Carcinomas of the cervix with intense stromal eosinophilia

Tumour eosinophilia combined with an immunohistochemistry panel is useful in the differentiation of type B3 thymoma from thymic carcinoma

It is sometimes difficult to differentiate between type B3 thymoma from thymic carcinoma histologically. Given the rarity of these tumours, studies have been limited. A series of 66 thymic neoplasms were reviewed and classified according to the World Health Organization (WHO) scheme. We performed a tissue microarray analysis of surgically resected thymic tumour specimens including 12 thymic carcinomas, 17 type B3 thymomas and 37 thymomas of other types. Percentage and staining intensity of immunohistochemical markers were recorded. Tumour eosinophilia was recorded positive if at least one eosinophilic cell identified. Positive staining of the following markers significantly differentiated type B3 thymoma from thymic carcinoma: cytokeratin 5/6 (15 vs. 3), Mesothelin (0 vs. 5), cytoplasmic androgen receptor (10 vs. 0), CD57 (9 vs. 0), CD5 (0 vs. 7), TdT (lymphocytic) (14 vs. 1), CD1a (lymphocytic) (14 vs. 2), CD117 (1 vs. 9), MOC31 (2 vs. 6), p21 (2 vs. 8), cytoplasmic Survivin (0 vs. 4), and tumour eosinophilia (1 vs. 11). Combining two or three markers was able to differentiate these two tumours with area under the curve percentage of at least 92%. Tumour eosinophilia combined with a panel of immunohistochemistry could differentiate type B3 thymoma from thymic carcinoma.

Presence and quantification of macrophages in squamous cell carcinoma of the cervix

Cervical cancer is a major cause of morbidity and mortality in women. The presence of macrophages as well as other inflammatory cells has been noted in many of these tumors. Intratumoral macrophages/monocytes induce anergy to cytokine therapy and cause apoptosis in natural killer(NK) and T cells. The aim of this study was to better evaluate and quantify the presence of macrophages in these tumors. Twenty-four cases of squamous cell carcinoma of the cervix seen at our institution were evaluated. Sections were stained with CD68, a marker for macrophages. Staining was graded microscopically by two reviewers together on a scale of 0-4+, with 4+ representing the greatest number of positive cells. Image analysis was conducted to quantify the percent area stained in a given lesion. For each lesion, 10 fields were evaluated, and a mean percentage area stained was calculated. 4+ staining was observed in five cases, 3+ in zero cases, 2+ in three cases, 1+ in six cases, 1-2+ in one case, and nine cases were negative. Image analysis results correlated well with the light microscopic scoring. Presence of a prominent infiltrate of macrophages did not correlate with tumor grade or with histologic lymph node status, but showed a strong negative correlation with tumor stage. Some squamous cell carcinomas of the cervix show a prominent macrophage component in the tumor-associated inflammatory infiltrate. The presence of this prominent infiltration of macrophages did not correlate with tumor grade or lymph node status, but showed a strong negative correlation with tumor stage. The results suggest that immunotherapy may have a potential role in the treatment of cervical carcinoma. Computerized image analysis appears to be a valid measure to assess macrophage counts in such lesions.

Eosinophils as a marker for invasion in vulvar squamous neoplastic lesions

A study of eosinophils directed against vulvar neoplastic squamous epithelium was undertaken to determine whether there were thresholds per high-power field (hpf) or 10 hpf that were a marker for invasion. The presence of stromal and intraepithelial eosinophils in 33 cases of vulvar grade 3 squamous intraepithelial neoplasia (carcinoma in situ) (VIN 3) was compared with that in 38 cases of vulvar invasive carcinoma with any degree of invasion (ISC). In both incisional biopsy and excisional specimens, the presence of >3 eosinophils per high-power field (eos/hpf) and the presence of >or=5 eosinophils per 10 high-power fields (eos/10 hpf) were both significantly associated with invasion, and the presence of >or=20 eos/hpf and/or >50 eos/10 hpf was limited to cases with invasion. The presence of eosinophils within the neoplastic squamous epithelium was also limited to cases with invasion. The author proposes: 1) eosinophil counts in vulvar incisional biopsy specimens of >3/hpf and/or >or=5/10 hpf warrant a note of caution that invasion may be present even when none is identified by conventional criteria; 2) eosinophil counts of >3/hpf and/or >or=5/10 hpf in excisional specimens should raise the suspicion of invasion in cases in which only VIN 3 is identified in the initial sections, and warrant additional sections and/or levels to search for invasion; 3) the above eosinophil counts provide supportive evidence for invasion in cases with equivocal invasion by conventional criteria; and 4) the presence of >or=20 eos/hpf and/or >50 eos/10 hpf, and the presence of intraepithelial eosinophils in conjunction with >3 eos/hpf and >or=5 eos/10 hpf is virtually diagnostic of invasion.

