Prognostic significance of regional lymph node histology in uterine cervical cancer

The clinical importance of the host anti-tumour reaction patterns in regional tumour draining lymph nodes in patients with locally advanced resectable gastric cancer: a systematic review and meta-analysis

BACKGROUND

The status of regional tumour draining lymph nodes (LN) is crucial for prognostic evaluation in gastric cancer (GaC) patients. Changes in lymph node microarchitecture, such as follicular hyperplasia (FH), sinus histiocytosis (SH), or paracortical hyperplasia (PH), may be triggered by the anti-tumour immune response. However, the prognostic value of these changes in GaC patients is unclear.

METHODS

A systematic search in multiple databases was conducted to identify studies on the prognostic value of microarchitecture changes in regional tumour-negative and tumour-positive LNs measured on histopathological slides. Since the number of GaC publications was very limited, the search was subsequently expanded to include junctional and oesophageal cancer (OeC).

RESULTS

A total of 28 articles (17 gastric cancer, 11 oesophageal cancer) met the inclusion criteria, analyzing 26,503 lymph nodes from 3711 GaC and 1912 OeC patients. The studies described eight different types of lymph node microarchitecture changes, categorized into three patterns: hyperplasia (SH, FH, PH), cell-specific infiltration (dendritic cells, T cells, neutrophils, macrophages), and differential gene expression. Meta-analysis of five GaC studies showed a positive association between SH in tumour-negative lymph nodes and better 5-year overall survival. Pooled risk ratios for all LNs showed increased 5-year overall survival for the presence of SH and PH.

CONCLUSIONS

This systematic review suggests that sinus histiocytosis and paracortical hyperplasia in regional tumour-negative lymph nodes may provide additional prognostic information for gastric and oesophageal cancer patients. Further studies are needed to better understand the lymph node reaction patterns and explore their impact of chemotherapy treatment and immunotherapy efficacy.

The Application of Liquid-Based Cytological Detection for P16, Cytologic Evaluation and High-Risk Human Papillomavirus Testing in Cervical Cancer Screening: A Clinical Evaluation

Objective

The aim of this study was to clinically evaluate the application of liquid-based cytology P16, cytologic evaluation, and high-risk human papillomavirus (HR-HPV) testing in cervical cancer screening.

Methods

This study screened 900 women, who attended the outpatient clinic, according to the exclusion criteria of study participants. The study participants’ screening results of liquid-based cytology P16, cytologic evaluation, and HR-HPV testing were analyzed. According to the pathological results of the biopsy, the efficacy of different screening strategies for the identification of high-grade lesions was evaluated.

Results

The positive rate of p16 expression increased with the severity of cervical lesions. P16 had the highest sensitivity and negative predictive value in identifying high-grade lesions (98.45% and 99.67%, respectively). Liquid-based Papanicolaou test (LBP), on the other hand, had the lowest sensitivity (85.27%) but the highest specificity (85.88%). HR-HPV’s positive predictive value and accuracy rate were the lowest (32.77% and 70.03%, respectively). The difference was statistically significant (P < 0.05). Dual combinations of certain tests were set up for this study; P16+LBP, HPV+LBP, and P16+HPV had sensitivities of 98.45%, 96.90%, and 99.22%, and specificities of 80.29%, 63.42%, and 64.33%, respectively. The P16 screening rates of histological and liquid-based cytology approaches were 75.74%.

Conclusion

Compared with traditional LBP+HPV, the application of a test that solely screen for P16 or the combined screening method that involves the screening of P16 is more effective in identifying high-grade lesions.

Evaluation of immunomorphological patterns of cervical lymph nodes in oral squamous cell carcinoma

Background:

The Immunomorphological patterns of Lymph Nodes indirectly assess the host immune response facing a malignant tumor. These patterns also help us predict the susceptibility of the patient to Lymph Node Metastasis.

Aims and Objectives:

To evaluate the Immunomorphological patterns of Lymph Nodes in Oral Squamous Cell Carcinoma and to correlate them with the histopathological subtype of Oral Squamous Cell Carcinoma, TNM staging and the degree of tumor involvement within the Lymph Nodes.

Methodology:

A total of 40 subjects were taken for the study. Individuals who were clinically and histopathologically diagnosed as cases of Squamous Cell Carcinoma, who had undergone Radical or Elective Neck dissection were considered. The excised Lymph Nodes along with the primary tumor were collected stained with Hematoxylin and Eosin. The Lymph Nodes were assessed for Metastasis and Immunomorphological patterns. Statistical Correlation was done between the Immunomorphological pattern of Lymph Nodes and (a) Size of the tumor, (b) TNM stage of the tumor, (c) Histopathological Grade of the primary tumor, (d) Metastasis of the Lymph Node and (e) Grade of the Metastasis of Lymph Node. Statistical Correlation was done between the Metastasis of the Lymph Node and (a) Size of the tumor and (b) TNM stage of the tumor.

Results and Conclusion:

Statistically, a significant association was observed between TNM staging and Immunomorphological patterns of Lymph Node (P < 0.01). The relationship between histopathological grade of primary tumor of Squamous Cell Carcinoma and the Immunomorphological patterns was statistically significant (P < 0.01). Statistically, a significant association was observed between Sinus Histiocytosis pattern and decreased occurrence of nodal metastasis (P < 0.01).

Role of immunoreactive patterns of lymph nodes in neck dissection cases of oral squamous cell carcinoma: a clinical and histopathological study

Objectives

Metastasis in oral squamous cell carcinoma (OSCC) can occur in a variety of ways, and draining lymphatics and lymph nodes serve as a common route. Prior to metastasis, lymph nodes elicit an immune response to either wall off or create a favorable environment for homing of tumor cells. This immune response to tumor stimuli is visualized by recognizing various immunoreactive patterns exhibited by the lymph node. The present study aims to evaluate the role of immuno-morphologic patterns of the lymph node in neck dissection for cases of OSCC.

Materials and Methods

Our retrospective study included 50 neck dissection cases of OSCC and a total of 1,078 lymph nodes. The grades of primary tumors with eight different immunoreactive patterns were compared. Vascularity and metastasis in lymph nodes were also evaluated.

Results

The lymphocyte predominant pattern was the most common immunoreactive pattern found in 396 of 1,078 lymph nodes. Patterns of lymphocyte predominant (P=0.0005), sinus histiocytosis (P=0.0500), paracortical hyperplasia (P=0.0001), cortical hyperplasia (P=0.0001), and increased vascularity (P=0.0190) were significantly associated with tumor grade.

Conclusion

The present study adds to the understanding of lymph node immunoreactivity patterns and their correlation with tumor grade. We recommend further study of lymph node patterns for all sentinel lymph node biopsies and routine neck dissections for OSCCs.

