Primary cutaneous plasmacytoma: the use of in situ hybridization to detect monoclonal immunoglobulin light-chain mRNA

A case of primary cutaneous plasmacytoma in a 16-year-old male is described. The neoplastic nature of the plasma cell infiltrate has been clearly established by the demonstration of monoclonal kappa immunoglobulin light-chain mRNA using in situ hybridization with biotin-labelled oligonucleotide probes applied to routine tissue sections.

Distribution of type IV collagen immunoreactivity to assess questionable early stromal invasion

AIMS

To determine if the immunocytochemical delineation of subepithelial basement membrane can be used in the assessment of questionable early invasive cervical carcinoma.

METHODS

The distribution of immunoreactive type IV collagen was examined in 15 cervical biopsy specimens in which the reporting pathologist had specifically described difficulty in assessing or excluding early invasion of subepithelial stroma associated with cervical intraepithelial neoplasia (CIN). The results were compared with those from biopsy specimens showing CIN III (N = 8), carcinoma with definite early stromal infiltration (FIGO stage 1a1) (n = 6), and more advanced invasive squamous tumours (FIGO stages 1a2 to 3) (n = 8). In all cases the immunocytochemical findings were assessed in relation to serial sections stained with haematoxylin and eosin.

RESULTS

Six of the 15 diagnostically problematic biopsy specimens were considered, on review, to show early infiltration of subepithelial tissue and putative invasive foci were consistently absent in basement membrane. A similar pattern was observed in the "definite" early invasive cases. Eight problematic biopsy specimens were considered to show only in situ neoplasia; five of these had intact though occasionally attenuated basement membrane, three showed focal type IV collagen defects. In the remaining case biopsy trauma precluded further assessment. Basement membrane defects were identified in five of eight cases of CIN III, while three of eight squamous carcinomas showed partial retention of type IV collagen immunoreactivity around invasive tumour cell nests.

CONCLUSIONS

Defects in subepithelial basement membrane occur in in situ and invasive neoplasia in the uterine cervix. Immunocytochemical staining for type IV collagen is of limited diagnostic value in the assessment of biopsy specimens with questionable early stromal invasion.

Pituitary macroadenomas associated with hyperprolactinaemia: immunocytochemical and in-situ hybridization studies

OBJECTIVE

We have assessed whether in-situ hybridization for prolactin messenger RNA (mRNA) provides additional information for the classification of pituitary macroadenomas associated with hyperprolactinaemia.

DESIGN

In-situ hybridization for PRL mRNA was performed on surgical biopsies of pituitary adenomas and the results correlated with serum PRL levels and PRL immunoreactivity.

PATIENTS

Twenty-one patients (11 men, 10 women) were included; five had normal serum PRL levels, 11 mild hyperprolactinaemia (less than 3000 mU/l) and five marked hyperprolactinaemia (greater than 3000 mU/l).

MEASUREMENTS

Immunocytochemistry for PRL and in-situ hybridization for PRL mRNA were performed on surgical biopsies.

RESULTS

Immunoreactivity for PRL was detected in tumours from all patients with serum PRL greater than 3000 mU/l and in one of 11 patients with mild hyperprolactinaemia. Positive signal for PRL mRNA was detected in four of five immunopositive cases studied, in a further two cases with mild hyperprolactinaemia, and in one tumour associated with normal serum PRL level.

CONCLUSIONS

In-situ hybridization provides evidence of PRL gene activation in the absence of immunoreactivity for prolactin. This may reflect low levels of hormone storage or defective translation of the mRNA.

