PURPOSE: With the recent increase in the incidence of orbital malignant lymphoma, it is important to make the appropriate decision on effective treatment. The purpose of the current study was to develop a protocol to treat orbital malignant lymphoma based on evidence from histopathological examination. METHODS: In the present study we analyzed the records of 18 cases of orbital lymphoma treated in the Yamagata University Hospital over the past 14 years, including 6 cases of isolated orbital disease and 12 cases of systemic disease. The tentative strategy for selecting the treatment was as follows: the cases at clinical stage I (Ann Arbor criteria) were treated with curative intent, and the cases at stages II-IV were treated with palliative intent. This strategy was evaluated from the viewpoints of efficacy and side effects. RESULTS: Histopathologically, all 6 cases of isolated orbital disease were classified as low-grade malignancy, 3 of the systemic disease cases were classified as low-grade, and 9 were classified as intermediate-grade malignancy. The isolated orbital disease cases at stage I were treated by radiation or chemotherapy. The systemic disease cases at stages II-IV were treated by chemotherapy and/or radiation. The lymphoma disappeared completely in all 6 isolated orbital disease cases. Although the survival rate was 42% in systemic disease cases after a mean period of 15-month observation, the ocular complications decreased with an improved quality of life. CONCLUSIONS: It is important to determine the histological features and clinical stages in order to choose the appropriate treatment methods. All the isolated orbital disease cases were treated effectively by radiation or chemotherapy. Our strategy for the treatment of the systemic disease cases contributed to the decrease in ocular complications and the improvement in the quality of life for the patients.

Academic Medical Centers↗

PubMedDate not supplied

Immune inhibitory effects of renal cell carcinoma extract on lectin and alloantigen-induced peripheral blood and tumor infiltrating lymphocyte blastogenesis.

The presence of tumor infiltrating lymphocytes (TIL) has been attributed to the host cell mediated immune response against the evolving malignancy. However, due to specific evasive and escape mechanisms, the immune competent cells are rendered ineffective. One such mechanism may be the production of immune suppressor substance(s), inhibiting lymphocyte proliferation, and subsequently, their transformation into effector cells. To evaluate a possible impact of RCC extract on lectin and alloantigen-induced proliferation of TIL and peripheral blood lymphocytes (PBL) from renal cell carcinoma (RCC) patients and from healthy control human subjects. Tumor extract and TIL were derived from 13 patients with RCC undergoing radical nephrectomy. Tumor infiltrating lymphocytes and PBL from these patients were activated with Concanavalin A (Con-A), Phytohemoglutinine (PHA) or Pokeweed (PW) and the rate of blastogenesis was measured by (3)H Thymidine incorporation. The same procedure was used in assay with PBL from control healthy blood donors. There was a significant reduction (88.6%) in the proliferative response to ConA of TIL compared to PBL from the same patients (P = 0.007). A similar decrease was seen following stimulation by PHA (85.8%, P = 0.01) and PW mitogen (78.5%, P = 0.001). A 79.5% decrease in response level of TIL to alloantigens compared to PBL from RCC patients (P = 0.021), was observed. Lectin induced proliferative response of RCC patients was significantly lower in the presence of RCC extract (82.9%) compared to normal kidney extract (P = 0.008). Alloantigenic stimulation of healthy individual PBL was also decreased significantly in the presence of RCC extract (92.9%, P = 0.0001) compared to normal kidney extract. Similarly, lectin induced stimulation of healthy control PBL in the presence of RCC extract was significantly lower (83.2%, P = 0.003). Our data suggest that RCC extract contains an immune suppressive substance(s), capable of inhibiting lymphocyte proliferative response of tumor infiltrating lymphocytes as well as of PBL from patients and healthy individuals alike. This may be one of the mechanisms by which the tumor evades the transformation of lymphocytes into effector killer cells, and thus affects the biological inter-relationship between tumor and host. Identification of this substance and its gene may provide an effective anti-tumoral treatment modality.

Adenocarcinoma, Clear Cell↗