[Manifestations of primary vasculitis in the ENT region]. / Erscheinungsbild primärer Vaskulitiden im HNO-Bereich.

The primary ANCA associated vasculitides, Wegener's granulomatosis (WG), Churg Strauss syndrome (CSS) and microscopic polyangiitis (MPA), frequently affect the ENT region. For several reasons WG is of special significance for the otorhinolaryngologist. First, disease activity limited to the upper respiratory tract (localized WG) often proceeds the systemic vasculitis (generalized WG). The early diagnosis therefore has decisive consequences for stage adapted therapy. Second, in most cases (nearly 80%) WG is diagnosed histologically on biopsy specimens from the ENT region. During the initial phase of WG this is of diagnostic relevance, because at this stage the serologic parameters (acute-phase proteins) usually have a normal value and PR3-ANCA is (still) negative in 2/3 of the patients. Third, in many cases recurrences reveal increased activity in the ENT region, or start in this area. Clinically in most cases chronic rhinosinusitis with crusting and epistaxis is seen, sometimes with septal perforation and/or saddle nose. Apart from this there are often unclear middle ear symptoms with recurrent effusions and the inner ear is sometimes also affected. Laryngeal manifestations are typically located in the subglottic area and lead to subglottic stenosis. In the differential diagnosis, diseases in which epitheloid cell granulomas occur, such as sarcoidosis and TBC, need to be considered, but also foreign body granulomas and fungus diseases. Finally malignant tumours, especially malignant lymphomas, have to be ruled out.

Mucosa-associated lymphoid tissue in human efferent tear ducts.

The recent description of primary marginal zone lymphomas in human efferent tear ducts with typical features of lymphomas arising in mucosa-associated lymphoid tissue (MALT) infers the presence of MALT in the human efferent tear ducts. To date, studies have not established clearly whether organised MALT occurs in normal human efferent tear ducts. To elucidate this problem, efferent lacrimal pathways from unselected body donors with unknown prior history of efferent tear duct, ocular, or nasal disease were examined for the presence of organised MALT. Organised lymphoid tissue was found with the cytomorphological and immunophenotypic features of MALT in 41% of the cases examined. These findings suggest that MALT is a feature that, although it need not be present in normal efferent tear ducts, is acquired during life in a proportion of apparently asymptomatic individuals.

High rate of p53 overexpression in head and neck carcinomas detected with a refined ELISA.

p53 mutations are amongst the most prevalent alterations in human cancer. Overexpression of p53 is usually caused by mutation and is observed in a high percentage of squamous cell carcinomas of the head and neck (SCCHN). Fifty two fresh samples of SCCHN were examined for p53 overexpression and 23 tumor-free tonsils served as controls. Using the monoclonal antibody Pab 1801 a refined ELISA technique was employed. In contrast to established ELISA procedures tumor tissue was pulverized at -80 degrees C prior to the actual ELISA (ELISA I). Comparative p53 detection was carried out by immunohistochemistry (IHC) and a commercially available ELISA kit (ELISA II). The modified ELISA I revealed p53 overexpression in 48 tumor samples (92%). p53 detection was obtained in 26 cases (50%) with ELISA II and with IHC 39 stained positive for p53 (75%). All of the controls were negative for p53 with ELISA and IHC. The p53 staining in IHC showed a significant correlation with the grading of the tumor. The ELISA results of the p53 overexpression did not show any correlation with tumor size or stage and rate of metastasis or other clinical parameters. This ELISA represents a more sensitive detection method of p53 than any other technique so far. It improves on former ELISA and IHC results on p53 overexpression in squamous cell carcinoma of the head and neck and underlines the involvement and the importance of the p53 tumor suppressor protein in carcinogenesis of head and neck cancer.

[Monoclonal antibodies against squamous epithelial carcinomas of the upper aerodigestive tract]. / Monoklonale Antikörper gegen Plattenepithelkarzinome der oberen Luft- und Speisewege.

BACKGROUND: Squamous cell carcinoma is the most common cancer of the head and neck. The application of monoclonal hybridoma technology to the identification and characterization of molecules preferentially expressed in carcinoma cells may provide potentially important diagnostic and therapeutic tools. METHODS: After immunization of mice with viable squamous cell carcinoma cells derived from human tumors of the upper aerodigestive tract hybridomas were selectively grown for production of monoclonal antibodies. Monoclonal antibodies produced by 690 hybridoma clones were tested on immunoreactions with frozen sections of human squamous cell carcinoma and reactive tonsils. RESULTS: Immunohistochemical trials showed that monoclonal antibodies produced by hybridoma clone K-640 are strongly accumulated at the plasma membrane whereas no immunoreaction in squamous epithelium of the tonsil could be detected. By means of ELISA it could be shown that these antibodies belong to the class of IgM. Immunoblotting revealed that the antibodies recognize antigenes with approximate molecular weights of 52 and 54 kD. CONCLUSIONS: The experiments suggest that the hybridoma clone K-640 produces antibodies which bind to the plasmamembrane of the tumor cells. Further recloning steps of this hybridoma clone could possibly enhance the specificity of these antibodies for squamous cell carcinoma.