Identification and characterisation in vitro of cells with a non-SCLC cell-like phenotype derived from a continuous SCLC cell line

Two adherent sublines, H69V and H69VZ, have been isolated from the classic SCLC cell line NCI-H69. Significant morphological differences were observed between the parental and the derivative cell lines. While NCI-H69 grew as densely packed free floating cellular aggregates the derivative lines grew as a monolayer of epithelioid cells. The growth rates of both the derivative lines were faster than the parental line with doubling times closer to non-SCLC cell lines in the derivative lines. Both H69V and H69VZ either express very low levels or do not express neuroendocrine cell markers including L-dopa-decarboxylase (DDC), creatine kinase-BB isoenzyme (CK-BB), bombesin-like immunoreactivity (BLI), neuron specific enolase (NSE), and neurosecretory type dense core granules (DGCs), compared to the parental cell line. All the lines stained positive for epithelial markers such as CAM5.2. LDH isoenzyme and chromosome analyses confirmed the human origin of all the cell lines. Therefore, it appears that cell line NCI-H69 contains stem cell subpopulation capable of generating cells of both small and non-small cell like phenotypes.

Non-isotopic in situ hybridization with digoxigenin and alkaline phosphatase labelled oligodeoxynucleotide probes. Applications in pituitary gland

We report the application of digoxigenin labelled oligonucleotide probes for the detection of hormonal messenger RNAs (mRNAs) in human pituitary adenomas. Positive signal for the appropriate mRNA was detected in tumours associated with Cushing's disease, acromegaly and hyperprolactinaemia, where immunoreactivity for adrenocorticotrophin (ACTH) growth hormone and prolactin had also been confirmed. In addition, we report the detection of proopiomelanocortin (POMC) mRNA in the rat pituitary gland using an oligodeoxynucleotide probe directly linked to alkaline phosphatase.

Oncogene transfection of mink lung cells: effect on growth characteristics in vitro and in vivo

Three sublines have been derived from the parental line Mv1Lu by transfection with normal and mutated Ha-ras, and myc oncogenes, and subsequent cloning. All the oncogenes have increased the growth rate of the cell in vitro, increased their plating efficiency in monolayer and suspension, and reduced their serum dependence. Growth in vivo as xenografts in nude mice has also been increased. Very few tumours were generated from the parental line and those that did form did so after a prolonged lag period, while the transfected lines produced tumours with 100% efficiency, and a short lag period. In general the effects of ras transfection were more extreme, with the highest growth rates and plating efficiencies in vitro and the shortest lag period and doubling times in vivo. There was no increase in plasminogen activator activity as a result of transfection, and the invasive behaviour of the lines in organotypic culture was broadly similar.

Detection of mRNA for ribosomal phosphoprotein P2 in normal colon and colonic tumours by in situ hybridization

We have localized the mRNA for the ribosomal phosphoprotein P2, a putative metastasis-related sequence, in normal colon and colonic carcinomas by in situ hybridization, using an oligonucleotide probe end-labelled with digoxigenin. The mRNA was identified in normal colonic epithelial cells, the intensity of the signal being greater in cells at the base of the crypts compared with those on the surface. A strong positive signal was also seen in plasma cells, in fibroblasts in granulation tissue, in ganglion cells, and in hepatocytes. A positive signal was identified in all 16 primary colonic tumours studied and in 7 hepatic metastases. In contrast to previous studies based on Northern blot analysis, we were unable to demonstrate increased expression in metastases as compared with primary tumours, nor could we demonstrate any increased expression in primary tumours which were associated with distant metastases.

Vasopressin stimulation of cell proliferation in the rat pituitary gland in vitro

Proliferative activity was measured in rat anterior pituitary cells in short-term culture by calculating the labelling index (LI), based on the immunohistochemical detection of cells incorporating the thymidine analogue bromodeoxyuridine. Basal LI was reproducible in the test system. Arginine vasopressin (AVP) induced a dose-related increase in LI up to 20 ng/ml. Corticotrophin-releasing factor-41 (CRF-41) had no effect at doses up to 20 ng/ml. However, in the presence of 10 ng CRF-41/ml, AVP induced a greater increase in LI at lower doses than did AVP alone. Fibroblast growth factor also induced a significant increase in LI. In the system used, epidermal growth factor and insulin had no effect on proliferation.

