[Long-term quality of life in patients with Brownâ ¡ maxillary defect repaired by different methods].

Objective: To analyze the long-term quality of life of patients with Brown Ⅱ maxillary defect repaired by tissue flap or prosthesis. Methods: Patients who underwent surgery for maxillary malignant tumors in the First Affiliated Hospital of Bengbu Medical College from 2014 to 2017 were selected to investigate the postoperative long-term (>5 years) quality of life using the fourth edition of the University of Washington quality of life questionnaire (UW-QOL). Mann Whitney U test was used to examine the differences between two groups. Results: In this study, 4 cases were lost to follow-up, 9 died, and a total of 46 valid questionnaires were collected, including 24 males and 22 females, aged 19-86 years. There were 26 cases of class Ⅱb/c and 20 cases of class Ⅱd. Tissue flap reconstruction was performed in 29 cases (tissue flap group) and prosthesis restoration in 17 cases (prosthesis group). The score of chewing QOL in the prosthesis group was higher than that in the tissue flap reconstruction group (Z=-2.787, P=0.005), but the scores of entertainment, swallowing, speech and emotion QOL in the former group were respectively lower than those in the latter group (Z=-3.185, -2.091, -2.556 and -1.996, respectively, all P values<0.05). In patients with Brown Ⅱb/c defect, the prosthesis repair could improve the chewing QOL score (Z=-2.830, P=0.005), but no statistically significant differences in other QOL scores between two groups. In patients with Brown Ⅱd defect, the tissue flap reconstruction could improve the scores of pain, entertainment, swallowing and speech QOL (Z=-2.741, -2.517, -2.320 and -2.843, respectively, all P values<0.05), and the average QOL score in tissue flap reconstruction group was also higher than that of the prosthesis group (Z=-2.276, P=0.023). Conclusion: For postoperative long-term quality of life, both prosthesis and tissue flap reconstruction can offer satisfactory results in patients with Brown Ⅱb/c defect, and patients with Brown Ⅱd defect repaired by tissue flap reconstruction have better speech and swallowing functions. Tissue flap reconstruction may bring more entertainment and emotional benefits.

[Quantitative analysis of near infrared optical signal in fluorescence molecular navigation surgery for oral squamous cell carcinoma].

Objective: To evaluate the effect of quantitative analysis of optical signal in the near infrared fluorescence molecular navigation surgery for oral squamous cell carcinoma (OSCC). Methods: SCC9, HSC3 and epithelial cell lines (Leuk-1) were co-cultured with indocyanine green (ICG) for 6 hours in vitro in order to verify whether the quantitative analysis of near infrared optical signal could distinguish tumor cells from normal cells. A total of 16 BALB/c male mice (5-6 weeks, 20-25 g) were selected and fed in clean grade equipment and were equally divided into two groups. SCC9 and HSC3 cells were inoculated into the back of each mouse at a concentration of 1×106 cells/ml to establish a subcutaneous graft tumor model. The 5 mg/kg ICG was injected into the caudal vein to each of the tumor bearing mouse and the difference between OSCC and normal tissues was then analyzed by near infrared optical signal quantitative analysis (Paired t test). Ten patients with OSCC were enrolled in the Department of Stomatology of the First Affiliated Hospital of Bengbu Medical College from November 2019 to July 2020, including 6 patients with tongue squamous cell carcinoma and 4 patients with buccal squamous cell carcinoma.The patients were 6 males and 4 females and the range of age was from 46 to 71 years with an average age of 58.6 years. These patients were injected ICG (0.75 mg/kg) via the cubital vein at 6-8 h before surgery. Intraoperatively, the fluorescence intensities (FI) of near infrared signal were measured at tumor, peritumor tissues (2.0 cm beyond the tumor boundary) and normal tongue or buccal mucosa respectively. The signal background ratios (SBR) from the three site groups were assessed using one-way ANOVA followed by the Tukey post hoc test for multiple comparisons. Results: In vitro, the levels of near infrared FI in HSC3 and SCC9 groups were higher than that in Leuk-1group (P<0.01). In vivo, the result showed that the SBR of OSCC and normal tissues was 8.67±0.35. Clinical studies showed that the intensity of tumor [(408.23±101.51) arbitrary units (AU)] was significantly higher than those of peritumoral [(253.12±64.89) AU] and normal tissues [(261.50±80.47) AU] respectively. The SBRs of near infrared FI of tumor and peritumoral tissues, tumor and normal tissues were 1.61±0.53 and 1.56±0.48 respectively, while that of peritumoral and normal tissues was 0.96±0.17. Conclusions: The quantitative analysis of near infrared optical signal could distinguish OSCC from normal cells and could locate the OSCC tissue intraoperatively. Optical signal quantification and ICG near infrared fluorescence molecular technology possessed the feasibility in primary OSCC resection.

