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Lymphomatoid granulomatosis is rare EBV mediated lymphoproliferative disorder occurring within the 4th to 6th decade, with most risk factors relating to an immunocompromised state. Histological analysis shows an angiocentric and angiodestructive infiltrate with varying degrees of necrosis and atypical EBV positive cells. The lungs are the primary site of involvement in over 90% of cases but central nervous system involvement can occur alongside or in isolation. Neurological presentation is varied and MRI commonly displays focal white matter parenchymal lesions. A brain biopsy may be required to exclude competing diagnoses or in the absence of identifiable disease elsewhere. Treatment depends on stage of disease and can range from observation, withdrawal of immunosuppressive regimes or aggressive chemo/immunotherapy
Serum levels of immunosuppressive acidic protein (IAP) and other immunological parameters were examined in 95 head and neck cancer patients and 27 control patients. The mean values of IAP in patients in the advanced stage were significantly higher than in early stage patients. Statistically significant increases in the mean concentration of IAP were also observed in patients with a recurrence, as compared to findings in those in the advanced stages. The mean values of blastogenesis response to PHA and NK cell activity in the cancer patients were lower than in disease free individuals, but with no statistical differences. In the endstage patients, the lAP concentration was considerably elevated and the blastogenesis response showed a statistically significant decrease. Thus, the monitoring of serum lAP, in combination with other immunological parameters, aids in planning and assessing clinical staging in head and neck cancer patients.
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