Immunohistochemical localization of pulmonary surfactant apoproteins in various lung tumors. Special reference to nonmucus producing lung adenocarcinomas

The value of PE-10, a monoclonal antibody against pulmonary surfactant, in distinguishing primary and metastatic lung tumours

A new monoclonal antibody (PE-10) raised against components of pulmonary surfactant has been assessed for its ability to distinguish primary from secondary carcinomas in the lung. We applied this antibody to a series of 107 primary lung carcinomas, 40 adenocarcinomas of other sites, and 26 cases of adenocarcinoma metastatic to lung and pleura. Of the primary lung carcinomas, all the non-mucinous bronchiolo-alveolar carcinomas were positive whereas all the mucinous cases were negative; 60% of other types of adenocarcinoma were positive and 10% of large cell undifferentiated carcinomas, 20% of small cell carcinomas and 40% of atypical carcinoids also showed focal positivity. Squamous cell carcinomas were all negative. Adenocarcinomas of the breast, kidney, large bowel and ovaries were all negative, as were all 26 cases of adenocarcinoma metastatic to the lung and pleura. We conclude that this antibody is highly specific and moderately sensitive for primary tumours of the lung.

Mucosal spreading adenocarcinoma at the hilar portion of the lung

The first case of mucosal spreading adenocarcinoma at the hilum of the lung is presented. The patient was a 72 year old Japanese male smoker. The carcinoma was located at the right main bronchus with involvement of the apical, posterior and anterior segmental bronchi. The tumor consisted of stratified oval or polygonal cells and signet ring cells spreading along the bronchial mucosa in an in situ fashion with extension down the bronchial gland ducts and acini. Only a small micro-invasive focus not extending beyond the bronchial cartilage was seen. Immunohistochemically, the tumor was positive for lysozyme but negative for lactoferrin and PE-10 indicating that this tumor was possibly showing goblet cell differentiation.

Monoclonal antibody KP16D3 as a prognostic marker in stage I lung adenocarcinoma

Monoclonal antibody KP16D3 recognizes a 60 kDa protein associated with mucin-nonproducing papillary adenocarcinoma, especially that originating from nonciliated bronchiolar epithelial cells of the lung. We immunohistochemically examined 56 primary lung adenocarcinomas using the monoclonal antibody KP16D3. Of these tumors, 31 (55%) were positive for KP16D3 immunoreactivity. The disease-free survival rates showed no statistical differences between KP16D3-positive and KP16D3-negative patients. However, in stage I and T1 disease, the disease-free survival rates of KP16D3-positive patients were statistically lower than those of KP16D3-negative patients (P < 0.05). These findings suggest that KP16D3 may be useful as a prognostic marker for patients with stage I primary lung adenocarcinoma. Conversely, use of this marker and subtyping of lung adenocarcinomas reflect the prognosis of the disease.

Langerhans cells in Langerhans cell histiocytosis and peripheral adenocarcinomas of the lung

The present paper deals with more precise characterization of Langerhans cells (LC) and accompanying lymphocytes in lung LC histiocytosis (LCH) and primary lung peripheral adenocarcinomas using immunohistochemical methods with various kinds of monoclonal antibodies against cell adhesion and activation markers and some cytokines. Tissue specimens were obtained from 4 patients with pulmonary LCH and from 29 patients with primary lung peripheral adenocarcinoma. In florid (exudative and granulomatous) nonfibrotic LCH lesions, LC, particularly those in contact with lymphocytes, were S100, CD1a, MHC Class II, CD11a and c, CD16, and CD54 positive. In this context, LC were CD4+ and CD25+. Lymphocytes around LC were CD3+ with a "memory" phenotype (CD45RO+) and, frequently, CD25+ and HLA-DR+. S100+ and CD1a+ LC were commonly observed in adenocarcinomas subclassified as papillary and as nonmucinous bronchioloalveolar, in both cases mainly where Clara cells and Type II pneumocytes were present. In carcinomas the vast majority of LC were HLA-DR+ and, rarely, weakly CD16+, CD25+, and CD54+. The infiltration of reactive cells in cancer tissue was mainly represented by T lymphocytes (CD3+CD45RO+). These T cells were HLA-DR- and CD25-. The presence of LC was associated with a strong reactivity of epithelial cells with antibodies PE-10 and 439-9B, both recognizing molecules mainly expressed by Type II alveolar cells. Several cells in LCH florid lesions showed immunoreactivity for both IL-1 alpha and beta. Immunostaining for IFN-gamma revealed the presence in the same areas of some positive cells showing lymphoid morphology. No IL-1 or IFN-gamma reactivity was found in adenocarcinomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Secretory differentiation and cell type identification of a human fetal bronchial epithelial cell line (HFBE)

