Mitsuaki Uchiyama

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.

The Immunohistopathologic Study of Scabies by the PAP Method — Identification of IgE Positive Mast Cells

Skin biopsy specimens taken from 18 cases of scabies were studied immunohistopathologically using the PAP method. In 12 of 18 cases, membrane‐bound, IgE positive mast cells were observed in the dermis and subcutaneous tissues of the scabies lesions. In a Norwegian scabies, IgE deposits were found not only on the surface of scabies mites but also on feces‐like granules. We conclude that the membrane‐bound IgE mast cells may play an important role in immune skin reactions of scabies.

Studies on leukemic cells in a patient suffering from exfoliative dermatitis (due to chronic lymphatic leukemia), especially by scanning electron microscopy.

SummaryLymphocytes (T cells and B cells) of a patient with chronic lymphatic leukemia (CLL) were studied immunologically and scanning electron microscopically. The subpopulation percentage of rosette forming cells (T cell) and surface immunoglobulin bearing cells (B cell) were decreased in the peripheral blood. Moreover, tritiated thymidine uptake by lymphocytes in the cell culture stimulated by phytohaemagglutinin (PHA), porkweed mitogen (PWM) and purified protein derivatives (PPDs) was decreased.Scanning electron microscopy (SEM) showed many long villi on the surface of the lymphocytes in the peripheral blood, which implies B cell origin. Observation by electron microscopic immunohistochemistry using the ferritin antibody technique revealed thatβ1C/β1A receptors normally seen on the B cells were also seen on the leukemic lymphocytes. Thus it appears that the leukemic cells in the peripheral blood of this patient are functionally and morphologically abnormal B cells.ZusammenfassungDie Lymphozyten (T-Zellen und B-Zellen) einer Patientin mit chronisch lymphatischer Leukämie (CLL) wurden immunologisch und mit dem Raster-Elektronenmikroskop untersucht. Der Prozentsatz der rosettenbildenden T-Zellen und den auf der Oberfläche Immunoglobuline tragenden B-Zellen war im peripheren Blut erniedrigt. Darüber hinaus war die Aufnahme tritiierten Thymidins bei Lymphozyten in der Zellkultur, die mit Phythaemagglutinin (PHA), Porkweed mitogen (PWM) und gereinigten Proteinderivaten (PPDs) stimuliert wurden, erniedrigt.Die Raster-Elektronenmikroskopie (SEM) zeigte viele lange Villi auf der Oberfläche der Lymphozyten im peripheren Blut, die diese als B-Zellen charakterisieren. Die elektronenmikroskopischen Untersuchungen mittels der Immunhistochemie durch Ferritin Antikörper deckten auf, daß dieβ1C/β1A Rezeptoren, die normalerweise den B-Zellen eigen sind, auch bei den leukämischen Lymphozyten nachgewiesen werden konnten. All das weist darauf hin, daß die leukämischen Zellen im peripheren Blut dieser Patientin funktionell und morphologisch anormale B-Zellen sind.

4 cases of malignant melanoma for 18 years.

In our clinic, we encountered 4 patients (3 men and one woman, 42-76 years old) with malignant melanoma during an 18-year period from 1975 to 1992. Acral lentiginous melanoma was observed in 3 patients, and nodular melanoma in one. Wide surgical excision was done in all cases, and right inguinal lymphadenectomy was added in one patient (case 1, pT4N1M0. Stage III) . One patient (case 1) died 3 years and 2 months after the first visit due to metastasis to the lung. Another patient (case 2, pT3aN0M0. Stage II) died 5 years and 1 month after surgery due to pneumonia without metastasis or recurrence. One patient (case 3, PT3aN0M0. Stage II) is still alive without metastasis or recurrence 1 year and 10 months after surgery. In the remaining patient (case 4, pT3aN0M0. Stage II), left axillar metastasis was found 8 months after surgery, despite DAV and IFN-& combination therapy. Although chemotherapy was not done in cases 1, 2 and 3, IFN-& therapy was added in case 3.

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。

A case of malignant fibrous histiocytoma produced on a burn scar.

56歳, 女, 27歳の時七輪の火が引火し, 全体表面積の約3分の1の熱傷を受傷。88年8月, 熱傷瘢痕部に腫瘤が出現。初診時, 右大転子付近に30×47×9mmの暗赤色の半球状結節。所属リンパ節の腫大なし。腫瘤辺縁から4センチ離して筋膜上で切除し, 分層植皮を施行した。組織像では, 表皮直下より密に増殖する多形性に富む線維芽細胞様細胞, 組織球様細胞を認め, storiform patternを示す部位もみられた。術後20ヵ月で再発なし。