Serum CA 125 concentrations in patients with benign ovarian tumours

Serum CA 125 concentrations have been measured in 115 patients with histologically confirmed nonmalignant pelvic disease, that is, serous cystadenoma (n = 56), mucinous cystadenoma (n = 14), fibroma (n = 33), thecoma (n = 8), and Brenner tumour (n = 4). Increased CA 125 concentrations (> 35 KU/L) were found in 14 patients, with a range of 46-891 KU/L, a mean of 205 KU/L, and a median of 97 KU/L. The highest values were found in patients with ascites. Serial measurements in one patient showed a fall in the 2 days immediately after surgery, over the next 3 days showing a two- to three-fold increase, followed by a slow return to normal over the next 7 weeks. Elevated CA 125 levels may not indicate ovarian malignancy and do not differentiate between benign and malignant pelvic masses.

CD-34 is expressed by a distinctive cell population in peripheral nerve, nerve sheath tumors, and related lesions

The pattern of CD-34 antigen (human progenitor cell antigen) immunoreactivity was studied within normal nerve, and a variety of nerve sheath and neuroectodermal tumors. Besides normal nerves, 111 soft tissue tumors were studied, including 17 neurofibromas, 10 neurilemomas, 12 malignant peripheral nerve sheath tumors, 1 melanocytic schwannoma, 21 fibroblastic lesions, 31 fibrohistiocytic lesions, seven neuroectodermal lesions, and 10 miscellaneous tumors. CD-34-positive dendritic cells were consistently identified within the endoneurium of normal nerve, all neurofibromas, dermatofibrosarcomas, and Antoni B (but not Antoni A) areas of neurilemomas. CD-34 was not expressed in the majority (eight of 10 cases) of malignant peripheral nerve sheath tumors. CD-34 was also lacking in all fibroblastic lesions (nodular fasciitis, fibromatosis, keloid, fibrosarcoma) and in neuroectodermal tumors that are not generally considered to show true nerve sheath differentiation (neurotropic melanoma, clear cell sarcoma, neuroepithelioma). We conclude that CD-34 (or a closely related epitope) defines a normally occurring nerve sheath cell that appears to be cytologically and immunophenotypically distinct from a fibroblast and conventional Schwann cell. The antigen can also be localized to benign nerve sheath tumors, but tends to be lost in malignant ones. The consistent presence of CD-34 within all 13 cases of dermatofibrosarcoma protuberans can be used as evidence in support of the view that these lesions are variants of nerve sheath tumors, and distinct from benign fibrous histiocytomas which consistently lack the antigen. Finally, expression of CD-34 by one of three giant cell fibroblastomas reinforces the close relationship between this tumor and dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans is a unique fibrohistiocytic tumour expressing CD34

Dermatofibrosarcoma protuberans (DFSP) is a slow growing, locally invasive tumour whose differentiation from other fibrohistiocytic tumours sometimes poses serious diagnostic problems. We investigated CD34 expression immunohistologically in various fibrohistiocytic tumours including dermatofibroma, DFSP, malignant fibrous histiocytoma (MFH), infantile myofibromatosis, fibrosarcoma, hypertrophic scar and keloid. Among these, DFSP was unique in that tumour cells themselves expressed CD34, whereas in other tumours. CD34 expression was observed only on vascular endothelial cells amongst the tumour cells. Until now, there have been no reports of useful immunohistological markers for DFSP. CD34 expression by the tumour cells can be an extremely useful marker in establishing a definitive diagnosis of DFSP.

Expression of HLA-A,B,C, beta 2-microglobulin (beta 2m), HLA-DR, -DP, -DQ and of HLA-D-associated invariant chain (Ii) in soft-tissue tumors

