Laminin receptor in lymph node negative breast carcinoma

BACKGROUND

Expression of 67 kD laminin binding protein, 67LR, is reported to be associated with invasive and metastatic phenotypes in several types of human malignancies. In mammary carcinomas, however, the biologic role of 67LR has been less clear. The authors explored the potential biologic significance of expression of 67LR in 148 patients with axillary lymph node negative breast carcinoma.

METHODS

Formalin fixed, paraffin embedded histologic sections were immunohistochemically evaluated for 67LR using monoclonal antibody MLuC5. The staining results were correlated with morphologic data as well as with estrogen receptor content and p53 product accumulation.

RESULTS

There were statistically significant correlations between positivity for 67LR and lower histologic grade (P = 0.003), lower nuclear grade (P = 0.002), positivity for estrogen receptor (P = 0.003), and lack of p53 abnormality (P < 0.001). Expression of 67LR had no independent effect on the disease free or overall survival of lymph node negative patients with breast carcinoma. Nevertheless, in the subgroup of 67LR positive patients, positivity for estrogen receptor was associated with significantly longer overall survival (P = 0.008).

CONCLUSIONS

The data from this study suggest that tissue expression of 67LR, as detected by antibody MLuC5, is associated with better differentiated, less aggressive forms of axillary lymph node negative breast carcinoma.

Suppression of human prostate cancer cell growth by forced expression of connexin genes

The cell-to-cell channels in gap junctions, formed of proteins called connexins (Cxs), provide a direct intercellular pathway for the passage of small signaling molecules (< or = 1 kD) between the cytoplasmic interiors of adjoining cells. It has been proposed that alteration in the expression and function of Cxs may be one of the genetic changes involved in the initiation of neoplasia. To elucidate the role of Cxs in the pathogenesis of human prostate cancer (PCA), the pattern of expression of Cx alpha 1 (Cx43) and Cx beta 1 (Cx32) was studied by immunocytochemical analysis in normal prostate and in prostate tumors of different histological grades. While normal prostate epithelial cells expressed only Cx beta 1, both Cx alpha 1 and Cx beta 1 were detected in PCA cells. The Cxs were localized at the cell-cell contact areas in normal prostate and well-differentiated prostate tumors; however, as prostate tumors progressed to more undifferentiated stages, the Cxs were localized in the cytoplasm, followed by an eventual loss in advanced stages. Thus, epithelial cells from prostate tumors showed subtle and gross alterations with regard to expression of Cx alpha 1 and Cx beta 1 and their assembly into gap junctions during the progression of PCA. Retroviral-mediated transfer of Cx alpha 1 and Cx beta 1 into a Cx-deficient human PCA cell line, LNCaP, inhibited growth, retarded tumorigenicity, and induced differentiation, and these effects were contingent upon the formation of gap junctions. In addition, the capacity to form gap junctions in most Cx-transduced LNCaP cells was lost upon serial passage. Taken together, these findings indicate that the control of proliferation and differentiation of epithelial cells in prostate tumors may depend on the appropriate assembly of Cx beta 1 and Cx alpha 1 into gap junctions and that the development of PCA may involve the positive selection of cells with an impaired ability to form gap junctions.

Cytologic characteristics of meningeal carcinomatosis: increased diagnostic accuracy using carcinoembryonic antigen and epithelial membrane antigen immunocytochemistry

BACKGROUND AND OBJECTIVES

Traditionally, the diagnosis of meningeal carcinomatosis has been based on clinical suspicion and confirmed by cytologic study of cerebrospinal fluid. However, routine cytologic study may fail to detect malignant cells in a relatively large number of cases. We used immunocytochemistry in an attempt to increase the sensitivity of cytologic detection of malignant neoplasms in cerebrospinal fluid.

MATERIALS AND METHODS

Thirty-eight consecutive cerebrospinal fluid specimens from patients with clinically suspected meningeal carcinomatosis were selected for this study. Immunocytochemistry for carcinoembryonic antigen and epithelial membrane antigen were used on the archival Papanicolaou-stained cerebrospinal fluid preparations.