[Application of superficial inferior epigastric artery flaps to repair oral and maxillofacial defects with the aid of digital three-dimensional reconstruction technique].

Objective: To explore the application value of digital three-dimensional(3D) reconstruction technology in the repair of oral and maxillofacial defects with superficial inferior epigastric artery (SIEA) flap. Methods: Twelve cases of oral cancer patients, including 8 males and 4 females; aged (57.4±12.6) years, were selected from the Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Bengbu Medical College from January 2018 to October 2019 and were proposed to repair with SIEA flap. There were 10 cases of squamous cell carcinoma, one case of adenoid cystic carcinoma and 1 case of mucinous epidermal carcinoma. The data were imported into AW4.7 software for post-processing. The left or right dominant donor area was selected to clarify the origin, diameter, alignment, and location of penetration point of the flap blood supply, and digital 3D reconstruction technology was used to guide the flap preoperative design. Results: Eleven cases were repaired by SIEA flap in 12 patients, one case was repaired by superficial iliac artery flap because the source artery was undiscovered, one case had venous vascular crisis after surgery, and the rest of the flap survived. In 11 patients repaired with SIEA flap, there was no significant difference between the preoperative SIEA diameter measured by CTA [(1.0±0.3) mm] and the actual measured value [(1.1±0.3) mm] (P>0.05). The follow-up was 6 to 12 months, with an average of 10 months, and the donor-receiver areas were all healed in phase Ⅰ. No obvious complications occurred, and the abdominal scar was hidden. Conclusions: In the SIEA flap repair oral and maxillofacial defect reconstruction surgery, the use of digital 3D reconstruction technology can objectively reflect the diameter and the location of the superficial artery of the abdominal wall before surgery, effectively reduce the difficulty and risk of flap surgery.

Expression of parvin-beta is a prognostic factor for patients with urothelial cell carcinoma of the upper urinary tract.

BACKGROUND: Parvin-beta (ParvB), a potential tumour suppressor gene, is a focal adhesion protein. We evaluated the role of ParvB in the upper urinary tract urothelial cell carcinoma (UUT-UC). METHODS: ParvB mRNA and proteins levels in UUT-UC tissue were investigated by quantitative real-time polymerase chain reaction and western blot analysis, respectively. In addition, the expression of ParvB in tissues from patients with UUT-UC at different stages was evaluated by immunohistochemistry. Furthermore, biological functions of ParvB in urothelial cancer cells were investigated using a doxycycline-inducible overexpression system and siRNA. RESULTS: Western blot and mRNA analysis showed downregulation of ParvB expression in frozen UUT-UC tissue. Immunohistochemistry revealed high staining intensity of ParvB in normal urothelium, which decreased markedly at advanced stages of UUT-UC (P=0.0000). Moreover, ParvB was an independent prognostic indicator for disease-specific survival of patients with UUT-UC. Functional assays indicated that overexpression of ParvB in an urothelial cancer cell line resulted in decreased cell growth rate and ability to migrate. In contrast, knockdown of ParvB expression increased cell migration ability. CONCLUSIONS: Downregulation of ParvB expression significantly increased urothelial cancer cell growth and migration. Downexpression of ParvB level in UUT-UC correlated with tumour stage, and was an independent unfavourable prognostic factor for disease-specific survival of patients with UUT-UC.

