Reproducibility of major diagnoses in a binational study of lung cancer in uranium miners and atomic bomb survivors

A binational panel of four Japanese and four American pathologists examined 208 pulmonary neoplasms, according to the World Health Organization (WHO) recommendations, second edition, for the histologic typing of lung tumors. The study design included independent evaluations by pathologists working alone, followed by group reviews. The individual evaluations, and their implications for reproducibility of the WHO recommendations, are reported. Consensus (agreement by six or more pathologists) with respect to major (ie, first digit) diagnosis was obtained for 76.4% of the cases. Consensus was obtained for 72.5% of the cases with any major diagnosis of small cell cancer; the comparable figures for adenocarcinoma and squamous cell carcinoma were 56% and 48%, respectively. American pathologists were twice as likely as Japanese pathologists to diagnose large-cell cancer, the only significant national difference. Consensus was far less frequent with the minor (ie, second digit) diagnosis categories. This study shows that lung cancers continue to be difficult to classify reproducibly.

A novel biological aspect of ovarian oxytocin: oxytocin gene expression in cumulus/luteal cells and the effect of oxytocin on embryogenesis in fertilized oocytes

Recently, several reports have demonstrated the presence of oxytocin (OT) in the corpus luteum of mammalian species. However, the biological role of ovarian OT remains obscure. This study was performed to examine OT gene expression in cumulus cells of mice and humans, and in human corpus luteum, and the role of OT in early embryogenesis. OT gene and OT mRNA were analyzed by reverse transcription-polymerase chain reaction, with single-strand-conformation polymorphism and heteroduplex procedures. OT-treated in-vitro-fertilized mouse oocytes were cultured and the rate of blastocyst development estimated. An immunohistochemical study was also carried out to detect OT on the surface of the mouse oocytes.

p53 mutations in lung cancers from non-smoking atomic-bomb survivors

Tobacco smoke contains many carcinogens and has been linked with the development of lung cancer. We sequenced the conserved regions of the p53 tumour suppressor gene in lung cancers from 17 non-smokers from Hiroshima, Japan; 9 were atomic-bomb survivors. The mutations were predominantly transitions (all G:C to A:T); there were no G:C to T:A transversions. By contrast, lung cancers from 77 Japanese smokers have a predominance of G:C to T:A transversions in which the guanine residues occur on the non-transcribed DNA strand. These findings further implicate tobacco smoke carcinogens in the molecular pathogenesis of lung cancer.

Proliferative and nonproliferative breast disease in atomic bomb survivors. Results of a histopathologic review of autopsy breast tissue

BACKGROUND

The risk of female breast cancer in association with radiation dose is well established, on the basis of follow-up studies of the atomic bomb survivors and other exposed populations. This association is especially strong for women exposed before 20 years of age and appears to be much weaker among women exposed after 40 years of age.

METHODS

Breast tissue samples from 88 high-dose and 225 low-dose autopsy cases from the Radiation Effects Research Foundation Life Span Study sample were examined in detail to determine whether nonproliferative and proliferative breast lesions are associated with radiation dose.

RESULTS

Prevalence of proliferative disease in general and atypical hyperplasia in particular were positively associated with radiation dose. The associations were strongest for subjects who were between 40 and 49 years of age at the time of the bombing.

CONCLUSIONS

It is hypothesized that the strongest association in women 40 to 49 years of age may be related to the age dependence of radiation-induced breast cancer, in that potential cancers induced in this age group by radiation exposure may receive too little hormonal promotion to progress to frank cancers.

Radiation-associated lung cancer: a comparison of the histology of lung cancers in uranium miners and survivors of the atomic bombings of Hiroshima and Nagasaki

A binational panel of Japanese and American pulmonary pathologists reviewed tissue slides of lung cancer cases diagnosed among Japanese A-bomb survivors and American uranium miners and classified the cases according to histological subtype. Blind reviews were completed on slides from 92 uranium miners and 108 A-bomb survivors, without knowledge of population, sex, age, smoking history, or level of radiation exposure. Consensus diagnoses were obtained with respect to principal subtype, including squamous-cell cancer, small-cell cancer, adenocarcinoma, and less frequent subtypes. The results were analyzed in terms of population, radiation dose, and smoking history. As expected, the proportion of squamous-cell cancer was positively related to smoking history in both populations. The relative frequencies of small-cell cancer and adenocarcinoma were very different in the two populations, but this difference was accounted for adequately by differences in radiation dose or, more specifically, dose-based relative risk estimates based on published data. Radiation-induced cancers appeared more likely to be of the small-cell subtype, and less likely to be adenocarcinomas, in both populations. The data appeared to require no additional explanation in terms of radiation quality (alpha particles vs gamma rays), uniform or local irradiation, inhaled vs external radiation source, or other population difference.

