A case of anaplastic thyroid carcinoma surviving disease free for over 2 years.

A 52-year female presented with an enlarged thyroid mass and lump sensation in the throat. The cytologic examination showed class five and she was admitted to the hospital to undergo operation. Total thyroidectomy was done and the tumoral invasion of the trachea was removed. We performed tracheoplasty using a sternocleidomastoid muscle-clavicle myoosseous flap in a single stage operation. Histologic diagnosis revealed anaplastic thyroid carcinoma After upper mediastinal dissection had been performed, systemic chemotherapy using pirarubicin, cisplatin and etoposide was administered. In addition, she was treated with radiochemotherapy using pirarubicin, cisplatin and a total of 58 Gy was administered. No recurrence of the tumor has been noted since the above operation 2 years ago. Immunohistochemical studies of primary and metastatic tissues in this case revealed a positive expression of p53 protein in both.

[A study of cytokine in palatine tonsil--flow cytometric analysis of cytokine production in tonsillar mononuclear cells].

Using two-color flow cytometry, we measured intracellular expression of interleukin-1 alpha (IL-1 alpha), IL-2, IL-4, IL-6, IL-8, interferon gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) in tonsillar mononuclear cells freshly isolated and stimulated by phorbol myristate acetate (PMA) and ionomycin. In freshly isolated tonsillar mononuclear cells, IL-1 alpha was produced in 0.39% of CD3 cells, 0.48% of CD4 cells, 0.66% of CD19 and 11.2% of CD14 cells; TNF-alpha was found in 5.4% of CD14 cells. After 8-hour culture without any mitogens, IL-4, IL-8, TNF-alpha and IL-1 alpha were detected in 2.1%, 0.8%, 0.55%, and 0.42% of tonsillar mononuclear cells, respectively. Flow cytometric detection of intracellular cytokines in tonsillar mononuclear cells stimulated with PMA and ionomycin revealed that CD3 cells produced IL-1 alpha, IL-2, IL-4, IL-8, IFN-gamma and TNF-alpha, and CD19 cells produced IL-1 alpha, IL-6, IL-8 and TFN-alpha. In CD3 cells, the number of cells producing IL-2 and TNF-alpha were significantly higher than those expressing other cytokines; and the number of cells producing IFN-gamma and IL-8 were significantly higher than those expressing IL-4 and IL-1 alpha. In CD19 cells, the number of cells producing IL-6 and TNF-alpha were significantly higher than those of IL-8 and IL-1 alpha; and the number of cells producing IL-8 was significantly higher than that of IL-1 alpha. There was no difference in the number of CD3 and CD19 cells producing any cytokine between the adult recurrent tonsillitis group and adult obstructive sleep apnea syndrome group. However, the number of CD3 cells producing IL-2 or TNF-alpha and CD19 cells producing IL-1 alpha, IL-6 or TNF-alpha were significantly lower in children than that of adults (p < 0.05). These findings indicate that the cytokine production in tonsillar mononuclear cells is heterogenous according to the subset and activation and that flow cytometric analysis of intracellular cytokines is a useful means to investigate the pathophysiological role of cytokines in the tonsils.

[A study of cytokine in palatine tonsil--cytokine mRNA expression determined by RT-PCR].

To clarify the cytokine profile of tonsils, cytokine mRNA was determined by reverse transcription-polymerase chain reaction (RT-PCR). The mRNA of interleukin-1 beta (IL 1 beta), IL-2, IL-4, IL-6, IL-8, interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) were expressed on the whole tonsillar tissue of all 5 subjects with recurrent tonsillitis, obstructive sleep apnea syndrome caused by tonsillar hypertrophy or tonsillar focal infection. These cytokine mRNAs were detected in tonsillar mononuclear cells freshly isolated from all or 14 of 15 subjects. The CD4, CD8 and CD19-positive cells were purified using immunomagnetic beads. The CD4-positive cells expressed mRNA of IL-1 beta, IL-2, IL-4, IL-8, IFN-gamma and TNF-alpha. The CD8-positive cells expressed mRNA of IFN-gamma and TNF-alpha. The CD19-positive cells expressed mRNA of IL-1 beta, IL-6, IL-8 and TNF-alpha. Quantitative measurement of PCR products in tonsillar mononuclear cells revealed that the IL-8 mRNA was expressed at a higher level than any other cytokine. A comparison among tonsillar diseases mentioned above revealed that the IL-1 beta and TNF-alpha mRNA were expressed at significantly higher levels in tonsillar mononuclear cells from patients with recurrent tonsillitis than in patients with obstructive sleep apnea syndrome caused by tonsillar hypertrophy. These data indicate that tonsils are active immunologic organs containing a wide variety of cytokines.