Detection of messenger RNA using a digoxigenin end labelled oligodeoxynucleotide probe

A synthetic oligodeoxynucleotide sequence complementary to the mRNA for the adrenocorticotrophin (ACTH) precursor pro-opiomelanocortin (POMC) was end labelled using digoxigenin. The probe was used to detect POMC mRNA both on nitrocellulose filters and by non-isotopic in situ hybridisation (NISH) in tissue sections. Digoxigenin was identified using anti-digoxigenin alkaline phosphatase. The model system examined was the rat pituitary gland. Removal of both adrenal glands and dexamethasone administration were used to change the concentrations of POMC mRNA in the rat anterior lobe. The labelled probe reacted with a single band of appropriate molecular weight in Northern blot analysis. The distribution of signal in tissue sections and the changes induced by experimental manipulation were as predicted. The results indicate that this method of NISH will prove useful in the detection of specific messenger RNAs in tissue sections of buffered, formalin fixed, paraffin wax embedded material.

Immunoreactive alpha interferon in cervical flat koilocytic lesions and intraepithelial neoplasia

Immunocytochemical staining for alpha-interferon was carried out on cervical biopsy specimens showing non-condylomatous koilocytic atypia (n = 12) and cervical intraepithelial neoplasia (n = 18), both of which are associated with human papilloma virus (HPV) infection. Normal cervical tissue obtained from hysterectomy specimens was also assessed. Koilocytes were not immunoreactive for alpha interferon and keratinocyte staining was observed in only four cases of intraepithelial neoplasia. HPV infection alone does not therefore seem to induce the production of alpha interferon in cervical squamous epithelium. There was variable but, in some cases, prominent staining of cells in the stromal inflammatory infiltrate as well as intraepithelial cells which had morphological and immunocytochemical characteristics of Langerhans' cells. Alpha interferon immunoreactivity in Langerhans' cells is in keeping with derivation from the mononuclear phagocyte system and may be important in the host response to HPV infection.

Association between CAM 5.2 and anti-CD1a reactivity in lymph nodes and gastrointestinal tract epithelium

Immunocytochemical studies, using the antibodies CAM 5.2 and NA1/34 (CD1a), were performed on normal lymphoid tissue and malignant lymphomas. A population of dendritic cells in the paracortex of lymph nodes and in T cell lymphomas reacted with both antibodies. Colocalisation with antibodies was also found in gastrointestinal epithelium. Immune blotting shows that the likely basis of this reactivity is a 12 kilodalton peptide which is recognised by both antibodies. This is almost certainly the beta t peptide which has been described as the light chain of CD1a.

Age-related variation in circadian rhythms of mitosis in the adrenal cortex of the male rat

Using a metaphase arrest technique, mitotic activity was quantified in the adrenal cortex over a 24-h period in 14-day-old male Sprague-Dawley rats before functional rhythmicity of the hypothalamic pituitary-adrenal (HPA) axis is established, and after its onset, in 6- to 7-week-old rats. At all times, proliferative activity was greater in the younger animals, as previously reported. A significant circadian rhythm was identified in both groups, but the timing of the peak differed, lying between 17.00 and 21.00 h at 14 days and 11.00 and 15.00 h at 6-7 weeks. These results raise the possibility that functional rhythmicity of the HPA axis may alter an inherent proliferative rhythm.

Bromocriptine-responsive Cushing's disease associated with anterior pituitary corticotroph hyperplasia or normal pituitary gland

