Cytoplasmic reactivity with the monoclonal antibody HMFG1 as a marker of cervical glandular atypia

Forkhead box protein P1 is a useful marker for the diagnosis of mucinous minimal deviation adenocarcinoma of uterine cervix

Mucinous minimal deviation adenocarcinoma (MDA) is a rare highly differentiated tumor of uterine cervix, of which the confusing histopathology resembling some benign lesions usually makes difficulty for pathologic diagnosis. The expression of forkhead box protein P1 (FOXP1) is found in some kinds of human tumors and is considered to be associated with the progression of the tumors. The purpose of this study is to detect the FOXP1 expression in MDA and evaluate its possible role in the diagnosis of MDA. Twenty-two MDA cases and 20 control cases consisting of 10 cases of lobular endocervical glandular hyperplasia and 10 cases of normal endocervical tissue were included in this study. All available clinical data were collected and immunostaining for FOXP1, carcinoembryonic antigen (CEA), human milk fat globule antigen 1 (HMFG1), estrogen receptor, and progesterone receptor were performed on these cases. The nuclear/cytoplasmic expression of FOXP1 was found in 18 of 22 MDA cases while in 1 of 20 control cases, which showed statistical significance (P = .000). The cytoplasmic CEA expression was found in 14 of 22 MDA cases and 2 of 20 control cases (P = .000), whereas cytoplasmic HMFG1 expression was found in 10 of 22 MDA cases and 4 of 20 control cases (P = .081). No statistical difference was found between FOXP1 and CEA expression (P = .083) or between FOXP1 and HMFG1 expression (P = .375) in MDA. Neither estrogen receptor nor PR expression was found in MDA. The significant expression of FOXP1 in MDA may be helpful to some extent in the pathologic diagnosis of cervical MDA. A widened observation range and further researches are needed to elucidate the potential mechanism.

Distribution of epithelial-specific antigen in uterine cervix with endocervical glandular dysplasia

The natural history of cervical adenocarcinoma is largely unknown, and whether endocervical glandular dysplasia is a precursor lesion to malignant tumor formation is a controversial issue. The aim of this study was to clarify the relationship of endocervical glandular dysplasia to the uterine endocervical adenocarcinoma. Thirty-one cases of glandular abnormalities of the uterine cervix were identified histologically from January 1984 to April 1992. These included 11 cases of endocervical glandular dysplasia, 5 cases of adenocarcinoma in situ, 4 cases of microinvasive adenocarcinoma, and 11 cases of invasive adenocarcinoma. The immunohistochemical localization of epithelial-specific antigen (ESA) was examined in these cases of endocervical glandular dysplasia and related lesions, and was compared to 10 normal endocervical specimens. ESA immunoreactivities were usually present in the basolateral membrane of endocervical cells in the normal endocervix. However, the expressions of ESA were increasing from the basolateral membrane to the diffuse cytoplasmic membrane, along with the malignant transformation of the endocervical cells, in 6 of 11 cases with glandular dysplasia, in 9 of 9 cases with in situ and microinvasive adenocarcinomas, and in 11 of 11 cases with invasive adenocarcinomas. This finding indicates that ESA is a useful marker for endocervical glandular dysplasia and related lesions with malignant transformation, and suggests that endocervical glandular dysplasia may be a precursor lesion to uterine cervical adenocarcinomas.

Glandular lesions of the cervix: diagnostic and therapeutic dilemmas

The term 'glandular lesions' applies mainly to the spectrum of intraepithelial neoplasia affecting the glandular epithelium of the cervix, but consideration must also be given to non-neoplastic disorders. Various systems of terminology are used, the most satisfactory being low grade and high grade CIGN. The criteria for histological diagnosis are quite well defined, although the distinctions between low grade and high grade lesions and between intraepithelial and early invasive disease can be problematic. Although many cases are initially diagnosed on smears, the cytological diagnosis can also be difficult, particularly when squamous lesions are also present, as happens in about 50% of cases. Both histologically and cytologically, the differential diagnosis between CIGN and non-neoplastic changes must be made. Treatment for high grade lesions has traditionally been hysterectomy, but there is evidence that conization with careful cytological follow-up may be safe in certain circumstances. Women with low grade lesions are generally managed in the same way; the role of cytological surveillance of women with mild glandular abnormalities in their smear is not clear. Although there is evidence to substantiate the belief that CIGN is a precursor of adenocarcinoma of the cervix, very little is known of the natural history of these lesions, their relations to one another and the significance of the low grade abnormalities. This uncertainty hampers a rational approach to management.

