Rosalyn E. Stahl

Disseminated Kaposi's Sarcoma in Homosexual Men

Nineteen cases from an epidemic of disseminated Kaposis sarcoma in homosexual men were studied by clinical, virologic, immunologic, and genetic methods. The patients were all male homosexuals ranging in age from 29 to 52 years, with histories of multiple sexually transmitted diseases and exposure to both prescription and recreational drugs. Sites of disease included skin (16 of 19 patients), lymph nodes (13 patients), gastrointestinal tract (12 patients), spleen (three patients), and lung (one patient). Most patients had elevated levels of serum immunoglobins, positive antibody titers to hepatitis A and B virus, cytomegalovirus and Epstein-Barr virus, and impairment of cell-mediated immunologic reactions. The frequency of HLA-DR5 in these patients was significantly elevated. Two of the 19 patients died. Although the precise cause of this epidemic is unknown, it is likely that a genetic predisposition, an acquired immunoregulatory defect, and one or more infectious agents and drugs may be involved.

Immunologic abnormalities in homosexual men: Relationship to Kaposi's sarcoma☆

Studies were performed to define the immunologic status of various groups of homosexual men including homosexual men with Kaposis sarcoma, healthy homosexual men who were of similar ages to the homosexual patients with Kaposis sarcoma and homosexual men with hyperplastic lymphadenopathy. Heterosexual men with Kaposis sarcoma were also studied. Immunologic parameters which were examined included serum immunoglobulin levels, enumeration of B cells, T cells, and T-cell subsets, and quantitation of lymphocyte responsive to phytohemagglutinin (PHA) and pokeweed mitogen (PWM). Significant immunologic abnormalities were observed in all three groups of homosexuals studied. These were most severe in the homosexuals with Kaposis sarcoma, somewhat less severe in homosexual men with lymphadenopathy, and least marked but still significant in healthy homosexual men. Heterosexual men with Kaposis sarcoma displayed essentially normal immunologic profiles. The possible etiologic factors underlying the immunologic abnormalities in the male homosexual population studied and the role of an altered immune system in the development of and the fulminant course of Kaposis sarcoma in these patients are discussed.

Primary carcinoid of the kidney. Light and electron microscopic study

A case of an asymptomatic primary renal carcinoid tumor in a 61‐year‐old male is presented. The tumor was large with extensive hemorrhagic necrosis. Metastases were present in para‐aortic lymph nodes. Ultrastructurally, dense core granules and masses of cytoplasmic filaments, including tonofilaments, were seen. The granules were faintly argyrophilic. The relevant literature is reviewed.

Carcinoid tumor within a squamous cell carcinoma of the cervix

Abstract A small focus of carcinoid tumor within an otherwise typical, poorly differentiated squamous cell carcinoma of the cervix in a 37-year-old female is described. This focus was argyrophilic, but argentaffin negative. There are several papers dealing with primary carcinoid or hormone-secreting tumors of the cervix and, although some of these have shown small foci of epidermoid differentiation, this is the first example in which a small carcinoid focus occurred within and in continuity with a large squamous cell tumor. This may support the theory that APUDomas of the cervix arise from undifferentiated basal stem cells.

Histiocytoid hemangioma with features of angiolymphoid hyperplasia and Kaposi's sarcoma. A study by light microscopy, electron microscopy, and immunologic techniques.

We examined by light and electron microscopy 99 vascular lesions removed on 17 occasions over a 2-year period from a 55-year-old black man. The lesions all showed histologic features of a vascular neoplasm composed of enlarged “histiocytoid” endothelial cells and overlapping features of angiolymphoid hyperplasia with cosinophilia and Kaposis sarcoma. An apparently unique feature was early loss of melanin from the overlying cpidermis and a monocuclear inflamatory-cell infiltrate. The patient also had an abnormal immunologic state very similar to that seen in homosexuals with Kaposis sarcoma.

THE USE OF BETA‐2 MICROGLOBULIN IN THE DIAGNOSIS OF AIDS, SUSPECTED AIDS, AND PRECLINICAL AIDS a

In the absence of a specific laboratory test for the diagnosis of AIDS, a number of nonspecific tests are being evaluated for their reliability in identifying patients with AIDS. The studies reported here constitute the first step in a series of experiments designed to delineate a marker that will identify patients with AIDS, patients with early or milder forms of AIDS, and patients with preclinical AIDS, that is, individuals who appear healthy but who proceed within a few months to develop AIDS. Development of a test that would identify individuals with early or preclinical forms of AIDS would be extraordinarily useful in distinguishing individuals in populations at high risk for AIDS who need medical follow-up. A marker for patients with preclinical AIDS would also permit clinicians and researchers to study those individuals progressing through the early prodromal stages of the disease, allowing a greater insight into the natural history of AIDS. Furthermore, a marker of preclinical AIDS would provide more accurate estimates of the latent period during which the disease is contagious and should disclose clues on the underlying pathogenesis of the disease because such an early marker might reflect a primary abnormality of the disease rather than a secondary manifestation. Several nonspecific markers are being studied as potentially valuable markers of AIDS. These include antibbdies to the core antigen of the hepatitis B virus, to cytomegalovirus (CMV) and Epstein-Barr virus (EBV),’ serum IgD levels,, serum thymosin alpha1 levels,-’ and serum interferon levels? ’ Serum beta-2 microglobulin (B,M) was also suggested as a potential marker of AIDS when it was found to be extraordinarily elevated in the serum of a single patient with AIDS: The validity of this suggestion was borne out by preliminary experiments in our laboratory showing that serum B,M levels were above normal limits (>2.5 ma i t r e ) in 12 out of 12 patients with AIDS.’ The purpose of the following study was to determine if elevated B,M levels appeared at different levels in AIDS patients with Kaposi’s sarcoma (KS) compared to patients with opportunistic infections (01); in addition, we undertook the study of B,M in patients with early or milder forms of AIDS and in apparently healthy homosexual men from New York City who were entered into a prospective

Fungal Stains in the Acquired Immunodeficiency Syndrome

Excerpt To the editor: It has been recommended that acid-fast staining be done routinely on all tissues taken from patients with or suspected of having the acquired immunodeficiency syndrome (1, 2)...