Cushing's disease may originate from either the anterior pituitary lobe or the neurointermediate lobe, a major characteristic of the latter group being bromocriptine responsiveness. This study of two patients with Cushing's disease demonstrates that bromocriptine responsiveness also may be associated with anterior pituitary corticotroph hyperplasia or a normal pituitary gland. The two patients were a 14-yr-old boy (patient 1) and a 29-yr-old woman (patient 2); their cortisol production rates were 121 and 234 mumol/24 h (normal values, less than 80 mumol/24 h), respectively. A single oral dose of 2.5 mg bromocriptine resulted in a gradual decrease in plasma cortisol from 680 to 130 nmol/L after 6 h in patient 1 and from 640 to 170 nmol/L after 4 h in patient 2. Both patients then received medical treatment for a period of 2 yr. Whereas sodium valproate was ineffective, bromocriptine (5 mg/day) abruptly decreased the cortisol production rate to 60 mumol/24 h in patient 1 and to 138 mumol/24 h in patient 2, and both patients had a partial clinical remission. Despite an increase in bromocriptine dosage to 30 mg daily and 24 mg/day cyproheptadine, the clinical and biochemical remission was not sustained in patient 1, and no further improvement occurred in patient 2. Total hypophysectomy then was performed in both patients. Sections of the pituitary from patient 1 showed diffuse anterior pituitary corticotroph hyperplasia, with early nodule formation in some areas. The sections from patient 2 showed normal numbers and distribution of corticotrophs. We conclude that the heterogeneous nature of Cushing's disease cannot be explained on the basis simply of anterior vs. intermediate lobe origin of the disease.

The distribution of immunoreactive interferon-alpha in normal human tissues

The cellular distribution of immunoreactive interferon-alpha (IFN-alpha) was studied in formalin-fixed paraffin-embedded normal human tissues from 36 different organs. These samples were drawn from over 300 individuals none of whom had evidence of viral infection. Tissue histiocytes from all organs in the body, with the exception of brain and renal cortex and medulla, stained positively for IFN-alpha. Kupffer cells, pulmonary alveolar macrophages and lymph node macrophages were also positive. Parenchymal cells in some other organs also appeared to contain immunoreactive IFN-alpha. These included cuboidal lining cells of the choroid plexus in the brain, thyroid follicular cells, pituitary endocrine cells, adrenocortical cells and parathyroid principal and oxyphil cells. These findings are compatible with previous suggestions that IFN-alpha may be synthesized and released in the absence of viral infection and may thus have a role in normal physiology. The presence of IFN-alpha in most cells of the mononuclear phagocyte system suggests that these cells may play a major part in defence against viral infection.

The use of electron microscopy and immunocytochemistry to characterise spontaneously-arising, transplantable rat tumors

When examined by light microscopy, transplanted animal tumors frequently bear little resemblance to the original neoplasm. If such tumors are to be used as models of human cancer they should be characterised as regards extant rather than historical features. Consequently, we have examined, by electron microscopy and immunocytochemistry, five spontaneously arising tumors transplantable in the WAB/Not rat that are currently diagnosed on the basis of historical features only. A typical sarcoma was used for comparison. Of four spontaneously arising tumors previously classified as carcinoma, Sp4 possessed epithelial features on both ultrastructural and immunocytochemical analysis, Sp107 on ultrastructural analysis only and Sp15 and Sp22 by neither technique. Expression of vimentin was most marked with Sp15 and Sp107. The putative sarcoma, Sp24, showed clear evidence of epithelial differentiation but no evidence of vimentin expression. This study (a) records the phenotypic drift of experimental tumors on transplantation (most clearly with Sp107) and the co-expression of cytokeratins and vimentin in putative carcinomas, (b) confirms the inadequacy of routine histology for accurate characterisation of such tumors and (c) details techniques for a more thorough assessment of state of differentiation that should guide the choice of experimental model.

AgNOR numbers in rat pituitary corticotrophs following adrenalectomy or corticotrophin releasing factor administration

Using a combined silver staining/immunoalkaline phosphatase technique, nucleolar organiser regions (AgNORs) were visualised and quantified in rat anterior and intermediate lobe pituitary corticotrophs following bilateral adrenalectomy or sham surgery. Compared to sham operated animals, the mean number of AgNORs was increased in anterior lobe corticotrophs in adrenalectomized rats and there was a shift to the right in the distribution. At 2 weeks after adrenalectomy, AgNOR numbers were greater than at 6 weeks. AgNOR numbers were also quantified in anterior lobe corticotrophs of intact rats receiving daily intraperitoneal injections of ovine CRF-41 at 50 micrograms/kg, which has been shown to stimulate ACTH release and to produce morphological evidence of increased corticotroph stimulation. CRF-41 did not produce an increase in AgNOR numbers, compared to saline injected controls.