Endocervical carcinoma and precursor lesions: c-myc expression and the demonstration of field changes

The monoclonal antibody Myc 1-6E10 was used in an immunocytochemical technique to examine the expression of the c-myc oncogene in normal endocervices and those with glandular intraepithelial neoplasia and invasive malignancy. Eleven of 14 normal endocervical biopsy specimens did not express the gene, while three showed nuclear, or light basal cytoplasmic localisation of the gene product, or both. All but one of 14 cases of low and high grade glandular intraepithelial neoplasia, and all 17 cases of invasive adenocarcinoma, showed a pan-cellular pattern of immunostaining. Of considerable additional interest was the demonstration of field changes in morphologically normal glandular epithelium in those biopsy specimens with concurrent cervical glandular intraepithelial neoplasia or adenocarcinoma. This was manifest as increased concentrations of myc proteins compared with normal tissues. These results further support the role of the c-myc gene in oncogenesis, and in the light of field changes, suggest possible difficulties in the clinical management of this group of patients.

Nucleolar organiser regions in adenocarcinoma in situ and invasive adenocarcinoma of the cervix

Silver binding nucleolar regions (AgNORs) were evaluated in normal endocervix, adenocarcinoma, and its potential precursor, adenocarcinoma in situ (AIS), in an attempt to increase an understanding of the natural history of cervical adenocarcinoma and to identify a marker for abnormal endocervical (atypical glandular) cells which could aid diagnosis and follow up of endocervical lesions. For every 50 cells the mean AgNOR counts were as follows: normal endocervical cells (n = 15) 79.8 (95% Cl 68-91); AIS (n = 20) 200.7 (95% Cl 182-219); and invasive adenocarcinoma (n = 30) 299 (271-328). There was no overlap between the groups of normal endocervical cells and invasive adenocarcinoma, but there was significant overlap between cases of invasive adenocarcinoma and carcinoma in situ. In six out of 17 cases with AIS, NOR count in adjacent morphologically normal glandular cells ("internal" controls) was increased when compared with the "external" (normal endocervical) control group. This suggests the presence of wider field changes not previously identified using routine histological methods. The findings suggest that AIS is a potential premalignant precursor of invasive adenocarcinoma, but that assessment of NORs is of no practical use in discriminating between the histological types of cervical carcinoma.

Minimal deviation adenocarcinoma (adenoma malignum) of the endocervix: a histochemical and immunohistochemical study of two cases

The histopathological diagnosis of minimal deviation adenocarcinoma (adenoma malignum) of the endocervix may be difficult. Two cases of minimal deviation adenocarcinoma (MDA) were examined using mucin histochemistry and immunocytochemistry with antibodies to epithelial membrane antigens (HMFG1, Ep1), low-molecular-weight cytokeratins (CAM 5.2), carcinoembryonic antigen (CEA), and alpha-amylase. The results were compared with those for normal endocervical glands. Reactivity for CEA in MDA was focal and would be unreliable for biopsy diagnosis. Both cases of MDA contained abundant neutral mucins and sialomucins, whereas sulfomucins were rarely detected; this pattern contrasted with that of normal endocervix. Neoplastic glandular epithelial cells in MDA consistently showed both luminal and cytoplasmic reactivity with Ep1 and HMFG1, whereas normal cervix showed luminal labeling only. Thus, mucin histochemistry and immunohistochemical detection of epithelial membrane antigens may distinguish between extremely well differentiated neoplastic glands in MDA and normal endocervical glands, and hence may aid diagnosis in biopsy specimens.

Modulation of the antigenicity of amylase in cervical glandular atypia, adenocarcinoma in situ and invasive adenocarcinoma

Using a polyclonal anti-salivary alpha-amylase antibody and a biotin-avidin-peroxidase detection system immunoreactive amylase was detected in 39/40 cases of invasive cervical adenocarcinoma, 6/7 cases of adenocarcinoma in situ, 6/6 cases of high-grade cervical glandular atypia and 12/14 cases of low-grade cervical glandular atypia. Expression was seen in only 2/18 normal endocervices and this was weak and patchy. In contrast, strong amylase activity was demonstrated in 18/18 normal endocervices using a starch film assay on frozen sections. It is proposed that antigenic modulation of amylase occurs during endocervical neoplastic transformation.

