Malignant neoplasms of the external ear are difficult diseases of the cervical-facial area to study clinically and therapeutically. The most frequent malignant histological patterns are spinocellular and basocellular carcinomas. Melanomas, basosquamous or "metatypical" carcinomas are less frequent. The latter have a transition histological pattern halfway between a basocellular and spinocellular carcinoma. In our experience, some external ear neoplasms, diagnosed as basocellular, were clinically more invasive (aggressive). Therefore we studied the immunohistochemistry of operative specimens with monoclonal antibodies (MoAb) with the purpose of revaluating the diagnosis after follow-up, and of detecting unrecognized basosquamous carcinomas. We studied 4 patients (2 male and 2 female) aged between 58 and 78, examined in the period 1990-92 an a diagnosed as having an external ear basocellular carcinoma. The immunohistochemical study was carried out using anti-CEA (carcinoembryonal antigen) monoclonal antibodies, high molecular weight acid anticytokeratins (anti-AE3) and low molecular weight basic anticytokeratins (anti-AE1). Appendage origin of the neoplasms was excluded after carrying out MoAb anti-CEA tests, negative in all patients. Epithelial origin of the neoplasms were confirmed after carrying out MoAb anti-AE3 tests, positive in all patients. After carrying out MoAb anti-AE1 tests, positive in 3 patients out of 4, we reviewed the classification of 2 basocellular carcinomas out of 4. These tumors evidenced an atypical dyskeratosis and a positivity for intracellular keratinization. These aspects were not evidenced in the previous histological examinations using routine stains and could be an index of unfavourable clinical evolution of these two cases from a basocellular carcinoma toward a more aggressive basosquamous carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

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[Simultaneous laryngeal carcinomas: a case report and review of literature].

The high incidence of second primary malignant neoplasms in patients under treatment for head and neck tumors has been well documented in literature. In these cases the second primary reappears still in the upper aero-digestive tract or in distant organs (lung, esophagus, stomach, skin,....). The Authors report a case of a male, 64 year old patient, a moderate drinker and smoker, with two distinct simultaneous laryngeal malignant neoplasms. One tumor, which arose on the laryngeal face of the epiglottis, was a verrucous carcinoma (Ackerman's tumor); the other neoplasm, on the right vocal cord, was a well differentiated squamous cell carcinoma. Microlaryngeal examinations and TC-scans revealed a normal, uninvolved right false vocal cord and the Morgagni's ventricle. After surgical therapy, serial laryngeal samples were removed and underwent immunohistochemical studies. Microscopic examination revealed that the anterior commissure, the pre-epiglottic and paraglottic spaces were intact, furthermore, monoclonal antibody studies proved that the two simultaneous laryngeal cancers were independent. In the discussion the Authors report some clinical considerations, a review of literature concerning multiple simultaneous laryngeal tumours and emphasize the concept of "field cancerization", first described with regard to the oral cavity by Slaughter.

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Telomerase activity in human hematopoietic progenitor cells.

BACKGROUND AND OBJECTIVE: Telomerase is the enzyme that stabilizes and elongates the telomeric ends of chromosomes. It is expressed in germline and malignant cells and absent in most human somatic cells. The selective expression of telomerase has thus been proposed to be a basis for the immortality of germline and malignant cells. Recently, telomerase activity has been observed in human bone marrow (BM) and peripheral blood (PB) samples. The objective of our study was to further characterize the telomerase-expressing population in BM and PB. METHODS: CD34+ cells were isolated from BM and PB, cultured in vitro, and telomerase activity was assessed by the PCR-based TRAP assay. RESULTS: Telomerase activity in human BM and PB could be almost exclusively assigned to the hematopoietic progenitor cell fraction expressing the CD34 antigen. We observed telomerase activity in CD34+ cells from BM and cytokine-mobilized PB. CD34+ cells lacking co-expression of CD33 demonstrated higher levels of telomerase than myeloid committed CD34+/CD33+ cells. In vitro culture of CD34+ cells in the presence of a cocktail of growth factors inducing differentiation resulted in a decrease of telomerase activity. Telomerase activity increased in peripheral blood during cytokine-induced mobilization of hematopoietic progenitor cells. INTERPRETATION AND CONCLUSIONS: Our data demonstrate that at least a portion of the hematopoietic stem/progenitor cell fraction expresses telomerase and downregulates its expression through differentiation.

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[Splenic lymphoma with villous lymphocytes. A clinical case].

Splenic lymphoma with circulating villous lymphocytes is a rare B-lymphoproliferative disorder of the elderly which has been only recently defined. Clinical features are spleen enlargement of various degree without lymphadenopathy and an indolent course, with a long survival, in most cases. Absolute lymphocytosis is present; atypical circulating lymphocytes show a medium or large size, a small prominent nucleolus and a few short and thin cytoplasmic protrusions and projections (villi), which are distributed at one or both poles of cell surface. Reaction for tartrate-resistant acid phosphatase is almost always negative. Immunological markers are as follows: CD 19+, CD 20+, CD 22+, CD 11c+/-, CD 5-, CD 23-, CD 25-, HLA DR+, SmIg+. Differential diagnosis with other chronic lymphoproliferative disorders, particularly chronic lymphocytic leukemia, hairy cell leukemia, prolymphocytic leukemia, follicular and mantle-cell lymphoma in leukemic phase, is based on clinical and immunocytomorphologic criteria. Bone marrow biopsy shows involvement of different degree and pattern; splenic involvement mostly occurs in the white pulp; hepatic nodules in portal areas may be present. Cytogenetic alterations are often present but not specific, such as increased serum LDH and monoclonal gammopathy. No therapy should be made in asymptomatic patients. In case of systemic symptoms, symptomatic splenomegaly or cytopenias, treatment may consist on splenectomy, splenic irradiation or alkylating agents. A case of splenic lymphoma with circulating villous lymphocytes is reported; differential diagnosis, particularly with other B lymphoproliferative disorders, is discussed.

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[Exclusive radical radiotherapy of laryngeal tumors: 10-year experience].

Exclusive irradiation is used to treat primary neoplasms localized to the larynx because it is known to be able to cure, or at least control, the disease in a high percentage of cases without affecting speech. We report our ten-year experience in the Radiotherapy Department of Chieti Hospital. From 1985 to 1994, exclusive radiotherapy was used to treat 87 patients bearing histologically proved epidermoid carcinomas of the larynx. The patients average age was 67 years. The primary site was the glottis in 64 cases and the supraglottic and subglottic areas in 21 and 2 cases, respectively. The lymph nodes were clinically positive in 8 patients (9%) and negative in 79 (91%). The minimum follow-up was 20 months. All the patients were treated with cobalt 60 beams; the daily dose was 2 Gy, fractionation was 5 days a week. Average tumor dose was 64 Gy (range: 55-70 Gy). Disease-free survival actuarial curves show 72% five-year survival for glottic cancer (75% for N0, 80% for T1 and 61% for T2-T3-T4 cases) and 21% for supraglottic cancer (25% for N0 cases). To conclude, irradiation is confirmed to be a useful tool to treat early laryngeal cancer, while new combinations of surgery, chemotherapy and irradiation are needed to treat locally advanced cancer.

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