Eosinophils as a marker for invasion in cervical squamous neoplastic lesions

A study of eosinophils associated with cervical neoplastic squamous epithelium was undertaken to determine whether their presence is a marker for invasion. Forty cervical incisional biopsy specimens of high-grade squamous intraepithelial neoplasia (HSIL), 12 with an element of invasive carcinoma, and 2 of HSIL suspicious for invasion, and follow-up excisional specimens of 27 cases of HSIL and 6 of microinvasive and invasive carcinoma were reviewed. In both incisional biopsy and excisional specimens, the presence of >or=5 eosinophils/high-power fields (hpf) and >or=10 eosinophils/10 hpf were both highly significantly associated with invasion with a high degree of specificity and positive predictive value, whereas counts below these thresholds had a high negative predictive value. The authors propose: 1) eosinophil counts in cervical incisional biopsy specimens of >or=5/hpf and/or >or=10/10 hpf warrant a note of caution that invasion may be present even when none is identified in the specimen by conventional criteria; 2) eosinophil counts of >or=5/hpf and/or >or=10/10 hpf in excisional biopsy and hysterectomy specimens should raise the suspicion of invasion in cases in which only HSIL is identified in the initial sections, and warrant additional sections and/or levels to search for invasion; and 3) the above eosinophil counts may provide supportive evidence for invasion in cases with equivocal invasion by conventional criteria.

Cytokine profile of cervical cancer cells

OBJECTIVE

In patients with cervical carcinoma, the presence of cytokines produced by T(H)2 cells, and the presence of an eosinophilic inflammatory infiltrate, has been associated with a less effective immune response and tumor progression. In the present study, we have investigated the cytokine profile of cervical carcinoma cells. In addition, we have measured whether differences in cytokine profiles between normal and malignant cervical epithelial cells are present.

METHODS

For this purpose we have determined the mRNA expression patterns of 20 relevant cytokines by RT-PCR and Southern blotting in 3 normal primary cervical epithelial cell cultures (NPE) and 10 cervical cancer cell lines (CCCL).

RESULTS

TGF-beta(1), IL-4, IL-12p35, and IL-15 were produced by all CCCL and NPE. TNF-alpha, IL-10, IL-5, and RANTES were present in most NPE, but not in any of the CCCL. MCP-1 was expressed in all CCCL but in only one NPE. The presence of the anti-inflammatory cytokine TGF-beta(1) in cervical carcinomas was confirmed by RNA in situ hybridization on tissue sections of carcinomas from which the CCCL originated.

CONCLUSIONS

Our results suggest that cervical carcinoma cells produce immunomodulatory cytokines and that cytokine expression patterns change after malignant transformation. The implications of locally produced cytokines by cervical cancer cells are further discussed.

Cervical carcinoma demonstrating tumor-associated tissue eosinophilia: a clinicopathological study of 17 patients

OBJECTIVES

Our objective in this study was to evaluate the clinicopathological significance of tissue eosinophilia associated with invasive cervical carcinomas.

MATERIALS AND METHODS

All cases of cervical carcinoma treated at the Medical College of Georgia between October 1982 and October 1989 were reviewed. We obtained data regarding all cases, including age at diagnosis, stage of disease, therapy, and outcome. Pathological review of all cases was undertaken to identify those patients in whom invasive carcinoma was associated with an intense infiltrate of eosinophils.