A human fetal bronchial epithelial cell line (HFBE) grew in an undifferentiated pattern under conventional culture conditions. Despite a somewhat fibroblastic shape the cells maintained immunoreactivity to cytokeratin, carcinoembryonic antigen and epithelial membrane antigen. When grown on a collagen gel in a growth-hormone-supplemented medium, their spindle shape became more conspicuous. With an additional supplement of vitamin A (6 micrograms/ml), most of the cells underwent differentiation by producing many bright inclusion bodies which proved to be strongly positive with periodic acid-Schiff and weakly positive with alcian blue staining. Electron microscopy revealed a well-developed rough endoplasmic reticulum, an enlarged Golgi apparatus and many highly electron-dense secretory granules resembling those of Clara cells. Biochemical analysis demonstrated that HFBE cells cultured on collagen gel with vitamin A secreted hyaluronic acid and neutral glycoproteins containing mainly N-linked glycoproteins whose glycans were of a complex type. A monoclonal antibody (SEC-41) generated against the neutral glycoproteins detected a glycoprotein of approximately 52 kDa in the spent culture medium of differentiated HFBE cells. This antibody also reacted with the intracytoplasmic secretory granules in these cells. When tested on frozen sections of lung tissue, the immunohistochemical reactivity of the SEC-41 antibody was confined to Clara cells, some type II pneumocytes in the adult lung, and respiratory epithelial cells in the fetal lung. Moreover, this antibody could detect secretory glycoprotein in broncho-alveolar lavages from two patients. This paper clearly demonstrates that cells derived from human fetal bronchial epithelium can be cultivated in an undifferentiated precursor state and, under appropriate culture conditions, can be stimulated to undergo differentiation into a Clara cell type.

Differentiation of Clara cell (distal type) antigen in human fetal bronchial epithelial cell line (HFBE)

A human fetal bronchial cell line (HFBE) grew in an undifferentiated pattern under conventional culture conditions. Despite a somewhat fibroblastic shape, however, they still maintained an immuno-reactivity to cytokeratin, carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA). When grown on a collagen gel in a growth hormone-supplemented medium, their spindle shape became more conspicuous. With the additional supplement of 6 micrograms/ml vitamin A, most of the cells underwent differentiation by producing many bright inclusion bodies which proved to be strongly positive to periodic acid Schiff (PAS) and barely positive to alcian-blue (AB) staining. Electron microscopy revealed well-developed rough endoplasmic reticulum (rER), enlarged Golgi apparatus and many highly electron-dense secretory granules resembling those of Clara cells. Biochemical analysis demonstrated that HFBE cells cultured on collagen gel with vitamin A secreted products containing glycoconjugates of two different molecular weights. The higher molecular weight-product was identified as hyaluronic acid and the lower molecular weight-product as a mixture of neutral glycoproteins containing mainly N-linked glycoproteins whose glycans were of a complex type. While the secretion of hyaluronic acid was inhibited by vitamin A in a dose-dependent manner, that of the neutral glycoproteins was most enhanced by vitamin A in the range from the physiological concentration of 600 ng/ml to 6 micrograms/ml. A monoclonal antibody (SEC-41) generated against the secretory products with the lower molecular weight detected a glycoprotein of approximately 52 kd in the spent culture medium of differentiated HFBE cells. This antibody also reacted with the intra-cytoplasmic secretory granules in these cells. When tested on freeze-sectioned lung tissue, immunohistochemical reactivity of SEC-41 antibody was confined to Clara cells, some type II pneumocytes in the adult lung and respiratory epithelial cells of the fetal lung tissue. Moreover, this antibody could detect the secretory glycoproteins in the broncho-alveolar lavages (BAL) of two human cases. This paper has clearly demonstrated that cells derived from human fetal bronchial epithelium can be cultivated in an undifferentiated precursor state and under appropriate culture conditions they can be stimulated to undergo differentiation into a Clara cell type.