Sternocleidomastoid muscle-clavicle myoosseous flap for single-stage reconstruction of postoperative tracheal defects in patients with invasive thyroid tumor. Three case reports.

In this report, we present 3 cases with thyroid carcinoma with tracheal invasion. In all cases, the tracheal defects were simultaneously reconstructed using a sternocleidomastoid muscle-clavicle myoosseous flap. We were able to close the tracheostomas without trouble, and no stenotic lesions or late complications were noted. This myoosseous composite flap has proved itself to be a reliable material for laryngotracheal reconstruction in some cases with thyroid carcinoma.

Nasal T-cell lymphoma causally associated with Epstein-Barr virus: clinicopathologic, phenotypic, and genotypic studies.

BACKGROUND: The authors have previously demonstrated nasal T-cell lymphoma (NTL) associated with Epstein-Barr virus (EBV). The detailed clinical, phenotypic, and genotypic features and the role of EBV in lymphomagenesis remain to be clarified. METHODS: The study group consisted of 18 patients with NTL. The phenotype was determined by immunoperoxidase staining with various monoclonal antibodies. Genotypic study was done using Southern blot hybridization. The presence of EBV-encoded small nuclear early region (EBER) RNA and EBV DNA were determined by in situ hybridization. The expression of EBV-encoded nuclear antigen (EBNA) and latent membrane protein (LMP1) were identified by immunohistologic methods. Clonotypic analysis of EBV genomes was performed by Southern blot hybridization with EBV termini fragment probe. RESULTS: The clinical features of NTL were characterized as prolonged fever (16 patients), widespread dissemination into distant sites (13 patients), and poor prognosis with a median survival of only 6 months. EBER transcripts were identified in 16 of 18 patients. Monoclonal EBV genomes EBNA1 and LMP1 were also detected in all EBER-positive cases tested. All 18 patients expressed pan-T antigens such as MT1, CD45RO, and/or CD2. The rearrangements of T-cell receptor (TCR)-beta, -gamma, and/or -delta genes were shown in all 11 patients tested. The natural killer (NK) cell phenotype CD56 was expressed in all EBV-positive cases tested, and was not detected in EBV-negative cases. Seven EBV-positive cases expressed a TCR-delta chain with rearranged TCR-gamma or -delta genes whereas both EBV-negative cases corresponded to alpha beta T-cell lymphoma, which expressed a TCR-beta chain with a rearranged TCR-beta gene. CONCLUSIONS: These data suggest that EBV-positive NTL may be derived from the lineage of NK-like T-cells or gamma delta T-cells, and that EBV may play a role in lymphomagenesis. Therefore, we propose that NTL which has peculiar clinical and histologic features could be classified as a new lymphoma entity.

Cytokine expression and production by tonsillar lymphocytes.

Expression of various cytokines in the tonsillar compartments, and in vitro cytokine production and cytokine mRNA expression by tonsillar lymphocytes (TL), were investigated. In immunohistological analysis, a wide variety of cytokines such as interleukin (IL)-1 beta, IL-2, IL-4, IL-5, IL-10 was expressed intensively in the lymphoepithelial symbiosis (LES). A certain number of cells producing IL-6, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha was distributed not only in the LES but also in the extrafollicular area. A significant amount of IL-6, IFN-gamma, and TNF-alpha was detected by enzyme-linked immunosorbent assay in the culture supernatants of TL cultured with streptococcal antigen, even without any mitogens. Furthermore, mRNA of IL-6, IFN-gamma, and TNF-alpha was determined by reverse transcription polymerase chain reaction on the TL freshly isolated and with streptococcal stimulated antigen, whereas, production of IL-1 alpha, IL-4, and IL-5, and expression of their mRNA were not found on TL with or without streptococcal stimulation. These data indicate that tonsils are highly active immunological organs containing a wide variety of cytokine-producing cells, and suggest that IFN-gamma, TNF-alpha, and IL-6 may play an important role on the immune response to bacteria in the tonsil.