Lymphocyte and macrophage subsets in active and inactive lesions of lichen planus

Lichen planus (LP) is a mucocutaneous disease for which the etiology and pathogenesis are poorly understood. We performed an immunohistochemical study on formalin-fixed tissue sections of 10 cases of LP using subsets of antibodies to lymphocytes (LCA, CD3, OPD4-CD4, L26, LN1 and Leu-7), and monocyte-macrophages [lysozyme, KP1-Mac, Factor XIIIa (FXIIIa) and S-100 protein]. Six cases showed typical histological features of active LP, two cases showed features of active and inactive LP, and two cases showed only inactive LP. In active LP, scattered T cells (CD3+ and pan T cells) were present in the epidermis, whereas large numbers of CD3+ T cells were present at the dermoepidermal junction and in the dermis. Approximately 40% of the T cells at the dermoepidermal junction were of the helper/inducer subset, whereas approximately 80% of those in the dermis were CD4 positive (helper/inducer T cells). Occasional B cells were present in the dermis only. Increased numbers of S-100-positive Langerhans cells, macrophages expressing lysozyme, and FXIIIa dendritic cells were present in the epidermis and dermis. The inactive lesions showed the presence of a few epidermal Langerhans cells and a mild infiltrate of T cells (helper/inducer subset). These results suggest that in addition to different subsets of T cells and macrophages, including Langerhans cells, dermal dendritic cells expressing Factor XIIIa and lysozyme-positive histiocytes play an important role in lichen planus. They may participate in the destruction and subsequent regeneration of the basal layer of the epidermis, or alternatively may be activated as a result of destruction of the basement membrane in LP.

Overexpression of p53 is a late event in the development of malignant melanoma

Overexpression of the p53 gene product has been observed in a high percentage of malignant melanomas. To evaluate the role of this protein in the development of melanoma, we examined p53 expression in benign, premalignant, and malignant melanocytic lesions. Using the antibodies DO-7 and 1801, which recognize both wild-type and most mutant forms of the p53 protein, we analyzed by immunohistochemical staining 26 benign nevi, 34 dysplastic nevi from patients at low risk for the development of melanoma, 22 dysplastic nevi from patients at high risk for the development of melanoma, 61 primary melanomas (including 15 that arose from dysplastic nevi), and 10 metastatic melanomas. Expression of the p53 protein was not observed in any of the benign or dysplastic nevi. Of the primary melanomas only 3 (5%) demonstrated nuclear staining, whereas 70% of the metastatic melanomas showed a positive reaction for p53. These data suggest that overexpression of the p53 gene product is a late event in the progression of melanoma and consequently indicate that expression of this protein cannot be used as a marker to identify patients at high risk for the subsequent development of melanoma.

Subcellular localization of HMFG2 in breast carcinomas: an immunohistochemical and immunoelectron microscopic study

Malignant transformation of human cells is associated with morphological and biochemical alterations. We have studied the distribution and pattern of staining of HMFG2 (human milk fat globulin) in normal breast, benign breast lesions, and 137 primary and metastatic breast carcinomas. Immunohistochemical staining was performed with an antibody to HMFG2 using the indirect peroxidase technique. Three patterns of staining were noted: 1) secretion and luminal staining (in normal breast, most benign breast lesions and some breast carcinomas); 2) plasma membrane staining (in breast carcinomas); 3) intracytoplasmic staining (in breast carcinomas). Immunoelectron microscopy was also performed on normal breast, infiltrating duct, and lobular carcinomas. Immunoelectron microscopy showed localization of the gold particles on the electron dense granules of the HMFG2 protein. These were localized along the surface of the extracytoplasmic lumina in normal breast ducts/acini and breast carcinomas, whereas localization was also noted within the intracytoplasmic lumina in cancer cells only. These results show that there is altered localization of milk fat globulin in breast cancer cells associated with membrane internalization and formation of intracytoplasmic lumina. This contributes to the understanding of the phenotypic alterations associated with malignant transformation in breast cancer.