Nucleolar organiser regions in pituitary adenomas

Nucleolar organiser regions have been identified by a silver-staining technique (AgNORs) and quantified in paraffin sections of normal foetal and adult pituitary gland and in a series of 35 pituitary adenomas, which included all the main types. In the adult pituitary there were 1.45 +/- 0.07 (mean +/- SEM) AgNORs per cell and in the foetal gland 2.94 +/- 0.37. The overall values for the adenomas were 1.98 +/- 0.08. Macroadenomas had significantly higher numbers (2.18 +/- 0.09) than microadenomas (1.69 +/- 0.11). Of the hormonally active tumours, corticotroph adenomas had the highest value (2.18 +/- 0.15), although four out of six were microadenomas.

Combined immunocytochemistry and nucleolar organizer region staining: some technical aspects

We have examined the feasibility of combining immunocytochemistry with argyrophilic staining of nucleolar organizer regions (AgNORs) on a single preparation. The combined technique gave positive results on fixed tissues, with immunoalkaline phosphatase methods providing better contrast. On frozen sections, there were problems with adhesion and with immunostaining. Delayed fixation did not affect AgNOR staining, suggesting that the technique may be applied to autopsy tissue. Trypsinisation of sections did not alter the count of silver stained granules.

Compensatory adrenal growth in dexamethasone treated rats

The changes in right adrenal weight and adrenocortical mitotic activity have been quantified in the early (up to 72 h) stages following left adrenalectomy or sham adrenalectomy in adult male Sprague Dawley rats. These have been compared with the changes seen in rats pretreated for 14 days with a daily intraperitoneal injection of the synthetic glucocorticoid, dexamethasone (200 micrograms/kg) body weight. The results indicate a significant proliferative response in both groups of animals, although basal proliferative activity and the amplitude of the response was lower in the dexamethasone treated animals. In addition, they suggest two waves of mitotic activity at 24 and 72 h.

Localization of alpha-interferon in the human feto-placental unit

The distribution of alpha-interferon in human placental tissue was investigated by immunocytochemical study of paraffin wax-embedded tissue sections using a sheep alpha-interferon antiserum. Fifty-eight placentas of gestational ages from 8 to 40 weeks were examined. alpha-Interferon was present in the syncytiotrophoblast of the chorionic villi of all placentas and was also in macrophages in 28 cases. The appearances suggest production of interferon in human placental trophoblast and, in view of its diverse biological effects, support the concept of a role for alpha-interferon in the complex series of events required for successful gestation.

Increased production of alpha-melanocyte-stimulating hormone in the pituitary gland of patients with untreated Addison's disease

There is evidence that peptides related to alpha-melanocyte-stimulating hormone (alpha-MSH) are involved in regulating the zona glomerulosa of the adrenal cortex in certain species. We have investigated the amount of immunoreactive (IR)-alpha-MSH in the human pituitary gland of patients suffering from Addison's disease. We show increased numbers of cells containing demonstrable IR-alpha-MSH in the anterior lobe in these patients. Using an antiserum with specificity for the acetylated N-terminus of alpha-MSH we suggest that the major form present is desacetyl-alpha-MSH. These findings are in keeping with a role for anterior lobe derived desacetyl-alpha-MSH in the regulation of the human adrenal cortex.

