Lysozyme and mucins in gastric adenomas

A method for the simultaneous demonstration of lysozyme and mucins in 39 cases of gastric adenomas differentiated two intermediate cell types. The first was similar to a columnar cell comprising a single cell population which covered extensive areas of the adenomas. This cell type often showed supranuclear lysozyme reactivity and apical neutral mucins, sialomucins, and sulphomucins in variable amounts. The second cell type was found in 11 adenomas, located mainly in the fundal area. It seemed to be a transitional form between the goblet cell and the Paneth cell. This cell type was scattered among columnar cells, occasional Paneth-like cells, and small goblet cells. These two types of intermediate cells may be regarded as abnormally differentiated integral elements of gastric adenomas. They may be associated with the neck stem cells in the cytogenesis of gastric adenomas.

Mucosal thickening adjacent to gastric malignancy: association with epidermal growth factor

A high false negative rate from endoscopic forceps biopsy is well-known in gastric carcinoma. The initial aim of the present study was to determine whether possible thickening of adjacent nontumorous mucosa by nonspecific or specific trophic factors could contribute to this observation; 167 gastrectomy specimens (77 carcinomas, 14 lymphomas, 76 gastric ulcers) were examined and mucosal thickness measured. Mean thickness of uninvolved mucosa near carcinoma (1.4 +/- 0.08 mm, mean +/- SEM) and near lymphoma (1.5 +/- 0.1 mm) was in each case significantly greater than mucosal thickness near ulcer (1.14 +/- 0.05 mm) or at a distance in the same specimen (P less than 0.01 for each comparison). A subset of specimens representing 20% of carcinomas, showed marked mucosal thickening (2.01 +/- 0.05 mm) above the control mean. Immunohistochemical evaluation for intratumoral epidermal growth factor content (EGF) correlated with mucosal thickness in all groups examined (R = 0.67). Immunostaining for EGF receptor showed similar patterns of expression to those of EGF. EGF and EGF receptor contents were also correlated with depth of invasion when possible. In conclusion, the mucosal thickening adjacent to gastric malignancy may well contribute to the insensitivity of endoscopic forceps biopsy. More importantly, the higher tumor EGF and EGF-receptor contents seen in these lesions may prove to be a useful marker of biologic behavior and predictor of prognosis in these tumors.

[Relation of the serosal invasion mode to a recurrence in advanced gastric carcinomas]

Discussed are the attributable factors affecting the type of carcinomatous recurrence seen in 126 patients who had been operated on for their gastric carcinomas from 1979 to 1982 and who later showed a macroscopically positive serosal invasion (S0) and a histologically ss alpha approximately se invasion and required a curative resection. Forty-six percent of the patients with an ss beta approximately se invasion had a peritoneal recurrence, 21% a liver recurrence, and 33% a recurrence of some other type, whereas those with ss alpha had no such recurrence. Peritoneal recurrence tended to increase with the increase in the length of the serosal invasion and its rates were: one third in serosal invasions of less than 3 cm, one third in invasions of 3 approximately 6 cm and another third in invasions of over 6 cm. The smaller ratio of submucosal length to subserosal length, especially when less than 1.0, meant a greater frequency of peritoneal recurrence. The histologic characteristics of carcinomas that developed a peritoneal recurrence were poorly differentiated, contained INF alpha and had weaker cellular cohesion, whereas those that developed a liver metastasis were well differentiated carcinomas, contained INF beta and had a tighter cellular cohesion.

[Comparison of DNA flow cytometry and microspectrophotometry in gastric carcinoma]

Flow cytometric (FCM) and microspectrophotometric (MSP) measurements of nuclear DNA content were made in 52 fresh gastric carcinoma specimens and in 30 gastric mucosal specimens from patients with chronic gastritis DNA aneuploidy was found in 60% (32/53) cases of gastric carcinoma, and it appeared more frequently in well-or moderately differentiated tubular adenocarcinoma (90%) than in undifferentiated and mucous cell carcinoma (23.6%) (P less than 0.01). No aneuploidy was found in benign gastric mucosal samples, but their proliferative cell fractions were significantly higher than those in normal control gastric mucosal samples (p less than 0.01). The comparison of the results measured with FCM and MSP showed a high correlation rate (r = 0.07, p less than 0.005). The advantages and limitations of both methods are discussed, and the authors think that the two can be regarded complementary to each other and may be used in combination for more precise cytochemical analysis.

