We examined the role of circulating autoantibodies in the pathogenesis of pemphigus vulgaris by passively transferring IgG fractions from five patients with pemphigus vulgaris into neonatal Balb/c mice, in doses of 1.5 to 16 mg per gram of body weight per day. Cutaneous blisters and erosions with the histologic, ultrastructural, and immunofluorescence features of pemphigus occurred in 39 to 55 mice given intraperitoneal injections of IgG from patients with pemphigus and in none of 58 control mice given normal human IgG. IgG fractions with high titers of pemphigus antibodies were most effective in inducing disease, and this effect was dose dependent. Titers of circulating IgG in mouse serum closely correlated with the extent of disease induced (P less than 0.002). This study strongly supports the proposed role of pemphigus autoantibodies in the pathogenesis of pemphigus vulgaris in human beings and demonstrates that pemphigus can be passively transferred to laboratory animals.

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A critical research frontier in head and neck oncology involves defining the use of induction chemotherapy regimens to allow organ preservation and to avoid functionally debilitating surgical resections. Completed clinical trials in laryngeal cancer indicate that such an approach is feasible, but progress thus far has been limited by our inability to predict which patients are likely to respond to chemotherapy and preserve their larynx. Mutation of the p53 tumor-suppressor gene is the most common genetic alteration identified thus far in human cancers, and it may be important in regulation of cell proliferation and chemosensitivity. To determine whether p53 overexpression predicts chemotherapy response, organ preservation, and survival in patients with advanced laryngeal cancer, we analyzed immunohistologic expression of p53 in tissue sections from 178 patients with advanced laryngeal cancer who were entered in the Department of Veterans Affairs Laryngeal Cancer Cooperative Study, a multiinstitutional clinical trial comparing induction chemotherapy (cis-platinum and 5-fluorouracil) plus radiation therapy (94 patients) to surgery plus postoperative radiation therapy (84 patients). Larynx preservation was significantly higher in the group of patients whose tumors overexpressed p53 (74% vs. 52.5%; p = 0.03). The presence of p53 overexpression did not predict survival in either the surgery or the chemotherapy groups (p = 0.82 and p = 0.53).

The histologic features of a malignant clear cell acrospiroma were those of infiltrative local growth, frequent mitoses and angiolymphatic invasion. The histochemical and ultrastructural findings were similar to those reported for benign clear cell acrospriomas. Amputation of the leg and regional node dissection were required for clinical control. Evaluation of this case and review of the literature suggests that the malignant clear cell acrospiroma often behaves in an aggressive manner and frequently metastasizes. As a consequence, therapeutic strategies should be appropriately planned.Cancer 41:641-647, 1978. UBCLASSIFICATIONS OF SWEAT GLAND CARCI-S nomas with specific clinicopathologic characteristics are now emerging from the various heterogeneous collected series and individual case reports published during the last two decades. Primary mucinous carcinomas, 'b6 apocrine carcinoma, adenoid cystic carcinoma,' and malignant acrospiroma' are four such distinctive neoplasms. If therapy is to be properly framed, the natural histories of these rare tumors must be understood.This report includes histochemical and ultrastructural description of a malignant clear cell acrospiroma (malignant clear cell hidradenoma); a detailed histologic investigation of the mode of spread with a search for in transit metastases; and an evaluation of the need for amputation of an extremity and regional lymph node dissection, both as therapeutic strategies and as staging procedures. CASE REPORTA 62-year-old Caucasian woman was admitted to the University of Michigan Medical Center with an erosive mass in the skin of the right plantar surface. For more than 25 years, she had been treated for a recurrent clavus in this area. Various past therapies included a series of local x-ray treatments 20 years before, numerous topical applications of keratolytic acids and more recently, invasive electrocautery. About one year before this admission, there was recurrence of local discomfort and the appearance of a mass. An excisional biospy established a diagnosis of Examination of the right foot showed an irregular 4 X 4 cm, somewhat nodular mass fixed within the superficial plantar tissues. There were two oval superficial epidermal erosions, 1 .O cm and 0.5 cm in diameter. A separate satellite dermal nodule 0.5 crn in diameter was present near the medial margin of the sole. Negative studies for evidence of metastatic disease included bone, liver and spleen scans as well as percutaneous lymphangiography of the right lower extremity. Biochemical and hematologic determinations were unremarkable.The right les was amputated below the knee and a superficial groin lymph node dissection performed. The presence of microscopic tumor in the superficial groin nodes was used as an indication for coeliotomy and iliac (deep node) node dissection. No gross tumor within the abdominal cavity and no metastatic involvement of iliac or para aortic lymph nodes were found. Recovery was without incident and the patient continued physical therapy and rehabilitation. The pat...