Architectural changes in the regional lymph nodes of oral squamous cell carcinoma

Background

The lymph nodes (LNs) in oral squamous cell carcinoma (OSCC) are enlarged as a result of reactive lymphadenopathy, metastasis or both. In response to tumor-associated antigens, diverse cell populations of LNs react in different ways, giving rise to a multitude of morphological patterns (MPs). The prognostic value of MPs has been contested. Hence, the aim of the study was to evaluate morphological alterations in the LNs related to LN metastasis (LNM), tumor size, grade and stage and the prognostic value for OSCC.

Materials and Methods

LN sections of 40 OSCCs were evaluated. Six MPs were observed: germinal center predominance (GCP), lymphocyte predominance (LP), sinus histiocytosis (SH), vascular transformation of sinuses (VTS), lymphocyte depleted (LD) and granulomatous reaction (GR). The data were subjected to Chi-square test.

Results

Four-hundred and eighteen nodes were evaluated, of which 24 were metastatic and 394 nonmetastatic. The predominant MP of LN reactivity was of VTS (116 nodes) followed by GCP (105); LP (90), LD (52), SH (43) and GR (12). A significant association was noted between LN status and the MPs. Risk of LNM with LP was less (13%) when compared with GCP (79%). A statistically significant relation was noted between the predominant MP and metastatic and nonmetastatic cases and with the tumor stage.

Conclusion

GCP pattern prevails in metastatic and advanced-stage tumors. LP or VTS/SH is prominent in early-stage tumors and nonmetastatic cases. MPs indicate the immune status and aid in foreseeing susceptibility to LNM, thus serving as a surrogate marker.

Immuno-reactivity of excised lymph nodes in neck dissections of squamous cell carcinomas of oral cavity

Background:

Regional lymph nodes play an important role in acting as anatomic barriers to systemic dissemination of tumor cells. This reflects in the host immunologic response. Oral squamous cell carcinoma, is known to be associated with early deficiencies of cell-mediated immunity, the pathology of which is reflected in the histology of the regional lymph nodes.

Aim:

The goal of this study was to study the different immunity reactions in the lymph nodes and to correlate it with the histopathology of tumor proper.

Materials and Methods:

Out of 40 head and neck dissections, 30 were male and 10 females within the age range of 21–72 years. According to Tumor Node Metastasis classification, there were 12 cases of stage II and stage III, respectively while 16 were of stage IV. A total of 372 nodes were histologically evaluated. The harvested lymph nodes were categorized into metastatic and non-metastatic nodes exhibiting four patterns as: Lymphocyte predominance pattern, germinal center predominance pattern, lymphocyte depleted pattern and unstimulated pattern.

Results:

The predominant pattern of lymph node reactivity was of lymphocyte predominance (199 nodes) followed by germinal center predominance (117 nodes); lymphocyte depleted (17 nodes) and unstimulated node pattern (39 nodes). Twenty-seven nodes were positive for metastasis. A statistically significant relationship (P = 0.0019 and P = 0.0290, chi square, respectively) was observed between the number of nodes harvested and stage and level of lymph nodes. A brief follow-up period of 3 years was carried out.

Conclusion:

Further studies relating the immuno-morphologic assessment of the lymph nodes in conjunction with other factors may be helpful in assessing the metastases risk of the individual.

Immunomorphological patterns of cervical lymph nodes in oral squamous cell carcinoma

Context:

Squamous cell carcinoma (SCC) comprises 80% of the cancers of the oral cavity. Metastases to the cervical lymph nodes affects prognosis. Studying lymph node reactivity may help to understand host immune reaction against the tumor and thus influence prognosis.

Aims:

This study observed patterns of lymph node reactivity, metastases and grades of metastases in cervical lymph nodes and compared them with the histopathology of the primary tumor.

Materials and Methods:

Lymph nodes from 30 patients of oral squamous cell carcinoma (OSCC) were taken. 10 of these were well-differentiated SCC (WDSCC), 10 moderately differentiated SCC (MDSCC) and 10 poorly differentiated SCC (PDSCC). Four immunomorphological patterns were observed: lymphocyte predominance, germinal centre predominance, mixed pattern (sinus histiocytosis) and unstimulated pattern.

Statistical Analysis Used:

Chi square test.

Results:

The predominant lymph node reactive patterns were germinal centre predominance (79.27%), unstimulated pattern (14.63%) and lymphocyte predominance (6.10%). Positive nodes showed invasion in the form of islands (57.14%), cords (39.29%) and total replacement pattern (3.57%). Tumor involvement in positive nodes showed grade 3 invasion, (53.57%), grade 2 invasion (26.79%), grade 4 invasion (17.86%) and grade 1 invasion (1.79%). Statistically significant association was found between:

Lymph node reactive pattern and histopathological grade of primary tumor. Higher numbers of germinal centre predominance lymph nodes were found in WDSCC and MDSCC

Histopathological grade of primary tumor and the grade of lymph node invasion

Conclusions:

Immuno-morphological assessment of draining lymph nodes reflects the immune status of the patient with respect to metastases. This may facilitate identification of high and low risk patients and help in planning appropriate therapy for the high-risk patients.

Prognostic Significance of Lymph Node Pattern in Oral Squamous Cell Carcinoma (OSCC)

BACKGROUND

Assessment of lymph node reactivity pattern is an important indicator of the host response status and prognosis of oral squamous cell carcinoma (OSCC).

AIM

To assess the prognostic significance of lymph node reactivity patterns in OSCC.

SETTINGS AND DESIGN

This is a cross-sectional study aimed correlating host status and prognosis of OSCC.

MATERIALS AND METHOD

Morphological patterns of lymph nodes received from 30 histologically proven cases of OSCC were analyzed. Five different patterns of the lymph node reaction were categorized (lymphocytic predominance, germinal center predominance, sinus histiocytosis, normal lymph node and lymphocytic depleted) and compared with the prognosis of OSCC.

STATISTICAL ANALYSIS USED

TNM, Histological grading parameters and Lymph node reactivity pattern were compared with the event of recurrence of OSCC and death of patient using Fisher's Exact test. Survival of the patients was analyzed for association with lymph node patterns using Log rank test.

RESULTS

Recurrence of the tumour was seen in association with all the patterns, with higher rates of mortality seen in patients with sinus histiocytosis of lymph node.

CONCLUSION

Morphological pattern being an aid in predicting prognosis, cannot be used as a lone predictor. An attempt is made to identify and discuss the possible pathogenesis for the reaction patterns.