Lack of tumorigenicity of aminopyrine orally administered to B6C3F1 mice

To test the tumorigenic potential of aminopyrine, an antipyretic analgesic, it was administered in drinking water at levels of 0 (control), 0.04 and 0.08% to 50 male and 50 female B6C3F1 mice for 100 weeks, and the mice were subsequently maintained without aminopyrine for a further 4 weeks. The most frequent types of tumor, in both treated and control groups, were hepatocellular tumor in male mice and malignant lymphoma/lymphoid leukemia in female mice. No statistically significant differences were observed in the incidences of these tumors between treated and control groups. The incidences of several other tumors in male and female mice also showed no statistically significant differences between treated and control groups. Therefore, no tumorigenic effect of orally administered aminopyrine in B6C3F1 mice was apparent in the present study.

Tumorigenicity study of sodium erythorbate administered orally to mice

Sodium erythorbate (SE) was administered at concentrations of 0, 1.25, or 2.5% (maximum tolerated dose, MTD) in the drinking-water to groups of 50 male B6C3F1 mice respectively. Female groups, each consisting of 50 mice, received SE in the drinking-water at concentrations of 0, 2.5 or 5% (MTD). Treatment continued for 96 wks and the experiment was terminated during wk 110. Tumors were observed at various sites including the liver, hematopoietic system, lung and soft tissue. However, at any of the sites, the tumor incidence, the time to death with tumors or the histological distribution of tumors did not differ significantly from those in the untreated control group. Thus, the present study did not demonstrate a tumorigenic effect of SE on B6C3F1 mice by means of oral administration.

Duodenal gangliocytic paraganglioma with lymph node metastasis in a 17-year-old boy

A case of duodenal gangliocytic paraganglioma (DGP) in a 17-year-old boy is presented. In this case a lymph node in the peripancreatic region was involved by a metastatic tumor. A review of the literature on DGP indicates that this case represents the youngest patient and is the second case of DGP with metastasis. Immunohistochemical staining for neuron-specific enolase (NSE), neurofilament (NF), pancreatic polypeptide, and somatostatin showed positive results for epithelioid and ganglion-like cells, whereas spindle cells showed immunoreactivities for S-100 protein, NSE, and NF. The histogenesis of DGP is discussed.

Mesonephric duct hyperplasia of the uterus. Report of two cases and three other cases of mesonephric duct remnant with findings of mucin histochemistry and lectin binding immunohistochemistry

Two cases of mesonephric duct hyperplasia of the uterus, together with three cases of uterine mesonephric duct remnant, are reported. The latter cases were identified by serial transverse sectioning of 42 surgically resected uteri, yielding a frequency of approximately 7%. Histochemical studies showed no mucin in the cytoplasm of cells lining the mesonephric duct remnant, as well as mesonephric duct hyperplasia. In contrast, the endocervical epithelium had abundant neutral mucin, sialomucin and sulfomucin. Immunohistochemical studies on lectin binding showed positive binding of PNA and SBA lectins only to the lining cells of mesonephric duct hyperplasia.

Duodenal gangliocytic paraganglioma with lymph node metastasis in a 17-year-old boy

A case of duodenal gangliocytic paraganglioma (DGP) in a 17-year-old boy is presented. In this case a lymph node in the peripancreatic region was involved by a metastatic tumor. A review of the literature on DGP indicates that this case represents the youngest patient and is the second case of DGP with metastasis. Immunohistochemical staining for neuron-specific enolase (NSE), neurofilament (NF), pancreatic polypeptide, and somatostatin showed positive results for epithelioid and ganglion-like cells, whereas spindle cells showed immunoreactivities for S-100 protein, NSE, and NF. The histogenesis of DGP is discussed.