[Fibronectin in gastrointestinal tumors and its relation to biological characteristics of tumor]

Through immunohistochemical technique, distribution of FN in normal mucosa, benign and malignant tumors of human gastrointestinal tract were studied. In normal and adenoma tissues, FN was found in both basement membrane (BN) and interstitial tissue. While in cancer tissue, there was a consistent decrease of BM FN content around the tumor nests particularly more apparently in cases of invading carcinoma. Statistical analysis showed that the reduction of BM FN was correlated with the degree of tumor dedifferentiation but not with the incidence of regional metastases. No association was noticed between the stroma FN and tumor behaviors. Since small blood vessels were usually delineated clearly by the staining for FN, FN might be considered as a marker in identifying the invasion of blood vessel wall by tumor cells. It is suggested that lack of BM FN in tumor tissues might be mainly due to decrease of FN synthesis by the tumor cells.

Flow cytometric DNA measurement of gastric cancers. Clinico-pathological implication of DNA ploidy

The relationship of DNA ploidy to clinical, pathological or prognostic data was investigated in 70 surgically removed gastric cancers, 60 of which were advanced cases. The cellular DNA content was measured by means of flow cytometry. Overall, DNA aneuploidy was seen in 43 of the cases (61%) while the normal gastric mucosa consisted of only a diploid line without any aneuploid population. Ploidy levels of gastric cancer spanned a wide range from a hypodiploid value to a hyperpentaploid value, although near-diploid and near-triploid cases were the majority in the series. No significant association between ploidy and either age or sex was found. The incidence of DNA aneuploidy was significantly higher in differentiated adenocarcinomas than in undifferentiated ones (p less than 0.05). However, DNA ploidy was not related to some pathologic characteristics such as the extent of tumor invasion and the frequency of lymph node metastasis. According to Kaplan-Meier survival plots, prognosis of the patients with DNA diploid tumors tended to be better than that of aneuploid tumors, but the difference was not statistically significant.

[Oncogenes in human gastric carcinoma]

Alteration of oncogene and loss of chromosomal heterozygosity are infrequent in human gastric carcinoma compared with those in other gastrointestinal carcinomas. Amplification of c-erbB-2 gene is observed in well differentiated adenocarcinoma, while sam gene is found in poorly differentiated adenocarcinoma or scirrhous carcinoma. sam gene, which was isolated from a gastric cancer cell line KATO-III by a DNA renaturation method, encodes tyrosine-specific protein kinase domain. A good correlation evidently exists between the synchronous expression of TGF alpha and ras p21 and biological malignancy of gastric carcinoma. c-myc and c-fos proteins are found not only in tumor cells but also in stromal cells including macrophages and fibroblast around the tumors. The prognosis of patients with c-myc p 62-positive stromal cells is significantly better than that of patient with p 62-negative stromal cells. Coamplification of the hst-1 gene and int-2 is observed in 50% of primary tumors and all metastatic tumors of esophageal carcinoma. PCR (polymerase chain reaction) technique seems to be useful for the detection of oncogene point mutation in human gastric carcinoma.

Immunological characterization and clinical implication of cobalamin binding protein in human gastric cancer

Cobalamin (vitamin B12) binding protein was purified from gastric cancer extracts and from serum-free culture medium of cancer cell line KATOH-III. The molecular weight, determined by immunoprecipitation and sodium dodecyl sulfate-polyacrylamide gel electrophoresis, was 70,000 and the pI was 2.8 to 3.2. From biochemical and immunological properties, this cobalamin binding protein was considered to be an isoprotein of cobalamin R binder. Monoclonal antibodies were produced against saliva R and cobalamin binding protein in culture medium to study their antigenic determinants. Monoclonal antibody 55-D reacted to an epitope of peptide in both binders, whereas WK-1 and H-12 reacted to determinants of a carbohydrate moiety, including sialic acid, in cancer cell-derived binder. In addition, we carried out an enzyme-linked immunoassay and examined plasma levels of immunoreactive R binder in patients with gastric cancer (n = 72), benign gastrointestinal disease (n = 30), and healthy individuals (n = 40). Even in patients without liver metastasis, the level of immunoreactive R binder detected by monoclonal antibody H-12 was elevated in some patients and decreased after excision of the tumor. R binder was also elevated in cancer tissue extract. Immunoreactive binder was histochemically detected in the cytosol of cancer cells and metaplastic cells of the gastric mucosa. The present findings suggest that cobalamin R binder is de novo synthesized in gastric cancer cells and that its plasma level increases in some patients. This binding protein may be a useful diagnostic and therapeutic parameter.