Pulmonary surfactant protein A in pleural effusions

Pulmonary surfactant protein A (SP-A) is known to be a major phospholipid-associated glycoprotein in pulmonary surfactant, which is specific to the lung. Immunohistochemically, expression of SP-A in tumor tissues is found in approximately 50% of patients with lung adenocarcinoma but not in the other histologic types of lung cancer of metastatic lung tumors. In this study, the SP-A content of pleural effusions was determined using an enzyme-linked immunosorbent assay. These results showed that approximately 40% of patients with lung adenocarcinomas (27 of 67) had high levels of SP-A (greater than 500 ng/ml) in their pleural effusions. By contrast, patients with other histologic types of lung cancers, adenocarcinomas of different primary sites, and tuberculosis had low levels of SP-A in their pleural effusions. The determination of SP-A in malignant effusions will contribute to distinguishing primary lung adenocarcinoma from adenocarcinomas of miscellaneous origin.

Pseudomesotheliomatous carcinoma of the lung. An immunohistochemical and ultrastructural study of three cases

The authors report immunohistochemical and electron microscopic studies on three new cases of pseudomesotheliomatous carcinoma of the lung. Although the distinct clinical and histopathologic features of this peripheral lung cancer were described many years ago, its recognition as a distinct variety of lung carcinoma has not gained wide acceptance. Little is known of its incidence and only few cases have been reported until now. In the current study the authors demonstrate the epithelial nature of this tumor by its positive immunohistochemical reactions for epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), Leu-M1, B 72.3, and surfactant apoprotein. The ultrastructural features and staining of nuclear inclusions with surfactant apoprotein indicate differentiation into type II cells as found in other forms of peripheral lung adenocarcinoma. Despite these morphologic similarities, pseudomesotheliomatous carcinoma is characterized by extensive invasion of the pleura and rapidly fatal course. Because of this biologic behavior it deserves recognition as a distinct variant of peripheral lung carcinoma.

Clinicopathologic and immunohistochemical characteristics of goblet cell type adenocarcinoma of the lung

Twenty-two resected goblet cell type adenocarcinomas of the lung were examined clinicopathologically and immunohistochemically. The stage and survival curve of goblet cell type adenocarcinomas were compared with those of 44 cases of pure or mixed Clara cell and bronchial surface epithelial cell (Clara and BSE) type adenocarcinomas. Each case of goblet cell type was matched with two cases of Clara and BSE type as to sex, age and date of surgery. In goblet cell type adenocarcinomas, lymph node metastasis was less frequently and intrapulmonary metastasis was more frequently detected than in other types of adenocarcinomas (p less than 0.001 and p less than 0.05, respectively). Goblet cell type adenocarcinomas showed better prognoses than Clara and BSE type adenocarcinomas. However, the estimated survival curves of those two groups become similar after adjustment of the TNM condition using Cox's proportional-hazard general linear model. This result indicated that the longer survival of goblet cell type adenocarcinoma was due to the characteristic distribution of TNM conditions, that is, unique local growth and low incidence of lymph node metastasis. When goblet cell type adenocarcinoma was macroscopically classified into two types, i.e. solitary peripheral nodule type (nodular type) and multifocal nodular type or consolidation of all or part of a lobe (diffuse type), the nodular type had better prognosis than the diffuse type (p less than 0.05). Immunohistochemically, 83%, 11%, and 0% of goblet cell type adenocarcinomas were positive for NCC-CO-450, carcinoembryonic antigen (CEA), and surfactant apoprotein, respectively. Most Clara and BSE type adenocarcinomas were negative for NCC-CO-450, but positive for CEA and surfactant apoprotein.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchioloalveolar adenocarcinoma with myoepithelial cells

A unique variant of papillary lung carcinoma in a 58-year-old woman with both Clara cell and myoepithelial components is reported. The tumor was characterized by the presence of glandular spaces lined by two cell layers. The superficial (luminal) layer was made up of columnar cells with ultrastructural and immunohistochemical features of Clara cells, and occasional interspersed type 2 pneumocytes. The cells of the basal layer possessed ultrastructural and immunohistochemical features of myoepithelial cells. Myoepithelial cells have not previously been reported in a bronchioloalveolar adenocarcinoma.

