Mucin leakage into the cervical stroma may increase lymph node metastasis in mucin-producing cervical adenocarcinomas

The role of the preoperative serum carcinoembryonic antigen level in early-stage adenocarcinoma of the uterine cervix

OBJECTIVE

The purpose of the study was to identify the relationship between preoperative serum levels of carcinoembryonic antigen (CEA) and clinicopathological variables in early-stage adenocarcinoma of the uterine cervix.

METHODS

From February 1990 to August 2002, 117 patients with surgically treated early-stage cervical adenocarcinoma that had had preoperative serum CEA evaluations were retrospectively reviewed. The cut-off value for CEA, based on the manufacturer's recommendations, was 5 ng/ml. For an evaluation of the relationship between the clinicopathological factors and increased levels of serum tumor markers, the Chi-Square/Fisher's exact test and logistic regression were used for univariate and multivariate analysis, respectively.

RESULTS

The mean age of the patients was 46 years (range, 21-78). Of the 117 patients, 28 had preoperative serum CEA levels greater than 5 ng/ml. In a univariate analysis, the increased marker was associated with a larger tumor size, presence of lymphovascular invasion, and deeper cervical wall invasion. However, in a multivariate analysis, the preoperative CEA level had a significant impact on the determination of the depth of stromal invasion (OR 4.12, 95% CI 1.97-8.68, P < 0.001).

CONCLUSION

In early-stage cervical adenocarcinoma, preoperative serum CEA levels seem to be useful in estimating the depth of cervical stromal invasion. Assessment of tumor antigen CEA levels should be integrated with the routine examination in the work-up of patients with adenocarcinoma of the uterine cervix.

Altered expression of nm23-H1 and c-erbB-2 proteins have prognostic significance in adenocarcinoma but not in squamous cell carcinoma of the uterine cervix

BACKGROUND

The reduced expression of nm23-H1 protein and/or overexpression of c-erbB-2 protein reportedly is associated with a high incidence of lymphatic metastasis or poor prognosis of the patient in a variety of human malignant tumors.

METHODS

The expression patterns of nm23-H1 and c-erbB-2 proteins were analyzed by immunohistochemical staining using formalin fixed, paraffin embedded sections of 88 cases of invasive carcinoma (39 matched pairs of adenocarcinoma and squamous cell carcinoma, 8 cases of adenosquamous carcinoma, and 2 cases of undifferentiated carcinoma) and 31 cases of preinvasive lesions of the uterine cervix.

RESULTS

Expression of nm23-H1 was detected in 46% of adenocarcinoma and in 36% of squamous cell carcinoma of the uterine cervix, whereas c-erbB-2 expression was evident in 49% and 38%, respectively. Negative expression of nm23-H1, positive expression of c-erbB-2, and a combined nm23-H1-negative and c-erbB-2-positive expression were associated with a high incidence of lymph node involvement (P = 0.36, P = 0.0015, P = 0.0055, respectively) and with poor prognosis of patients (P = 0.034, P = 0.014, P = 0.00008, respectively) with adenocarcinoma of the uterine cervix, but not in those with squamous cell carcinoma. Multivariate analysis using the Cox's proportional hazard model also revealed that these three factors significantly contributed to the prognosis of patients with cervical adenocarcinoma.

CONCLUSIONS

Reduced expression of the nm23-H1 protein, increased expression of the c-erbB-2 protein, and a combined nm23-H1-negative and c-erbB-2-positive expression have prognostic significance in patients with adenocarcinoma, whereas they may not be associated with the prognosis of squamous cell carcinoma of the uterine cervix, nm23-H1 and c-erbB-2 proteins may have different functions according to the subtype of cervical carcinoma.

Glycoconjugate profile and CD44 expression in human melanoma cell lines with different metastatic capacity

Changes in glycoconjugate production have been reported for tumor cells. In this study, we investigated the glycoconjugate expression pattern in normal human melanocytes and in a panel of 6 human melanoma cell lines with different metastatic capacity after s.c. inoculation into nude mice. Glycoconjugates were labeled in vitro with [35S] sulphate and [3H] glucosamine, purified from cells and culture medium by column chromatography and identified by treatment with specific glycosidases. Characterization of the purified glycoconjugate fractions as well as alcian-blue staining of xenograft lesions revealed that hyaluronic acid (HA) is the main glycoconjugate produced by all cell lines. Highly metastatic cell lines expressed higher levels of HA than melanocytes and than weakly metastatic or non-metastatic cell lines. In addition, a shift in dominance from chondroitin-sulphate proteoglycan to heparan-sulphate proteoglycan was observed with increasing metastatic capacity. We also studied the expression and binding activity of the HA receptor CD44. Immunoprecipitation experiments indicated high CD44 synthesis only in highly metastatic cell lines, but FACS analysis demonstrated approximately the same surface expression in melanocytes as in all cell lines. Adhesion assays to immobilized HA showed that CD44 can be present in an inactive or an active conformation. Our data suggest that a combination of increased HA production and the expression of CD44 on the cell surface may be associated with high metastatic potential of human melanoma cell lines in nude mice.

Close association between tumour cells and vascular basement membrane in gastric cancers with liver metastasis. An immunohistochemical and electron microscopic study with special attention to extracellular matrices

To investigate morphological features valuable in estimating the propensity of gastric cancer to metastasize to the liver, we examined the primary tumours from 49 surgically resected advanced gastric cancers (24 with liver metastasis) and 45 autopsy cases, 19 with liver metastasis. We paid special attention to extracellular matrices--connective tissue stroma and basement membrane (BM)--using immunohistochemistry and electron microscopy. Type IV collagen staining showed that in differentiated carcinomas neoplastic glands were occasionally located in close proximity to the BM of thin-walled tumour blood vessels in back-to-back fashion. In poorly differentiated lesions, tumour cells were also oriented toward the vascular BM in pseudorosette-like pattern. Type III collagen staining and electron microscopy showed that in such regions tumour cells, with continuous or discontinuous BM, were immediately adjacent to vascular BM with no connective tissue stroma in between. On occasion tumour cells were in direct contact with vascular BM. These close associations were often found in carcinomas with a medullary growth pattern, irrespective of the degree of histological differentiation. However, they were virtually never seen in their benign counterpart. Of the resected cases, all 24 with liver metastasis showed this association, whereas only 10 of 25 (40%) without liver metastasis did so (P less than 0.001). In the autopsied cases, a similar positive correlation was observed between liver metastasis and this association. Furthermore, the tumor cells showing this juxtaposition showed evidence of vascular invasion. These results suggest that the close association between tumour cells and vascular BM is specific to the malignant neoplasm, and may be related to liver metastasis. Immunohistochemistry can be a great help in estimating the probability of liver metastasis.

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.