An analysis of gastric and oesophageal cancers found with 'epidemiological necropsy' during 1953-1982

The 'epidemiological necropsy' is a newly proposed research strategy in which the size and composition of the epidemiological reservoir of undetected disease is estimated from the relative frequency of necropsy surprise patients, in whom the disease was not suspected during life. The current study was done to help validate a basic premise of the strategy. We examined the surprise necropsy discovery of two upper gastrointestinal malignancies: oesophageal cancer, for which an undetected reservoir would not be expected because the cancer has little room to grow, and gastric cancer, for which a sizeable reservoir might be anticipated. In a review of 15,812 necropsies during 1953-1982 at Yale-New Haven Hospital, 70 cases of oesophageal cancer were identified postmortem. Except for five surprise cases, located at the gastro-oesophageal junction where there is room to grow, no oesophageal cancer reservoir was found during the 30-year period. In the same secular period, however, a distinctive set of reservoir cases was found among 162 necropsy instances of gastric cancer. About two-thirds of these gastric cancers had been previously diagnosed during life, but the remainder consisted of either necropsy surprise cases or patients with wrong primary cancer diagnoses during life. The secular rates of occurrence remained stable and similar in both sexes for surprise gastric cancer cases during the three 10-year periods from 1953-1982, but no wrong primary diagnoses occurred during 1978-1982, after the introduction of improved methods of premortem diagnosis. The results help validate the cancer reservoir theory for malignancies that have room to grow, and confirm the concept that the 'epidemiological necropsy' can reflect qualitative and quantitative changes in cancer reservoirs.

[DNA ploidy pattern in diffuse infiltrating carcinomas of the stomach]

Analysis of DNA ploidy patterns was performed on 76 diffusely infiltrating carcinomas of the stomach and the results correlated with histologic findings and outcome. Twenty six cases were diploid (34%) and 50 cases were aneuploid. There was no correlation between DNA ploidy and histologic type, depth of invasion, lymphatic invasion, evidence of peritoneal dissemination or curability. In aneuploid tumors, incidence of vascular invasion was significantly higher than that in diploid tumors (p less than 0.05). In addition, the patients with aneuploid tumors had a poor prognosis than with diploid tumors. These results indicate that DNA ploidy patterns may possibly be a useful prognostic marker for diffusely infiltrating carcinomas of the stomach.

[Angiogenesis activity of tissues and cells of different malignancies]

Cancer cells are able to produce tumor angiogenesis factors (TAF), by which the tumor growth could be maintained. Angiogenetic activity of 12 kinds of cells and tissues with distinct character from different sources were detected by chick embryo chorioallantoic membrane. The results indicated that all the cells and tissues tested showed angiogenetic activity but they differed from one another, some were strong and other weak. Of them, the breast cancer was the strongest. The ascitic tumor didn't show any angiogenetic activity, but it reappeared when the ascitic cells were transformed to solid tumors. The level of angiogenetic activity of tumors was closely related to their biological properties and form of existence.

Expression of growth factor and epidermal growth factor receptor encoded transcripts in human gastric tissues

Expression of mRNA-encoding transforming growth factors alpha and beta (TGF alpha and beta), epidermal growth factor receptor (EGFR), and platelet-derived growth factors (PDGF) A and B chains was examined in 63 human gastric biopsies. Despite considerable individual variation, transcript levels were generally higher in 16 paired gastric tumors compared with surrounding epithelium. Marked increases were observed for the TGFs and c-sis, whereas EGFR mRNA was poorly expressed; there was no correlation with pathological staging of the cancers. In the nonneoplastic tissues, 14 had normal histology and 27 displayed superficial (SG) or atrophic gastritis (AG). Transcript levels greater than or equal to + were similar between these categories for all the growth factors, but were about 50% higher for EGFR in the tissues with gastritis. Concurrent expression of TGF alpha and EGFR (greater than or equal to + level) was more frequent in the paired tumors (38%) than in adjacent nonmalignant tissue (6%) and was seen in only one of 14 (7%) normal samples, in three of 19 (16%) of those with AG, and none of eight of those displaying SG. High levels of TGF beta and PDGFA mRNA were expressed in gastric ulcers, with little or no TGF alpha and EGFR transcripts; in contrast both TGFs and EGFR message were found in normal oesophagus. Stomach tissues are thus capable of synthesizing a variety of growth factors. These may be associated with nonneoplastic hyperplasia and/or malignant proliferation. Coexpression of TGF alpha/EGFR supports the possibility of an autocrine loop sustaining tumor growth which is different from the mechanisms responsible for normal cellular proliferation.

