Expression of progesterone receptor form A and B mRNAs in gynecologic malignant tumors

This study was designed to examine the biological implication of progesterone receptor (PR) forms A and B mRNA expressions in gynecologic cancers. The ratio of PR form A to form B in mRNA expression was approximately 1:1 in all endometria studied. The predominant expressions of form B transcript occurred in 6 out of 7 cases of advanced stages (stages III and IV) in ovarian cancers, in 5 out of 9 cases of cervical cancers, and in 5 out of 11 cases of endometrial cancers. In conclusions, the dominancy of PR form B mRNA expression might be associated with the expression of a malignant phenotype in gynecologic cancers, and advanced clinical stage in ovarian cancers, suggesting a biological marker of malignant phenotype in these three types of cancer cell.

Immediate changes in subcellular structures of transplanted tumors following photodynamic and laser hyperthermic therapy

BACKGROUND AND OBJECTIVE

To further understand the precise process of the tumor cell degeneration after photodynamic therapy (PDT), laser hyperthermic therapy (LH), and combined treatments using an Nd:YAG laser. It is important to examine initial morphological alteration of tumor cells after these treatments.

STUDY DESIGN/MATERIALS AND METHODS

In this study, nude mice bearing HeLa cell tumors were treated with PDT, LH, and combined treatments of the two. Tumor tissues obtained immediately after these treatments were analyzed using electron microscopy and morphometry.

RESULTS

In the combined treatments, which produced more severe effects on tumor cells, morphological features of apoptosis such as cytoplasmic condensation, blebs, and apoptotic bodies appeared in the cells, although the typical alteration in the nuclear chromatin was not seen.

CONCLUSION

Cytoplasmic alterations may proceed more rapidly than nuclear alterations in the cellular degeneration induced by the single or combined treatments of PDT and LH.

Effect of recombinant human interferon-alpha/2b on epidermal-growth-factor-, estrogen- and progesterone-receptor expression in primary cervical cancer

The effects of a short period of in vivo systemic rh-IFN-alpha/2b treatment on epidermal-growth-factor(EGFR)-, estrogen(ER)- and progesterone(PR)-receptor content in 11 primary human cervical tumors was investigated by the radioreceptorial technique. EGFR levels were found to be significantly higher in cervical tumors after rh-IFN-alpha/2b treatment with respect to basal levels. In 2 cases, immunohistochemical and cytofluorimetric analysis showed that rh-IFN-alpha/2b treatment induces an increase in EGFR immunoreactivity and in the fraction of EGFR-positive cells. No difference in ER and PR levels in cervical tumors before and after rh-IFN-alpha/2b treatment was observed. Our results suggest that rh-IFN-alpha/2b up-regulates EGFR in primary human cervical tumors in vivo.

Nuclear morphometry as a predictor of response to neoadjuvant chemotherapy plus radiotherapy in locally advanced cervical cancer

We have studied nuclear morphometric characteristics from H & E slides of 23 patients with locally advanced squamous cell carcinoma of the cervix treated with neoadjuvant chemotherapy (cis-platinum + 5-fluorouracil) plus radiation therapy to see if a correlation existed between these morphometric assessments and response to chemotherapy/radiotherapy. On the same 23 patients, biopsies were taken at three times: before treatment, after chemotherapy alone, and after chemotherapy plus radiation therapy. Using the Zeiss Videoplan III morphometric workstation, tumor nuclear area and nuclear roundness factor were assessed on three different tumor cell populations: the basal, intermediate, and superficial cell layers. There were two principal results from this study: (1) There was a significant (P = 0.007) reduction in the appearance of the basal layer of tumor cells following chemotherapy. (2) The reduction in nuclear area of intermediate layer tumor cells by chemotherapy alone was significant in responders (P = 0.005) but not in nonresponders (P = 0.74) to the combined therapy. The ability to differentiate between responders and nonresponders to combined therapy after only the chemotherapy has been administered may allow more rational patient selection for radiation therapy.

