Active cell death induced by the anti-estrogens tamoxifen and ICI 164 384 in human mammary carcinoma cells (MCF-7) in culture: the role of autophagy

Active cell death in hormone-dependent cells was studied using cultured human mammary carcinoma cells (MCF-7) treated with the anti-estrogens (AEs) tamoxifen (TAM), 4-hydroxy-tamoxifen (OH-TAM) or ICI 164 384 (10(-8)-10(-5) M) as a model. The following results were obtained. (i) In untreated MCF-7 cells a wave of replication occurred in the first 5 days of culture. All three AEs caused a dose-dependent inhibition of cell replication. (ii) TAM and OH-TAM at 10(-5) M, but not ICI 164 384, caused lytic cell death (necrosis) within 24 h, which was not inhibited by estradiol (10(-9)-10(-6)M). (iii) Lower concentrations of TAM or OH-TAM (up to 10(-6) M) or ICI 164 384 induced a more gradual appearance of cell death beginning at day 3. This type of cell death was inhibited by estradiol (10(-9) M), indicating its active nature. (iv) Nuclei showed two distinct patterns of alteration: (a) apoptosis-like condensation and fragmentation of chromatin to crescent masses abutting the nuclear envelope; (b) condensation of the chromatin to a single, pyknotic mass in the center of the nucleus, detached from the nuclear envelope. Quantitative histological evaluation revealed the predominance of pyknosis. (v) Biochemical DNA analysis revealed that only a relatively small amount of the total DNA was finally degraded into low molecular weight fragments (20 kb and less). (vi) Active cell death, with both apoptotic and pyknotic nuclear morphology, was associated with extensive formation of autophagic vacuoles (AV).3-Methyladenine, a known inhibitor of AV formation, partially prevented cell death as detected by nuclear changes. (vii) ICI 164 384 was about 10 times more effective than TAM or OH-TAM at inhibiting DNA synthesis, but had equal potency in inducing active cell death. It is concluded that AEs have anti-proliferative and anti-survival effects on MCF-7 human mammary cancer cells in culture. These two effects are under separate control because they differ by kinetics, dose dependence and sensitivity to the various AEs. Active cell death in MCF-7 cells seems to be initiated by autophagy, in contrast to concepts of apoptosis, and thus corresponds to autophagic/ lysosomal or type II death as previously defined. This may be important because of biochemical and molecular differences between these various subtypes of active cell death.

[Polipoid melanoma]

Polypoid melanoma is a less known aggressive variant of nodular melanoma. It is characterised by earlier manifestation, exophytic growing, more frequent secundary alteration and whorse prognosis. On the basis of clinical and histological data of 14 patients, authors present characteristics of polypoid melanoma its differential-diagnosis and draw attention to the stressed importance of clinical diagnosis and treatment.

Cutaneous gangrene due to hyperparathyroidism secondary to chronic renal failure (uraemic gangrene syndrome)

Cutaneous and subcutaneous gangrene are serious sequelae of secondary or tertiary hyperparathyroidism which may accompany chronic renal failure. Based on analysis of the present typical case and a retrospective survey of similar cases in the literature, we propose the term 'uraemic gangrene syndrome' for this association. These skin lesions in chronic renal failure patients represent the most serious clinical manifestation of calciphylaxis, a condition originally described by Selye. The appearance of early skin lesions should be regarded as an indication for subtotal parathyroidectomy. The association of cutaneous gangrene with vascular calcification was first described by Bryandt and White in 1989, and was termed by these authors as 'gangrenous calcification'. A total of 80 cases of this rare complication of chronic renal disease had been reported up to early 1994. A retrospective review of these reports has strongly suggested a close interrelationship between renal failure, secondary hyperparathyroidism, vascular calcification and cutaneous gangrene. The present report concerns a characteristic case to draw attention to this syndrome which is accompanied by serious, predominantly cutaneous, changes.

Role of active cell death (apoptosis) in multi-stage carcinogenesis

Active cell death is a genetically encoded self-destruction of a cell. There occur morphologically different types of active cell death, e.g. apoptosis in the liver or autophagic cell death in human mammary carcinoma cells after tamoxifen treatment (Pre)neoplastic lesions in rat liver exhibit enhanced rates of apoptosis, which tend to increase with increasing malignancy. Tumor promoters and non-genotoxic carcinogens inhibit active cell death, thereby increasing the accumulation of (pre)neoplastic cells and accelerating the development of cancer. On the other hand promoter withdrawal, fasting or application of negative growth signals such as transforming growth factor beta 1 (TGF beta 1) enhance apoptosis and can lead to selective regression of preneoplastic lesions or tumors.