Immunohistochemical study of epidermal growth factor and epidermal growth factor receptor in gastric carcinoma

Immunohistochemical study for epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) was performed on 222 specimens of gastric carcinoma. The authors placed each carcinoma into one of the following three groups: group 1, neither EGF nor EGFR was stained (123 cases); group 2, either EGF or EGFR was stained (64 cases); and group 3, both EGF and EGFR were stained (35 cases). Compared with the carcinomas in groups 1 and 2, those in group 3 had significantly higher rates of infiltrative gross type, microscopically infiltrative type, poorly differentiated type, scirrhous type, and deep invading type. These results suggest that carcinomas in group 3 may have more proliferative and invasive activity and thus may have an autocrine mechanism, that is, the ability of cancer cells to produce and respond to their own growth factor.

[Immunohistologic detection of pepsin and gastricsin in carcinoma of the stomach]

Immunohistological tests for pepsin and gastricsin were carried out in bioptic samples of 51 patients with carcinoma of the stomach. Pepsin was detected in only 2 cases (4%), gastricsin in 26 patients (55%). Compared to the histological picture, the rate of incidence of gastricsin showed no difference between the intestinal and diffuse types of this tumour. In all examined cases, only gelatinous carcinomas were negative. Nor were any differences found in the cardia, the body or antrum. Surprisingly, these enzymes were found in the cytoplasma of neutrophylic granulocytes in the inflammatory infiltrate of the mucosal and tumorous stroma. Intestinal metaplasia of the epithelium was always negative even in the neighbourhood of positive tumours. The detected changes are evidence against the possibility of different histogenesis of the diffuse and intestinal forms of carcinoma of the stomach as well as against the possibility that intestinal metaplasia in a chronic inlammation of the stomach could be regarded as a direct first stage of the intestinal form of carcinoma of the stomach. In cases of metastases of unknown origin, pepsin and gastricsin cannot serve as markers due to their insufficient organ and cell specificities.

[Experimental study on combination chemotherapy of UFT and calcium antagonist in gastric cancer]

The antitumor effect of combined use of UFT and verapamil, a calcium antagonist, was examined in gastric cancer transplanted to BALB/c athymic nude mice. Four experimental groups included Group I (Control) which was administered 3% Gummi Alabicum (p.o.), Group II (UFT) which was administered 64.8 mg/kg UFT (p.o.), Group III (UFT + verapamil) which was administered UFT and 10 mg/kg verapamil (s.c.) and Group IV (verapamil) which administered same doses of verapamil. All mice were sacrificed at the day of 12 and pathological and flow cytometric studies were performed to those tumors. At the day of 8, significant retardation of tumor growth was observed in Group II and Group III compared with Group I (P less than 0.05). The ratio of tumor retardation of Group III was more predominant than that of Group II at the day of 9 (p less than 0.05). However, no difference in pathological and flow cytometric changes was observed between Group II and Group III. Weight loss and death, as side effects, were found in Group II and III. It was assumed that this may be depend on the over dose of UFT or methods of administration. These results suggested that combination chemotherapy of UFT and verapamil was effective in the retardation of gastric cancer, however the doses of UFT and verapamil have to be reexamined in order to control the side effect.

Gastric large cell lymphoma expressing cytokeratin but no leukocyte common antigen. A diagnostic dilemma

A case of undifferentiated malignant tumor of the stomach is reported. The immunohistochemistry of biopsy specimens pointed to a diagnosis of carcinoma, the tumor cells being cytokeratin positive and leukocyte common antigen (LCA) negative. After resection, however, histopathologic results showed that the tumor was a large cell lymphoma with plasmablastic differentiation. A new immunohistologic study confirmed, on the one hand, the diagnosis of lymphoma with its monotypic character IgA kappa and, on the other, positivity with three different cytokeratins of the lymphoma cells and their negativity with LCA. The aberrant immunophenotyping of this lymphoma is exceptional and must not undermine the recognized usefulness of LCA and cytokeratin, which both are basic antibody markers of immunohistochemistry in undifferentiated malignant neoplasms.

Expression of transforming growth factor alpha messenger RNA in the normal and neoplastic gastro-intestinal tract

The presence of TGF alpha mRNA has been reported previously to occur in primary colon cancers. We report the expression of the normal 4.5 kb TGF alpha transcript in the mucosa of the normal human gastro-intestinal tract from oesophagus through to colon. The highest levels of human TGF alpha mRNA occurred in the duodenum but significant levels were present in all of the mucosa. Similarly, in the rat gastro-intestinal tract, TGF alpha transcripts were detected in the lower gastro-intestinal tract mucosa. The relative abundance of the TGF alpha mRNA appeared to decrease in distal regions of the gastro-intestinal tract. The level of the TGF alpha mRNA was similar in both the normal and the neoplastic colon tissue. Similarly, in 2 patients with carcinomas, the TGF alpha mRNA was expressed at similar levels in the tumour and in adjacent mucosa. Although TGF alpha mRNA is associated with transformed cells from the gastro-intestinal tract, the presence of this mRNA at equivalent concentrations in normal mucosa suggests that over-production of TGF alpha is not an essential feature of carcinomas in the gastro-intestinal tract.