Fine structural observation of a nucleolar-nuclear matrix-lamina-intermediate filament system in transformed cells

The nuclear matrix is a nonchromatin structure of the nucleus normally concealed by a much larger mass of chromatin. Several methods have been developed to remove chromatin from nucleus while preserving the underlying matrix architecture to some degree. The present study showed that after extraction of PtK2 cells and cervical carcinoma cells (CC3) with Triton X-100, ammonium sulfate and DNase, the nucleolar-nuclear matrix-intermediate filament (Nu-Nm-L-IF) network remained. The nucleolus was oval in shape and appeared as a fibrillar mass with an accentric dense fibrillar centre. This nucleolar skeleton was in direct connection with the nuclear matrix which in turn is connected with cytoplasmic intermediate filaments by lamins. It is concluded from these observations that the Nu-NM-L-IF system forms a continuous system which plays an important role in the maintenance of the nucleolar, nuclear and cytoplasmic integrity and cellular function.

AgNOR counts as a discriminator of lesions of the endocervix

Recently the argyrophil for staining proteins associated with nucleolar organizing regions (AgNORs) has been applied widely in cytohistopathology in various malignancies. Nucleolar organizer region-associated proteins (NORs) are located on the short arm of chromosomes 13, 14, 15, 21 and 22. We applied the technique to 78 cytologic smears from the endocervix stained with the Papanicolaou technique. These included 36 normal endocervical cases, 17 reactive endocervical cases, 19 dysplastic endocervical cases and 6 endocervical adenocarcinoma cases. Statistically significant differences were found between AgNOR counts from normal endocervical smears and smears of endocervical gland dysplasia (P < .001), between normal endocervical smears and smears of endocervical adenocarcinoma (P < .001), between reactive endocervical smears and smears of endocervical gland dysplasia (P < .001) and between reactive endocervical smears and endocervical adenocarcinoma (P < .005). The AgNOR technique appears useful as an adjunct in the diagnosis of endocervical lesions.

Efficiently estimated histologic cell counts

Three different estimates were compared with complete nuclear counts made over 200 fields (20 sets of 10) selected from histologic sections of 18 breast carcinomas. All counting used a 10 x 10 square grid eyepiece graticule at x 400. Two area sampling techniques agreed well with overall counts (59,210 cells counted in all 200 fields; estimates were 58,500 and 59,805 cells), but an estimate based on linear intersection of nuclei yielded a lower estimate (23,382 cells). The most efficient estimate was 10 times the number of carcinoma cell nuclei in a random sample of 10 small graticule squares; summation over 10 fields yielded a mean ratio of estimated to counted total of 98.2% with limits of agreement of 89.9% to 107% for individual-case 10-field estimates. To improve efficiency further a simplified version of this estimate was devised and validated on carcinoma cell nuclei in 200 fields (20 sets of 10) selected from 20 invasive cervical carcinomas. An invariant sampling set was randomized to one of four rotations (0 degree, 90 degrees, 180 degrees, or 270 degrees). A total of 102,799 cells was counted in all 200 fields; the estimate was 101,280 cells. Summation over 10 fields yielded a mean ratio of estimated to counted total of 98.3% with limits of agreement of 89.8% to 108%. This simplified procedure facilitated estimation of cell numbers without detriment to agreement with denumerated counts and could be implemented as a custom-made counting graticule.

Primary melanoma of the cervix. A case report

A case of malignant melanoma of the cervix was diagnosed on a Papanicolaou-stained cervical smear from a 70-year-old women who had several small purpura-like spots on the ectocervix at the time of a routine cervical examination. The smear was characterized by scattered, small, dissociated cells with hyperchromatic, irregular nuclei, prominent nucleoli and occasional cytoplasmic, brown pigment. The diagnosis was confirmed by subsequent cervical biopsy and radical hysterectomy.