RESULTS

A total of 441 patients with invasive cervical carcinomas were treated at the Medical College of Georgia between October 1982 and October 1989. Of these patients, 403 had squamous carcinomas, 34 had adenocarcinomas, 4 had adenosquamous carcinomas, and 18 demonstrated tumorassociated tissue eosinophilia (TATE). In all cases TATE was associated with squamous cell carcinomas. Patients in whom TATE was identified were younger (range, 20-67 years; mean, 40.2 years) than were those patients without TATE (range, 17.5-93.5; mean, 54.8 years; p = .0004; t = 3.626, with 233 degrees of freedom) No significant difference was noted with regard to size of tumor, stage at diagnosis, outcome, or length of survival.

CONCLUSION

Although it is an interesting and unusual finding when identified in relationship to cervical carcinoma, TATE is of no prognostic significance.

Tumor-associated eosinophilic infiltrate of cervical cancer is indicative for a less effective immune response

The local inflammatory tumor infiltrate related to cervical carcinoma has been shown to consist mainly of T lymphocytes and macrophages. In 5% to 40% of the cases, eosinophilic granulocytes from a major part of the tumor-infiltrating cells. The presence of a high percentage of eosinophilic granulocytes in the infiltrate might reflect a less effective antitumor response, resulting in a worse overall survival. In the present study, histological slides from 83 patients who had been treated for cervical squamous carcinoma were reviewed. Special emphasis was put on the presence of eosinophils in the tumor infiltrate and correlated with clinical outcome as a parameter of the strength of the host-antitumor response. Multivariate analysis showed that the presence of a large amount of eosinophils among the infiltrate was an independent parameter, predicting a worse overall survival in patients with tumor-negative lymph nodes and tumor-negative resection margins (n = 61). The presence of eosinophilic granulocytes might represent a less appropriate immune response based on a disturbed equilibrium between Th-1- and Th-2-mediated immune response.

Clinically-occult mixed cellularity Hodgkin's disease with Charcot-Leyden crystals

Charcot-Leyden crystals (CLC) are rarely described in tissue. Because of the derivation of CLC from eosinophils, and the antineoplastic functions that eosinophils effect, it is plausible that CLC in neoplastic tissue specimens may be significant. We recently encountered a case in which Hodgkin's disease and CLC were unexpectedly found. We reviewed 31 cases of Hodgkin's disease for CLC and sought relationships between CLC incidence and morbidity or mortality. While various grades of eosinophilia were represented, CLC were encountered only in the case reported. The role of eosinophils and CLC in Hodgkin's disease is enigmatic. With clinicopathologic correlations from additional patients, it may be determined that CLC play a role in the natural history or prognosis of Hodgkin's disease.

Effect of tumour associated tissue eosinophilia on survival of women with stage IB carcinoma of the uterine cervix

AIMS

To examine the survival of a group of women with stage IB invasive carcinoma of the uterine cervix, divided according to the expression of tumour associated tissue eosinophilia (TATE).

METHODS

Histological material from 81 women with stage IB squamous and adenosquamous cervical carcinomas before radiotherapy was assessed for the extent of tissue stromal eosinophilia, quantified using antibodies to human major basic protein.

RESULTS

Twenty eight (38%) of the cases demonstrated TATE of over 30 eosinophils/mm2, with 12 (16%) having greater than 100 eosinophils/mm2. Eleven women in the series developed distant spread or recurrent pelvic disease, this group having a stromal eosinophil density significantly less (13.8/mm2) than the remainder (69.9/mm2) (p = 0.03). The actuarial five year survival rate for women with a tumour eosinophil density over 30/mm2 was 92% compared with 70% with a density under 30 mm2, with a significant difference in the survival curves for these two groups (p = 0.03).

CONCLUSIONS

As a univariate parameter, a tumour associated tissue eosinophilia of at least modest proportions is associated with statistically improved survival in women with stage IB cervical carcinomas.

Tumor-associated tissue inflammatory reaction and eosinophilia in primary superficial bladder cancer

In a retrospective study the data of 428 patients with primary superficial transitional cell carcinoma of the bladder were evaluated. The histologic slides were reviewed for presence of a tumor-associated tissue inflammatory reaction, especially tumor-associated eosinophilia. Tumor-associated cell infiltration was found in 23.1 percent and tumor-associated eosinophilia in 2.1 percent. Tumor-associated cell infiltration was associated with less recurrences (p = 0.01). Tumor progression rate was not significantly influenced by tumor-associated cell infiltration. Tumor-related death rate was lower in the group with tumor-associated cell infiltrate (p = 0.50). Using the Cox regression model carcinoma in situ of the tumor margin, tumor-associated cell infiltrate, and grade of differentiation appeared to be important factors in the prognosis for survival.