Scedosporium apiospermum infection imitating lymphocutaneous sporotrichosis in a patient with myeloblastic-monocytic leukaemia

A 63-year-old man with a history of myeloblastic-monocytic leukaemia developed partly suppurating cutaneous nodules on the lower left leg. The nodules proceeded to spread in a linear fashion up the limb, following the line of the lymphatic drainage. Mycological examination of a skin biopsy demonstrated Scedoporium apiospermum. This case highlights the potential for Scedosporium species to act as opportunistic infections in immunosuppressed humans.

Role of endocrine factors in male infertility

On the evidence of physical examination, history, and semen analysis, endocrinological alteration is suspected in the background of infertility in about one third of the husbands of couples consulting a doctor because of childless marriage. The data of 206 male patients have been processed, and in 71 cases the serum FSH, LH, prolactin and testosterone contents were examined. Statistical analysis was performed for the relationship between gonadotropic hormones and testosterone level, and between the sperm motility and the FSH level, the results of which are presented here.

[Chronic renal failure with acquired perforating dermatosis]

A 50-year-old male patient suffering from renal failure was maintained in a stable condition by means of dialysis for 6 years. Hyperkeratotic papules appeared on his extremities. Histological investigation confirmed the diagnosis of perforating collagen disease. The dermatoses that are characterized by transepithelial elimination and associated with renal failure are discussed. The authors consider that the acquired perforating dermatoses should be regarded as a single entity.

Active cell death: role in hepatocarcinogenesis and subtypes

Active cell death, the genetically programmed self-destruction of a cell, is now recognized to be a widespread phenomenon in biology that counterbalances mitosis to preserve tissue homeostasis. It is subject to the control of the growth regulatory networks in tissues. Close examination of the morphology of dying cells in liver and other tissues suggests that there are a number of morphological types of active cell death, ranging from forms dominated by nuclear changes and without signs of autophagy ("classical" apoptosis), e.g., in thymocytes and the liver, to those dominated by autophagic degradation of cytoplasm, e.g., in the mammary gland. The induction of gene expression in these diverse types of cell death is anticipated to be different. Here we review the data regarding the regulation of apoptosis in the liver by liver tumor promoter, transforming growth factor beta-1 and related peptides as well as nutrition. In the course of hepatocarcinogenesis, initiated cells as well as preneoplastic and neoplastic cell populations showed enhanced cell replication, but also enhanced apoptosis. Tumor promoter shift the balance between birth and death by increasing the rate of cell replication and by decreasing the rate of apoptosis. Thereby, liver tumor formation is accelerated. Food restriction exhibits the opposite effect and consequently, provides protection from carcinogenesis.

[Scedosporium apiospermum infection in a patient with myelomonocytic leukemia presenting as lympho-cutaneous sporotrichosis]

63 year old patient is presented with myelo-monocytic leukemia, in whom subcutaneous nodules developed at the lower limb, spreading along the lymph vessels, and partly ulcerating. By mycologic investigation Scedosporium apiospermum was disclosed. Attention is drawn to human infections brought about by opportunistic Scedosporium species.

Bacillary angiomatosis in a patient with lymphocytic leukaemia

A 78-year-old man, who suffered from chronic lymphocytic leukaemia and diabetes mellitus, but was human immunodeficiency virus (HIV)-negative, developed disseminated angiomatous papules following a cat scratch. Bacillary angiomatosis was diagnosed by light and electron microscopic demonstration of the causative bacteria in the vascular lesions. The lesions resolved completely when he was treated with erythromycin. This case demonstrates that bacillary angiomatosis can be an important cutaneous manifestation of immunodeficiency in individuals who are not infected with the human immunodeficiency virus.

[Significance of skin manifestations in current medical diagnosis]

Skin lesions may signify not only cutaneous diseases, but also pathological changes of inner organs or standing of systemic diseases. The cutaneous symptoms characteristically associated with internal diseases are known as dermatodromes. The author analyzes the general impact of these on up-to-date medical diagnostic work, with special regard to their unique role in the early diagnosis of many important organic diseases, as well as to their significance for disease prognosis and therapy.

