Mucin histochemistry in colonic polyps and cancer

Mucins are the predominant glycoproteins found in gastrointestinal epithelia, and their structures differ according to the location in the GI tract and the state of cellular differentiation. Different forms of mucin are secreted in colonic polyps and cancers compared to those found in the normal colon. This paper reviews the methods available to probe mucin structure and the state of knowledge regarding the structures of neoplasia-associated mucins. Many of the assumptions made in the interpretation of classical histochemical stains on tissue sections have recently been questioned, and new insight into mucin structure has been gained from the development of newer methodologies such as lectin histochemistry and immunocytochemistry that use well-defined monoclonal antibodies.

Cancer-associated colonic mucin in cultured human tumor cells and athymic (nude) mouse xenografts

Mucins derived from colonic cancers differ immunologically and chemically from those in normal colonic epithelium. It has been demonstrated that the lectin from the peanut will bind to mucins present in colonic cancers and other neoplastic lesions but not to those from the normal colon. It was hypothesized, therefore, that in transformed colonic epithelium the glycosylation of mucins occurs differently than in normal epithelium. To rule out the possibility that the differences in oligosaccharide structure were due to postsecretory degradation, studies were designed to evaluate cancer-associated colonic mucins produced under more controlled conditions. We studied nine different cancer cell lines first in monolayer culture and then as xenografts in athymic or nude mice. Eight of the nine cell lines in monolayer culture synthesized glycoconjugates that were labeled by fluorescein-conjugated lectins. After injection into nude mice, eight of the nine cell lines produced tumors typical of human colonic cancer, and six of nine secreted mucin. The mucins produced by the xenografts were labeled at fluorescence microscopy by peanut lectin and other lectins, characteristic of what had been seen in other primary human colonic cancers. One cell line, LS174T, produced large amounts of mucin in the xenograft model. Mucin was purified from these tumors and characterized biochemically. It was demonstrated that mucin purified from the xenografts bound peanut lectin. Therefore, we have concluded that cancer-associated mucins are present in cultured colorectal tumor cells. The cancer-associated mucins are also found in nude mouse xenografts, indicating that they are not the result of postsecretory degradation by colonic flora or by tumor cell necrosis. The cell culture and xenograft can therefore be useful for studying the biosynthesis of cancer-associated mucins.

Comparison of T-antigen expression in normal, premalignant, and malignant human colonic tissue using lectin and antibody immunohistochemistry

The Thomsen-Friedenreich antigen has been implicated as a cancer-associated antigen in some human organs including the colon. Most previous studies of Thomsen-Friedenreich antigen expression in the colon used peanut agglutinin (PNA) to identify the immunodeterminant in tissues. However, evidence from other organs suggests that anti-T antibodies have specificities which differ from those of peanut lectin. To elucidate the nature of the T-immunodeterminant in colonic mucosa, we compared staining by PNA to that of a polyclonal (PAb) and monoclonal (MAb) anti-T antibody. PNA demonstrated the best sensitivity (91%) in cancer tissues but the lowest specificity (68%) in normal mucosa. Staining with MAb was only 76% sensitive but 100% specific. Sensitivity and specificity of PAb were intermediate between PNA and MAb. MAb stained fewer adenomatous polyps than either PNA or PAb, but staining appeared to correlate with premalignant features of the polyps. PNA-binding sites were more prevalent than either PAb or MAb in hyperplastic polyps. Cell cytoplasm was stained by both antibodies more often than by PNA. The majority of fetal colonic specimens stained with all three reagents suggesting that Thomsen-Friedenreich antigen may be an oncodevelopmental antigen in human colon. Differences in staining patterns in some tissues may be due to different antigenic specificities among PNA, PAb, and MAb.

Pseudomyxoma peritonei. Radiologic features

Diagnostic radiologic features of pseudomyxoma peritonei consist of diffusely scattered plaques of calcifications in the abdomen, poorly defined soft tissue masses and ascites on plain abdominal radiographs, characteristic scalloping of the hepatic margin, numerous multilocular cystic masses with rims of curvilinear calcifications and compression of abdominal viscera without evidence of invasion at computed tomography, and an echogenic mantle with ascitic septations at ultrasonography. In an appropriate clinical setting, this spectrum of radiologic features is highly specific for the diagnosis of pseudomyxoma peritonei.

Regional differences in normal and cancer-associated glycoconjugates of the human colon

Because inherent regional differences in colonic epithelium may determine the biologic behavior of tumors originating from different sites, and inasmuch as colonic epithelial cells secrete mucins that may reflect the state of cell differentiation, colonic goblet cell mucin was analyzed with the use of fluorescein isothiocyanate-conjugated lectins and fluorescence microscopy in normal fetal and adult mucosa and in cancers of the proximal and distal colon. In the adult proximal colon only the goblet cell mucin in the upper portion of the crypts was specifically labeled by the lectin Dolichos biflorus agglutinin (DBA), whereas this gradient was progressively lost distally; mucin in the upper and lower crypts of the sigmoid colon and rectum bound the label uniformly. In fetuses less than 22 weeks of age, DBA bound only to mucin in the crypts of the distal colon. Seven of 12 (58%) cancers originating from the proximal colon bound DBA, whereas only 2 of 23 (9%) from the distal colon bound this lectin (P less than .005). Logistic regression analysis suggested that this difference may reflect the occurrence of larger tumors in the proximal colon. Regional differences in the binding of Ulex europaeus agglutinin (UEA-I) to nonneoplastic mucosa was similar to that found by others; predominant binding occurred in the proximal colon in the adult. No difference was noted for UEA-I binding to tumors of the proximal (8 of 12; 66.6%) versus distal (11 of 23; 48%) colon (P = .48). These findings may reflect regional differences in normal and tumor-related carbohydrate structures in mucin of the human colon.