Induced lymphatic sinus hyperplasia in sentinel lymph nodes by VEGF-C as the earliest premetastatic indicator

Research on tumor-induced lymphangiogenesis has predominantly focused on alterations and abnormal growth of peritumoral and intratumoral lymphatic vessels. However, recent evidence indicates that lymphangiogenesis of sentinel lymph nodes might also contribute to cancer progression. In clinical oncology, the sentinel lymph nodes play an important role in diagnosis, staging and management of disease. The prognostic value that may be placed in the analysis of various parameters in tumor-free lymph nodes is still under debate. We, therefore, chose to investigate genetically fluorescent MDA-MB-435/green fluorescent protein human cancer cells transfected to overexpress VEGF-C in a nude mouse model and investigated metastasis, lymph node lymphangiogenesis, lymph node angiogenesis and size of sentinel lymph nodes. The nature of MDA-MB-435, identified as a breast cancer cell line for several decades, has recently been reidentified as being from melanoma origin. Vascular endothelial growth factor-C overexpression induced early metastasis and significantly increased the lymphatic vessel area in sentinel lymph nodes even before the tumor metastasis. At early time-points, expansion of the lymphatic network was observed even though no difference of blood vessel area and lymph node size was detected. These results suggest that primary tumors -via secretion of VEGF-C- can induce hyperplasia of the sentinel lymph node lymphatic vessel network and thereby promote their further spread. In cases of tumor-free lymph nodes the increased lymphatic network of sentinel lymph nodes is a very early premetastatic sign and may provide a new prognostic indicator and target for aggressive diseases.

Can the lymph node reactivity pattern in the pN0 neck analysis provide any additional prognostic information in patients with laryngeal squamous cell carcinoma?

OBJECTIVE

To evaluate the influence of lymph node reactivity on recurrence and survival rates in a population of pT3 or pT4 pN0 patients with laryngeal squamous cell carcinoma.

METHODS

Between 2002 and 2005, 105 patients with LSSC underwent total laryngectomy with bilateral selective neck dissection including levels II, III and IV. Most (69) received PO radiotherapy. All pathological specimens were either pT3 or pT4, and all necks were pN0. All lymph nodes were analyzed and their reactivity status were classified as the following four patterns: follicular hyperplasia associated with humoral response, paracortical hyperplasia associated with cellular response, sinus histiocytosis with no association with specific immune response, or normal lymph node. Only the first two patterns were considered stimulated, whereas the last two were considered non-stimulated. The most prevalent pattern in a particular neck specimen was considered for the analysis of recurrence and survival.

RESULTS

The total number of lymph nodes studied was 3,648, with an average of 34.7 lymph nodes/neck specimens. The most frequent lymph node reactivity patterns were sinusal histiocytosis (50 cases), paracortical hyperplasia (35 cases), and follicular hyperplasia (20 cases). There was no statistical association of these individual patterns with recurrence rate (p = 0.98) or mortality (p = 0.49). However, there was a statistically significant association between paracortical hyperplasia pattern (related to cellular lymph node immunity) and improved five-year survival (76 versus 60%; log-rank = 0.05).

CONCLUSIONS

There was a positive correlation between stimulated cellular lymph node pattern and improved 5-year survival rate in patients with pN0 laryngeal squamous cell carcinoma, suggesting the indication of adjuvant treatment for those individuals with decreased immune response, even in the absence of pathologic metastases detected by the usual methods.

The morphology, immunophenotype and distribution of paracortical dendritic leucocytes in lymph nodes regional to cutaneous melanoma

Our aim was to identify and delineate alterations in the distribution and immunophenotype of the lymphocytes and paracortical dendritic leucocytes (interdigitating dendritic cells; IDCs) in lymph nodes regional to tumours. Using immunocytochemistry and computer-assisted image analysis we examined 65 lymph nodes excised from 47 patients with malignant melanoma. Twenty-nine patients had American Joint Committee on Cancer (AJCC) stage II melanoma (no tumour spread beyond the primary site) and 18 had AJCC stage III disease (metastases in the regional nodes). There were significant differences in the frequency, morphology, immunophenotype and anatomical distribution of the IDCs and in the complexity of their dendritic processes in different areas within individual lymph nodes. We conclude that morphological and phenotypical variations in IDCs correlate with differing levels of antigen presentation. Downregulation of antigen presentation in lymph nodes regional to tumours is most probably mediated by tumour products. Differences in IDC distribution and characteristics in lymph nodes from different anatomical sites must be considered in interpreting studies of nodal morphology and function.

Host defense and survival in patients with lung carcinoma

BACKGROUND

Numerous studies have investigated locoregional immune responses and long term survival in patients with various types of cancer; few have focused on patients with lung carcinoma. The current study was designed to assess the prognostic value of immunomorphologic changes in locoregional lymph nodes and lymphocytic infiltration of primary tumor (LI) in patients who undergo resection for bronchogenic carcinoma.

METHODS

In a retrospective analysis, immune responses in locoregional lymph nodes and at primary tumor sites were studied histologically in 172 selected patients. Lymph node morphology was studied according to the system of Cottier et al. Sinus histiocytosis and paracortical lymphoid cell hyperplasia were considered to be cellular immune responses, and follicular hyperplasia of the cortical area was considered to be a humoral reaction. LI was classified with Black's method. The survival rate was estimated by using the Kaplan-Meier product-limit method. The log rank test and the Cox proportional-hazards model were used to determine statistical significance in univariate and multivariate survival analyses.

RESULTS

Among the 172 patients, 35.5% had no evident response in regional lymph nodes, 19.8% had a marked cellular response, 11% had a marked humoral response, and 33.7% had a mixed cellular and humoral response. LI was intense in 36.6% of patients and was absent or scarcely evident in 63.4%. A lymph node cellular response and marked LI improved long term survival rates even in patients with regional lymph node metastases. Multivariate analysis identified two independent variables that had high prognostic value: lymph node immunoreactivity and LI.

CONCLUSIONS

Lymph node immunoreactivity and LI significantly influence long term survival after curative surgery for patients with carcinoma of the lung and may be useful in stratifying patients for prospective trials of adjuvant treatment, including immunotherapy.

Hereditary nonpolyposis colorectal cancer (Lynch syndrome II) in Uruguay

PURPOSE

We updated an Uruguayan family with hereditary nonpolyposis colorectal cancer first described in 1977, incorporating knowledge of how the hMLH1 germline mutation has been established and shown to segregate in accord with the expected autosomal dominant mode of genetic transmission.

METHODS

DNA-based molecular genetic testing was performed in conjunction with genetic counseling. Individuals were provided with their genetic test results, so that at-risk family members would be able to benefit from targeted management programs.

RESULTS

We counseled 19 members of this kindred, 13 of whom were positive for the hMLH1 germline mutation. Specific recommendations for surveillance and management were provided. We were able to describe follow-up, including anecdotal cancer survival and pathology findings extending from the initial 1977 report of this family to the present. A remarkable sibship within this kindred was comprised of eight siblings, six of whom underwent resections for colorectal carcinoma between 1963 and 1971. Colon carcinomas before 1977 in this sibship were treated with classic hemicolectomies. Of those who had hemicolectomies for their first primary colorectal cancers, two had a second colon cancer primary, and two had a third colon cancer primary.