Non-neoplastic mesenchymal cells, along with 33 benign and 87 malignant soft-tissue tumors (STT) were examined for expression of HLA-A,B,C, beta 2-microglobulin (beta 2m), HLA-DR, -DP, and -DQ molecules and the HLA-D associated invariant chain (Ii). Serial frozen sections were immunostained using monoclonal antibodies (MAbs) to monomorphic framework determinants of HLA sublocus products, beta 2m and Ii, and to CD53, a recently defined broadly distributed pan-leucocyte molecule. Compared with the normal state, an induction/neo-expression of HLA-A,B,C/beta 2m was found in a considerable number of tumors of muscle, peripheral nerve, cartilage-forming, adipose, and vascular tissues. Conversely, some tumors of fibrous origin and of autonomic ganglia showed an abnormal abrogation/loss of HLA-A,B,C/beta 2m with respect to their cells of origin. Small, round tumor cells present in various types of STT exhibited a heterogenous pattern of expression of these molecules with a preponderance of HLA-A, B,C/beta 2m-negativity. HLA-D/Ii determinants were rarely detectable in STT. Besides their expression in some fibrohistiocytic tumors, they were only occasionally found in tumors of smooth-muscle, peripheral-nerve and vascular origin as well as in one clear-cell sarcoma. In all tumors but one, there was no microtopographic association between HLA-D/Ii-positive tumor cells and inflammatory cells. CD53 allowed discrimination between dendritic interstitial cells (DIC) and neoplastic cells and additionally revealed that, in contrast to other solid tumors, STT are generally characterized by an extreme scarcity of lymphohistiocytic infiltrates. Our data indicate that, aside from very rare exceptions, aberrant induction or abrogation of MHC molecules in STT occurs in the absence of lymphohistiocytic stromal infiltrates, suggesting that these alterations might not be a consequence of local cytokine effects.

Combined immunohistochemical study of tissue polypeptide antigen and cancer antigen 125 in human ovarian tumours

An indirect immunoperoxidase method was used to study the expression of tissue polypeptide antigen (TPA) and cancer antigen 125 (CA 125) in 47 benign and malignant ovarian tumours. Tissue polypeptide antigen and CA 125 antigen were expressed respectively in 22 (73%) and 16 (53%) of the 30 adenocarcinomas and in five (29%) and four (23%) of the 17 benign tumours. Co-expression of TPA and CA 125 antigen occurred in 12 (40%) malignant and four (23%) benign tumours. Ultrastructurally, TPA and CA 125 antigens were located at the cell surface and microvillous surfaces. Evaluation of combined TPA and CA 125 antigen results revealed a remarkable improvement in the positivity rate and a significant decrease (P less than 0.05) in the negativity rate of ovarian carcinomas as compared with the result of each one separately. These findings provide complementary evidence for the previous results on the plasma levels of TPA and CA 125 antigen and suggest that specific combinations of tumour markers may be more effective for the diagnosis and monitoring of ovarian carcinomas, than the use of any single marker.

Bovine serological response to a recombinant BPV-1 major capsid protein vaccine

Four of five groups of Holestine by Angus calves (5 calves/group) were immunized with different formulations of a recombinant BPV-1 DNA vaccine using a BPV-1 major capsid:B-galactosidase fusion protein as the immunogen. Group 5 was not vaccinated. Vaccinated calves received the vaccine on days 0 and 21 of the trial, and calves from all five groups were challenged intradermally with 10(10) BPV-1 particles at each of two different sites on day 56. All calves were bled on days 3, 24, 55, 77, and 104 of the trial, and the sera were tested for reactivity with intact and disrupted BPV-1 particles by ELISA. At the time of challenge with BPV-1 virions (day 56), 19 of 20 vaccinated calves were seropositive for disrupted BPV-1 particles; sera from 3 of 20 calves reacted with intact BPV-1 virions. By day 77, 11 of 19 vaccinated calves had developed antibody titers to intact BPV-1 virions; only 1 calf in group 5 developed antibodies (transiently) against BPV-1 capsid epitopes. After challenge, 24 of 25 calves from the five groups developed intradermal fibromas, the biological end point of this study. Fibromas appeared to increase in size in group 5 (unvaccinated, inoculated controls), whereas most tumors from the four vaccinated groups (1-4) stabilized or decreased in size. Although the calves developed fibromas, 90% of calves (in groups 1-4) developed antibodies against disrupted BPV-1 capsid proteins whereas 58% developed antibodies that reacted with intact virions. The immunologic response of vaccinated calves to intact and disrupted BPV-1 particles appeared to be determined in large part by the various formulations of the vaccine, particularly the adjuvant.

Infantile digital fibromatosis. Immunohistochemical and ultrastructural observations of cytoplasmic inclusions

Using antibodies against actin, tubulin, and intermediate filaments immunohistochemical studies were performed on a nodule from an 8-month-old girl with infantile digital fibromatosis. None of the antibodies significantly stained the cytoplasmic inclusion bodies, which were a distinct morphologic feature of this fibromatosis. This result is in contrast to a previous report that stated that the inclusions were composed chiefly of actin filaments. In ultrastructural term, the tumor cells were morphologically consistent with cells in myofibroblasts. The inclusions consisted of packed fibrillar and granular substances. Cultured cells containing inclusions identical to those seen in the original tumor mimicked a growth pattern in vivo. Scanning electron microscopy showed that cultured cells had thin foot processes containing many microspikes. Detergent-treated preparations examined by transmission electron microscopy displayed a microtrabecular meshwork characterized by three, major cytoskeletal domains with many actin cables. Cultured cells showed a normal karyotype.