[Effects of combined instillation of dapiprazole and epinephrine on human anterior chamber depth, intraocular pressure and pupil diameter]

Pilocarpine, a first choice drug for primary angle closure glaucoma (PACG), is reported to produce shallow anterior chamber and posterior synechia and consequently a small immobile pupil. In this paper, dapiprazole, a newly synthesized alpha 1 blocker, was given topically in combination with epinephrine eye drops to 15 healthy volunteers and 10 patients with PACG. In both volunteers and patients, the treated eyes revealed deeper anterior chambers, thinner lenses and significant IOP reduction after the combined instillation of dapiprazole and epinephrine. Though light reaction was preserved, mild miosis was observed in volunteers, but no pupillary change in patients. The conjunctival hyperemia induced by dapiprazole was reversed by additional instillation of epinephrine. Burning sensation was the only side effect observed after instillation of dapiprazole. In conclusion, the combined instillation of dapiprazole and epinephrine appears to be a good choice for the therapy of PACG.

Involvement of the nipple in early carcinoma of the breast

Cancerous involvement of the nipple and subareolar tissue (nipple and areolar complex, NAC) was confirmed histopathologically in 24 of 65 patients with gross tumors measuring 2.5 centimeters or less. Erosion of the nipple as a clinical manifestation of involvement of NAC was seen in only two patients. The other 22 were all subclinical. The histologic form of involvement of NAC included intraductal-1 in 19 patients, stromal in one patient, lymphatic in two patients and intraductal-1 as well as stromal in two. Stepcut and serial observation of the whole breast suggested that both intraductal spread and stromal invasion of carcinoma were continuous processes from the underlying tumor. Involvement of NAC was more frequent if the patient was aged 50 years or less and if the proximity of the tumor to the nipple was less than 4 centimeters, regardless of the size of the tumor.

Incidence of female breast cancer among atomic bomb survivors, Hiroshima and Nagasaki, 1950-1980

Ascertainment of breast cancer incidence among the cohort of the RERF Life Span Study extended sample identified 574 breast cancers among 564 cases diagnosed during 1950-1980 of which 412 cancers were reviewed microscopically. There were no dose-dependent differences with respect to diagnostic certainty or histological type. As in previous studies, the dose response appeared to be roughly linear and did not differ between the two cities. The most remarkable new finding was the emergence of a radiation-related excess among women under 10 years of age at exposure. The risk of radiogenic breast cancer appears to decrease with increasing age at exposure, whether expressed in relative or absolute terms. These results suggest that exposure of female breast tissue to ionizing radiation at any time during the first four decades of life, even during the premature stage, can cause breast cancer later in life, and that the length of time that tumor promoters such as endogenous hormones operate following exposure has an important influence on the development of radiation-induced breast cancer. An unresolved question is whether breast cancer risk is increased by radiation exposure at ages older than 40.

Malignant and benign ovarian neoplasms among atomic bomb survivors, Hiroshima and Nagasaki, 1950-80

For 1950-80, 194 ovarian cancer cases were ascertained among the 70,030 females of the Radiation Effects Research Foundation's Life-Span Study E-85 sample, and 106 autopsied cases with benign ovarian neoplasms were ascertained among all 3,046 autopsies performed in the same sample. On the basis of microscopic review, 66% of the cancer and 84% of the benign tumor cases were classified by histologic type. The age-adjusted ovarian cancer incidence rates showed a statistically significant increase with increased exposure dose, both in the entire exposed group (P less than .01) and in the microscopically reviewed subset (P less than .01). This dose response was only significant (P less than .01) in the latter half of the study period, 1965-80. The radiation effect was higher in the younger age group at the time of the bomb (ATB) for the specific attained age or was adjusted for attained age. In general, relative risk (greater than or equal to 100 rad vs. 0 rad) did not differ by attained age, except for the youngest age group, less than 20 years old ATB, where the relative risk tended to decrease with increased attained age, although cases were few in number and follow-up study was necessary. Estimated minimum latent period for radiation-induced ovarian cancer seemed to be 15-20 years. The proportion of autopsied cases with benign ovarian tumor increased with increasing exposure dose, both in the entire series of cases (P less than .05) and in the microscopically reviewed subset. Statistical significance, however, was not achieved in the latter group (P greater than .10). The distribution of histologic types of both cancer and benign tumor of the ovary did not vary significantly with radiation dose. The data are consistent with the hypothesis that radiation injury of the ovaries and secondary excess of gonadotropic hormones are important causative factors in the development of ovarian neoplasms.