A quantitative study of the interphasic nucleolar organizer regions in two human cervical carcinoma cell lines

We have studied the relationship between interphase nucleolar organizer regions (NORs) distribution and nucleolar size in cancer cells under prolonged culture. Six morphometric parameters (NUCLEAR SIZE, NOR NUMB, AREA SUM, MEAN AREA, SIZE RATIO and SIZE RATIO MEAN) of AgNORs in cancer cells were analyzed by an image analyzing system. The results show that the parameters NORN NUMB, AREA SUM and NUCLEAR SIZE demonstrate the most consistent changes in the two cervical carcinoma cell lines studied. These three parameters of AgNORs appear to be correlated with the degree of "dedifferentiation" that occurred in tumor cells under prolonged culture.

In situ localization of parathyroid hormone-like protein and mRNA in intraepithelial neoplasia and invasive carcinoma of the uterine cervix

Parathyroid-like protein (PLP), or parathyroid hormone-related peptide, is a well-recognized mediator of paraneoplastic hypercalcemia (humoral hypercalcemia of malignancy syndrome). In this study we examined the expression of PLP by 40 invasive squamous cell carcinomas (SCCs) of the cervix and selected carcinomas of nonsquamous histology. Using a polyclonal antibody to human PLP, 93% of SCCs, including two tumors from patients with humoral hypercalcemia of malignancy syndrome, showed moderate to strong cytoplasmic immunoperoxidase staining for PLP. The strongest staining often was observed in areas of invasion associated with stromal desmoplasia. The small number of weak or negatively stained SCCs were all poorly differentiated tumors. Although native uninvolved squamous epithelium showed weak to moderate staining of the superficial layers, there was variable or full-thickness immunostaining in areas of dysplasia. Normal endocervical glands and stroma as well as cervical adenocarcinomas and neuroendocrine carcinomas were negative. In situ hybridization studies showed abundant PLP mRNA within SCC in patients with hypercalcemia. However, PLP mRNA was of relatively low abundance in tumors of normocalcemic patients. Ultrastructural studies showed cytoplasmic, membrane-bound, granular inclusions in tumor cells from the hypercalcemic patients. Our data suggest that increased PLP gene transcription contributes to the increased production of PLP and the pathogenesis of humoral hypercalcemia of malignancy syndrome.

[Nucleolar organizer regions in uterine cervical cancer and its precursor epithelial lesions]

The number of nucleolar organizer regions was assessed in 115 histological samples of uterine cervical carcinoma or precursor epithelial lesions. Normal endocervical or exocervical epithelial tissues were used as controls. Nucleolar organizer regions were stained with colloidal silver in formalin fixed histological samples and quantified in 100 cells, according to Crocker's method. The mean number of nucleolar organizer regions were 13.7 in infiltrative carcinoma, 9.15 in carcinoma in situ, 9.3 in severe dysplasia, 8.4 in moderate dysplasia, 7.5 in mild dysplasia, 6.4 in condylomas and 3.2 and 2.9 in normal exocervical and endocervical epithelia respectively. There were significant differences in the number of nucleolar organizer regions between normal and abnormal tissues and between the different lesions except between moderate and mild dysplasia and between carcinoma in situ and moderate and severe dysplasia. The highest number of nucleolar organizer lesions was always observed in the basal strata of both normal and abnormal tissues. It is concluded that nucleolar organizer regions are a good index of cellular proliferation in uterine epidermoid cervical carcinoma and its precursor lesions, and have a diagnostic value in infiltrative carcinoma.

Biological characteristics of a newly established human cervical carcinoma cell line

A new cell line, designated CC2/CUHK2, was established from a squamous carcinoma of the uterine cervix from a Chinese patient. The cell line grew well without interruption for over 12 months and over 90 passages. The doubling time of CC2/CUHK2 was 72 hours at passage 57. When seeded at a density of 1.5 x 10(3) cells per 25 cm2 tissues culture flask, the plating efficiency was 2.15%. Chromosome analysis showed a range of 30 to 130 with a modal number of 75. Immunoperoxidase staining of keratin showed positive reaction. Most of the CC2/CUHK2 cells showed weak nuclear staining of HPV capsid antigens with the ABC detection system. Analysis of the DNA samples extracted from the cervical cancer cells showed the presence of HPV type 16 DNA.