[Bacillary angiomatosis]

In a 78 years old patient with chronic lymphoid leukemia, diabetes mellitus a cat scratch induced disseminated angiomatous papules were observed. In the lesions great number of bacilluses were observed with light -and electron microscope. As a result of antibiotic treatment the lesions regressed without trace. This opportunist infection resulting general symptoms as well, may be regarded as a cutaneous manifestation of immunodeficiency. The adequate antibiotic treatment depends on the exact diagnosis.

Systemic lupus erythematosus with pigmented skin

The authors present the case of a thirty-six-year-old woman with systemic lupus erythematosus with specific vesiculobullous symptoms. Degos dermal infarcts and Schönlein-Henoch-type purpura was observed in the course of her illness. Attention is drawn to the rarity of this symptom group, which has not been documented in previous publications. Degos lesions accompanying the systemic lupus erythematosus were benign. The effectiveness of sulfone in the treatment of vesiculobullous symptoms in this case is noted.

Waldenström's macroglobulinaemia presenting with cold urticaria and cold purpura

A case of Waldenström's macroglobulinaemia presenting with non-specific dermatological symptoms (cold urticaria and cold purpura) is described in a 37-year-old female patient. Progressive telangiectasia and spider naevi were also observed. Involvement of the skin may be explained by the presence of macroglobulins with cryoprotein-like qualities. This facilitated an early diagnosis.

[Waldenstrm macroglobulinemia presenting in the form of cold urticaria and cold purpura]

A Waldenström macroglobulinemia case, manifested in the form of non-specific skin-symptoms (cold urticaria and cold purpura) is described in a 37 years old female patient. As new skin-symptoms progressive telangiectasia and naevi aranei could be observed. Involvement of skin may be explained by macroglobulins with kryoprotein properties, making early diagnosis possible at the same time.

[Sneddon syndrome (livedo and cerebrovascular lesion)]

A typical syndrome going on with skin (livedo racemosa generalisata) and brain (ischemic vascular) involvement is presented. Symptoms of skin and nervous system are made known in detail, as well as possibility of early diagnosis and standpoint of treatment.

[Role of Chlamydia trachomatis in diseases of the urogenital system]

The authors carried out 402 examinations to detect Chlamydia trachomatis. The agent was detected by serological methods. The cultivation and serological methods proved to give significant results. Doxycyclin and Eryc capsules were successful in the therapy. The great number of positive chlamydia cases suggest to focus attention on detecting the agent on the therapy and on the prevention of the spreading of infection.

[Cutaneous gangrene secondary to nephrogenic hyperparathyroidism]

Ischemic cutaneous gangrene is described in a 44 years old woman-patient, which could be attributed to metastatic calcinosis developed on account of secondary hyperparathyroidism. Recovery was obtained by subtotal parathyroidectomy, as well as by local treatment. For naming of the characteristic syndrome mentioned above, "uremic gangrene syndrome" is recommended.

[Secondary hyperparathyroidism manifesting as cutaneous gangrene in a patient on hemodialysis (uremic gangrene syndrome)]

Ischaemic cutaneous gangrene is described in a 44-year-old female patient. It was found to be attributable to metastatic calcinosis following secondary hyperparathyroidism. Recovery was obtained by means of subtotal parathyroidectomy combined with local treatment. The designation "uremic gangrene syndrome" is recommended for this characteristic syndrome.

[Anti-androgen treatment of hirsutism with cyproterone acetate]

22 female patients suffering from idiopathic hirsutism were treated according to Hammerstein's reversed sequential scheme over 12 months. During each treatment cycle of 21 days, the daily medication consisted of 1 coated tablet containing 0.035 mg ethinyl estradiol and 2 mg cyproterone acetate (Diane-35); in addition, the patients received one i.m. injection of 300 mg cyproterone acetate (Androcur-Depot) on the first day of each cycle. This therapy resulted in improvement of the disease in 19 of our patients (86.4%). The transitory, mild side effects observed did not require interruption of the treatment. The reversed sequential scheme making use of the depot form of CPA can successfully be administered in patients with hirsutism.

[Gardner syndrome]

A syndrome going with skin-bone signs and precancerous gastrointestinal polyposis is presented. Interest of our case is given by the extension of polyposis onto the whole digestive canal, early appearances of abdominal signs accompanying polyposis, and as a new symptom polycystic lung and extended superficial naevus lipomatosus.