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Wepresent a patient with primary retroperitoneal synovial sarcoma which showed a monophasic fibrous pattern, the fourth such case to be described, and a review of the literature. Synovial sarcoma cells in the present case were stained positive for cytokeratin and epithelial membrane antigen (EMA),of which histology was differentiated from other spindle cell sarcoma with similar light microscopic features. Retroperitoneal synovial sarcoma is usually treated surgically, however only one of 16 cases identified in the literature survived five years after resection. Due to the high fatality rate, physicians should be alerted to the possibility of this disorder in the differential diagnosis of an abdominal mass. (Internal Medicine 33: 692-696, 1994)

Appendiceal cancer associated with pseudomyxoma peritonei is a low grade malignancy and its extraperitoneal metastasis is extremely rare. We report a case of gastric metastasis of this tumor in a 76-year-old man. Two metastatic gastric tumors, which appeared after a 1-year interval, were successfully resected endoscopically. The patient was well for more than 3 years after the onset of the disease. To our knowledge, gastric metastasis from appendiceal cancer with pseudomyxoma peritonei has not been previously reported.

The immunomodulatory activity of cefodizime (CDZM), an aminothiazo-lylcephalosporin, was compared to that of HBW 538, a derivative of the CDZM side chain at position 3 (the mercaptothiazolyl group) in respect to the production of reactive oxygen species (ROS) by human whole blood and polymorphonuclear leukocytes (PMN) in vitro. Ten-fold diluted whole blood and PMN from healthy individuals were incubated with CDZM or HBW 538 alone at the concentrations of 1,10, or 100 μg/ml, or CDZM or HBW 538 at 100 μg/ml in combination with tumor necrosis factor-α (TNF-α) at 100 U/ml or lipopolysaccharide (LPS) at 1 μg/ml. The production of ROS was measured by a chemiluminescence (CL) assay in which luminol was added to a mixture and after which the PMN or whole blood were stimulated with nonopsonized zymosan or phorbol myristate acetate. The following results were obtained: (1) The CL responses of whole blood and PMN were slightly but not significantly enhanced by CDZM at 100 μg/ml, whereas both CL responses were significantly enhanced by exposure to HBW 538 at 10 and 100 μg/ml. (2) The enhanced PMN CL response which followed priming with TNF-α or LPS was not augmented by CDZM but was significantly augmented by HBW 538. These results indicate that the ability of the HBW 538 molecule to enhance the production of ROS by stimulated PMN and to act agonistically with TNF-α or LPS is abrogated when HBW 538 is part of the CDZM molecule. These findings have important clinical implications as they indicate that treatment with CDZM in patients with severe gram-negative septicemia would not increase tissue injury by enhancing the already excessive release of ROS by stimulated and LPS- or TNF-α-primed PMN.

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