An altered lectin binding to mucus glycoprotein in goblet cells of human tracheobronchial epithelium among former mustard-gas workers

Lectins, which are well known to have an ability to bind with specific carbohydrate residues of glycoprotein, have been used to examine cellular changes associated with malignant transformation. For the analysis of mucus glycoprotein of goblet cells in the tracheobronchial epithelium, 192 paraffin-embedded sections from 54 autopsy cases including the cases with a history of mustard-gas (MG) exposure were stained with seven plant lectins using PAP method. PNA binding with no neuraminidase treatment as well as BSA-1 binding was observed most frequently in MG-exposed lung cancer cases. The proportion of cases positive for SBA binding in MG-exposed and/or lung cancer cases had a statistical difference from non-MG-exposed non-lung cancer cases. These observations may indicate a large heterogeneity in oligosaccharide chains of mucus glycoprotein and suggest its incomplete or abnormal synthesis, which is most likely to be due to previous exposure to carcinogen, such as MG.

[Fibrocystic disease of the breast in autopsy cases with special reference to the age frequency distribution of epithelial hyperplasia and its relation to liver cirrhosis]

A histological examination of 306 breast tissues taken consecutively from autopsied Japanese women aged from 12 to 104 during the period between 1973 and 1984, excluding breast cancer cases, was undertaken. Two peaks at the ages of 40 to 44 and 55 to 59 were seen in the age-frequency distribution of fibrocystic disease (FCD), blunt duct adenosis (BDA), and duct papillomatosis (DP). There was no significant difference in the frequency of FCD, BDA, and apocrine metaplasia between the cases of liver cirrhosis and those without any hepatic disorders (controls). On the other hand, DP was seen more frequently and in higher degree in those with liver cirrhosis as compared with controls.

Early cancer and related lesions in the bronchial epithelium in former workers of mustard gas factory

The bronchial epithelium in stepwise transverse sections was examined histologically in 66 male autopsy cases, composed of the groups of 19 mustard gas (MG) ex-workers with lung cancer, 17 MG ex-workers with non-lung cancer, 10 non-MG lung cancer cases, and 20 non-MG non-lung cancer cases. Foci of moderate or severe atypical cellular lesion or dysplasia, or of carcinoma in situ (CIS) in total slides of each group, were counted as 146 in 3,485, 72 in 2,226, 70 in 3,797, and 18 in 4,611, respectively. The relative frequency of moderate or severe dysplasia and CIS in MG exposed non-lung cancer cases resembled that found in lung cancer cases of both MG and non-MG exposed. Seven CIS lesions were detected from among all MG-exposed cases and one CIS was found in a non-MG lung cancer case. Six out of eight CIS examples were adjoined by dysplasia. A multi-variate analysis revealed a significant correlation between the incidence of atypical lesions and MG exposure, though the incidence of atypical lesions was also influenced significantly by age, smoking, and chronic bronchitis. The incidence of atypical lesions was significantly higher in cases of squamous cell lung cancer than those of other histological types, particularly small cell cancer.

Tumorigenicity study of disodium glycyrrhizinate administered orally to mice

Disodium glycyrrhizinate (DG) was administered at concentrations of 0.15 (maximum tolerated dose), 0.08, 0.04 or 0% in the drinking-water to groups of 50, 70, 60 and 60 male B6C3F1 mice, respectively. Female groups, each consisting of 50 mice, were given DG in the drinking-water at concentrations of 0.3 (maximum tolerated dose), 0.15, 0.08 or 0%. Treatment was continued for 96 wk and the experiment was terminated at wk 110. There was no difference between treated and control groups in tumour incidence, in the latent period before tumours appeared or in the distribution of different types of tumour. Thus the long-term oral administration of DG to mice did not yield any evidence of chronic toxicity or tumorigenicity.

Tumorigenicity study of butyl and isobutyl p-hydroxybenzoates administered orally to mice

Butyl p-hydroxybenzoate (n-BHB) and isobutyl p-hydroxybenzoate (i-BHB) were administered orally to ICR/Jcl mice at concentrations of 0.6 (maximum tolerated dose), 0.3 or 0.15% in the diet for up to 102 wk. Tumours were observed at various sites including the haematopoietic system, the lung and the soft tissue. However, at none of the sites did the tumour incidence or the time to death with tumours differ significantly from that in the untreated control group.