RESULTS

Of the 23 specimens from patients with proven meningeal carcinomatosis, 13 were correctly diagnosed using cytomorphologic criteria alone. The diagnosis of malignant neoplasm in 8 cytologically suspicious and 1 cytologically negative specimen was confirmed using immunocytochemistry. All cases that were negative on follow-up were also negative cytologically and immunocytochemically.

CONCLUSIONS

We conclude that in using common antibodies, such as carcinoembryonic antigen and epithelial membrane antigen, the sensitivity of the cytologic diagnosis of meningeal carcinomatosis increases, and that previously Papanicolaou-stained preparations are suitable for immunocytochemical studies.

Detection of p53 gene abnormality by sequence analysis of archival paraffin tissue. A comparison with fresh-frozen specimens

This parallel study was designed to compare the sensitivity and specificity of detection of point mutations in fresh-frozen and formalin-fixed, paraffin-embedded breast cancer tissue. Sequence analysis of exon 5 of p53 gene was performed on polymerase chain reaction-amplified DNA from 25 infiltrating ductal carcinomas of the breast. Four tumor showed mutations with identical base substitutions in their respective codons of both frozen and paraffin-embedded specimens. We conclude that subtle genetic alterations can be detected in archival paraffin tissue with an accuracy comparable to that of fresh-frozen histologic samples.

Surgically defined prognostic parameters in patients with early cervical carcinoma. A multivariate survival tree analysis

BACKGROUND

This study was performed to identify a statistical combination of independent pathologic and clinical features that best predict 5-year disease free survival (DFS) in patients with early stage cervical carcinoma treated by radical hysterectomy. The main goal of the study was to identify subsets of patients based on risk factors with maximal differences in DFS.

METHODS

Three hundred and seventy patients were found for whom complete clinical and pathologic material, including cone and cervical biopsies, were available for analysis. Variables studied included age, weight, race, marital status, economic status, tumor size (TS), depth of invasion (DI), lymph-vascular space involvement (LVSI), cell type, tumor grade, lymph node metastasis (LNM), and number of lymph nodes removed. Patients with LNM, parametrial involvement, and positive or close surgical margins were offered postoperative radiation. After excluding patients with microinvasive and small cell carcinoma, data from the remaining 301 patients were submitted to univariate and multivariate analyses to define those variables that best predict DFS.

RESULTS

Univariate analysis showed that, ranked by degree of significance, DI, TS, LVSI, LNM, tumor volume (TV) and clinical stage were significant in predicting survival. Significant (P < 0.05) single parameters and other variables considered important were chosen for multivariate analysis, including the creation of a survival tree. With this method, DI (< or = 6 mm and > 2 cm), LVSI, age (> or = 40 yrs), and LNM were found to be the best combination of risk factors to define prognosis.

CONCLUSIONS

The multivariate survival tree analysis maximally separates patients with early stage invasive carcinoma of the cervix into 3 subgroups with 5-year DFS of 91%, 68%, and 43%, respectively. The authors excluded patients with microinvasive carcinoma (SGO, Society of Gynecologic Oncologists), who have an excellent DFS of 100%, and patients with small carcinoma, who have a poor DFS of 36.4% based on cell type alone, to define independent risk factors that maximally separate the remaining patients by DSF. The survival tree prognostic scoring system is easy to apply, and only requires DI (mm), LVSI (+, -), LNM, and age to assign an individual patient to one of three risk groups.

Cathepsin D in host stromal cells, but not in tumor cells, is associated with aggressive behavior in node-negative breast cancer

One hundred fifty-four axillary lymph node-negative invasive ductal carcinomas of the breast were immunohistochemically evaluated for the expression of cathepsin D. Formalin-fixed paraffin sections of each tumor were stained using a polyclonal antibody raised against recombinant procathepsin D. Cathepsin D content of tumor cells and host histiocytes and fibroblasts within or immediately at the invasive border of tumors were assessed separately and correlated with histomorphology, estrogen-receptor content, and patients' survival data. Positive cathepsin D staining of tumor cells was associated with a lower nuclear grade and well-differentiated histology, whereas moderate to strong staining of host cells correlated with larger tumor size, higher nuclear grade, poorly differentiated histomorphology, and lack of estrogen-receptor (ER) protein. No statistically significant correlation was found between cathepsin D in tumor cells and survival. There was, however, a statistically significant correlation between moderate to strong cathepsin D staining of host cells and shorter disease-free and overall survivals. Expression of cathepsin D by host cells, however, did not have an independent influence on survival. The authors conclude that cathepsin D in stromal cells, but not in tumor cells, is associated with aggressive behavior in node-negative invasive ductal carcinomas of breast. Furthermore, determination of cathepsin D in cytosolic extracts of tumors is of no practical value because it may represent cathepsin D content of tumor cells, intratumoral host cells, or both.