CONCLUSIONS

Attention given to this extended family with hereditary nonpolyposis colorectal cancer has had a positive impact on the physician community in Uruguay, leading to the identification of additional families with hereditary nonpolyposis colorectal cancer.

Prognostic importance of lymphatic reaction pattern in laryngeal carcinoma

PURPOSE

Cervical lymph node status is a widely accepted important prognostic parameter in laryngeal carcinoma.

PATIENTS AND METHODS

In this study, we retrospectively reviewed neck specimens of 46 laryngeal carcinoma patients operated in our clinic. Presence of neck metastasis and pattern of reactivity in nonmetastatic nodes was correlated with recurrence and survival during a follow-up period of at least 2 years.

RESULTS

Fourteen of the patients had at least one metastatic node and survival was 64%; 32 of the patients had reactional nodes only and the survival was 81%. Pattern of lymph node reactivity was evaluated as stimulated in type I (lymphocyte predominance) and type II (germinal center predominance); as unstimulated in type III (histiocytosis and/or normal) and type IV (lymphocyte depletion). Thirty two neck [-] patients had reactional nodes--16 of them were classified as stimulated and 16 of them as unstimulated; the 2-year survivals were 94% and 68%, respectively. In the 14 patients with cervical metastasis (classified according to nonmetastatic reactional nodes) 9 were stimulated and 5 were unstimulated with 2-year survivals of 100% and 0%, respectively.

CONCLUSION

Stimulated lymphatic pattern reflects a better prognosis, especially in N+ neck laryngeal cancer patients.

Histomorphological characteristics of non-metastatic lymph nodes in patients with head and neck cancer according to their site in the neck

The prognostic relevance of histomorphologically defined reaction patterns of lymph nodes was demonstrated in head and neck cancer. Till today the lymph node site in the neck has not been taken into account. Therefore histomorphologically defined reaction patterns of non-metastatic lymph nodes in the neck were examined according to their site in the neck. A total of 1188 dissected neck lymph nodes of 32 previously untreated patients with carcinoma of the head and neck region were examined histologically by serial sections and classified into 6 different lymph node levels and 6 histomorphological types. The objectivity of the morphological examinations could be evaluated morphometrically by means of an interactive image analysis system (IBAS) and a more precise definition of the lymph node reaction types could be established. The results of the morphological and morphometrical classifications show a statistically highly significant relationship (p < 0.0001) between the reaction types of lymph nodes and their site in the neck. These findings allow a division of the neck in an upper anterior half with immunologically active lymph nodes and a lower caudal-dorsal half, which contains essentially less immunologically active lymph nodes.

Female genital tract cancer

BACKGROUND

Site-specific cancer frequencies and incidence rates are reported regularly by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, but not by histologic type within site. This report reviews data for 160,977 histologically or cytologically confirmed invasive and in situ cancers of the female genital tract.

METHODS

Data were supplied by the SEER program for histologically confirmed cases of uterine corpus, uterine cervix, ovary, vulva, vagina, fallopian tube, and placental cancers diagnosed between 1973 and 1987. Histologic types were reviewed for race, age at diagnosis, incidence, stage, and survival.

RESULTS

There were 89,943 invasive and 71,034 in situ neoplasms. Squamous carcinoma was the most common invasive malignancy of the cervix (77.1%), vulva (74.4%), and vagina (70.8%). Adenocarcinoma was the most frequent malignancy in the uterine corpus (81.5%) and ovary (86.6%), with these percentages reaching 91.6% for corpus and 86.9% for ovary if adenosquamous carcinoma and adenocarcinoma with squamous metaplasia are included. Cervical carcinoma in situ accounted for 91.0% of all in situ cancers. In situ cancers made up 78.5% of all cervical cancers, 35.1% of vaginal cancers, and 50.4% of vulvar cancers.

CONCLUSIONS

There are dominant histologic groups in each female genital tract site that are largely responsible for incidence and survival statistics. Within the groups, however, there are subtypes with differing features. Epidemiologic studies may provide more definite information by considering the effect of these subtypes in examining risk factors.

The desmoplastic lymph node reaction as a prognostic factor of cancer of the tongue and floor of the mouth

To determine the prognostic significance of desmoplasia in metastatic lymph nodes of squamous cell carcinoma of the oral tongue and floor of mouth, 37 cases of this disease were studied. Desmoplasia was present in 59.4% of the cases and associated extracapsular spread in 40.5%. The association of desmoplasia with large lymph node involvement occurred in 59.4%. These relationships were statistically significant (p = 0.002 and 0.0069). The results obtained suggest that desmoplasia is a bad prognosis associated factor.

Antitumor activity of regional lymph node lymphocytes in patients with lung cancer

Cytotoxic activities of regional lymph node lymphocytes (RLNL) and peripheral blood lymphocytes (PBL) of 49 primary lung cancer patients who were subjected to surgical resection were examined by 4 h 51Cr release assay. PBL showed significantly lower cytotoxicity against autologous tumor cells than against K562 and QG-56. On the other hand, RLNL exhibited the same level of cytotoxicity against autologous tumor cells as PBL, although the cytotoxicities against K562 and QG-56 were low. Cytotoxicity of RLNL against autologous tumor cells exhibited a significant degree of depression with the advance of stage, T and N factors. Cytotoxicity of PBL did not significantly change as the stage progressed. When both PBL and RLNL were cultured with purified interleukin-2 (p-IL2) in vitro, their cytotoxic activities were markedly augmented and the cytotoxicities could not be diminished by the treatment with anti-Leu-7 + anti-Leu-11b + C'. These facts indicate that the augmented cytotoxicity may be due to lymphokine activated killer (LAK) cells.

Lymph node response and its relationship to prognosis in carcinomas of the head and neck

The lymph nodes of 32 patients operated on for carcinomas of the larynx and pharynx, were evaluated for the pattern of lymph node response. Pattern 1 (predominantly lymphocytes) and pattern 2 (predominantly germinal centres) showed a fewer number of nodal metastases than pattern 3 (non-stimulated nodes). Well-differentiated carcinomas predominated in patterns 1 and 2, whereas moderately and poorly differentiated predominated in pattern 3. Patterns 1 and 2 predominated in clinical stages I-III, and pattern 3 in stage IV. The survival decreased progressively from pattern 1 to pattern 3.

Immunohistological reaction patterns of cervical lymph nodes in patients with laryngeal carcinomas

An attempt was made to assess the immunological importance of regional lymph node histology in relation to the survival of 107 patients with carcinoma of the larynx, operated on from 1973 to 1982 at the ENT-Clinic in Marburg. A total of 2765 sections of lymph nodes removed during neck dissections were examined microscopically to evaluate the morphological patterns of response. Microscopically, four distinct patterns were defined. Patients whose lymph nodes demonstrated immunological responses according to patterns I and II in the form of either expanded inner cortices or increased numbers of germinal centers had a greater 5-year survival rate than those patients whose lymph nodes showed an unstimulated pattern. Eight patients whose lymph nodes showed a depleted pattern, IV, did not survive more than 3 years. Morphological assessment of immunological activity in lymph nodes draining malignant tumors seems to be of value in predicting survival. The evaluation of the reaction pattern and difficulties in methodology, however, set definite limitations to our study.