Human cervical epidermal carcinoma-associated intracellular localization of glycosphingolipid with blood group A type 3 chain

A monoclonal antibody, MRG-1, was produced by immunizing a mouse with a human ovarian mucinous cyst adenocarcinoma-derived cell line, RMUG-L. By immunohistochemical staining, the antigen was found to be exclusively localized in the intracellular structures of the cells used as the antigen and of the epithelial cells in normal human cervical glands. However, although the antigen was predominantly detected in the plasma membrane and the intercellular structure of the middle layer of normal human cervical squamous epithelium (92%), it was also contained in the intracellular structure of cervical epidermal carcinoma at a high frequency (80%). The striking difference in the distribution of the MRG-1 antigen between normal and cancerous tissues was found to be a cervical carcinoma-associated phenomenon and a useful tumor marker for immunohistochemical examination. Since the antigen was found to be of a blood group A-related nature by immunohistochemical staining of the tissues and to be a glycosphingolipid, it was purified from human erythrocytes of blood group A, and the structure was concluded to be GalNAc alpha 1-3Gal(2-1 alpha Fuc)beta 1-3GalNAc alpha 1-3Gal(2-1 alpha Fuc)-beta 1-4GlcNAc beta 1-3Gal beta 1-4Glc beta 1-1' Cer, blood group A type 3 chain-containing glycosphingolipid, by NMR, negative ion FABMS and permethylation analysis. In the subcellular localization analysis of the antigen, type 3-A glycosphingolipid antigen was detected in the Golgi body and the microsomes of RMUG-L cells, and the distribution coincided with the finding by immunohistochemical staining. In addition, in cervical epidermal carcinoma, although the blood group A, mainly type 2-A chain, was localized in the plasma membrane and the intercellular structure, the blood group A type 3 chain was selectively found in the perinuclear structure. Also, the blood group A type 3 chain in cervical dysplasia as well as that in normal cervix was predominant in the plasma membrane. Thus, the selective intracellular localization of blood group A type 3 chain was a phenomenon characteristic of cervical epidermal carcinoma and the carcinoma in situ.

Localized amyloidosis in squamous cell carcinoma of uterine cervix: electron microscopic features of nodular and star-like amyloid deposits

An ultrastructural study of amyloid deposits in four cases of squamous cell carcinoma of uterine cervix was performed. The amyloid deposits reacted with anti-keratin antiserum on frozen sections. Amyloid deposits showed nodular (4 cases) and star-like forms (3 cases). Nodular amyloid deposits were composed of slightly whorled fibrils, measuring 7-10 nm in width. Some of them contained cellular debris and thicker, more electron-dense filaments than amyloid fibrils. In three cases, filamentous tumour cells and filamentous masses were observed together with amyloid. Star-like amyloid deposits were composed of bundles of straight amyloid fibrils. Some of the tumour cells in contact with star-like amyloid deposits had deep cytoplasmic invaginations, where closely packed amyloid fibrils were arrayed in parallel fashion. In addition, a few tumour cells had membrane-bound amyloid fibrils in the cytoplasm. It is suggested that nodular amyloid deposits are derived from the tumour cells through filamentous degeneration. Amyloid fibrils in star-like amyloid deposits are thought to be formed within the cytoplasm or in the vicinity of invaginated cytoplasmic membranes of the tumour cells.

[Molecular and ultrastructural study on the relationship between human papillomavirus and female genital condyloma in China]

From the results of DNA hybridization, it has been shown that there is a close relationship between HPV 16 and human uterine cervical carcinoma in China, and also that the viral DNA is integrated into the cancer cell genome. Genital condyloma revealed a high positive hybridization rate with HPV 11 DNA, and the viral DNA presented as an episome apart from the cell genome. Under the electron microscope, the inter and perichromatin granules as well as nuclear bodies were observed in all biopsies with positive hybridization, but no HPV particle was found in cancer cells, besides these two kinds of chromatin granules. Human papillomavirus nucleocapsid particles were observed in the nuclei of some genital condyloma cells. Electron-dense matrix aggregates of different sizes were seen in the perinuclear cytoplasm and in the nuclei. This kind of structure may be related to the process of HPV maturity, but its nature remains to be studied.