Efficacy of radical hysterectomy as treatment for patients with small cell carcinoma of the cervix

BACKGROUND

This study was performed to identify pathologic and clinical features that best predict disease free survival of patients with early stage small cell carcinoma of the cervix treated by radical hysterectomy.

METHODS

Three hundreds and seventy patients with cervical carcinoma were analyzed retrospectively to define those variable that best predict disease free survival (DFS). Variables included age, weight, race, marital status, economic status, tumor size, depth of invasion (DI), lymph-vascular space involvement (LVSI), cell type, tumor grade, lymph node metastasis (LNM), and total number of lymph nodes removed. Patients with lymph node metastasis, parametrial involvement, and positive or close surgical margins were offered postoperative radiation.

RESULTS

Twelve patients were found to have small cell carcinoma (3.2%). One patient had microinvasive carcinoma of the cervix (MIC) as defined by the Society of Gynecologic Oncologists with a depth of invasion of 3 mm or less and no lymph-vascular space invasion, and has been reported previously. A detailed analysis of the other patients with nonsmall cell carcinoma is presented separately. Five patients achieved a DFS of at least 5 years, whereas 7 patients died with disease. Excluding the patient with MIC, the 5-year DFS rate was 36.4%.

CONCLUSIONS

Relative to other cell types, small cell carcinomas of the cervix is an aggressive neoplasm with a higher rate of LVSI and LNM despite smaller DI and tumor size. These data suggest that multimodality therapy, combining radical surgery and radiation with cytotoxic chemotherapy, may provide these patients with the best chance for cure.

Uterine polypoid hemangioendothelioma: conservative treatment

BACKGROUND AND OBJECTIVE

A polypoid uterine hemangioendothelioma was treated by conservative means.

STUDY DESIGN/MATERIALS AND METHODS

The diagnosis of hemangioendothelioma was confirmed by histopathology and angiography. The patient desired to retain her fertility; therefore, the hemangioendothelioma was treated by hysteroscopically guided Nd:YAG laser ablation.

RESULTS

Five years of follow-up by hysteroscopy and dilation and curettage reveal no evidence of recurrence. The patient continues to have regular menses.

CONCLUSION

Conservative management of a uterine hemangioendothelioma by Nd:YAG laser ablation was successful over 5 years of follow-up.

Prognostic factors of early stage cervical cancer treated by radical hysterectomy

BACKGROUND

This study was performed to identify pathologic and clinical features that best correlate with lymph node metastasis and disease free survival among patients with Stage I and II cervical cancer treated by radical hysterectomy.

METHODS

Three hundred-seventy patients with complete clinical information and pathologic material, including cone and cervical biopsies, were selected for analysis. Of these patients, 301 with clinical stages I and II disease were the subject of this paper. The results of patients with microinvasive carcinoma of the cervix, as defined by the Society of Gynecologic Oncologists (depth of invasion < or = 3 mm and no lymph node vascular space invasion), were reported previously and excluded from this analysis. Patients with small cell carcinoma of the cervix were found to have a very poor prognosis (disease free 5-year survival of 36%) and were also excluded from this analysis (Sevin BU, Nadji M, Metkoch MW, Lu Y, Averette HE. Unpublished data, 1995). Variables studied were patient age, weight, race, marital status, and economic status; tumor size; depth of invasion; lymph node-vascular space involvement; cell type; tumor grade; lymph node metastasis; and number of lymph nodes removed. The influence of these variables on survival was examined by univariate analysis with use of Cox's regression model and the log rank test for comparison of survival curves.

RESULTS

Factors that predict disease free survival, ranked by degree of significance, were depth of invasion, tumor size, lymph node-vascular space invasion, number of positive nodes, tumor volume, clinical stage, and tumor extension to the vagina or surgical margins.