The correlation of Ki67 growth factor and ERICA in breast cancer

Estrogen receptor (ER) status is an accepted prognostic indicator for breast cancer when measured by either the biochemical or immunohistochemical (ERICA) methods. Moreover, ERICA was found to be a better predictor of survival in human breast cancer than the biochemical assay for ER. The antibody to Ki67 recognizes the growth fraction of proliferating cells. We examined 100 primary breast cancers to investigate the relationship between ER status as measured by ERICA and Ki67 reactivity. Of the 56 ERICA positive cases, 47 (84%) were Ki67 negative whereas 30 of the 44 ERICA negative tumors were Ki67 positive (68%). There was evidence of a significant inverse relationship between ERICA and the growth fraction (77% of cases, p less than 0.001). In addition, a cluster of ERICA-positive Ki67-positive tumors that were larger and occurred in older patients was identified as a subset that might require aggressive therapy. Our results suggest that Ki67 may be an important additional criterion for predicting the biological behaviour of breast cancers.

Altered distribution of desmin filaments in hypertrophic cardiomyopathy: an immunohistochemical study

Hypertrophic cardiomyopathy (HCM) is characterized by myofiber hypertrophy and disarray. Intermediate filaments play an important role in maintaining of normal cell shape. Desmin filaments have been detected in adult cardiomyocytes, and vimentin and keratin filaments in cardiomyocytes during embryonic development. The pattern of arrangement of intermediate filaments in HCM has not been reported. We examined the distribution of intermediate filaments in formalin-fixed tissue sections of the disarrayed myofibers from 10 hearts with HCM using an immunohistochemical technique and antibodies to desmin, vimentin, and high and low molecular weight keratins. The controls consisted of subaortic tissue from surgically explanted hearts of patients with ischemic heart disease. In the ischemic hearts, desmin was detected in the Z bands and intercalated disks. In all HCM cases, three patterns of staining for desmin were noted: (a) individual myocytes showing a parallel arrangement along Z bands; (b) focal myofibers with decreased or complete loss of labeling of Z bands; and (c) individual myocytes with intense granular cytoplasmic staining especially in disarrayed myofibers. No staining for vimentin or keratins was noted in the cardiomyocytes from either the HCM or ischemic cases. The altered arrangement of desmin filaments in the disarrayed cardiac muscle fibers may play a role in the altered contractility that occurs in patients with HCM.

Lymphocyte markers on formalin-fixed tissue in Jessner's lymphocytic infiltrate and lupus erythematosus

Clinical and histological differentiation between Jessner's lymphocytic infiltration of the skin (JLI) and lupus erythematosus (LE) may be difficult. Previous immunohistochemical studies using monoclonal antibodies on frozen sections have shown that the majority of inflammatory cells in JLI and LE are T lymphocytes, whereas B lymphocytes are few or absent. We have performed an immunohistochemical study on formalin-fixed, paraffin-embedded tissue sections from seven patients with JLI and five with LE using monoclonal antibodies MT1 (pan T-cells), OPD4 (helper/inducer T-cells CD4), MT2 (mantle zone B and some T-cells), MB2 (pan B-cells), L26 (pan B-cells), and LN1 (germinal centre B-cells). In both diseases, the-majority of the inflammatory cells were T lymphocytes (MT1 positive), confirming the results others have obtained on frozen material. OPD4 positive cells were detected in varying numbers in all cases. However, the percentage of B lymphocytes tended to be higher in JLI than LE. LN1 was the most useful B-cell marker in distinguishing JLI from LE. However, a combination of MT2 and LN1 gave the most significant difference. We conclude that immunohistochemical analysis using a panel of monoclonal antibodies to T and B lymphocytes may be useful in differentiating JLI from LE, although there is still considerable overlap.

Expression and amplification of neu oncogene in pleomorphic adenomas of salivary gland

Amplification of the neu oncogene and overexpression of its product was found to be a potential marker for aggressive biological behavior in breast cancer. However, the expression of the neu oncoprotein in normal breast ducts and myoepithelial cells has also been demonstrated. Hence, we examined normal salivary gland tissue and 15 cases of pleomorphic adenoma for the expression of the neu oncoprotein by immunohistochemistry using two polyclonal antibodies and 12 cases for the amplification of the neu oncogene using slot blot hybridization. Immunohistochemistry in the normal salivary gland revealed positive staining of all ductal cells. In the pleomorphic adenomas all cellular elements stained to a variable degree. The positive staining was seen in the ductal cells, in the solid sheets, and in chondroid, myxoid, and metaplastic foci. The normal salivary gland and 11 of 12 cases of pleomorphic adenoma showed no increase in copy number of the neu oncogene, whereas one case showed threefold amplification. These results indicate that the neu oncoprotein is expressed but the neu copy number is not increased in normal salivary gland epithelium and in most pleomorphic adenomas. The threefold amplification of the gene in one case may indicate an aggressive biological behavior.