[Intraepithelial cervical lesions: colpo-microcolposcopic diagnosis]

Integration of colposcopy and microcolposcopy allows to perform a complete study of eso- endo-cervix, for a diagnostic and topographic evaluation of cervical intraepithelial lesion. We have endoscopically studied 172 patients with histologically demonstrated CIN. In 218 cases (74.4%) the microcolposcopical evaluation corresponded to the histological diagnosis. These data confirm the methodological effectiveness of microcolposcopy and recommend it as helpful mean for cervical pathology investigation. However we believe that histological evaluation is necessary for a correct staging of the lesion. According to our experience indications for microcolposcopy are: 1) identification of endocervical lesion and squamo-columnar junction, when colposcopically not evident; 2) possibility of performing a "tailored" conization; 3) study of endocervix after conization.

Primary malignant melanoma of the cervix and review of the literature

Primary malignant melanoma of the cervix was diagnosed in a patient presenting with postmenopausal bleeding. A cervical lesion was biopsied, and diagnosis was established by electron microscopy and staining procedures. After failing radiotherapy, the patient was treated with simple hysterectomy and bilateral salpingo-oophorectomy. The cytology, histology, and electron microscopy of this lesion are presented in addition to a clinical discussion.

Squamous cell carcinomas, an immunohistochemical and ultrastructural study

Fourty-seven squamous cell carcinomas (SCCs) were studied by light microscopy, immunohistochemistry and electronmicroscopy. Nineteen percent (9 cases) of SCCs in different locations were immunoreactive for CAM5.2 and three poorly differentiated SCCs did not express cytokeratins 6 and 18. No cases were positive for c-erbB2 protein. p53 protein overexpression was found in malignant cells in 40% of the primary tumours and in 60% of the lymph node metastases. Four poorly differentiated SCCs expressed vimentin and in these cases the tumour cells had accumulations of less dense intermediate filaments in cytoplasm.

Assessment of the accuracy of cytology in women referred for colposcopy and biopsy: the results of a 1 year audit

The results of weekly colposcopy review meetings have been audited for 1 year and cases where there was a discrepancy between the referral cervical smear and the initial colposcopy biopsy have been analysed. New referrals (n = 476) for colposcopy were studied. In the final outcome 80% of 326 women referred for moderate or severe dyskaryosis were found to have cervical intraepithelial neoplasia (CIN) grade II or III or invasive carcinoma. Three women found to have invasive carcinoma had been referred for severely dyskaryotic smears. Twenty women were referred for smears with cell changes suggesting glandular neoplasia: five were found to have adenocarcinoma in situ, whereas eight had CIN and seven had negative biopsies. The results justify the referral policy and demonstrate the need for further investigation when initial colposcopic biopsies are negative.

Superficial nuclear enlargement without koilocytosis as an expression of human papillomavirus infection of the uterine cervix: an in situ hybridization study

Nuclear enlargement of the superficial cervical epithelial cells in the absence of koilocytosis is frequently observed. The purpose of this study was to investigate whether this change represents human papillomavirus (HPV) infection. We reviewed 257 cervical biopsies with the diagnosis of "suggestive of condyloma," mild or moderate dysplasia, or both. Of the 257 consecutive biopsies, 23 fulfilled the two criteria: the superficial cells had a nuclear diameter of at least twice that of the basal nuclei, and complete absence of koilocytosis was seen. Parallel sections from each paraffin block were hybridized with biotinylated probes for HPV 6/11, 16/18, and 31/35/51 under high-stringency conditions. The cases that were negative at high-stringency conditions were then hybridized under low-stringency conditions with a mixture of the three HPV probes. Twelve of the 23 cases (52.17%) were positive for HPV, including one positive for HPV 16/18 in one area and for HPV 31/35/51 in another area, four positive for HPV 31/35/51, two positive for HPV 16/18, two positive for HPV 6/11, and three positive for HPV probe mixture at low-stringency conditions. The positive in situ hybridization was located predominantly in the enlarged nuclei in the superficial layers. In conclusion, HPV infection can be expressed as nuclear enlargement in the superficial layers of the cervical epithelium in the absence of koilocytosis.