Papillomavirus genomes in experimentally induced fibromas in white-tailed deer

Cutaneous fibromas of white-tailed deer were transmitted successfully to 5 young deer. Serial biopsy specimens of the induced lesions were analyzed for white-tailed deer papillomavirus, using Southern blot hybridization. Viral genomes were found in all specimens taken 1 to 7 weeks after inoculation and, in some cases, from specimens of the inoculation site obtained later. Viral DNA was found before histologic evidence of fibroblast proliferation and persisted in low copy number, compared with viral DNA of naturally developing fibromas.

"Clear cell" atypical fibroxanthoma

An 87-year-old man with extensive solar damage presented with a 2-month history of a dome-shaped, crusted lesion on the dorsum of the left hand. Microscopically, the tumor consisted of fascicles of spindle cells with bizarre nuclei and clear, vacuolated cytoplasm. Histochemical, immunohistochemical, and ultrastructural features supported the diagnosis of atypical fibroxanthoma. There was no evidence of metastatic disease. The lesion was completely excised, and there has been no recurrence in 3 months of observation. This unusual "clear cell" variant of atypical fibroxanthoma must be distinguished from other clear cell tumors, such as metastatic renal cell carcinoma, clear cell eccrine carcinoma, and clear cell sarcoma (malignant melanoma) of soft parts. Although atypical fibroxanthoma is usually cured by complete surgical excision, metastases have been reported.

Atypical fibroxanthoma of the skin: a clinicopathological and immunohistochemical study and a discussion of its histogenesis

The morphological and immunohistochemical characteristics of 37 atypical fibroxanthomas of the skin were examined. Twenty-four tumours were nodular ulcerative lesions on the head and face of patients with a median age of 75 years, whereas 13 tumours occurred on the trunk and limbs of patients with a median age of 48 years. Both pleomorphic polygonal and giant cells as well as the spindle cell component of the tumours stained for the histiocytic markers alpha 1-antichymotrypsin, alpha 1-antitrypsin, lysozyme and, less frequently, for ferritin. Leu M1 antigen and peanut agglutinin receptors were not demonstrable in tumour cells. This antigenic profile was contrasted with the findings in six cases of dermatofibroma which were largely not reactive with the antisera used. The immunohistochemical findings in atypical fibroxanthomas suggest that they represent a homogeneous group of tumours which are related to tissue histiocytes. These results are discussed in the context of the published findings in other so-called fibrohistiocytic tumours including dermatofibrosarcoma protuberans and malignant fibrous histiocytoma. The diagnoses in three cases coded as atypical fibroxanthomas were revised on the basis of their showing a different immunohistochemical profile.

Pseudosarcomatous fibromyxoid tumor of the urinary bladder

The light-microscopic, immunohistochemical, and ultrastructural features of two examples of a pseudosarcomatous fibromyxoid tumor of the urinary bladder are reported. Both patients were women, 56 and 52 years old. Gross hematuria was the chief complaint and occurred for two days and two weeks, respectively, before presentation. Cystoscopy revealed a 2 X 1 X 1 cm mass located at the dome in case 1 and a 4 X 3 X 3 cm mass at the left posterior lateral wall in case 2. Microscopically, the lesions were composed of spindle, plump, or stellated fibroblast-like cells embedded in myxoid stroma with little collagen; mitotic figures were about 2 per 10 high-power fields, and both cases showed encroachment of the superficial muscle bundles. Because of bizarre spindle cell proliferation, occasional mitoses, and invasion to the underlying muscle, these lesions were initially diagnosed as embryonal rhabdomyosarcoma. However, follow-up examination disclosed the benign nature of these lesions. There was no previous instrumentation or surgery on the genitourinary tract. Immunohistochemical and ultrastructural studies revealed the fibroblastic-myofibroblastic nature of these lesions. These cases illustrate that clinicopathologic correlation is essential to define certain pseudosarcomatous lesions.

Biological characterization of human bone tumors. VIII. Expression of HLA-DR antigens in bone tumors and tumor-like lesions

A total of 45 cases of bone tumors and tumor-like lesions were studied in order to determine the expression of an HLA-DR antigen by the monoclonal antibody 910-D-7, and its possible correlation with histology, using the indirect immunoperoxidase method on frozen sections. The pattern of antigen expression was nearly constant for the individual cell types, though varying in intensity, and did not depend on the biological behavior of the respective lesions. No clear correlation could be established between antigen expression and cell maturation. Although the biological significance of antigen expression in these tumors is not yet understood, it is clear that here, too, the mere presence of an HLA-DR antigen cannot be interpreted as a sign of malignant transformation.