CONCLUSIONS

Radical hysterectomy and bilateral lymphadenectomy is standard therapy for patients with Stage IB and IIA carcinoma of the cervix. A variety of surgically defined risk factors predict 5-year disease free survival, and many of these factors are related. Identification of independent risk factors requires a multivariate analysis of data.

Retrospective c-erbB-2 immunostaining in aspiration cytology of breast cancer

Fifty fine-needle aspiration cytologies of breast that were diagnosed as carcinomas were retrieved from the files and retrospectively evaluated for the expression of c-erbB-2 oncoprotein using standard immunocytochemical methods. Corresponding histologic sections of all tumors were similarly studied. Seventeen fine-needle aspirates (34%) reacted positively for the presence of c-erbB-2 oncoprotein. All but one (32%) of the corresponding tissue sections were also positive for c-erbB-2 by immunohistochemistry. All positive cases were infiltrative ductal carcinomas with a preponderance of the comedo type. Positive reactions were localized in the cytoplasmic membrane of tumor cells. The staining was either present in all cells throughout a tumor, or it was completely absent. We conclude that immunocytochemistry for c-erbB-2 oncoprotein can be performed on fine-needle aspiration cytology samples that are previously fixed and stained with the Papanicolaou technique. Furthermore, the sensitivity of immunostaining results are comparable to that obtained in histologic sections.

Ganglioneuroma of the prostate. A novel finding in neurofibromatosis

Urinary tract involvement in neurofibromatosis is relatively rare. We report a previously undescribed (to our knowledge) form of involvement of the prostate gland by ganglioneuroma in this syndrome.

Fine-needle aspiration cytology of palpable lesions of the lower female genital tract

During January 1978 through May 1989, 232 fine-needle aspirations of palpable lesions of the vulva, vagina, inguinal area, and perineum were performed on 209 women. Five samples were considered inadequate for cytologic evaluation. Eighty-seven (38.3%) aspirates were interpreted as malignant, 80 of which were further classified into specific cell types. Most malignant neoplasms represented metastases from other gynecologic organs. Of the 140 (61.7%) nonmalignant aspirates, only 28 (20%) could be categorized into specific pathologic disorders. The false-positive and false-negative rates were 0 and 4.6%, respectively. We conclude that, because of its safety, simplicity, and accuracy, fine-needle aspiration cytology represents a valuable diagnostic tool in the evaluation of palpable lesions of the lower female genital tract. This technique is particularly helpful in the assessment of primary, metastatic, or recurrent malignant neoplasms of this region.

Cell proliferative activity and mutation of P53 suppressor gene in human gestational trophoblastic disease

Cell proliferative activity and the overaccumulation of P53 suppressor gene were evaluated in 26 cases of gestational trophoblastic disease and five cases with normal placentae. Formalin-fixed, paraffin-embedded histological sections were used for immunohistochemistry, utilizing the avidin-biotin-peroxidase technique and antibodies to PCNA (proliferative cell nuclear antigen) and to P53 (product of suppressor gene). Positive reactions for PCNA were graded from 1+ to 3+ (1(+)-less than 10% of cells; 2(+)-10-50%; 3(+)-more than 50%). Eight of 10 cases of choriocarcinoma (80%) showed moderate to strong reactivity for PCNA (2+ and 3+). All 9 cases with hydatidiform mole and 6 of 7 cases with partial mole also demonstrated 2+ and 3+ reactions for PCNA. There was minimal or no PCNA staining in the trophoblastic cells of normal placentae. Five of 10 cases with choriocarcinoma (50%) exhibited P53 overaccumulation as did 7 of 9 cases with hydatidiform mole (78%). In hydatidiform moles, P53 staining was limited to the areas of trophoblastic proliferation separate from chorionic villi. None of the partial moles or normal placentae showed P53 overaccumulation. It is concluded that the cell proliferative activity of choriocarcinomas as well as complete and partial hydatidiform moles are comparable. On the other hand, the mutation of P53 suppressor gene, as demonstrated by the overaccumulation of P53 protein, is seen only in true trophoblastic neoplasms, namely, choriocarcinomas and hydatidiform moles.