Strain A/J mouse lung adenoma growth patterns vary when induced by different carcinogens

The histogenesis of mouse lung adenomas is currently being investigated in several laboratories. Based upon studies of a limited number of carcinogens in different mouse strains, some investigators suggest that all lung adenomas in mice are derived from alveolar type II cells, whereas others suggest a Clara cell origin for a majority of the tumors. This report differs from previous investigations in that 12 different carcinogens were evaluated for the types of lung tumor growth patterns they induced in a single mouse strain (strain A mice). The carcinogens aflatoxin B1 (AFB1), benzo(a)pyrene (BP), 1,2-dimethylhydrazine (DMH), 3-methylcholanthrene (MCA), 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and N-nitrosomethylurea (MNU) induced tumors with a predominantly solid/alveolar growth pattern, whereas N-nitrosodiethylamine (NDEA) induced predominantly papillary tumors. Most of the other carcinogens induced a higher proportion of lung tumors with the solid/alveolar growth pattern than with the papillary growth pattern; however, ratios between the 2 growth patterns varied. If, as suggested by others, solid tumors are derived from alveolar type II cells and papillary tumors from Clara cells, then carcinogens may differ with respect to their ability to transform one cell type or the other.

Atypical differentiation of bronchiolar epithelial cells following experimental pneumonia

In the bronchiolar and alveolar epithelial responses to experimentally induced organizing pneumonia in the rat evoked by Streptococcus pneumoniae type 25, the appearance of lamellar body-containing bronchiolar cells is reported. Such cells, which are interspersed among proliferating type 2 pneumocytes in the form of intraalveolar and bronchiolar buds, also stain immunohistochemically with antisera to alveolyn, a surfactant-associated protein. We believe this phenomenon supports an hypothesis that in response to specific stimuli, proliferation of a common precursor cell of both the bronchiolar Clara cell and the type 2 pneumocyte occurs, with varying expression of a latent or precursor capacity for surfactant secretion.

Pleural lavage cytology immediately after thoracotomy as a prognostic factor for patients with lung cancer

Pleural lavage cytology was examined in 230 lung cancer patients just after opening the chest. There were 16 cases (7.0%) of positive pleural lavage cytology, and the results of pleural lavage cytology were related to the presence of pleural involvement by cancer, microscopical pleural dissemination and lymphatic permeation of the cancer cells. If the cancer involves the pleura or lymphatics of the submesothelial layer, being covered with visceral mesothelium, positive cytology may still be obtained. Pleural lavage cytology at opening of the chest seems to be available as a premonitory indicator for exfoliation and dissemination into the pleural cavity or subpleural lymphatic extension of cancer cells, and it was suggested that positive pleural lavage cytology has an influence on postoperative survival.

Immunohistochemical distinction of malignant mesothelioma from pulmonary adenocarcinoma with anti-surfactant apoprotein, anti-Lewisa, and anti-Tn antibodies

Nine cases of malignant mesothelioma of pure epithelial and biphasic types (five pleural, three peritoneal, and one pericardial mesotheliomas), seven cases of benign adenomatoid tumor of the uterus, and 21 cases of peripheral pulmonary adenocarcinoma of non-mucus-producing type were examined immunohistochemically for expression of keratin, vimentin, carcinoembryonic antigen (CEA), surfactant apoprotein, Lewis blood group antigens, and Tn antigen. The majority (78%) of the malignant mesotheliomas expressed keratin, but CEA and surfactant apoprotein were not detected in any mesotheliomas. On the other hand, pulmonary adenocarcinomas expressed not only keratin (100%), but also CEA (62%) and surfactant apoprotein (62%). The expression of Lewisa blood group antigen and Tn antigen was detected in 76% and 62% of the pulmonary adenocarcinomas, respectively, but only one mesothelioma was stained for Lewisa antigen. This study reveals that the majority of malignant mesotheliomas can be distinguished from pulmonary adenocarcinomas by immunohistochemcial staining for CEA, surfactant apoprotein, Lewisa antigen, and Tn antigen. Immunohistochemically, adenomatoid tumors behaved similarly to malignant mesotheliomas.