The mitogenic effects of corticotrophin-releasing factor on the anterior pituitary gland of the rat

The immunohistochemically defined corticotroph population in the anterior pituitary gland of the adult male Sprague-Dawley rat has been quantified at 2 and 6 weeks after bilateral adrenalectomy using the stereological measurement, volume density (Vv). An approximately twofold increase in corticotroph Vv was demonstrated at 2 weeks in adrenalectomized rats compared with that in sham-operated controls and this was maintained at 6 weeks. Daily i.p. injections of ovine corticotrophin-releasing factor (CRF-41) induced a significant dose-related increase in corticotroph Vv when administered at doses of 25 and 50 micrograms/kg body weight, but this was less than the increase following adrenalectomy. Assessment of changes in mitotic activity of the total anterior lobe of adult Sprague-Dawley rats and of the corticotroph population was also made after daily i.p. injections of 50 micrograms CRF-41/kg for 2 and 7 days. There was no increase in overall mitotic index at either time. However, the numbers of mitotic corticotrophs were significantly increased in CRF-injected animals compared with those in saline-injected rats. These results indicate a role for CRF-41 in the regulation of corticotroph growth.

Absence of gradient of thyrotropin receptor antibody and T cell subset distribution between thyroid and peripheral venous blood in patients with Graves' disease prepared for surgery with carbimazole and potassium iodide

The aim of the study was to examine tri-iodothyronine, thyroxine, thyroid antibody and thyrotropin receptor antibody levels in thyroid and peripheral venous blood at the time of surgery in patients with Graves' disease. T cell subset patterns in peripheral and thyroidal venous blood were compared to the distribution of T cell subset patterns within the thyroid gland itself. The results showed that at the time of surgery there were no significant differences in any of the parameters measured between thyroidal and peripheral venous samples. T cell subset patterns within the thyroid gland were subjectively similar to those in the venous samples.

Class II MHC expression in normal adrenal cortex and cortical cells in autoimmune Addison's disease

It has been proposed that aberrant expression of class II major histocompatibility complex (MHC) molecules by target cells may be an initiating factor in some forms of organ specific autoimmunity. This hypothesis was tested in relation to the autoimmune form of Addison's disease by studying autopsy adrenal glands from eight patients who had died of recent onset idiopathic Addison's disease. Using an immunohistochemical technique, class II MHC expression was found in a minority of adrenal cortical cells in the zona reticularis in 25 normal and four hyperplastic glands, while in Addison's disease almost all residual cortical cells expressed class II MHC. Three tuberculous adrenals showed increased staining of cortical cells around areas of chronic inflammation. It is concluded that since adrenal cortical cells of the normal gland express class II MHC, aberrant expression of this product cannot be invoked as an initiating mechanism in autoimmune adrenalitis. The increased cortical expression of class II MHC seen in idiopathic Addison's disease and tuberculosis may be due to local release of lymphokines by inflammatory cells.

The morphological effects of dexamethasone on the pituitary-adrenal axis of the rat--a quantitative study

Adult Sprague-Dawley rats received a daily intraperitoneal injection of dexamethasone (100 or 200 micrograms/kg) for 2 or 6 weeks. Quantitative assessment of the anterior pituitary corticotroph population performed using the stereological measurement of volume density (Vv). An indirect assessment of corticotroph function was also made, based on adrenal weight and histology. Adrenal changes were consistent with dose-related inhibition of corticotroph function in all dexamethasone-treated animals. Immunopositive corticotrophs were easily identified and in no treatment group was corticotroph Vv significantly less than in the appropriate vehicle-injected control group. In male animals, there was a significant increase (P less than 0.05) in Vv with 100 micrograms/kg at both 2 and 6 weeks. These results suggest that it is possible to produce inhibition of corticotroph function by the administration of such doses of dexamethasone without causing a significant reduction in the anterior pituitary corticotroph population. This may be related to the mode of negative feedback of such a regime.