[Early cancer and related changes in the bronchial epithelium of former mustard gas workers]

The bronchial epithelium taken in stepwise transverse sections was examined histologically in 66 autopsy cases, composed of groups consisting of 19 mustard gas (MG) ex-workers with lung cancer, 17 MG ex-workers with non-lung cancer, 10 non-MG lung cancer cases, and 20 non-MG non-lung cancer cases. An additional 5 surgical lung cancer specimens removed from MG ex-workers were also examined. From these groups, foci of moderate or severe atypia including cellular atypia, dysplasia and carcinoma in situ (CIS), detected in the total number of slides for each autopsy group, were counted as 146 out of 3,485, 72 out of 2,226, 70 out of 3,797, and 18 out of 4,611, respectively. Seven CIS lesions were detected from among all MG-exposed cases and 1 CIS lesion was found in a non-MG lung cancer case. Six of these occurred with dysplasia and 4 were associated with early invasion. Among 62 autopsy cases with known smoking histories, multivariate analysis revealed a significant correlation between the incidence rate of atypia and MG exposure only in non-lung cancer cases: the incidence rate of atypia was also influenced significantly by smoking and age. Among lung cancer cases, the incidence rate of atypia was significantly higher (p less than 0.01) in cases of squamous cell carcinoma than those of small cell carcinoma.

Histologic review of breast cancer cases in survivors of atomic bombs in Hiroshima and Nagasaki, Japan

A panel of Japanese and American pathologists reviewed existing histologic material used to study breast cancer risk among the A-bomb survivors in Hiroshima and Nagasaki, a population in which incidence studies have found a strong relationship between breast cancer risk and radiation dose. The primary charge to the panel was to define a body of confirmed cases in the Life Span Study sample of the Radiation Effects Research Foundation that would require little or no review for inclusion in future studies of breast cancer incidence. Broad agreement on histologic type was reached for 298 of 300 confirmed cases. The distribution of histologic types was, overall, similar to that seen in other studies of breast cancer in Japanese women, and did not appear to depend on dose; thus radiation-induced breast cancer appeared to be no different histologically from other breast cancer. Also, no evidence was found of variation in histologic type by city, age at exposure, age at diagnosis, or calendar time.

Findings of myoepithelial cells in human breast cancer. Ultrastructural and immunohistochemical study by means of anti-myosin antibody

Detailed light and electron microscopic, and immunohistochemical observations were made on the distribution and morphological characteristics of myoepithelial cells in the 53 cases of breast cancer. In non-invasive carcinoma, myoepithelial cells in the normal duct were found to be remaining at the outer margin of the cancer nests, but neoplastic myoepithelial cells were not detected in the carcinoma tissue. In invasive carcinoma, a small number of fluorescence-weakly-positive cells could be observed in more than 50% of medullary-tubular carcinoma, in all cases of papillary-tubular carcinoma, and two of three cases of invasive lobular carcinoma. Almost all of these cells were ultrastructurally intermediate cells which have the morphological characteristics of both epithelial cell and myoepithelial cell. Fluorescence-positive cells were observed in all cases of scirrhous carcinoma. Moreover, these cells showed a stronger fluorescence than that of other types of carcinoma and were ultrastructurally more similar to normal myoepithelial cell. The tumor cells having myoepithelial characteristics in invasive carcinoma showed a stronger tendency for arranging at the margin of carcinoma nests in contact with the stroma. The results of the present study indicate that in invasive carcinoma of the breast, neoplastic myoepithelial cells could be demonstrated together with ductal epithelial cells and as to its histogenesis, there is a possibility that breast cancer develops from common stem cells which have the ability of differentiating into both epithelial and myoepithelial cell because of the presence of intermediate cells.

Estrogen-producing adrenocortical carcinoma. A light and electron microscopic study

A case of adrenocortical carcinoma with feminization seen in a man aged 35, is reported. The levels of estron (E1) and estradiol (E2) in the venous blood draining the tumor were high, and it was confirmed by in vitro assay of tumor cells taken from the primary tumor of the left adrenal gland that the tumor produced estrone. The light microscopic examination demonstrated that the primary tumor was composed of mixture of large cells with pleomorphic nuclei and vacuolated cytoplasm and uniform cells with ovoid nuclei and eosinophilic cytoplasm. The electron microscopic examination on the latter cells revealed numerous large and irregularly shaped mitochondria with mostly tubular or lamellar and occasionally vesicular cristae and electron-dense matrix, well-developed smooth-surfaced endoplasmic reticulum in the cytoplasm. However, lipid droplets and lysosomes or lipofuscin granules were scanty. From these findings, it is suggested that cells of the present tumor have characteristics of those in the zona reticularis of the adrenal cortex as well as in the fetal cortex, and the functional property of this tumor is well correlated with its morphological features.