Acalculia: an historical review of localization

This article reviews the brain localization of calculation disorders (acalculia) beginning with Gall's claim in the early 19th century for a "center" of calculation. A renewed interest in the subject arose around the time of Henschen during the first quarter of the 20th century. A summary of the cases of acalculia since Henschen leads to the conclusion that regardless of the functional modular nature of calculation ability, there is neither a localized region nor a specific hemisphere uniquely underlying the disorder.

Immunoreactivity of S100 beta in heart, skeletal muscle, and kidney in chronic lung disease: possible induction by cAMP

S100 protein is a calcium-binding protein composed of two subunits S100 alpha and S100 beta, which are expressed selectively by specific cell types. The distribution of S100 beta was examined among various tissues obtained at autopsy from 18 subjects with chronic lung disease and 10 control subjects. The presence of S100 beta in individual cell types was demonstrated by immunoperoxidase staining using polyclonal and monoclonal antibodies specific for S100 beta. In the 10 control subjects, positive staining was seen in a number of cell types that normally produce S100 alpha and S100 beta, (e.g., glial cells, melanocytes, chondrocytes) or only S100 beta, (e.g., Schwann cells). There was no staining of myocardial cells, skeletal muscle fibers, or kidney tubules, which normally produce S100 alpha but not S100 beta. In contrast, in the 18 subjects with chronic lung disease, all of the above cell types stained positively for S100 beta, showing that in these subjects cell types that ordinarily expressed only S100 alpha also expressed S100 beta. We suggest that the observed induction of S100 beta in these cell types seen in subjects with chronic lung disease was mediated by an elevation of cAMP levels secondary to bronchodilator therapy with beta-adrenergic agonists and phosphodiesterase inhibitors.

Heterogeneity in expression of S100 beta mRNA in human melanoma and pleomorphic adenoma demonstrated by in situ hybridization

S100 protein is a widely used immunohistochemical marker for identification of a number of tumors including malignant melanoma and pleomorphic adenoma of the salivary gland. To extend the detection techniques for S100 protein to the level of its mRNA, sections of malignant melanoma and pleomorphic adenoma were hybridized in situ with a 35S-labeled anti-sense RNA probe complementary to the mRNA for the beta subunit of human S100 protein. Both tumors were labeled with the anti-sense RNA probe but not with a sense RNA probe. In addition, sections of normal and tumor tissues which were known not to express S100 protein on the basis of immunohistochemical studies were not labeled with the anti-sense RNA probe. These results established the specificity of the in situ hybridization technique for the detection of S100 protein mRNA. Although most of the tumor cells in both malignant melanoma and pleomorphic adenoma were labeled with the anti-sense RNA probe, unlabeled tumor cells were also present in their vicinity, suggesting there was a heterogeneity among the cells in both tumor types with respect to S100 protein mRNA expression.

Immunohistochemical demonstration of actinically damaged elastic fibers in keratoacanthomas: an aid in diagnosis

The inclusion of elastic fibers within the epithelium of keratoacanthomas is a phenomenon suggested to be an aid in differentiating this lesion from squamous cell carcinoma. Antilysozyme antibodies have recently been noted to stain actinically damaged elastic fibers but not those from sunprotected skin. In this study, 54 keratoacanthomas and 46 squamous cell carcinomas were stained with a histochemical elastic tissue stain and polyclonal antibody to lysozyme using an immunoperoxidase technique. Elastic fibers were demonstrated in keratoacanthomas (37/54, 68%) significantly more often than squamous cell carcinomas (12/46, 26%) (p less than 0.001) using both techniques. This study confirms that the inclusion of elastic fibers occurs significantly more often in keratoacanthomas than squamous cell carcinomas. These elastic fibers were also actinically damaged, suggesting a role for sun damage in the evolution of keratoacanthoma.