Stimulation of pituitary corticotrophs in the rat--ultrastructural studies

The ultrastructural changes occurring in the corticotrophs of adult male and female Sprague-Dawley rats at 2 and 6 weeks after bilateral adrenalectomy were assessed on both a qualitative and quantitative basis. Qualitative changes were similar to those previously described but at both time points, female rats showed more marked changes than males. Corticotroph hypertrophy reached a plateau in male animals between 2 and 6 weeks, but continued to increase in females. There was an increase in mean granule diameter in both sexes at 2 weeks after adrenalectomy. The changes induced by the daily administration of CRF for 2 weeks by intraperitoneal injection were also examined in male rats. CRF induced corticotroph hypertrophy at both 25 micrograms/Kg and 50 micrograms/Kg body weight and increased the granule content. The addition of vasopressin (VP) to the higher dose of CRF induced a further increase in cell area and reduction in granule content. Low dose CRF was associated with an increase in mean granule diameter, whereas a decrease was seen after high dose.

Pituitary adenomas

This review highlights various aspects of the new functional classification of pituitary adenomas which is based on detailed immunohistochemical and ultrastructural analysis and correlation with clinical and biochemical findings. In addition, current investigation of the non-hormonal aspects of these tumours is discussed, including the application of flow cytometry in tumour ploidy studies.

A study of cell migration in the adrenal cortex of the rat using bromodeoxyuridine

Bromodeoxyuridine (BrdU) was administered by a single intraperitoneal injection to immature (14 days) male and female and adult male Sprague-Dawley rats. Animals were killed at intervals from 2 hr to 28 days following injection. Labelled cells in the adrenal cortex were identified by an indirect immunoperoxidase technique using a monoclonal antibody to BrdU. At 2 hr, labelling was maximal in the outer zona fasciculata and zona glomerulosa in both prepubertal and adult rats. The numbers of immunopositive cells were greater in the 14 day rats. In both groups, the front of immunopositive cells moved deeper into the cortex with time. These results support the centripetal migration theory of adrenal growth.

A study of intermediate lobe differentiation in the human pituitary gland

The immunohistochemical demonstration of neurofilament (NF) polypeptide was used to identify nerves in a series of 17 pituitary adenomas. NF-positive fibres were present in two out of five corticotroph adenomas sited deep in the anterior lobe, in one out of five sited in the intermediate zone and in two out of seven non-corticotroph adenomas. Such nerve fibres were often seen in relation to blood vessels. The distribution of alpha-MSH immunoreactive cells was examined in 25 normal pituitaries and in 23 cases of Cushing's disease. Such cells were scattered throughout the normal gland and there was no increase in numbers in pregnancy. alpha-MSH was demonstrated in 18 corticotroph adenomas in Cushing's disease. There was no correlation with the site of the tumour or the presence of nerve fibres. alpha-MSH cells were distributed normally in the para-adenomatous gland. Crooke's hyaline change and alpha-MSH coexisted in some corticotrophs. These findings support the concept that 'intermediate lobe' function, as found in animals, has no discrete anatomical location in man.

Myelofibrosis complicated by intestinal extramedullary haemopoiesis and acute small bowel obstruction

A 78 year old woman with myelofibrosis presented with an acute small bowel obstruction. Pathology of the resected small bowel showed extramedullary haemopoiesis leading to acute small bowel obstruction. As far as we know this is the first such reported case.

A study of corticotroph adenomas in Cushing's disease: no evidence of intermediate lobe origin

There is little evidence for a separate functional or anatomical intermediate lobe in the adult human pituitary gland. Nevertheless, Lamberts et al. (1982) proposed that a subgroup of corticotroph adenomas in Cushing's disease arise in that lobe and can be identified by the presence of argyrophil (? neural) fibres, and that these tumours are more often associated with corticotroph hyperplasia and hyperprolactinaemia than those arising in the anterior lobe. We have examined a series of corticotroph adenomas from patients with Cushing's disease for evidence of argyrophil fibres, and have correlated this with tumour site, corticotroph distribution in the para-adenomatous gland, serum PRL levels and PRL immunoreactive cells in the tumour. Argyrophil fibres were identified not only in tumours adjacent to the posterior lobe, but also in tumours situated deep in the anterior lobe. There was no correlation between the presence of fibres or the site of the tumour and corticotroph hyperplasia. Whilst the two patients with the highest serum PRL levels did have argyrophil fibres they also had a subpopulation of PRL immunoreactive cells in the tumour. On the basis of these results, we propose that the 'intermediate lobe' hypothesis as outlined above should not be accepted.