Frequency distribution of plasma cells in the medullary cords of tumour-draining axillary and paracolic lymph nodes

Five hundred and ninety-seven axillary lymph nodes draining 104 invasive ductal breast cancers, and 94 paracolic lymph nodes draining 30 invasive adenocarcinomas of the large bowel were investigated immunohistologically to determine the frequency distribution of plasma cells (PC) in the medullary cords (MC). The degree of plasmacytic infiltration was calculated semiquantitatively using the 3-grade scale (0/+, + +, + + +) of Cottier et al. (1973). Statistical analysis yielded the following results: While a marked reactive plasmacytosis (+ + +) was seen in 28.7% of the paracolic lymph nodes, only 1.5% of the axillary lymph nodes exhibited a comparable degree of plasmacytic infiltration (p less than 0.0001). Conversely, low PC counts (0/+) were encountered in 51.1% of the paracolic lymph nodes, but in 83.9% of the axillary lymph nodes. A comparison of axillary lymph nodes with and without nodal metastasation revealed no significant differences (nodal-negative cases: 0/+: 83.6%, + +: 14.3%, + + +: 2.1%; nodal-positive cases: 0/+: 84.3%, + +: 14.9%, + + +: 0.8%). However, significantly more (p less tha 0.001) paracolic lymph nodes of the nodal-negative group revealed a marked plasmacytosis, whereas in the nodal-positive group lymph nodes with low PC counts were more frequent (nodal-negative cases: 0/+: 27.7%, + +: 29.7%, + + +: 42.6%; nodal-positive cases: 0/+ 74.5%, + +: 10.6%, + + +: 14.9%). The degree of plasmacytic reactions in the tumour-regional lymph nodes was not related to the stage of the primary tumour. Moreover, no correlation exists between the PC content of the MC and the amount of PC in metastatic deposits of the same lymph nodes. Altogether, these results do not support the concept that the plasmacytic reactions in the MC of tumour-draining lymph nodes are chiefly determined by effects (stimulating or suppressing) of the primary carcinomas. The topography of the lymph nodes, however, seems to be the main determinant influencing the PC content of MC.

Immunologic patterns of regional lymph nodes in squamous cell carcinoma of the floor of the mouth. Prognostic significance

Histologic specimens from 43 patients with squamous cell carcinoma of the floor of the mouth treated exclusively by surgery were studied with special attention paid to the reactivity of regional lymph nodes. The lymph nodes were classified into four microscopic patterns of immune response: lymphocyte predominance for sinus histiocytosis, germinal center predominance, unstimulated, and lymphocyte depletion. No nodes of the lymphocyte depletion pattern were found. Correlations were then made between the patterns and survival rate at 5 year follow-up. The results showed that those patients with lymph nodes that demonstrated lymphocyte predominance had a better survival rate than patients with germinal center predominance and the unstimulated patterns. These correlations were independent of stage and metastatic nodal status and the differences were statistically significant (p less than 0.5). Morphologic assessment of immunologic activity in lymph nodes that drain carcinoma of the floor of the mouth appears to be of significant prognostic value.

Histopathologic grading of squamous cell carcinoma of the uterine cervix. An evaluation of 70 stage Ib patients

Multiple histopathologic parameters were evaluated to determine which were of prognostic value in predicting patient outcome. Seventy patients with clinical stage Ib squamous cell carcinoma constituted the study population. The patients were primarily treated by surgery, with actuarial survival rates of 76%, 68%, and 57% at 5-, 10-, and 15-year intervals. Eight of 57 patients (14%) with lymph node material available for review had pelvic lymph node metastases and a decreased survival rate (P less than 0.001). Thirty-six patients had 5 mm or less depth of tumor invasion in their hysterectomy specimen and a 5-year survival rate of 94%. Thirty patients had greater than 5 mm of invasion in resected uteri and a 5-year survival rate of 58% (P = 0.007). None of the patients with less than 5 mm of invasion died of their disease. Evaluation of nine histologic parameters in the initial biopsy specimens demonstrated that only vascular invasion (lymphatic and/or capillary) predicted a poor outcome (P = 0.046). Cell size, inflammatory response, degree of keratinization, or any of the other histologic parameters tested failed to demonstrate significant prognostic value in this study.

Prognostic factors in carcinoma of the vulva

The clinical and pathologic characteristics of epidermoid carcinoma of the vulva in 84 women treated by vulvectomy were evaluated in relation to inguinal node status and survival. Tumor diameter, depth of invasion, clinical node status, vascular invasion, and pattern of invasion were all individually correlated with the pathologic status of the inguinal nodes. However, when evaluated in combination, only the clinical status of the inguinal nodes, the depth of invasion, and the pattern of invasion (in this order of significance) were predictive of pathologic inguinal node status. Tumor diameter, inguinal node status, depth of invasion, pattern of invasion, and vascular invasion were individually correlated with survival. When evaluated in combination, the clinical diameter of the lesion was the most important predictor of survival; depth of invasion and vascular invasion contributed additional information.

Human monoclonal antibodies to cytokeratins associated with squamous cell carcinoma

Human lymphocytes from a lymph node draining the tumor-bearing area of a patient with a large primary squamous cell carcinoma of the oral mucosa were fused with the nonproducer mouse myeloma, NS-1, to produce interspecies hybridomas. Of 95 hybridoma culture supernatants tested, 23 contained from 0.5 to 50 micrograms/ml of human IgM or IgG. Six supernatant fluids containing greater than 15 micrograms/ml of Ig were tested by indirect immunoperoxidase and immunofluorescence against sections of the autologous carcinoma. Five IgM (lambda) monoclonal antibodies stained the cytoplasm of autologous and allogeneic squamous carcinoma cells. All five monoclonal antibodies stained all layers of normal epidermis but each antibody stained the superficial keratin layer most intensely. Two of the five hybridoma antibodies were further tested. Both antibodies stained all types of normal epithelium; a network of fibers characteristic of intermediate filaments in cultured squamous carcinoma cells and cultured fibroblasts; Z lines in skeletal muscle; and axons in peripheral nerve fibers. We conclude that all five IgM monoclonal antibodies recognize cytokeratins associated with the autologous squamous cell carcinoma. Two of the five hybridoma antibodies recognize an antigenic determinant common to all types of intermediate filament proteins. These data indicate that cytokeratins released by squamous carcinoma cells induced an antibody response in this patient.