Lysozyme in abnormal dermal elastic fibers of cutaneous aging, solar elastosis and pseudoxanthoma elasticum

Staining of elastic fibres with antilysozyme antibodies has been noted previously. In this study, we examined the staining pattern of dermal elastic fibres in aging, solar elastosis, and lesional skin of pseudoxanthoma elasticum (PXE) using an antibody to lysozyme and the indirect-peroxidase technique. To assess the effects of aging, sun-protected skin (buttock) from a younger and an older group of patients was used. Sun damage was studied in skin specimens from varying sun-exposed body regions (trunk; head and neck). No staining was seen in sun-protected skin from younger individuals, whereas sun-protected skin from older persons had scattered positive fibres. Solar elastotic material was intensely positive and the number of positive fibres appeared to correlate with the amount of sun damage. Abnormal elastic fibres in PXE also stained positively, but less intensely, than fibres in solar elastosis. This study shows that changes in the elastic fibres due to degenerative processes or genetic factors results in altered antigenic expression of the fibres. This may be an epiphenomenon secondary to changes in proteoglycans, which are known to occur with solar elastosis and PXE, or may represent an adaptive phenomenon to maintain the elastic properties of the altered fibres or to decrease their antigenicity.

S-100 protein antibodies do not label normal salivary gland myoepithelium. Histogenetic implications for salivary gland tumors

Neoplastically modified myoepithelial cells have a key role in developing the histologic characteristics of some salivary gland tumors. S-100 protein expressed in certain of these tumors is suggested to support this role, as the principal component in the human salivary gland reported to be S-100 protein-positive is myoepithelium. Confirmation of such an important aspect is required. Immunoperoxidase staining of parotid salivary gland shows considerably different patterns obtained with antibodies to S-100 protein, neuron-specific enolase, and neurofilaments compared with those for muscle-specific actin and cytokeratin 14; many more cells and their processes associated with acini and ducts are evident with the latter two antibodies. Double immunofluorescent staining with antibodies to either S-100 protein or neuron-specific enolase combined with muscle-specific actin does not reveal colocalization of these antigens in myoepithelial cells. The former localize only to nerve fibers adjacent to, but separate from, acini, and the latter only to myoepithelial cells. It is apparent that S-100 protein staining of the rich network of unmyelinated nerves in the interstitial tissues, evident ultrastructurally, has been misinterpreted as myoepithelium. This result has important implications for histogenetic classifications of salivary gland tumors.

Distribution and patterns of staining of Neu oncogene product in benign and malignant breast diseases

Amplification of the Neu oncogene (c-erbB-2) has been reported by various researchers as a marker for poor clinical outcome in patients with breast cancer. We have performed immunohistochemical staining using a polyclonal antibody to the Neu oncoprotein on formalin-fixed material from normal breast, benign breast lesions, and 102 stage I node-negative breast cancers. Hybridization studies were also performed on 66 of the breast cancer cases. In the cancers 33% of cases showed positive staining of the in situ and invasive component, whereas only 25% of cases showed amplification of the Neu oncogene. The staining pattern in the tumor cells was cytoplasmic with plasma membrane accentuation. Focal positive cytoplasmic staining was noted in some cases of fibrocystic disease, fibroadenoma, and normal breast duct epithelium. Myoepithelial cells and smooth muscle of blood vessels also showed a positive reaction. This study shows that the Neu oncoprotein can be demonstrated on formalin-fixed material from normal, benign, and malignant breast lesions. In the breast cancers the differences in the number of cases showing amplification and those showing a positive immunohistochemical reaction could be due to increased transcriptional activity. It is possible that the node-negative patients whose tumors express the Neu oncogene may correspond to the group of patients who are expected to have a poor prognosis.