Adenosquamous carcinoma of the cervix: prognosis in early stage disease treated by radical hysterectomy

The prognosis of adenosquamous carcinoma of the cervix compared to the pure cell types of this disease is a controversial issue. Survival rates vary widely among published series, with some authors finding the prognosis to be much worse and others finding it to be equal. We have studied a group of 290 patients, all of whom had the diagnosis of stage IB or IIA cervical cancer, and all of whom were treated by radical hysterectomy and bilateral pelvic and paraaortic lymphadenectomy. The pathology specimens were reviewed for every case. Median follow-up for all living patients was 73 months. Forty-five patients (15.5%) had adenosquamous histology, 220 (75.9%) had squamous cell, and 25 (8.6%) had adenocarcinoma. By X2, there was no significant difference among the three groups with regard to race, economic status, number of grade 3 lesions, number with positive pelvic lymph nodes, number with positive margins, stage distribution (IB vs IIA), or number of recurrences. Using Student's t test, there was no significant difference between any combination of two groups with regard to mean patient age, mean depth of invasion, or mean tumor size. Estimated disease-free survival and overall survival were not different among the three cell types. We conclude that for early stage cervical cancer treated by radical hysterectomy, the adenosquamous cell type does not carry a worse prognosis than either of the pure cell types.

Localization of metallothionein in breast carcinomas. An immunohistochemical study

Metallothionein (MT) is a cysteine-rich, low molecular weight protein that binds zinc, copper, and cadmium. It is present in a number of normal cells including hepatocytes particularly during fetal and early postnatal life. It has been suggested that developmental profile of MT is similar to other oncofetal gene products and hence, it could be used as a marker for aggressive tumour behaviour. In order to test that hypothesis, we used a monoclonal antibody to MT and immunohistochemically evaluated formalin-fixed, paraffin-embedded tissues from 79 breast carcinomas. In non-neoplastic breast tissue, a strong nuclear and cytoplasmic staining was observed in myoepithelial cells. Positive staining for MT was present in 35 (44%) of breast carcinomas. In most positive cases, nuclear, or both nuclear and cytoplasmic staining was seen. All positive tumours were invasive ductal carcinomas, including a medullary and a metaplastic carcinoma. None of the mucinous, lobular, or intraductal papillary carcinomas reacted for MT. A statistically significant association was found between MT immunostaining and histological grade (P < 0.01) as well as with nuclear grade (P < 0.01). We also observed an inverse relationship between MT staining and oestrogen receptor content of tumours (P < 0.01). Similarly, a statistically significant association was found between moderate and strong MT immunostaining and decreased overall survival and shorter disease-free survival (P < 0.01). MT immunostaining was also predictive of a worse prognosis in the subgroup of lymph node negative (P < 0.001) and oestrogen receptor negative patients (P < 0.01). No statistically significant association was found between MT staining and size of tumour or the presence of lymph node metastasis. We conclude that MT staining may be a useful marker of less differentiated and more aggressive carcinomas of the breast.

Microinvasive carcinoma of the cervix

BACKGROUND

Microinvasive carcinoma of the cervix (MIC) has been poorly defined in the past and is still a focus of persistent controversy. In 1985, the International Federation of Gynecology and Obstetrics (FIGO) defined Stage IA as "preclinical invasive carcinoma, diagnosed by microscopy only," subdividing it into Stage IA1 or "minimal microscopic stromal invasion," and Stage IA2 or "tumor with invasive component 5 mm or less in depth taken from the base of the epithelium and 7 mm or less in horizontal spread." In 1974, the Society of Gynecologic Oncologists (SGO) defined MIC as any lesion with a depth of invasion of 3 mm or less from the base of the epithelium, without lymphatic or vascular space invasion.

METHODS

To assess the risk of lymph node metastasis and treatment failures, pathologic material and clinical data on 370 patients with Stage I carcinoma of the cervix, who were treated by radical hysterectomy and pelvic-aortic node dissection, were reviewed. Histopathologic analysis of tumors was based on a uniform format, including measurement of the maximum depth of invasion, the width and length of the horizontal tumor spread, invasive growth pattern, cell type, tumor grade, and lymphatic or vascular space involvement.