Prognostic significance of morphology of tumor and retroperitoneal lymph nodes in epithelial carcinoma of the ovary. II. Correlation with survival

Correlation between prognostic indices derived from morphologic studies of retroperitoneal lymph nodes as well as primary tumor and survival in 39 patients with epithelial carcinoma of the ovary is reported. All had maximal surgery, adjuvant chemotherapy, and were followed for more than 2 years. A selective biopsy of pelvic and para-aortic lymph nodes was performed during the staging laparotomy in all instances. The chemotherapeutic regimen was a combination of Adriamycin, cis-platinum, and Cytoxan in a majority of cases. Prognostic indices, which showed positive correlation with survival, were cancer involvement, type of lymph node reaction, sinus histiocytosis, and fibroblastic proliferation in the regional lymph nodes; tumor grade, lymphocytic infiltration, stromal fibrosis, and histologic type in primary tumor; and stage of disease. Unfavorable factors for survival were nodal metastasis, lymphocytic depletion in abdominal nodes, and Grade 3 tumor. Clinical implications of our findings are discussed.

Prognostic significance of morphology of tumor and retroperitoneal lymph nodes in epithelial carcinoma of the ovary. I. Correlation with lymph node metastasis

The prognostic indices based on a morphologic study of tumor and retroperitoneal lymph nodes in 63 patients with epithelial carcinoma of the ovary are reported. The purpose of the study was to identify those variables most frequently related to nodal involvement. The cases in the series consisted of 11 Stage I, 10 Stage II, 34 Stage III, and 8 Stage IV. Histologic distribution was 60.4% serous type, 11.1% mucinous, 6.3% endometrioid, 6.3% clear cell, and 15.9% unclassified. All patients had maximal surgery and selective biopsy of para-aortic and pelvic lymph nodes. The results showed statistically significant variables associated with nodal metastasis in both primary tumor and regional lymph nodes. The indices in primary tumor were grade of tumor, vascular invasion, lymphocytic infiltration, and stromal fibrosis; those in lymph node were type of lymph node reaction, sinus histiocytosis, and fibroblastic proliferation. The nodes with lymphocyte depletion were associated with nodal spread in 81.3% of cases. It is concluded that morphologic study of tumor and lymph node could identify prognostic factors predicting regional nodal metastasis in ovarian carcinoma.

The contribution of regional lymph nodes in the resistance against breast cancer: practical implications

Experimental evidence suggests that regional lymph nodes (RLN) are important in the initiation and possibly the maintenance of tumor immunity. "Negative" nodes denote strong tumor immunity and "positive" nodes low. The latter also serve as markers of systemic disease. From histological and immunological studies, and mostly from recent clinical studies in breast cancer, the following practical recommendations are made: (1) Clinically positive axillary nodes are best eliminated by surgery. (2) Resection of positive internal mammary nodes appears to increase survival of patients with central and inner quadrant lesions; however, destruction of these nodes by irradiation, although improving local disease control, may decrease survival. (3) Negative RLN should be preserved, as they appear to prevent lymph node metastases and stimulate systemic immunity. Only a small fraction of unresected RLN harboring micrometastases will ultimately develop palpable disease, and their elimination at that late phase yields the same results as when these nodes are treated prophylactically.

Conservative surgery for regional lymphadenectomy in the treatment of early gastric carcinoma

The relationship between lymph node metastases and postoperative prognosis in 209 patients with early gastric cancer was studied. As to the postoperative prognosis in relation to the extent of lymph nodes dissection, no significant difference was observed among the age-corrected 5-year survival rates following three surgical procedures in patients with early gastric cancer. Age-corrected 5-year survival rates were 0.92 +/- 0.44 R1-resection, 0.95 +/- 0.44 in R2-resection, and 1.00 +/- 0.06 in R3-resection, respectively. In addition, in 71 patients including 33 with early gastric cancer and 38 patients with advanced but relative early gastric carcinoma, the relationship between the immunostatus and postoperative prognosis was investigated. Postoperative age-corrected 5-year survival rate (0.904 +/- 1.153) of the optimal responders with good immunostatus was significantly higher than that (0.582 +/- 1.153) of the suboptimal responders with impaired immunostatus (P less than 0.01). Thus, conservative surgery for regional lymphadenectomy may be an effective procedure for cure of early gastric carcinoma, particularly in cases of a carcinoma limited to the mucosal area of the stomach.

Gastric carcinoma with lymphoid stroma: correlation to reactive hyperplasia in regional lymph nodes and prognosis

The pathological changes of regional lymph nodes in cases of gastric carcinomas with lymphoid stroma (LS group) and the prognostic significance of the findings were studied in comparison with those in cases of ordinary stroma (OS group). The purpose of this study was to elucidate the immune responses of regional lymph nodes, histologically, in patients with gastric carcinoma and lymphoid stroma. In the LS group, the incidence of paracortical hyperplasia (PH) was high, irrespective of lymph node metastasis, while that of germinal center hyperplasia (GH) was high in the absence of lymph node metastasis but tended to be low in the presence of metastasis. In the OS group, the incidences of PH and GH were low, particularly in the presence of lymph node metastasis. The five year survival rate in those with no lymph node metastasis was as favorable as that of patients with lymph node metastasis in the LS group, the latter being significantly higher than the rate in the OS group. These results indicate that gastric carcinomas with lymphoid stroma are closely related to reactive hyperplasias of the regional lymph nodes, particularly paracortical hyperplasia, and in such cases, there is a favorable prognosis, regardless of the lymph node metastasis.

Prognostic significance of the tumor antigen TA-4 in squamous cell carcinoma of the uterine cervix

Prognostic values of a tumor antigen (TA-4) of squamous cell carcinoma were studied in 135 patients with invasive squamous cell carcinoma of the uterine cervix. In order to evaluate the host defense responses against cancer, the percentage of lymphocytes (percentages of lymphocytes in total leukocyte counts in the peripheral blood) was also determined simultaneously in each case. All patients were followed up for 2 years. Sixty patients with Stage II disease underwent a radical operative procedure, and all other cases (75 cases) were treated primarily with radiation therapy. In both groups of patients, the survival rate or disease-free rate was significantly worse in those with TA-4 levels of greater than or equal to 15 microunits/ml compared to that of those with lower levels. The prognosis was particularly poor in those patients who had TA-4 levels of greater than or equal to 15 microunits/ml and lymphocyte percentages of less than 30. It was concluded that the simultaneous determinations of serum TA-4 and lymphocyte percentages would be useful in predicting the prognosis of cervical squamous cell carcinoma.