Prostatic stromal sarcoma in a young adult: a case report.

Prostate stromal sarcoma is quite rare, comprising only 0.1-0.2% of all prostate cancers. Here, we report one case of prostate stromal sarcoma in a 38-year-old man. Initially, the patient suffered from lower urinary tract symptoms, and intravenous pyelography showed a larger filling defect in the bladder. Transrectal ultrasound showed a huge heterogenous mass between the bladder and rectum. Abdominal computed tomography revealed prostate tumor with local invasion. Radical cystoprostatectomy with ileal conduit was performed; pathology revealed high-grade prostate stromal sarcoma with invasion to the right seminal vesicle and urethra. This article describes the pathology and immunohistrochemical features of this case and briefly reviews the literature.

High frequency of functional anti-YMDD and -mutant cytotoxic T lymphocytes after in vitro expansion correlates with successful response to lamivudine therapy for chronic hepatitis B.

BACKGROUND: Many determinants for a sustained response to lamivudine therapy have been reported but the role of T cell responsiveness remains unclear. The finding that tyrosine-methionine-aspartate-aspartate (YMDD) motif of the reverse transcriptase domain of hepatitis B virus (HBV) DNA polymerase carries a HLA-A2 restricted cytotoxic T lymphocyte (CTL) epitope makes quantitative measurement of the numbers of peptide specific CTLs feasible using MHC tetramer-peptide complex staining. AIM: To investigate the correlation between anti-YMDD motif CTL activity and the efficacy of lamivudine therapy in HLA-A2 positive patients with chronic hepatitis B (CH-B). METHODS: The function and phenotype of peptide and interleukin 2 expanded peripheral blood mononuclear cells were quantified by cell lytic assay and immunocytochemical analysis by staining with HLA-A2-peptide tetramer complexes. RESULTS: After in vitro expansion, sustained responders had more potent CTL responses against YMDD, YVDD, and YIDD, as well as other epitopes on HBV antigens than non-responders. The frequency of YMDD/YVDD/YIDD motif specific CTLs increased significantly with an effective cell lytic function during and after therapy in sustained responders but not in non-responders. YMDD specific CTLs cross reacted with YIDD and YVDD mutant epitopes, and shared T cell receptor gene usages with YIDD and YVDD specific CTLs. CONCLUSIONS: Sustained responders, at least HLA-A2 patients, elicited a more potent CTL immunity against YMDD and its mutants. YMDD specific CTLs are cross reactive with YVDD and YIDD mutant epitopes, which may further contribute to immune clearance of the mutant viruses and a successful response to lamivudine therapy in CH-B patients.

Epstein-Barr virus infection in urothelial transitional cell carcinoma tissues.

OBJECTIVE: To explore a possible correlation of Epstein-Barr virus (EBV) infection with urothelial tumours, as the mutation of oncogenes, inactivation of tumour suppressor genes and viral infections may be important in the tumorigenesis of urothelial tumours, and EBV has been implicated in the pathogenesis of a variety of lymphoproliferative disorders and several epithelial neoplasms. MATERIALS AND METHODS: In all, 104 surgical specimens of transitional cell carcinoma (TCC) were obtained from urological operating rooms, fixed in 10% buffered formalin and processed for in situ hybridization using DNA probes, to locate the signal of EBV-encoded RNAs (EBERs). Immunohistochemistry with antibodies against CD20 and EBV-encoded latent membrane protein-1 (LMP-1) was used on EBER-positive tumour specimens. RESULTS: Thirty-one tumour specimens were positive for EBER hybridization in 100 evaluable specimens. Of these positive specimens, 21 were positive in both the infiltrating B lymphocytes and TCC tumour cells, seven only in B lymphocytes and three only in TCC cells. Of 31 EBER-positive tumour tissues, 26 (84%) had LMP-1, suggesting that EBER is more sensitive than LMP-1 for detecting EBV infection. CONCLUSION: There is a strong association between EBV infection and a significant proportion of primary urothelial TCC tumour cells.