Current topics in neuropathology. Cushing's disease

The application of modern investigative techniques, particularly electron microscopy and immunohistochemistry, to the pituitary gland in Cushing's disease have confirmed that in the majority of cases (up to 90% in some series) the disease is due to a corticotroph microadenoma. It has also been shown that the tumours may produce not only ACTH, but also other peptides derived from the same precursor molecule, pro-opiomelanocortin and, in a small minority of cases, other pituitary hormones (e.g. prolactin). Since these peptides are known to have physiological actions they may account for some of the varied symptoms and signs of Cushing's disease. Because of the high incidence of single tumours the treatment of choice in many centres has become selective adenomectomy by the transsphenoidal route. However, a minority of cases appear to be the result of primary hypothalamic or central abnormalities and this may account for the identification of a normal pituitary gland or of corticotroph hyperplasia (with or without tumour formation). It is not possible at the present to identify these groups of patients on the basis of biochemical testing. It is hoped that detailed prospective studies correlating hormone secretion, responses to biochemical testing and detailed investigation of pathological tissue will provide further insight into the pathogenesis of particular variants of the disease.

The corticotrophic cells of the canine pituitary gland in pituitary-dependent hyperadrenocorticism

The distribution of specifically stained corticotrophic cells has been studied in the pituitary glands of 11 dogs with pituitary-dependent hyperadrenocorticism. The results suggest that the disease is not a single entity, and that some cases are caused by primary abnormality of the pituitary gland whereas others appear to be the result of dysfunction of the hypothalamus or central nervous system. The patterns correspond closely to those demonstrated in the human pituitary gland in Cushing's disease, and confirm that the canine disease is a useful model for the study of the pathogenesis of the variants of the condition.

Effects of trimethoprim and sulphonamide preparations on the pituitary-thyroid axis of rodents

The effects on pituitary-thyroid function of the commonly prescribed anti-bacterial preparations co-trimoxazole and co-trifamole, and their component drugs, have been studied in the rat and compared to the changes caused by propylthiouracil. Co-trimoxazole and co-trifamole, in doses 20-fold in excess of a pharmacological dose administered for 10 days, produced marked changes in hormone levels consistent with blocking of hyperplastic goitre formation, were also demonstrated. Propylthiouracil produced less marked changes of thyroid hormone levels but higher levels of thyroid-stimulating hormone. Pharmacological doses of co-trimoxazole and co-trifamole and sulphamoxole, the sulphonamide component of co-trifamole, caused significant changes in thyroid hormone levels consistent with anti-thyroidal activity. In contrast, there was no evidence that trimethoprim, which is common to both preparations, or sulphamethoxazole, the sulphonamide component of co-trimoxazole, had an anti-thyroidal action, indeed, serum thyroxine levels were significantly increased at pharmacological dosage. We have concluded that the new commonly prescribed combination preparations retain the goitrogenic properties of the earlier sulphonamides.

Patterns of corticotropic cells in the adult human pituitary in Cushing's disease

The overall anatomical distribution of specifically stained corticotropic cells has been studied in pituitaries obtained at autopsy from 9 patients with Cushing's disease. Three patterns have been demonstrated consistent with the theory that it is not a single entity, but that some cases are of primary pituitary aetiology, whereas others are the result of hypothalamic or central nervous system dysfunction. The junctional corticotropic cells appear to react differently from those in the anterior pituitary to some stimuli, supporting the hypothesis that these cells may represent the remnants of the pars intermedia in the human adult, and suggesting that they may have some as yet unidentified physiological function.