Lymph node reactions to cancer

Histological, histomorphometrical and histochemical data on the response of regional lymph nodes to tumor development, as recorded in experimental and clinical studies, were coordinated and supplemented by recent findings in experimentally induced autochthonous carcinomas in the rat gastrointestinal tract. The attempted correlation led to the definition of several prognostic parameters: 1) The development of germinal centers and the plasmocytic reaction in tumor draining nodes are morphological expressions of active humoral immune responses that may be specifically directed against the tumor. These reactions attain their maximum usually during late stages of tumor development. Their incidence and prognostic significance may vary depending upon the stage and the type of tumor. 2) Sinus histiocytosis is an immunologically nonspecific lymph node response with debatable prognostic significance. 3) Granulomatous sarcoid-like lesions may be understood as signs of an immunologically mediated antitumor response of macrophages activated by T lymphocytes. They are indicative of a favorable prognosis. 4) Paracortical hyperplasia, characterized by an increased population of lymphocytes and eventually immunoblasts, is an expression of an active T-cell reaction. This reaction occurs typically during early stages of experimental tumors. Correspondingly, it is of favorable prognostic significance in human tumors. 5) Lymphocytic depletion and nodular alteration of T-cell areas, with increased histiocytic infiltration, are reactions most often seen in the draining nodes of an advanced tumor. Both seem to coincide with depression of the cell-mediated immune reactivity. The present assessment of the reactive behavior of diverse lymph node compartments may serve as a first pointer to the proposed histologic immunostaging of malignant tumors.

Morphology of draining lymph nodes after local immune stimulation with C. parvum: comparison of pelvic nodes in carcinoma of cervix and popliteal and inguinal nodes of guinea-pig

Morphological changes are described in pelvic lymph nodes excised 10 days after C. parvum (CP) treatment of patients with cervical carcinoma. Guinea-pig popliteal and inguinal lymph nodes were investigated from Days 1 to 10 after an injection of 70 micrograms CP into the footpad. Eosinophils were detected from the first few hours after stimulation, initially in the marginal sinus, then in the medullary sinuses and subsequently in the efferent lymphatics. From Day 2 to Day 6, histiocyte accumulations with the appearance of epithelioid cells were found mainly in subcapsular and interfollicular areas, and small granulomas were also seen in the paracortex. The granuloma formation in the lymph node was considered as an indication of the activation of histiocytes. Besides small granulomas in the paracortex, activated interdigitating cells, surrounded by scattered lymphoblasts and eosinophils, were also present. We considered this lymphoblastic response and eosinophilic accumulation as likely to be due to blastogenic factor and eosinophil stimulation promotor. Eight to 10 days after CP stimulation, the macrophage lymphoblast eosinophil response was replaced by a B-cell reaction: germinal-centre activation and medullary plasma cells. Such a B-cell reaction was also found in the human pelvic nodes removed at operation, but this reaction could not be attributed to CP treatment alone, since cervical-carcinoma patients not treated with CP also showed such reactions. In contrast, pelvic lymph nodes removed at necropsy from females killed in traffic accidents showed no predominance of either B- or T-cell stimulation.

Bronchogenic carcinoma: survival after surgical treatment according to stage, histologic type and immunomorphologic changes in regional lymph nodes

The survival rates of 90 patients who underwent operation for bronchogenic carcinoma were analyzed statistically according to sex, age, tumor stage and histologic type, types of surgical procedures (lobectomy or pneumonectomy), and to immunomorphologic parameters of immunologic activity in peribronchial and hilar lymph nodes. The Stage I group survived significantly longer than did the Stage II and III groups, the lobectomized patients survived significantly longer than the pneumonectomized patients. The absence or presence of lymph node metastases was one of the major determinants of survival. The mean values (percent of total node cut surface) of lymph node sinus histiocytosis and of paracortical area could be correlated directly to survival in each of the histologic tumor-type groups, while the development of follicular cortex and germinal centers correlated inversely with survival. Increased survival might be associated with changes concomitant with immune reactivity in lymph node T-cell areas and with the sinus histiocytosis pattern, the latter representing probably a tumor--host reaction of the delayed hypersensitivity type. By contrast, increased activity of lymph node B-cell areas tended to correlate with poor prognosis of lung cancer patients. Moreover, patterns showing germinal center hyperplasia were statistically associated with lymph node neoplastic invasion, while the pattern with sinus histiocytosis and expanded paracortical areas was statistically associated with tumor-free lymph nodes.

Prognostic significance of histologic host response in cancer of the large bowel

Histologic material from 156 patients treated with surgery for cancer of the large bowel was studied with regard to tumor host interaction and with particular emphasis on the reactions of the regional lymph nodes. Prognostic evaluation of the tumor included the extent of the primary lesion according to Dukes' classification and the grade of differentiation of the carcinoma. Morphologic evidence of host resistance was judged by the presence and degree of lymphoplasmacytic infiltration of the tumor and the reactions of the regional lymph nodes, which were classified in four histologic patterns: lymphocyte predominance, germinal center predominance, lymphocyte depletion, and unstimulated. Of the factors evaluated, those that appeared to correlate best with five-year survival were the stage of the disease, the grade of differentiation of the carcinoma, the degree of lymphoplasmacytic infiltration of the tumor, the lymphocyte predominance pattern, and, to a lesser degree, the germinal center predominance pattern. None of the other morphologic features related to lymph nodes showed favorable prognostic significance. The relationship of morphology to host immune mechanisms is discussed.

Prognostic significance of Lauren and Ming classifications and other pathologic parameters in gastric carcinoma

One hundred seventy-two patients with gastric carcinoma were studied (111 men and 61 women). Mean age was 54.0 +/- 11.2 years, and the overall five-year survival rate was 37.5%. There were four carcinomas in situ and one double carcinoma; the remaining 167 were classified as intestinal (112), diffuse (48), and atypical (7), according to Lauren; and as expanding (96) and infiltrative (71), according to Ming. Both classifications had prognostic significance; that of Lauren's could not be ascribed to sex and age of patients, to location of tumors, or to extent of disease, but appeared to be associated with the histologic pattern of regional lymph nodes. The prognostic significance of Ming's classification did not seem to depend upon sex and age of patients, location of tumors, or lymphoid response, but appeared to be partially related with extent of disease. The concurrent use of both classification did not provide further prognostic information.

Dynamic and morphological responses of draining lymph nodes to single and repeated applications of oxazolone to guinea-pig skin

Auricular lymph nodes in guinea-pigs were studied for 3 weeks under continuous stimulation with oxazolone applied to the ear skin. Quantitation of 3H-Tdr labelled paracortical lymphocytes following pulse labeling, demonstrated a marked, but only transitory rise in the proportion of cells in DNA synthesis. In spite of this, the total number of cells in S-phase continued to rise during the remaining part of the observation time, as a result of a steady increase of the paracortical cell mass. The variation in the proportion of large, pyroninophilic blast cells, revealed a pattern similar to that of the labelling index. A high proportion of blast cells was found only in the initial phase of the reaction, while the chronic response was characterized by a low proportion, no different from the starting level. Paracortical enlargement appeared to be the most reliable morphological criterion on which a chronically stimulated paracortex could be distinguished from an "unstimulated". The initial paracortical response, similar to a primary reaction, was followed by an equally pronounced development of germinal centres and plasma cells. These were also persistent features under continued stimulation. The reported changes are most likely specific responses to oxazolone stimulation.