Identification of Charcot-Leyden crystals by electron microscopy

Observations of the ultrastructure of Charcot-Leyden crystals are sporadic in the literature. These crystals appear occasionally in clinical materials, however, and may pose diagnostic dilemmas if not correctly identified. Two cases in which unusual crystallike structures were seen on electron micrographs of specimens were evaluated for diagnostic purposes. These structures were tentatively identified as Charcot-Leyden crystals and subsequently were confirmed as such by immunoperoxidase labeling. The cases are reported together with a review of the ultrastructure, histology, immunology, and natural history of Charcot-Leyden crystals.

Glassy cell carcinoma of the cervix: a bimodal treatment strategy

Glassy cell carcinoma of the cervix is a distinct clinicopathologic entity. This infrequent pathologic subtype is an aggressive biologic tumor associated with a rapid clinical course and poor outcome with conventional treatment modalities in the majority of cases. In a 12-year period from July 1976 to June 1988, 32 cases of glassy cell carcinoma of the cervix were identified. This accounted for 5.3% of all cervical carcinomas. The mean age was 10 years younger than that of other histologic subtypes. A disproportional number of patients with glassy cell carcinoma had malignancies of early clinical stages. The 5-year survival of patients with Stage IB glassy cell carcinoma of the cervix was 45% when treated with primary radical surgery in contrast to 90% for squamous cell and 78% for adenocarcinoma. When bimodal therapy with radical surgery and radical radiotherapy was used, the survival of patients with Stage IB glassy cell carcinoma improved to 87%. Survival of patients with Stage II glassy cell carcinoma of the cervix improved from 50% to 85% with combined radical surgery and radiotherapy. Despite a combination of radical surgery and radiotherapy, complications were minimal.

The importance of the eosinophil in head and neck cancer

In a previous study, we found tumor-associated tissue eosinophilia (TATE) to be a favorable prognostic indicator for squamous cell carcinoma of the head and neck (p less than 0.05). The present expanded study was undertaken to confirm this finding. The pathology of 120 head and neck tumors was examined for histologic features suggestive of poor prognosis. Ten descriptive histopathologic variables, including two malignancy grading scales, were correlated with DNA flow cytometric data and clinical outcome. No correlation was found between the malignancy grading scales and DNA flow cytometric data or clinical outcome. The present expanded study confirmed with greater statistical significance (p less than 0.001) that high-grade TATE is a favorable prognostic indicator for head and neck cancer. Furthermore, high-grade TATE was associated with the absence of distant metastasis (p less than 0.05). Using a stepwise logistic regression analysis of the clinicopathologic variables in the study, high-grade TATE was the most influential variable affecting clinical outcome, followed by border, stage, and perineural invasion. We conclude that the grade of TATE is a significant prognostic indicator for head and neck cancer. The significance and possible role of the eosinophil in the tumor-host interaction are discussed.

Local and systemic eosinophilia in patients with carcinoma of the uterine cervix undergoing radiation therapy: correlation with radiation response

Forty-nine patients with squamous carcinoma of the uterine cervix undergoing supervoltage 60Co radiotherapy were investigated to determine the significance of quantitation of eosinophils in the tumour tissue as well as in blood. The blood absolute eosinophil count (AEC) at presentation was higher in patients with Stages III and IV disease (0.52 +/- 0.09 x 10(9)/l, mean +/- SEM) when compared with early stages (Stages I and II, 0.35 +/- 0.07 x 10(9)/l). Forty-four patients (90%) showed a steady rise in AEC during the course of therapy. The patients showing good radiation response (n = 13, greater than or equal to 50% regression), displayed a more pronounced rise in AEC during the course of radiotherapy (0.66 +/- 0.24 x 10(9)/l) and had more eosinophils in the tumour tissue (7.4 +/- 0.66/oil immersion field) than the poor responders (n = 36, less than 50% regression, rise in eosinophil count 0.22 +/- 0.04 x 10(9)/l, eosinophils in tumour tissue 2.9 +/- 0.55/oil emersion field, P less than 0.0001 for both parameters). We conclude that quantitation of eosinophils in blood and tumour tissue before and during radiotherapy in patients with squamous carcinoma of the uterine cervix is useful in predicting radiation response.