RESULTS

Of the 370 patients, 110 had a depth of invasion of 5 mm or less. Of these, 54 patients fulfilled the SGO definition of MIC; 42, the new FIGO Stage IA2 definition; and 27, both definitions. None of the patients with MIC, as defined by either the SGO or the new FIGO Stage IA2, had lymph node metastases or tumor recurrence. These data support the conclusion that MIC, defined by either the SGO or FIGO definitions, have a low risk for lymph node metastasis or recurrent carcinoma. A review of the literature indicated a recurrence rate for Stage IA2 of 4.2%. In addition to depth of invasion, lymph vascular space invasion is a better predictor of lymph node metastasis and recurrence than the surface dimension.

CONCLUSIONS

The authors recommend adoption of the SGO definition of MIC. Patients with a depth of invasion of 3 mm or less without lymph vascular space invasion safely can be treated conservatively.

Vulvar Paget's disease. Is immunocytochemistry helpful in assessing the surgical margins?

From January 1977 to December 1988, 19 patients with biopsy-proven Paget's disease of the vulva underwent simple or radical vulvectomy at the University of Miami/Jackson Memorial Medical Center. All vulvectomy specimens were evaluated immunocytochemically for the expression of carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA) and low-molecular-weight keratins 8 and 18 (LMK), both in areas containing neoplastic cells and in histologically negative surgical margins. Neoplastic Paget's cells stained positively for CEA in all cases; they were positive for EMA and LMK in 18 and 17 cases, respectively. In all eight cases with underlying in situ or invasive carcinomas, CEA, EMA and LMK were localized in the underlying tumors as well. None of the histologically proven negative margins reacted for CEA, EMA or LMK on immunocytochemistry. CEA appears to be a valuable immunocytochemical marker for extramammary Paget's disease; EMA and LMK are also expressed by the majority of such cases. None of these markers, however, is of added value in identifying Paget's cells in surgical margins if those margins appear negative on routine hematoxylin-and-eosin staining.

Special report. Immunocytochemistry in diagnostic cytology: a 12-year perspective

In recent years immunocytochemistry has become an important addition to diagnostic cytology. Its routine application in cytology, however, has not yet reached the practical levels it has achieved in diagnostic histopathology. This review examines the values and limitations of immunocytochemistry in diagnostic cytology and addresses some of the most common technical and analytical factors that can affect the outcome of the procedure.

[Immunohistochemistry in the diagnosis of gynecologic neoplasms]

This survey presents the practical application of immunohistochemistry additional to clinical anamnesis and histology (HE staining) in the differential diagnosis of morphologically similar lesions. First of all, the algorithmic approach for immunohistological diagnosis of undifferentiated or non-classifiable malignant neoplasias of the female genital tract is described and the significance of immunohistochemistry for the differential diagnostic discrimination and the histogenesis of organ-specific gynaecological neoplasias is re-assessed.

Tumor markers in gynecologic neoplasms

The applications of tumor markers and steroid receptors in gynecologic neoplasms are described. The value of immunohistologic techniques in the histogenetic assessment of gynecologic neoplasms is examined. Approaches to the diagnosis of similar-appearing lesions are presented.

A monoclonal antibody which identifies an antigen in endothelial cell and epithelial basement membrane

We isolated a monoclonal antibody which decorates the endothelial cells of normal and lymphatic vessels in formalin-fixed, paraffin-embedded tissue. In addition, the antibody recognizes a previously undescribed substance found in the basement membrane zone and subbasement membrane zone of a variety of epithelial. By ELISA assay, the antigen recognized by this monoclonal antibody is not laminin, type IV collagen or fibronectin. This antibody may be used as a diagnostic tool because it identifies an epitope in neoplasms differentiating towards endothelial cell such as angiosarcoma and Kaposi's sarcoma.