Primary malignant melanoma of the vagina and cervix uteri: case report and literature review

Malignant melanoma of vagina is rare. Malignant melanoma of the cervix is even rare. To date, only 96 cases of the former and 26 cases of the latter have been reported. We report here a very rare case of primary malignant melanoma involving both vagina and cervix in a 70-year-old woman. The clinical, cytologic, light microscopic and ultrastructural findings are presented, and the pertinent literature is reviewed and discussed.

High prevalence of human papillomavirus transcripts in all grades of cervical intraepithelial glandular neoplasia

Cervical biopsy specimens containing cervical intraepithelial glandular neoplasia (CIGN) were examined for the presence of human papillomavirus (HPV) RNA transcripts by in situ hybridization with iodine 125-labeled riboprobes. HPV RNA was detectable in 95.2% of biopsy specimens. HPV 16 RNA was present in 12, HPV 18 in 27, and both in 1 of the 42 cases examined. Among HPV-positive cases, HPV RNA was detectable in all grades of CIGN and, in three cases, in glands displaying only minimal nuclear abnormality insufficient for a diagnosis of CIGN. Patients with HPV RNA-positive CIGN were younger than those with negative findings for HPV, and patients with less severe grades of CIGN showed a trend toward a younger age of presentation than patients with severe glandular lesions. Increasing grades of CIGN may reflect progressive stages in the development of cervical adenocarcinoma, and this progression may closely involve HPV gene expression from its earliest stages.

[Validity of the AgNOR count in cervical pathology]

Nucleolar organizer regions (NORs) were counted on ten cases each of normal ectocervix, CIN 1, 2 and 3 to verify the possibility of a differentiation between the various grades of CIN and between them and condylomata. Counts were performed on the full thickness of the tissue, layer by layer (stratified counts). A significant difference (p < 0.05) was found between the means of normal tissue toward condylomata and CIN 2 and 3 and between CIN 1 and CIN 2 and 3. There was no significance (p < 0.05) between normal tissue and CIN 1, between CIN 2 and 3 and between condylomata and CIN 2 and 3. The range of variations on the counts was associated with overlapping between the various cases. Our data showed also a progressive rise in mean NOR values from normal tissue to CIN 3. The stratified counts showed in all the groups a rise from basal to parabasal cells. Counts on parabasal and intermediate layers distinguished two groups of cases. In one there was either the same number of dots or a further rise from one layer to the next, while in the other a definite decrease was seen. The former pattern may be related to a potential for malignant evolution of the lesion. NORs should be counted in all cases of CIN and condylomata to treat more aggressively those lesions which present the pattern of a progressive rise of NORs from basal to intermediate cells.

AgNOR counts are useful in cervical smears

Because they present marked cellular changes, the cytological appearances of epithelial repair may be confused with those of cancer. To see whether the Ag-NOR staining technique for nucleolar organizer regions would be useful to distinguish benign proliferative reactions (squamous metaplasia and repair) from cervical intra-epithelial neoplasia (CIN I, CIN II, and CIN III), we studied a series of cervical smears. The smears, previously stained with the Papanicolaou technique, were destained and restained with Ag-NOR silver. Significantly different (P less than 0.05) Ag-NOR counts were found in squamous metaplasia, epithelial repair, and various degrees of CIN. The Ag-NOR technique appears useful in the diagnosis of cervical cytology and particularly in cases with marked cellular change, which could be confused with neoplasia.