Inflammatory pseudotumour of the liver

Five cases of inflammatory pseudotumour of the liver are reported and compared with seven individual previously published case reports. Clinical presentation was variable but often comprised low grade intermittent fever, vague abdominal symptoms, and a history of weight loss. Leucocytosis, raised erythrocyte sedimentation rate, and polyclonal hyperglobulinaemia were also sometimes detected. All five cases in the present series were considered to be clinically malignant; and in two the histological diagnosis was also that of malignancy. The lesion is clearly inflammatory and reactive, but the aetiology remains unknown.

Characterization of breast carcinomas by two monoclonal antibodies distinguishing myoepithelial from luminal epithelial cells

Two monoclonal antibodies, KA 1 and KA 4, raised against human epidermis, were biochemically and immunologically characterized and were shown to react with specific cytokeratin polypeptides. On frozen sections of human mammary gland, these antibodies distinguish between myoepithelial and luminal epithelial cells. We present evidence that in these cells KA 1 antibody recognized cytokeratin 5 and KA 4 antibody cytokeratin 19. In normal mammary tissue, KA 4 antibody invariably reacted with the epithelial cells lining the lumina of acini, ductules, ducts, and sinus. In contrast, KA 1 antibody decorated only the myoepithelial and basal epithelial cells of acini, ducts, and sinus. In ductules, however, KA 1 also stained the luminal cells. All 73 invasive lobular and ductal carcinomas studied reacted with KA 4 antibody; five of these were also positive, apparently in the same tumor cells, with KA 1. The tumor cells of in situ carcinomas were also stained in a homogeneous pattern with KA 4 antibody; KA 1 antibody reacted only with the surrounding myoepithelium. In epithelial hyperplasias, the proliferating cells were decorated by KA 1 and KA 4 antibodies in a heterogeneous pattern. Other antibodies were used for comparison. The results are discussed with respect to epithelial differentiation and pathogenesis and to the application of such antibodies for immunohistodiagnosis of mammary lesions.

Inflammatory lymphadenoid reactions with dermatofibroma/histiocytoma

Lymphoid nodules were found associated with 44 of 1,506 dermatofibroma/histiocytoma tumors of the skin. The lymphoid nodules were usually in the adjacent fat. Germinal center formation occurred, and perinodular and perivascular plasmacytosis was frequently associated.

Inflammatory fibroid polyp of the stomach

Fourteen cases of inflammatory fibroid polyp of the stomach were studied in terms of immunohistochemistry and ultrastructure. They occurred as polypoid lesions in the antrum, except for two found in the body of the stomach. Out of the 14 cases, two were found to be multiple and the remainder solitary. In all but one lesion, the mucosal layer was involved and six lesions were entirely localized within the mucosal layer, suggesting that inflammatory fibroid polyps of the stomach originate in the mucosal layer. Neither S100 protein, factor VIII-related antigen, alpha 1-antitrypsin nor lysozymes were found in the cytoplasm of the proliferating cells. The ultrastructures of the proliferating cells were fibroblastic rather than neurogenic, angiogenic, or myofibroblastic. These findings suggest that the cells are fibroblasts, though the possibility that they are facultative fibroblasts remains. An interesting observation made with electron microscope was the infection of micro-organisms similar to mycoplasma. This seems to deserve further investigation as a possible etiologic factor of the disease.

[Unilateral pseudotumor of the orbit--an autoimmune disease?]

An eleven-year-old boy with congenital paresis of the left superior rectus eye muscle developed symptoms of acute left orbital expansion: pain, ptosis, redness, extraocular muscle dysfunction. Computer assisted tomography of the orbit showed typical signs of inflammatory orbital pseudotumor and immunological screening cryoglobulinemia. Short-term treatment with prednisone (2 mg/kg bodyweight/day) rapidly improved symptoms. However several relapses occurred following discontinuation of therapy. Therefore a long-term treatment with corticosteroids was instituted. The simultaneous development of inflammatory orbital pseudotumor and cryoglobulinemia support the hypothesis that orbital pseudotumor is an autoimmune disease. The meaning of the congenital superior rectus muscle paresis in this case for the development of the inflammatory process remains uncertain.