Binding of lectins to goblet cell mucin in malignant and premalignant colonic epithelium in the CF-1 mouse

The lectin peanut agglutinin binds to mucin secreted by neoplastic but not normal human colonic epithelial cells. Peanut agglutinin was found to bind to mucin secreted by experimentally induced neoplasms in the distal colons of CF-1 mice, but not in the distal colons of control animals. Serial examination of colonic tissues after exposure to carcinogen has revealed the "cancer-associated" mucin in histologically normal but potentially premalignant epithelium. Thus, in the chemical carcinogen-rodent model, a diffuse alteration in glycoprotein structure is found in that part of the murine colon that subsequently develops cancer, and this precedes the appearance of neoplastic tissue. Changes in mucin structure may prove to be useful in the identification of premalignant gastrointestinal epithelium in certain humans at high risk for colon cancer.

Abnormal goblet cell glycoconjugates in rectal biopsies associated with an increased risk of neoplasia in patients with ulcerative colitis: early results of a prospective study

A group of 18 patients with stable ulcerative colitis involving the entire colon for at least eight years was subjected to a biopsy of normal appearing rectal mucosa and followed prospectively over four years for the development of either dysplasia or cancer. Goblet cell glycoconjugate structure was examined in the rectal biopsies using fluorescein conjugated lectins. At the beginning of the study, 13 of the 18 patients had abnormalities of goblet cell mucin or cytoplasmic glycoconjugates in the rectal biopsies. Dysplasia subsequently developed in six and carcinoma in one of these patients. Among the five patients with normal lectin binding studies in the initial rectal biopsies, colonic dysplasia has subsequently developed in one. The abnormalities seen in the rectal goblet cells resembled in part those previously seen in immature and neoplastic colonic cells. The dysplastic tissues all contained the form of mucin which has been found in other neoplastic colonic tissues. This preliminary report after four years of prospective study suggests that abnormalities of glycoconjugate structure may be associated with, and may precede, neoplastic events in the setting of chronic ulcerative colitis.

Characteristics of colorectal carcinoma cells with high metastatic potential

Malignant tumors shed large numbers of cells into the circulation, only a small fraction of which actually produce distant metastases. The cells comprising these tumors may be heterogeneous in many respects including their biological behavior. Inasmuch as colonic epithelial cells secrete mucins that reflect the state of cell differentiation, and differences in mucin structure may be detected by selective lectin binding, we used fluorescein isothiocyanate-conjugated lectins and fluorescence microscopy to analyze mucins secreted by primary colon cancers and metastases. In this way we hoped to determine whether differences exist in the glycoconjugates produced by metastatic and nonmetastatic cell populations. Out studies demonstrated that, in a given primary cancer, the mucin produced differed from that made by its metastases. Thus the vast majority of cells in primary tumors produced mucin that was specifically labeled by fluorescent peanut agglutinin (14 of 16 tumors). In contrast, 72% (37 of 51) of metastatic tumors produced mucin that did not bind peanut agglutinin (p less than 0.001). Colon cancer cells with high metastatic potential may therefore produce mucins that lack an exposed oligosaccharide receptor for this lectin.

Alterations in human colonic mucin occurring with cellular differentiation and malignant transformation

The binding of fluorescein isothiocyanate (FITC)-conjugated lectins to mucin in the human colon was studied by using fluorescence microscopy. In normal mucosa, lectins that preferentially bind to exposed N-acetyl-galactosamine residues (Dolichos biflorus agglutinin and soybean agglutinin) bound selectively to the goblet cell mucin of well-differentiated cells in the upper colonic crypt. By contrast, lectins that require exposed non-reducing galactose residues for binding (Ricinus communis agglutinin1 and Bauhinia purpurea agglutinin) preferentially labeled the mucin of less-differentiated goblet cells located in the lower portion of the colonic crypt. The lectin derived from Arachis hypogaea (peanut agglutinin) has a high affinity for a carbohydrate structure not normally exposed in human tissues. This lectin did not label the goblet cell mucin in the normal colon. However, the mucin was labeled in all 21 colon cancer specimens examined. Additionally, the nonmalignant epithelium immediately adjacent to colon cancer (termed "transitional mucosa") also contained goblet cell mucin that was labeled by FITC-peanut agglutinin. Three conclusions may be drawn from the selective binding characteristics of FITC-lectins to colonic mucins. First, an alteration in the exposed, nonreducing carbohydrate residues occurs in human colonic mucin during the process of goblet cell differentiation. Second, an exposed carbohydrate structure that is not normally present in human tissues is expressed in the mucin produced by malignant colonic epithelium. Third, the presence of the cancer-associated carbohydrate structure in the mucin of transitional mucosa suggests that this tissue may be in the process of early malignant transformation.

Liquid caustic ingestion. Spectrum of injury

Seventeen patients who ingested liquid caustics were reviewed for location, extent, severity, and outcome of the mucosal injury. Although many complained of glossopharyngeal pains and dysphagia (12 patients), and most had some oral mucosal burns (15 patients), the absence of severe oral burns or pharyngoesophageal symptoms did not exclude esophageal or gastric injury as determined by endoscopy. The location of the most severe mucosal injury was unpredictable by symptoms alone; seven of the 17 patients demonstrated gastric mucosal injury greater than esophageal. One patient died of extensive esophageal, gastric, and duodenal injury; esophageal strictures developed in three patients. Caustic ingestion is a serious medical condition whose severity can best be gauged by endoscopic findings and not by patient symptoms alone. Outcome is variable, ranging from an asymptomatic state to stricture formation or even death.