Immunohistochemistry of intravascular papillary endothelial hyperplasia

Intravascular papillary endothelial hyperplasia is an interesting endothelial proliferation, the nature of which has aroused some controversy. Five cases were studied by light microscopy and by immunohistochemistry using antibodies to Factor VIII-related antigen (FVIII-rAg), ferritin, alpha 1-antitrypsin, alpha 1-antichymotrypsin and vimentin and were compared with conventional intravascular organizing thrombi. The results show a similar progression of the immunophenotype of the endothelial cells in both entities: they are initially positive for ferritin, then acquire vimentin positivity and only display FVIII-rAg positivity in advanced ("mature") lesions. This suggests that intravascular endothelial hyperplasia is closely related to organizing thrombi and is probably a peculiar form thereof.

Monoclonal antibody MT1: a marker for Langerhans cell histiocytosis

Langerhans cells and their pathologic counterparts can be identified in paraffin sections using immunohistochemical staining for S-100 protein. This procedure is useful in confirming a diagnosis of Langerhans cell histiocytosis (LCH). However, many other cell types are also positive for S-100 protein. Positive staining for CD1 (Leu 6) supports a diagnosis of LCH, but requires frozen tissue. A panel of antibodies would be desirable in confirming a diagnosis of LCH, particularly if these antibodies could be used on paraffin-embedded material. We studied the pattern of staining for commercially available monoclonal antibodies MT1, MT2, MB2, and LN1, which were originally marketed as lymphocyte markers, using paraffin-embedded tissue sections of cases of LCH. In all 20 cases pathologic Langerhans cells stained positively with MT1 only. Various other S-100 protein-positive lesions were also examined with MT1 and were consistently negative for MT1. Other cutaneous histiocytic and mast cell lesions were positive with MT1, but S-100 protein negative. Our results demonstrate that the monoclonal antibody MT1 serves as an additional marker for LCH and, together with S-100 protein, would make up a diagnostic panel of antibodies for LCH to be used on routine paraffin-embedded sections.

Cystosarcoma phylloides of the breast and its mimics. An immunohistochemical and ultrastructural study

Cystosarcoma phylloides of the breast is a tumor composed of breast ducts and a cellular stromal component that can be benign or malignant. The origin of the stromal cells is controversial. We undertook an immunohistochemical and ultrastructural study of 11 cases of cystosarcoma phylloides to assess the histogenesis of the stromal component. By light microscopy, 4 were diagnosed as benign, and 7 were diagnosed as malignant. Antibodies to vimentin, desmin, actin, high- and low-molecular-weight keratins, and S100 protein were used for immunohistochemical staining. In the 4 benign cases of cystosarcoma phylloides, the stromal cells stained positively only for vimentin. In the malignant tumors, the spindle cell component stained for vimentin in all the cases. In addition, the malignant stromal cells coexpressed desmin in two cases and keratin and S 100 protein in another case. By electron microscopy the stromal component in the benign case and in two of five malignant cases was composed of a mixture of fibroblasts and myofibroblasts. The entire neoplastic stroma in two other malignant cases showed features of smooth-muscle differentiation, whereas in another case all the stromal cells showed myoepithelial differentiation. Thus, in benign and malignant cystosarcoma phylloides, the stromal component consists of a mixture of fibroblasts and myofibroblasts. Leiomyosarcomas and myoepitheliomas can mimic malignant cystosarcoma phylloides, but immunohistochemistry and electron microscopy can differentiate these entities. This is important since their biologic behavior is different.

Nucleolar organizer regions in superficial spreading melanoma with nodule

Nucleolar organizer regions (NORs) are genes coding for the ribosomal RNA; they also induce the formation of the nucleolus at interphase. Transcriptionally active NORs can be visualized in histological sections with a silver colloid method, allowing direct counting of these structures (so-called AgNORs). Seven superficial spreading melanomas with nodule (i.e., melanomas containing both a radial and a vertical growth phase) were studied with the technique. The nuclear AgNOR counts (mean +/- SEM) were 5.44 +/- 1.70 for the radial growth phase and 7.65 +/- 2.35 for the vertical growth phase (P less than 0.01). This difference in mean nuclear AgNOR numbers may be related to other known differences in the biological behavior of the two growth phases.