Production of multiple cytokines and induction of cachexia in athymic nude mice by a new anaplastic thyroid carcinoma cell line.

An anaplastic thyroid cancer cell line, Thena, was recently established in our laboratory following radical thyroidectomy of a patient with anaplastic thyroid cancer. Microscopically, Thena cells were spindle-shaped or small round cells. Thena cells were reactive with cytokeratin AE1/AE3 antibodies, epithelial membrane antigen, interleukin (IL)-6, epithelial growth factor receptor, transforming growth factor (TGF)-alpha, vascular endothelial growth factor, and vimentin. Thena cells secreted high levels of IL-6, leukemia inhibitor factor (LIF), tumor necrosis factor (TNF)-alpha, and TGF-beta1 in the culture supernatants, as determined by enzyme-linked immunosorbent assay. When subcutaneously injected with Thena cells, athymic nude mice developed tumor masses in the skin within 2 weeks. Furthermore, Thena cells induced cachexia in these tumor-bearing mice. High levels of human IL-6, LIF and TGF-beta1 were detected in the mouse sera. To our knowledge, the Thena cell line is the first thyroid cancer cell line reported to induce cachexia in nude mice. This cachectic animal model is worthy of further study to explore the treatment of thyroid cancer-induced cachexia.

The melanocyte inducing factor MITF is stably expressed in cell lines from human clear cell sarcoma.

Clear cell sarcoma (CCS) is associated with the EWS/ATF1 oncogene that is created by chromosomal fusion of the Ewings Sarcoma oncogene (EWS) and the cellular transcription factor ATF1. The melanocytic character of CCS suggests that the microphthalmia-associated transcription factor (Mitf), a major inducer of melanocytic differentiation, may be miss-expressed in CCS. Accordingly, we show that the mRNA and protein of the melanocyte-specific isoform of Mitf (Mitf-M) are present in several cultured CCS cell lines (Su-ccs-1, DTC1, Kao, MST-1, MST-2 and MST-3). The above cell lines thus provide a valuable experimental resource for examining the role of Mitf-M in both CCS and melanocyte differentiation. Melanocyte-specific expression of Mitf-M is achieved via an ATF-dependent melanocyte-specific cAMP-response element in the Mitf-M promoter, and expression of Mitf-M in CCS cells suggests that EWS/ATF1 (a potent and promiscuous activator of cAMP-inducible promoters) may activate the Mitf-M promoter. Surprisingly, however, the Mitf-M promoter is not activated by EWS/ATF1 in transient assays employing CCS cells, melanocytes or nonmelanocytic cells. Thus, our results indicate that Mitf-M promoter activation may require an appropriate chromosomal context in CCS cells or alternatively that the Mitf-M promoter is not directly activated by EWS/ATF1.

Analysis of a murine anti-ganglioside GD2 monoclonal antibody expressing both IgG2a and IgG3 isotypes: monoclonality, apoptosis triggering, and activation of cellular cytotoxicity on human melanoma cells.

In this study we have documented a hybridoma secreting an unusual MAb, which expresses both IgG3 and IgG2a subclasses with a lambda-light chain. How this dual expression of isotypes was exactly brought about is not clear. To resolve this problem, it will have to wait the complete sequence analysis the heavy chain gene of MAb 9C4. Although the expression of IgG2a was about 50% that of IgG3, antibody titration studies showed the major binding affinity of MAb 9C4 to GD3-positive cells being mostly contributed by the IgG3 rather than IgG2a part of the antibody. This antibody could induce apoptosis in melanoma cells in 10-15% of cells in vitro, but the generality of this phenomenon is yet to be confirmed by the use of different cell targets and different anti-GD2 MAbs other than 9C4. Aside from the demonstrated indirect killing mechanisms of many anti-GD2 MAbs through CDC and ADCC, MAb 9C4 induction of apoptosis represents an alternative mechanism of tumor cell killing, by which direct killing of anti-GD2 antibody takes its effect. This apoptotic effect was demonstrated for the first time with an anti-ganglioside monoclonal antibody. From the therapeutic point of view, the cytolytic activity of MAb 9C4-targeted ADCC/LAK killing against GD2-positive tumor cells to be more effective than that of LAK alone and a possibility for dendritic cells to effectively acquire antigen through pulsing with MAb-induced apoptotic cells are both of great clinical importance. Further studies are warranted aiming at elucidating the molecular basis of bi-isotypic specificity and aberrant isotype switching, molecular pathway of anti-GD2 antibody-induced apoptosis, and ways to improve clinical utility of this unusual hybridoma/MAb 9C4.