Cellular differentiation in ovarian sex-cord-stromal and germ-cell tumors studied with antibodies to intermediate-filament proteins

Seventy ovarian sex-cord-stromal and germ-cell tumors were immunohistochemically studied for the presence of intermediate-filament proteins of different types used as markers for cellular differentiation. Cells of ovarian granulosa-cell tumors constantly expressed vimentin and appeared to lack cytokeratin. Two tumors previously classified as granulosa-cell tumors were reclassified as poorly differentiated "common" epithelial tumors based on their cytokeratin positivity, vimentin negativity, and morphologic features. Dysgerminomas and Leydig-cell tumors showed only vimentin positivity. Tubular structures in androblastomas, which are considered to represent Sertoli-cell differentiation, were cytokeratin positive, and thus differed from the majority of normal Sertoli cells that are known to express vimentin and not cytokeratin. Embryonal carcinomas, choriocarcinomas, and endodermal sinus tumors showed cytokeratin positivity in the neoplastic cells whereas vimentin was observed in the stromal cells. In immature teratomas, epithelial differentiation was demonstrated with cytokeratin antibodies, and neural and glial differentiation was also frequently demonstrated by immunostaining with antibodies to neurofilaments and glial fibrillary acidic protein. The results show that antibodies to intermediate filaments can be used in the differential diagnosis between ovarian epithelial and nonepithelial tumors, and they provide a very accurate additional method to characterize the cellular differentiation of ovarian neoplasms.

Subcutaneous fibromatosis associated with an acquired immune deficiency syndrome in pig-tailed macaques

A spontaneous multifocal subcutaneous fibromatosis is described in 6 pig-tailed macaques (Macaca nemestrina) with simian acquired immune deficiency syndrome (simian AIDS). The lesions consisted of a proliferation of vascular fibrous tissue that was infiltrated by lymphocytes and plasma cells. One animal also had retroperitoneal fibromatosis, which has also been found in this colony of pig-tailed macaques. Progressive weight loss, diarrhea, lymphadenopathy, and neutropenia were seen. Peripheral lymph nodes were hyperplastic, and there was splenomegaly. Aggregates of lymphocytes were present in the bone marrow, kidneys, liver, and lungs. Type D retrovirus particles were found in three nodules by electron microscopy; intracytoplasmic type A and budding particles were identified in fibroblasts. In a setting of acquired immunodeficiency, these subcutaneous tumors in pig-tailed macaques present a striking analogy to Kaposi's sarcoma in human AIDS.

Human papilloma virus (HPV) antigens and local immunologic reactivity in oral squamous cell tumors and hyperplasias

A series of 191 oral mucosal tumors including those with suspected HPV (Human Papilloma Virus) etiology; squamous cell papilloma (SQP), condyloma acuminatum (CA), focal epithelial hyperplasia (FEH), as well as those regarded as unrelated to HPV; fibrous hyperplasia (FH), papillary hyperplasia (PH), and true fibroma (TF), were analyzed for HPV structural proteins (by indirect immunoperoxidase IP-PAP technique), for the presence of epithelial dysplasia, and for the cellular composition (B and T lymphocytes, mononuclear phagocytes, (MPS cells] of their local inflammatory cell infiltrates using ANAE-(acid alpha-naphthyl acetate esterase) stain. HPV structural proteins were disclosed in 85% of FEH, in 75% of CA, and in 41% of SQP. These three lesions significantly differed from PH and FH with regard to the intensity and cellular composition of the local infiltrates, being most intense and B cell predominated in the latter two. Mild dysplasia was found in 20% of both CA and SQP lesions, the former also showing moderate dysplasia in 12% of cases. The HPV antigen positivity was negatively correlated with dysplasia in CA and SQP, the intensity of the infiltrate showing positive association with dysplasia. The results are discussed in terms of HPV etiology of CA, SQP and FEH, of the host immunologic reactivity against these lesions, as well as of the possible role of HPV in human squamous cell carcinogenesis.

Immunohistologic study of cellular populations of histiocytofibromas ("dermatofibromas")

Histiocytofibromas (HF) are benign tumours of the skin, the cellular composition of which is not yet known with certainty. The immunohistologic characteristics of 5 lesions were studied by using monoclonal antibodies and an indirect immunofluorescence method. All tumours were found to contain HLA-DR(+) cells, and, to a minor degree, OKM1(+) cells. OKT6(+) cells were present in the epidermis overlying the tumours; however in the HF themselves, no OKT6(+) cells were found. The presence of HLA-DR(+) and OKM1(+) cells demonstrates that HF contain cells bearing antigenic characteristics of histiocytes but not of Langerhans' cells, and we feel that the term "histiocytofibroma" is a more accurate designation for these lesions than "dermatofibroma".