Primary multilobulated B-cell lymphoma of the breast

Malignant lymphomas with multilobulated nuclei are recently recognized neoplasms. We report a case of multilobulated B-cell lymphoma arising in the breast. The light microscopic, electron microscopic, and immunohistochemical features are described and compared with those of previously reported T- and B-cell multilobulated lymphomas from other sites. A follicular center cell origin of this lymphoma is postulated. To our knowledge, this is the first report of a primary multilobulated lymphoma of the breast.

Palisaded encapsulated neuroma: an immunohistochemical study

Ten palisaded neuromas of the skin were studied immunohistochemically for the presence of S-100 protein, epithelial membrane antigen, neurofilaments, glial fibrillary acidic protein, and positivity with the Leu-7 monoclonal antibody. In all cases, the fascicles of tumor cells were positive for S-100 protein and negative for epithelial membrane antigen; the tumor capsules were negative for the former in all cases but positive for the latter in seven of ten cases. In three lesions, epithelial membrane antigen-positive cells formed sheaths around fascicles of tumor cells. Axons were demonstrated by anti-neurofilament antibody in seven lesions. None of the lesions stained for glial fibrillary acidic protein. All of them showed positivity with the Leu-7 antibody, which stained both tumor spindle cells as well as membranous profiles consistent with myelin sheaths. These results indicate that the tumor is composed of cells of schwannian differentiation whereas the capsule and sheaths surrounding intratumoral fascicles are of perineurial origin. They also indicate the presence of axons, some of which are myelinated. Our findings support the concept of a close relationship between palisaded and traumatic neuroma.

Primary malignant lymphoma of the spleen in systemic lupus erythematosus

Malignant lymphoma has been infrequently reported in the course of systemic lupus erythematosus (SLE). We report a case of primary malignant lymphoma of the spleen, an unusual site of primary lymphoma, complicating the course of systemic lupus erythematosus (SLE). Our patient had been treated with low dose prednisone and hydroxychloroquine only, and her lupus was quiescent at the time of presentation with the lymphoma. Thus primary malignant lymphoma should be considered in the differential diagnosis of splenomegaly in SLE.

Epithelial proliferation in thymic hyperplasia. An immunohistochemical study and correlation with the developing fetal thymus

Thymic hyperplasia is a B-cell lymphoid proliferation in which an epithelial component has not, to our knowledge, been previously described. We present a case of thymic hyperplasia in which numerous lymphoid follicles with germinal centers were partially surrounded by small sheets of spindle and epithelioid cells. Electron microscopy confirmed the epithelial nature of these cells. Immunostaining was performed using antibodies to keratins, S100 protein, and two B-cell markers, LN1 and MB2. The proliferated epithelium stained only for high-molecular-weight keratin, whereas the lymphoid tissue stained positively for both B-cell markers. To determine the origin of the proliferated epithelium, the staining was compared with that of the developing fetal and normal adult thymus. We have shown that during fetal development, the keratin composition of thymic epithelium changes from staining predominantly with low- to high-molecular-weight keratin. The immunostaining characteristics of the epithelium in this case of thymic hyperplasia suggest an origin from adult-type epithelium. Furthermore, the association of S100-positive interdigitating reticulum cells with the proliferated epithelium suggests that it is of medullary origin. Our results indicate that epithelial proliferation can be an important component of thymic hyperplasia.

Monoclonal antibody to a human pancreatic carcinoma cell line recognizes gastrointestinal neoplasms

A monoclonal antibody designated RWP1.1 was produced against a human pancreatic carcinoma cell line RWP1. This antibody was shown to recognize an epitope of carcinoembryonic antigen. The reactivity of the antibody was evaluated on formalin-fixed normal tissues, 86 malignant neoplasms, 10 colonic polyps, and 6 cases of chronic pancreatitis using the peroxidase anti-peroxidase technique. RWP1.1 did not react with normal tissues apart from weak staining of fetal pancreatic ducts. This antibody preferentially reacted with primary and metastatic adenocarcinomas of the colon, stomach, pancreas, and colonic polyps but not with most adenocarcinomas from other sites nor with other types of tumors or cases of chronic pancreatitis. It also reacted with colon adenocarcinomas on frozen sections. The restricted specificity of this antibody could be used in differentiating gastrointestinal adenocarcinomas from other types of tumors including adenocarcinomas from other sites and most pancreatic adenocarcinomas from chronic pancreatitis.