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Systemic immunostimulation followed an experimental treatment trial of scatter argon laser photocoagulation directed to the retina of one eye of 10 patients with heredo-degenerative retinitis pigmentosa (RP). Significantly increased RP lymphocyte CD25, CD26, and CD4/CD26 activation epitope expressions over prelaser values and controls were found with a normalization of soluble interleukin-2 receptor secretion after laser treatment. Serum interferon-gamma was low both pre- and postlaser. Interestingly, when a panel of viral antibodies was tested, only those to rubella virus were elevated in the early postlaser period. The character of RP immunostimulation after laser-induced inflammation could be consistent with an antigenic stimulus from laser-released retinal proteins which might be of autoimmune or latent infectious origin. Enhanced immune responses may be a common but unrecognized sequellae of retinal laser.

A postmenopausal patient presented with a pelvic mass and ascites. The CA-125 level was 329 U/ml, and transvaginal color Doppler sonography of the tumor vasculature suggested malignancy. At laparotomy, a luteinized thecoma and cytologically benign ascites were found. On rare occasions ovarian thecoma may be associated with ascites without hydrothorax. Preoperative evaluation of the patient with ascites and a pelvic mass may suggest malignancy, but histologic confirmation is necessary to exclude this rare association.

Considerable debate centers on the optimal treatment for vulvar melanoma, as well as those clinicopathological factors influencing prognosis. We reviewed 80 patients with vulvar melanoma seen between 1949 and 1990. Primary tumors were assessed according to Chung (47 patients) and Breslow (65 patients) microstaging systems. Fifty-nine patients (76%) underwent radical vulvectomy, ten patients (13%) had a partial vulvectomy, and nine patients (12%) had a wide local excision. Fifty-six also underwent inguinal node dissection. Median follow-up was 193 months. Median survival was 63 months. Ten-year survival by Chung level was as follows: I 100%; II, 81%; III, 87%; IV, 11%; V, 33%. Ten-year survival by tumor thickness was as follows: 0.75 mm, 48%; 0.75-1.5 mm, 68%; 1.51-3.0 mm, 44%; greater than 3.0 mm, 22%. Increased depth of invasion was associated with increased incidence of inguinal node metastasis. Cox regression analysis demonstrated prognostic significance for tumor thickness (P less than 0.001), inguinal node metastasis (P less than 0.001), and older age at diagnosis (P less than 0.001). Radical vulvectomy did not seem to improve survival over less radical procedures. Based on this experience, we recommend radical local excision for patients with malignant melanoma of the vulva. Patients who have more than a superficially invasive melanoma should also have inguinal lymph node dissection.

Altered immunoregulation, suggested previously in the heredo-familial retinal degeneration, retinitis pigmentosa (RP), led us to examine cell-mediated immune responses in 58 RP patients who expressed either recessive or dominant inheritance. Increased absolute numbers of activated T-cells, quantitated by flow cytometry using the Ta1 epitope, were found in the peripheral blood of 60% of these RP patients. The unusual finding was equally distributed between dominant (16 of 25) and recessive (19 of 33) types of RP, suggesting an immune process present in both patterns of heredity. Additional altered lymphocyte immunoregulation was suggested in all RP by lymphocyte responses to stimulants modified by indomethacin or histamine in vitro. Although no clear association could be found between Tal expression and demographic factors including age, sex, years with RP symptoms, or percentage of life with RP disease, the significantly altered immunoregulatory responses in RP may be related to the pathogenesis of RP.