Atypical histiocytic granuloma of the tongue: case report

Primary malignant lymphomas of the tongue have rarely been described, and reported cases are usually related to the posterior part of the tongue which is rich in lymphoid tissue, forming part of Waldeyer's ring. Making a distinction between pseudolymphoma and malignant lymphoma is important. Pseudolymphoma is a benign lesion not requiring aggressive therapy. Several lesions in the oral cavity, including atypical histiocytic granuloma, angiolymphoid hyperplasia with eosinophilia, and traumatic ulcerative granuloma with stromal eosinophilia have been described as having certain microscopic features similar to those of pseudolymphoma. Atypical histiocytic granuloma is not associated with systemic disease or dissemination and heals spontaneously despite its microscopic appearance.

Endocervical carcinoma

The past two decades have seen an increase in the incidence of endocervical carcinoma. Numerous studies have increased understanding of these tumors; hormonal therapy, human papilloma virus, and other cofactors have been implicated in the etiology of endocervical carcinoma. Early diagnosis is difficult: precursor lesions to adenocarcinoma in situ are still poorly defined and understood, and there may be a rapid transit time from in situ to invasive carcinoma. The definition of microinvasive adenocarcinoma is not uniformly agreed upon, and at this time the recommendation is not to use the term. Histologic typing and grading of adenocarcinoma may be useful in the prediction of prognosis for patients. Therapy is based upon stage of disease, the most beneficial results being obtained from either radical surgery or combination surgery and radiation therapy.

Eosinophil cationic protein in urine in patients with urinary bladder tumors

Measurement of eosinophil cationic protein (ECP) in urine constitutes a new biochemical method for assessment of local eosinophil activity in the bladder. ECP in urine was measured in 18 patients previously treated for various types of urinary bladder tumors and a comparable control group of 18 normals. The median concentration of ECP in urine from the patients was 46.5 arb. U/l versus 24.5 arb. U/l from normals. This difference was statistically highly significant (p less than 0.01). This study suggests that eosinophils are involved in the host tumor relationship in patients with urothelial neoplasia. Measurement of ECP in urine may imply a new concept for assessment of urothelial tumors.

Carcinoma of the cervix with massive eosinophilia

Massive local eosinophilia of 100 or more eosinophils per high power field was found in 3.2% cases of invasive carcinoma of the cervix. The prevalence, length of history before presentation to surgery and histological features were similar in patients from Great Britain and Malawi, but in both populations the mean age at diagnosis was lower than in patients with cervical carcinomas without tissue eosinophilia. In some of the tumours, the malignant cells were very difficult to find because of the eosinophil infiltrate, and misinterpretation as an inflammatory lesion was possible. In the absence of circulating eosinophilia, cervical carcinomas with massive eosinophilia were found to have a better prognosis than tumours without. Five patients had circulating eosinophilia as well as local tumour eosinophil infiltration, and each of them had extensive tumour spread.

Tumor-associated tissue eosinophilia in nasopharyngeal carcinoma. A pathologic study of 422 primary and 138 metastatic tumors

A study of biopsy specimens from 422 consecutive primary nasopharyngeal carcinomas (NPCs) revealed tumor-associated tissue eosinophilia (TATE) in a large proportion (26%) of the tumors. TATE occurred more frequently in nonkeratinizing carcinomas (NKC, 38%) than in the squamous (21%) or undifferentiated (23%) types. There was no sex predilection and no association with the presence of intratumor amyloid deposits. Stromal eosinophilia was also observed in 53 (38%) of 138 metastatic NPCs in lymph nodes, where it had occasionally led to confusion with Hodgkin's disease. TATE may be a feature of diagnostic importance in NPC, although its prognostic significance remains to be ascertained.