Distribution and physical properties of BCA200, a Mr 200,000 glycoprotein selectively associated with human breast cancer

Of 122 mouse monoclonal antibodies selective for human breast cancer, 13 immunoprecipitated an acidic glycoprotein from SK-Br-3 and ZR-75-30 human breast cancer cells. The antigen (BCA200) migrates with an apparent molecular weight of 200,000 on reducing and 180,000 on nonreducing sodium dodecyl sulfate-polyacrylamide gel electrophoresis, suggesting a single polypeptide chain with a folded domain stabilized by a disulfide bond. Cross-blocking and sandwich immunoassays detected at least three distinct antigenic determinants on BCA200. Scatchard experiments measured 1,000,000 to 5,000,000 antigen copies per SK-Br-3 cell. The tissue distribution of BCA200 was studied using two monoclonals to different epitopes. Neither antibody stained any cells in human blood. When frozen sections of 20 normal human tissues were immunoperoxidase stained, the only positive structures were mucinous glands of colon, transitional epithelium of bladder, sweat glands of skin, and acinar epithelium of breast. Antibody 454C11 stained 16 of 21 breast tumor frozen sections and 9 of 12 breast cancer cell lines, while antibody 520C9 stained 5 of 20 breast tumors and 4 of 10 breast cancer lines. Cross-reaction was observed with lung, prostatic, pancreatic, endometrial, and ovarian cancer, but not with lymphoma, melanoma, colon, stomach, bladder, or esophageal cancer. When conjugated to ricin A chain, 10 of 13 antibodies produced immunotoxins selectively cytotoxic to SK-Br-3 breast cancer cells.

Histologic markers in primary and metastatic tumors of the liver

To investigate the value of different tissue markers in the histologic diagnosis of hepatic tumors, we performed immunoperoxidase stains for alpha-fetoprotein (AFP), alpha-1-antitrypsin (AAT), carcinoembryonic antigen (CEA), and an erythropoiesis-associated antigen (ERY-1) on formalin-fixed, paraffin-embedded samples from 107 primary and metastatic tumors of the liver. AFP was present in 17% of the hepatocellular carcinomas, in 7% of the metastatic carcinomas, and in none of the cholangiocarcinomas. AAT was present in 41% of the hepatocellular carcinomas, in 37% of the cholangiocarcinomas, and in 50% to 70% of the metastatic carcinomas of the liver. Intracytoplasmic CEA was found in 75% of the cholangiocarcinomas, in 92% to 100% of the metastatic carcinomas, and in only one of the mixed hepatocellular-cholangiocarcinomas. ERY-1 was present in 89% of the hepatocellular carcinomas, whereas none of the cholangiocarcinomas or metastatic carcinomas stained for this marker. We conclude that immunohistochemical assays for AFP and AAT are of limited value in the differential diagnosis of hepatic tumors. However, immunohistochemical stains for ERY-1 and CEA can be valuable in differentiating hepatocellular carcinomas from metastatic tumors.

C-cell hyperplasia in thyroid tissue adjacent to follicular cell tumors

An immunohistochemical study was conducted on the number and distribution of C-cells in the nonneoplastic thyroid tissue adjacent to tumors of follicular cell origin. It consisted of 49 cases, of which 25 were papillary carcinomas, 22 were follicular adenomas, and 2 were follicular carcinomas. Twenty normal adult thyroids from the Broward's Medical Examiner's morgue served as controls. In 17 of the 49 cases (34.6%), there was a statistically significant increase in the number of C-cells in the normal-appearing thyroid tissue adjacent to follicular cell tumors, with at least 50 C-cells in one low power field, while only one of 20 normal thyroids had a similar number of cells. (P = .02; chi 2 = 5.05). In two tumor cases there were more than 100 C-cells in several low power fields with formation of small C-cell nodules similar to those described in the type II Multiple Endocrine Neoplasia Syndrome (MEN). It was concluded that the nonneoplastic thyroid tissue adjacent to 34.6% of tumors with follicular cell phenotypes contains significantly more C-cells than those present in normal adult thyroids. The possible pathogenesis and clinical significance of these findings are discussed.

Laparoscopically directed fine needle aspiration for the diagnosis of hepatocellular carcinoma: a safe and accurate technique

Although ultrasonography and computerized tomography have been useful in the diagnosis of hepatocellular carcinoma, the extent of metastases and the presence of cirrhosis are not identified by these techniques before surgery. We studied 27 cases of presumptive hepatocellular carcinoma by means of laparoscopy and fine needle aspiration. Fine needle aspirates provided positive diagnoses of hepatocellular carcinoma in all patients. Laparoscopy complements imaging studies and allows selection of patients amenable to hepatic resection.