Adult Wilms' tumor presenting as acute abdomen with elevated serum lactate dehydrogenase-4 and -5 isoenzymes: case report.

Wilms' tumor, an embryonic neoplasm, is the most frequent renal tumor in childhood but is rare in adults. The prognosis of adult Wilms' tumor is worse than pediatric Wilms' tumor. The preoperative diagnosis of adult Wilms' tumor is extremely difficult to make because diagnostic imaging techniques, such as intravenous pyelography, computed tomography, ultrasound, renal angiography, and nuclear magnetic resonance imaging, only confirm the presence of a renal mass. Diagnosis usually depends on histological characteristics, such as the presence of blastemic, epithelial, and mesenchymal components. A 27-year-old female presented with acute abdomen and with elevated serum lactate dehydrogenase (LDH) at 212 U/l (normal range: 47-140), and 2 of 5 LDH isoenzymes, namely LDH-4 at 13.6% (normal range: 6.8%-10.2%) and LDH-5 at 20% (normal range: 6.5%-9.7%). In this patient, stage I Wilms' tumor was managed by radical nephrectomy. The levels of LDH returned to its normal range. In conclusion, in cases of acute abdomen with a renal mass in young adults, the possibility of Wilms' tumor should be considered. Serum LDH and its isoenzymes, LDH-4 and LDH-5, could be used as tumor markers for either differential diagnosis or monitoring the response of treatment.

Human bladder carcinoma cells with an unusual pattern of in vitro growth: transition from nonproliferative spheroids to active monolayer growth upon interaction with tumor-derived fibroblasts.

A new transitional cell carcinoma cell line, BCCA-1, derived from a primary urinary bladder carcinoma, was characterized with respect to the growth patterns of in vitro culture, xenotransplantability in SCID mice and immunophenotypic profile. The most unusual finding was a strong tendency of forming many aggregates (multicell spheroids) in the first few days of flask cultures, followed by the attachment of spheroids to monolayer fibroblasts, which came along from stroma of the same tumor. Unlike those reported tumor spheroids whose peripheral layers contained proliferative cells, BCCA-1 spheroids rarely contained mitotic cells. The three-dimensional architecture of BCCA-1 spheroids drastically changed by the attachment of spheroids to fibroblasts, from which epithelial tumor cells spread; this was accompanied by pseudopodia formation and highly aggressive growth of tumor cells. As the fibroblasts degenerated due to overgrowth, tumor cells started to aggregate by retracting their pseudopods and forming many semi-attached spheroids, which eventually detached from the sheet of degenerated fibroblasts. BCCA-1 produced solid tumors as xenografts in SCID mice by subcutaneous injection with as low as 5 x 10(6) cells, suggesting malignant nature of these cells. Immunostaining revealed the expression of MHC-class I, S100 protein, cytokeratin CK7 and CK20, beta-HCG, CEA, epithelial membrane antigen, Le(y) and folate-binding protein by this tumor. While the biological significance of spheroid formation of this kind by BCCA-1 cells remains unclear, it may represent a protection mechanism, by which TCC cells could sustain their viability under unfavorable culture conditions, but proliferate when the conditions became improved, such as the presence of fibroblasts. Our results point to the importance of tumor-associated stromal fibroblasts in TCC tumor progression. Further mechanistic studies to elucidate the mechanism involved in the stromal cell contact mediated-activation of TCC cells in this model system are warranted.