Eosinophilia in squamous cell carcinoma of the oral cavity, external genitalia and anus--clinical correlations

The incidence and pattern of tumour-associated eosinophilia is described in squamous cell carcinomas of the oral cavity, vulva, penis, scrotum and anus. Massive tissue eosinophilia appears to be related to the histological differentiation of the tumours in which it occurs, and in the cases in this series was associated with a favourable prognosis. Circulating eosinophilia occurred in patients with metastatic disease and a poor prognosis.

Eosinophil infiltration in keratoacanthoma and squamous cell carcinoma of the skin

The incidence of tissue eosinophilia in keratoacanthoma and in early and late cases of squamous cell carcinoma of the skin has been studied. Eosinophil infiltration of over 10 cells per high power field was found in 80 cases, and was not related to the size, site or aetiology of the lesions in which it was present. In cases where diagnostic difficulty arises between keratoacanthoma and well differentiated, keratinizing squamous cell carcinoma, if tissue eosinophilia is present the lesion is more likely to be malignant. Though in isolation the finding of an eosinophil infiltrate is not diagnostic it should be added to the list of criteria which help to distinguish these lesions. The pattern of tissue eosinophilia in late cases of squamous cell carcinoma was more extensive and there were two cases which showed massive tumour-associated tissue eosinophilia. This has previously been reported in squamous cell carcinoma at other sites, and may be related to the production of an eosinophilochemotactic factor.

Tumour-associated eosinophilia in the bladder

Tumour eosinophilia is an uncommon but striking phenomenon which has been found in many tumours, mostly of large cell type or squamous differentiation. The incidence, appearance and importance of tumour eosinophilia in the bladder are described. Eosinophilia is commoner in deeply invasive tumours and in tumours showing squamous metaplasia. Transitional cell carcinomas with eosinophilia have a better prognosis than those without, but this improvement is not seen in squamous cell carcinomas of the bladder. When eosinophilia is found on superficial biopsies of a bladder tumour, the possibility of muscle invasion should be considered.

Intense eosinophilic stromal infiltration in carcinoma of the uterine cervix: a clinicopathologic study of 14 cases

Stromal responses to tumor, usually characterized by the intensity of the lymphoplasmacytic infiltration, have been felt to be of prognostic significance in a wide range of neoplasms. Little attention has been focused on stromal reactions composed primarily of infiltration by eosinophilic leukocytes. We describe here the clinical and histopathological findings in 14 patients with invasive carcinoma of the uterine cervix in whom pronounced eosinophilic infiltration was observed in the stroma in the initial diagnostic biopsy material. These patients tended to have early stage disease, had associated increased lymphoplasmacytic stromal response, and were somewhat younger than the patients lacking this intense eosinophilic infiltration. A suggestion of improved survival was noted in patients with intense stromal eosinophilia treated primarily with radiation therapy.

Peripheral lymphocyte and eosinophil counts as indicators of prognosis in primary breast cancer

As a part of a major study on the pathophysiologic indices for recurrence of human breast cancer, preoperative eosinophil and lymphocyte counts were determined on 419 and 581 primary breast cancer patients, respectively. Patients with lymphocyte counts less than or equal to 1500/mm3 and/or eosinophil counts of less than 55/mm3 had significantly higher risk of recurrent disease than those patients who had normal or high levels of eosinophils and/or lymphocytes. These findings may indicate that the immunologic activities of eosinophils and lymphocytes enhance the patients' ability to respond against disease.

Traumatic ulcerative granuloma with stromal eosinophilia (Riga-Fede's disease and traumatic eosinophilic granuloma)

A review of the English literature revealed ten lesions classified as Riga-Fede's disease and nineteen lesions classified as traumatic eosinophilic granuloma. These two entities have the same histologic features and are often associated with a history of trauma. These are benign, reactive, nonosseous lesions that occur either in infancy or later in life. It is suggested that they be considered as one entity. To delineate them from more aggressive lesions, such as the eosinophilic granuloma of histiocytosis X, the author suggests the term traumatic ulcerative granuloma with stromal eosinophilia. Forty-one previously unreported cases are described. Histologic examination revealed the presence of mast cells in addition to eosinophils. A pathogenesis for traumatic ulcerative granuloma with stromal eosinophilia, based on the hypothesis that mast cells release an eosinophilic chemotactic factor and that eosinophils may act as cytotoxic agents, is suggested.