Chronic Sinusitis

The LDH activity of maxillary cancer tissues was considerably higher than in the other tissues including the surrounding tissues, irradiated cancer tissues, and the mucosa of the maxillary sinus in chronic sinusitis. from the standpoint of classified LDH isozyme patterns, the maxillary cancer tissues were characterized by predominant fractions of LDH4 and LDHs in contrast to the chronic sinusitis tissues in which LDHa prevailed. We designated the type of the former “Cancer type” and the latter, “Inflammation type”, and proposed designation of ten types of the LDH isoenzyme pattern (from 1 to 10). the enzymologic studies on the basis of the LDH activity and isozyme aspect classified that the histologically proliferative type in chronic sinusitis resembles the cancer type.

Inhibitory Effect of Xian-Qing-Long-Tan Extract on Degranulation and Histamine Release from Rat Mast Cells

Xian-Qing-Long-Tang (XQLT), a Chinese medicine, is useful for treating allergic diseases. To demonstrate the anti-allergic effect of this drug we examined its effect on degranulation and histamine release from rat mast cells induced by antigen and compound 48/80. The effect on 48 h homologous passive cutaneous anaphylaxis (PCA) in rats was also studied. In the IgE antigen-antibody reaction using DNP-As, XQLT inhibited histamine release from rat mast cells, in vitro; it also inhibited 48 h rat homologous PCA reaction, in vivo. These results suggest that XQLT inhibits type 1 allergic reaction, and has effectiveness for allergic disease.

Cases of Primary Unknown Neck Carcinoma in Our Department.

Between 1982 and 1991, 326 patients were treated for head and neck malignant tumors at Osaka Prefectural Hospital. Among them, there were 5 patients (4 males, 1 female) with primary unknown neck carcinoma. The carcinomas were located in the submandibular area (2 cases) and upper jugular area (3 cases). There was one case in which the stage of the disease was N 1, two cases in which it was N2a and two in which the disease had reached the N3 stage. The histological diagnosis of all cases was squamous cell carcinoma of various levels of differentiation (1-low, 2-middle, 3-well).After treatment of the carcinoma, the primary lesions appeared in two cases, one in the buccal mucosa, the other on the base of the tongue, and both patients died of the disease. The remaining patients who showed no primary lesion included one patient who died of distant metastasis and two patients who showed no evidence of disease and are still alive. Both of the cases in N3 stage at first examination later died of the disease.

A case with candida albicans of the neck.

Candidasis of the paraphryngeal space is very rare. We report a case of neck and phanyngeal abscess due to candida albicans.A 73-year-old woman came to our hospital complaining of a sore throat, hoarsness. Prulenta plugs were seen on left tonsillar swelling. She had a very tumorlike swelling on the left side of the neck. At first, she was treated with an incision from the molar and soft palatine. We recognized about 50 ml yellow, whitish pus with a bad smelling gas. The first bacteriological examination showed abundant streptococcus and a small amount of candida albicans. Finding its test results, she was treated with broadspectrum antibiotics. Though antibiotic treatment, the neck tumor grew gradually up and massive pus was discharged from the incision wound. As streptococcus decreased, candida albicans increased. After detective bacteriological findings, we treated with antifungal antibiotics and the patient rapidly recovered. X-ray film and. CT revealed gas-like in the soft tissue in the so called bubble shadow.

A clinical study of MS-antigen 40 (MS-A) nebulizer therapy for nasal hypersensitivity.

The clinical effects of MS-A nebulizer therapy were evaluated in 23 patients with nasal hypersensitivity: 13 with nasal allergy (NA) and 10 with vasomotor rhinitis (VMR). The patients received 2 ampules once or twice a week for a total of 8 times.The efficacy rate was 61.5% for NA and 60.0% for VMR. The rate of improvement in nasal congestion was 46.2% for NA and 60.0% for VMR. Rhinorrhea decreased in 61.5% of these with NA and 70.0% of those with VMR. Percentages of patients showing a decrease in the number of sneezing attacks was 61.5% for NA and 57.1% for VMR. In half of the patients, the effects of MS-A nebulizer therapy were noted by the 5th application. There was no side effect observed in any subject.MS-A nebulizer therapy was considered to be effective for the treatment of nasal hypersensitivity.

Immunological Studies on Human Malignant Tumor VIII Cytotoxicity Assay of Normal Human Lymphocytes Against 51Cr Labelled Target Cells

Cytotoxicity occurring in vitro when lymphocytic cells from a normal individual are added to the target cells has been termed spontaneous cell mediated cytotoxicity (SCMS). The present studies were undertaken to identify the effector cells in human peripheral blood mediating SCMC. The target cell was an in vitro cultured cell line derived from maxillary cancer of a epidermoid carcinoma characteristic. The target cells were labelled with 51CrNa2O4 under an optimal condition. The mononuclear cells were separated by centrifugation on Ficoll-Hypaque gradients. The suspension of mononuclear cells containing a high percentage of lymphocytes was then incubated at 37°C for 1hr in a plastic dish to remove adherent cells. The separation of T cell and non-T cell populations from the suspension of non-adherent cells was a final preparation. The rosetting procedure with sheep red cell (E) was empolyed. T cells forming rosettes with E were obtained by Ficoll Hypaque gradients and the attached E were lysed with treatment of 0.75% ammonium chloride. Each lymphocyte suspension was used for 51Cr release assay according to Herseys methods.The Cytotoxicity of effector cells was expressed as a percentage of 51Cr release, when the effector cells were added to the culture of 51Cr labelled target cells. The cytotoxicity of effector cells was measured at different ratios to the target cells. Mononuclear cells showed a cytotoxicity with a percent lysis ranging from 6.7 to 11.2. An additional experiment revealed that the cytotoxicity of non-adherent cells was higher than that of mononuclear cells. The cytotoxicities of T cells and non-T cells separated from the non-adherent cells greatly decreased. The exact mechanisms involved in SCMC are now being studied.