Immunobiologic, cytogenetic and drug response features of a newly established cell line (SCRC-1) from renal small cell carcinoma.

PURPOSE: We describe the establishment and preliminary characterization of a cell line designated SCRC-1, which was derived from a primary renal small cell carcinoma. MATERIALS AND METHODS: Continuous cultures of a primary stage IVa renal small cell carcinoma and a xenograft in nude mice derived therefrom were characterized by immunohistology, electron microscopy, immunofluorescence/flow cytometry, cytogenetic analysis, and an in vitro drug resistance assay. RESULTS: SCRC-1 cells were reactive with antibodies to NSE, chromogranin-A, bombesin, Bcl-2, CD44s, CD44v6, CD44v7 to 8, vimentin and S100 protein (predominantly beta-subunit), and were unreactive with antibodies to EMA, CD54, EGFR(R1), URO-5, URO-7, URO-8 and URO-10. A similar immunoprofile was also found in both the primary tumor and the xenograft. Cytogenetic analysis revealed the following common clonal aberrations in all 50 metaphases analyzed: 45, XX, t (X;10;18) (p11;p11;q11), -der(18)t(X;10;18), indicating the clonal nature of this neoplasm. SCRC-1 cells showed low drug resistance to cyclophosphamide, doxorubicin, gemcitabine and fluorouracil, intermediate resistance to carmustine and mitomycin-C, and extreme resistance to cisplatin. CONCLUSION: We have documented the initial characterization of SCRC-1, which may be the first cell line reported to be derived from a primary small cell carcinoma of the kidney. This cell line can be used for further studies uncovering the biology and histogenesis of this rare cancer and delineating differences among small cell carcinomas of the kidney and other histological types.

Imbalances between tumor necrosis factor-alpha and its soluble receptor forms, and interleukin-1beta and interleukin-1 receptor antagonist in BAL fluid of cavitary pulmonary tuberculosis.

OBJECTIVES: We investigated the possibility that the large pulmonary cavity in tuberculosis (TB) lesions might result from imbalances between tumor necrosis factor-alpha (TNF-alpha) and soluble TNF-alpha receptor forms (sTNF-RI and sTNF-RII), and interleukin-beta (IL-1beta) and IL-1 receptor antagonist (IL-1RA) in sites of local inflammation. PATIENTS AND METHODS: BAL was performed in 32 patients with active pulmonary TB, and the recovered BAL fluid (BALF) was examined for concentrations of TNF-alpha and its soluble receptor forms, IL-1beta, and IL-1RA. Patients were classified into two groups: group 1, patients with a large cavity (> or = 4 cm) on chest radiographs (n = 15); and group 2, patients with a small cavity (< 4 cm; n = 3) or no cavity (n = 14) on chest radiographs. RESULTS: The concentrations of TNF-alpha, IL-1beta, and IL-1RA in BALF were significantly higher in group 1 patients than in group 2 patients before standardization. The difference was also statistically significant for TNF-alpha and IL-1beta after standardization with urea. Furthermore, group 1 patients had significantly higher ratios of TNF-alpha to sTNF-RI and sTNF-RII and IL-1beta to IL-1RA compared with group 2 patients. CONCLUSIONS: These findings suggest that the relative abundance of TNF-alpha and IL-1beta associated with imbalances of secretion of soluble TNF-alpha receptor forms and IL-1RA may have caused tissue necrosis leading to cavity formation in patients with active pulmonary TB.

The role of free to total prostate-specific antigen ratio for prostate cancer in screening patients with total serum levels between 4 and 20 ng/ml.