Evidence of enhancement of the ras oncogene protein product (p21) in a spectrum of human tumors

Using a direct binding liquid competition radioimmunoassay, the amount of the ras oncogene protein product, p21, was quantitated in a variety of human tumors and adjacent apparently normal tissues. In 48 of 50 matched tumor and normal tissue biopsy specimens from 50 patients, more ras p21 was detected in the tumor than in its normal counterpart. Twenty-five of 28 breast tumors demonstrated more ras p21 than the average of the values obtained for fibroadenomas. Furthermore, in 17 of the 19 cases studied, over 20% more ras p21 was observed in breast carcinomas compared with their respective normal counterparts. More ras p21 was also demonstrated in the majority of tumors of the stomach, lung, colon and bladder compared with their respective adjacent normal tissues. Our data therefore indicate that ras p21 expression is quantitatively enhanced in many human tumors originating from several different tissue types.

Quantitative determination of chromium and nickel in tumour and tumour-free human tissue

Environmental pollution with carcinogenic substances, in addition to individual abuse, are discussed as important factors causing development of cancer. We must assume that certain nickel and chromium compounds, which are ubiquitous in our ecosystem, must have carcinogenic effects on humans too. The aim of this study is therefore to examine the extent to which the accumulation of the potentially carcinogenic metal ions nickel and chromium could be measured in tissue from tumour patients. We examined tumour and tumour-free tissue obtained from a total of 48 patients who had carcinomas of the stomach, bowel, or kidney. We also analyzed nickel and chromium content in whole blood and urine samples from these persons. The quantitative metal estimations were done using atomic absorption spectrophotometry. Differences between chromium and/or nickel content in tumour or tumour-free tissue were not observed. An accumulation of these metal ions in tumour tissue is therefore improbable. We were also unable to find differences in metal content with regard to chromium and nickel as related to the appearance of tumour in the organ. In contrast, tumour patients had a 5- to 7-fold increase over normal values for chromium and nickel in blood and urine. This was attributable to unavoidable contamination of tissue and body fluids with chromium- and nickel-containing instruments during major surgical procedures.

Clinico-histochemical studies on type 4 carcinoma of the stomach--with special reference to mucopolysaccharides and sialic acid in tumor tissue

One hundred and twenty-one patients with gastric cancer of Borrman IV (type 4) were classified into two types according to the macroscopic appearance of their tumors, namely, those tumors with giant folds (type G, n = 84) and those without giant folds (type P, n = 37). A large percentage of the cases in both type groups had advanced stage carcinoma. Type G was found to be predominant in young women and the incidence of high-grade lymph node metastasis was higher in type G than in type P. Histochemically, it was shown that the tumor interstitium of type G contained obviously many more acid mucopolysaccharides (AMPS) than the localized Borrman II (type 2) gastric cancer, which was used as a control. The results of enzymatic digestion tests suggested that the amounts of hyaluronic acid, chondroitin sulfate, and sialic acid were greater in type G than in type P or the localized type, the differences involved being marked between type G and the localized type.

Carcinoma at the esophago-gastric junction--its biological behaviour toward the squamous epithelium

The purpose of this paper is to assess the clinical and histopathological significance of tumors at the esophago-gastric junction (EGJ). The biological behaviour of these tumors was studied, with regard to the infiltrative pattern and mitotic index, in 15 patients with tumors at the EGJ. Twenty-seven tumors at the cardia, with or without esophageal invasion, were chosen for DNA analysis at their most proximal and deepest apexes. The esophageal and gastric apexes of the tumors had the same infiltrative pattern in 14 out of 15 cases and this tendency was not altered with further stratification of the anatomical layers. In comparing the deviations of the stem lines, the relative frequency of nuclei with DNA over 4n and 6n and aneuploid from the DNA histograms between the esophageal and the deepest apexes of the tumor revealed no statistically significant differences, depending on esophageal invasion. From these results, the specificities of EGJ toward tumor invasion or activity were not regarded as consequential, and the EGJ couldn't be regarded as a barrier against tumor invasion.