An investigation of NCRC11 immunoreactivity in normal and neoplastic epithelia of the female genital tract and ovary

NCRC11 is a monoclonal antibody raised against human mammary carcinoma cells. The prognostic value of tumour cell immunoreactivity to NCRC11 in breast cancer has been shown previously. This study describes NCRC11 immunoreactivity in a wide range of normal and neoplastic epithelial types from the female genital tract and ovary. In the tumours examined, a wide range of staining patterns was seen. The implications of these findings are discussed in relation to the potential uses of this antibody in diagnosis and monitoring of gynaecological diseases.

Patterns of reactivity with the monoclonal antibodies HMFG1 and HMFG2 in normal endometrium, endometrial hyperplasia and adenocarcinoma

Using an indirect immunoperoxidase technique the expression of the epitopes in human milk fat globule (HMFG) membranes detected by the monoclonal antibodies HMFG1 and HMFG2 was studied in the normal endometrium and in cases of cystic glandular hyperplasia, glandular hyperplasia with architectural atypia (complex hyperplasia), glandular hyperplasia with cytological atypia (atypical hyperplasia) and invasive adenocarcinoma. Luminal reactivity with HMFG1 was seen in cases of normal endometrium, cystic glandular hyperplasia and glandular hyperplasia with architectural atypia. In contrast most cases of glandular hyperplasia with cytological atypia and invasive adenocarcinoma also showed areas of cytoplasmic reactivity. Reactivity with HMFG2 was scanty.

Immunohistochemical localizations of CA 125, carcinoembryonic antigen, and CA 19-9 in normal and neoplastic glandular cells of the uterine cervix

Immunohistochemical reactivities with CA 125, carcinoembryonic antigen (CEA), and CA 19-9 were studied in 15 cervixes without histologic abnormalities, ten with microglandular hyperplasia, nine adenocarcinomas in situ, ten adenocarcinomas with an invasion of less than 5 mm in depth, and 25 frankly invasive adenocarcinomas of the uterine cervix. The glandular cells of the normal cervix and microglandular hyperplasia always exhibited reactivity with anti-CA 125 in the luminal surfaces and the secretory products within the lumina, but there was usually no reactivity with either anti-CEA or anti-CA 19-9. In the neoplastic glandular cells (adenocarcinoma in situ and invasive adenocarcinoma), the reactivity with anti-CA 125 was negative or was not in the luminal surface, but in the perinuclear region of the cytoplasm as accumulations of atypical coarse granules. In addition, the positive reaction with anti-CEA and anti-CA 19-9 was seen in 78% and 0% of adenocarcinomas in situ, in 80% and 40% of adenocarcinomas less than 5 mm in depth, and in 84% and 56% of frankly invasive adenocarcinomas, respectively. Therefore, neoplastic cervical glandular cells show an unusual staining pattern with anti-CA 125, which may be associated with impaired production and/or the intracytoplasmic transport of CA 125, and they begin to produce antigens recognized by anti-CEA and/or anti-CA 9-9, which are usually negative in the normal tissue.

Expression of epithelial membrane and 3-fucosyl-N-acetyllactosamine antigens in cervix uteri with particular reference to adenocarcinoma in situ

The staining patterns obtained with antiepithelial membrane antigen (anti-EMA) and the monoclonal antibody to 3-fucosyl-N-acetyllactosamine (AGF 4:48) in the uterine cervix in intraepithelial and invasive neoplasia were compared to determine a possible role in differential diagnosis of reactive and neoplastic conditions. Both early invasive and in situ adenocarcinoma stained equally intensely with both agents and both antibodies stained diffusely tubal metaplasia, endometrial lined glands, and even occasional areas of normal endocervical mucosa. It is concluded that these agents are unlikely to be of use in the routine histological differentiation of glandular and squamous cervical dysplasia or neoplasia, but immunostaining with anti-EMA may help differentiate between reactive and metaplastic changes in endocervical glands and adenocarcinoma in situ.