BACKGROUND: We retrospectively tried to determine if the free to total prostate-specific antigen (f/t PSA) ratio could improve the specificity of PSA in prostate cancer screening of patients with total serum levels between 4 and 20 ng/ml. METHODS: Two hundred ninety-five patients with serum PSA levels from 4 to 20 ng/ml had undergone sextant prostate needle biopsy. Each patient had no prior history of prostate cancer, acute urine retention, or prostatitis. Prebiopsy free PSA values were measured in 155 patients. Total PSA levels were determined with the AxSYM enzyme-linked immunosorbent assay. Free PSA levels were measured with the AxSYM microparticle enzyme immunoassay. RESULTS: Mean f/t PSA ratios were 0.114+/-0.004 in men of the cancer group and 0.161+/-0.008 in men of the benign group (p<0.002). Based on the analysis of sensitivity and specificity in relation to f/t PSA ratios, use of the 18% cutoff point could detect 89% of cancer cases, and at the same time could avoid 35% of unnecessary prostate biopsies. The areas under the receiver-of-characteristic curve for f/t PSA ratio and total PSA were 0.649 and 0.545, respectively. CONCLUSION: Serum f/t PSA ratios were significantly lower in patients with prostate cancer than in patients with benign disease. The determination of an appropriate f/t PSA ratio should be based on the generated data such as that demonstrated in this study in order to improve diagnostic accuracy and specificity for patients with equivocal PSA values and to avoid conducting unnecessary prostate biopsies.

Partial nephrectomy for incidental primary renal neuroendocrine carcinoma: case report.

Here we present an 83-year-old woman who was referred to our hospital and had had left flank pain and oligouria for 3 days. Plain abdominal film and ultrasonography revealed left ureteropelvic junction stone with obstructive uropathy. The serum level of creatinine fell to 3.1 mg/dl from 7.6 mg/dl after ureteral catheter drainage was given 5 days after admission. Then a left pyelolithotomy was performed and a tumor of 2 x 1 x 1 cm over the lower pole of the left kidney was found incidentally. Partial nephrectomy was performed in consideration of her age and poor renal function although the biopsy result showed it to be carcinoma. The final pathological report and immunohistochemical study results proved that it was neuroendocrine carcinoma. To our knowledge, this is the first case of primary renal neuroendocrine carcinoma to be treated using conservative surgery. The clinical course was acceptable, since she had been found to be free of disease during regular follow-up of 2.5 years with the creatinine level of about 2.5 mg/dl.

Increased absolute number but not proportion of gamma/delta T-lymphocytes in the bronchoalveolar lavage fluid of patients with active pulmonary tuberculosis.

SETTING: The proportions and absolute cell count of gamma/delta T-lymphocytes in the peripheral blood of patients with pulmonary tuberculosis (PTB) remains controversial. Since PTB is an infections airway disease, bronchoalveolar T-lymphocytes should be a better indicator of local immune T-cell reaction after TB infection than peripheral blood T-lymphocytes. OBJECTIVE: To quantitate the absolute cell count and proportions of gamma/delta T-lymphocytes in the bronchoalveolar lavage fluid (BALF) of patients with active PTB. DESIGN: Bronchoalveolar lavage (BAL) and analysis of lymphocytes in the BALF was performed in 25 patients with active PTB and 16 normal controls. All of the patients were negative for HIV infection and none was immunocompromised. BALF and blood were prepared for cell differential count and flow cytometry analysis using monoclonal antibodies CD3, CD4, CD8, CD25, HLA-DR and gamma/delta as well as alpha/beta T-lymphocyte receptors. RESULTS: The number of cells per volume of recovered BALF was significantly higher in the patients with active PTB than in normal controls. BALF from active PTB patients also showed increased percentage of lymphocytes and neutrophils. The absolute number of total lymphocytes, CD3+ lymphocytes and CD3+ gamma/delta T-lymphocytes were significantly higher in the BALF, but not in the blood, of patients with TB, however, the proportions of CD3+ gamma/delta T-lymphocytes in BALF of patients with TB was comparable to that of normal controls. gamma/delta T-lymphocytes in the BALF rarely expressed CD4, CD25, and HLA-DR in both groups. CONCLUSION: These results suggest that gamma/delta T-lymphocytes are not the major subpopulation of CD3+ lymphocytes in the BALF that react to mycobacterial infection in the patients with clinically established active TB.