Carcinoma of the pyriform sinus: predictors of TNM relapse and survival

To determine predictors of TNM relapse and survival for 108 patients with epidermoid carcinoma of the pyriform sinus, the histopathologic features of tumor-related and host-related characteristics were correlated with primary and/or cervical nodal failure, distant metastases, and actuarial three-year survival. Patients in this study received preoperative irradiation and partial laryngopharyngectomy (PLP) or total laryngopharyngectomy (TLP) with en bloc radical neck dissection. Higher rates of local failure were observed in patients with keratinizing tumors (34 vs. 15%), with tumors having an "infiltrating" tumor-stromal interface (30 vs. 14%), with positive surgical margins in PLP or TLP specimens (30 vs. 16%), and with extranodal extension of tumor (39 vs. 22%). The development of distant metastases was significantly correlated with nonkeratinizing carcinomas (30 vs 11%, P = 0.02), and was observed more often in patients with positive lymph nodes (17 vs. 7%). Patients with negative surgical margins in PLP or TLP excision (50 vs. 21%, P = 0.01) survived significantly longer.

Morphology of the spleen in women who died of metastatic genital tract cancer

The histology of the white pulp of the spleen was assessed in 56 women who died of metastatic genital tract cancer and in 56 age-matched women who died of a myocardial infarction or a stroke. Special attention was paid to the areas associated with T cells and B cells. The T-cell and B-cell areas were profoundly depleted in patients with carcinoma. This suggests that women who die of genital tract cancer have impaired humoral and cell-mediated immunity.

Immunomorphologic study of regional lymph nodes in cancer: response of regional lymph node cells from gastric and colorectal cancer to PHA stimulation

To obtain information regarding the immunologic capacity of uninvolved regional lymph nodes (RLNs) draining tumor, the in vitro response of regional lymph node cells (RLNCs) to PHA was investigated in lymph nodes from 55 patients with gastric or colorectal cancer, and gastric ulcer. Evaluation of data relative to cancer progress demonstrated that, in gastric cancer patients, the response of stimulated RLNCs from patients with middle stage carcinoma was significantly higher compared with those of cells from patients with early or late stage carcinoma, such being similar to the response of RLNCs from control patients with gastric ulcer. The results from colorectal cancer patients were also similar to those from patients with gastric cancer. Our results suggest that RLNs without metastasis contain cells capable of responding to PHA despite the presence of growing tumors in these cancer patients. In the results of PHA stimulation in relation to the lymph node morphology, we observed in both groups of patients with gastric or colorectal cancer that, regardless of the extent of the cancer lymph nodes with lymphocyte predominance there was a high PHA response while lymph nodes with lymphocyte depletion and unstimulated nodes exhibited a low PHA response. These results show a close relationship between this lymph node morphology and immunologic status of nodes.

Relationships between cervical node histological patterns and rosette test scores: possible prognostic value in laryngeal cancer

In previous research the authors have remarked that some hystological patterns--macrophagic hyperplasia and thymus-dependent areas hyperplasia--when prevailing in cervical nodes of laryngeal cancer patients, possess a positive prognostic value. In this study the possible relationship between the results of E and EAC-rosettes and prevailing hystologic patterns in cervical nodes is investigated. A positive correlation was not found. Conclusively, the inconsistency of aspecific tests for prognostic purposes and the need for a specific immunological monitoring system are outlined.

Lymphadenectomy in Urology

Surgical radicality in tumours of the urinary tract with lymphonodular deposits requires extirpation of the adjacent and regional lymphadenoid tissues, in particular of the lymph nodes. The theoretical and practical aspects of lymphadenectomy in testicular and renal tumours are discussed, and the technical problems are outlined. The importance of early diagnosis and the benefits of surgery of adequate radicality involving lymphadenectomy are emphasized.

Impaired thymus-derived lymphocyte function in patients with malignant brain tumour

Cell-mediated immunity was evaluated in 28 patients with malignant glioma, using in vivo and in vitro tests of lymphocyte function. The results were compared to those found in patients with carcinomatosis (11 subjects), benign brain tumours (9), other neurological disorders (20) and normal, healthy controls (21). Significant impairments of delayed hypersensitivity responses to common antigens was found in patients with malignant glioma and in those with generalised malignancy. A less significant depression of lymphocyte responses was also detected in patients with meningioma. The impairment in cell-mediated immunity was shown not be due to a serum blocking factor. Our data indicate that there is defective T cell function in patients with glioma, similar to that reported in cases with malignancies outside the central nervous system. This impaired immunity may have clinical significance.

Human regional tumour lymph nodes: alterations of micro-architecture and lymphocyte subpopulations

Axillary lymph nodes draining mammary carcinoma showed an alteration of both micro-architectue and lymphocyte subpopulations. Lymph nodes with a normal or increased T and/or B lymphocyte compartment (assessed by histology) had a low incidence of nodal tumour spread, whilst hypocellularity of the T- or B-lymphocyte-dependent areas was associated with a significant increase in metastatic invasion. Tumour-draining lymph nodes, in particular the more proximal ones, were often enlarged, spherical and tense due to an increased cellular content, predominatly B lymphocytes and their various subsets. The increased number and percentage of B lymphocytes was associated with follicular hyperplasia and prominent germinal centres. Lymph nodes with a prominent paracortex tended to have a higher ratio of T to B lymphocytes than nodes with a hypocellular paracortical area, but in many instances both the T- and B-lymphocyte-dependent areas were increased. There was no correlation between a particular axillary-node lymphocyte subpopulation pattern (assessed by surface markers) and the size, degree of necrosis, inflammatory infiltrate or histologic type of breast carcinoma, or the presence of metastatic node invasion.

Regional lymph node and stromal immunomorphology in colorectal carcinoma and relation to tumour spread

A quantitative morphometric study of lymphocyte patterns in the stroma and regional lymph nodes was made in 509 cases of colorectal adenocarcinoma and 17 non-invasive adenomas. An increase in the perivascular lymphocytes, and in the size of lymph nodes, germinal centres and paracortical areas was most obvious in 'localized' invasive tumours and significantly more in Dukes' stage B than in stage C. Stage C1, defined as cases where the primary tumours were confined to the wall but with lymph node spread, showed hardly any perivascular lymphocyte aggregates, although in the regional lymph nodes there was relative paracortical, i.e. T-lymphocyte, hyperplasia. It is concluded that the presence of cuffs of perivascular lymphocytes at the tumour edge, and the increased size of tumour-free regional lymph nodes together with the relative and absolute abundance of germinal centres (B-lymphocyte) and paracortical areas (T-lymphocyte), are stage dependent. This is most obvious in stage B. These morphological expressions of host immunoreactivity may well reflect favourable anti-tumour mechanisms.