Epithelial-mesenchymal interactions can influence the phenotype of carcinoma metastases in the mucosa of the intestine

Possible reversibility between epithelioid and sarcomatoid types of mesothelioma is independent of ERC/mesothelin expression

Background

Mesothelioma is histologically divided into three subgroups: epithelioid, sarcomatoid, and biphasic types. The epithelioid or sarcomatoid type is morphologically defined by polygonal or spindle-like forms of cells, respectively. The biphasic type consists of both components. It is not yet understood how histological differentiation of mesothelioma is regulated. ERC/mesothelin is expressed in most cases of the epithelioid type, but not in the sarcomatoid type of mesothelioma. Consequently, its expression is well correlated to the histological subtype. We hypothesized that ERC/mesothelin expression influences the histological differentiation of mesothelioma, and tested this hypothesis.

Methods

We performed studies using the overexpression or knockdown of ERC/mesothelin in mesothelioma cells to examine its effect on cellular morphology, growth kinetics, or migration/invasion activity, in vitro. We then transplanted ERC/mesothelin-overexpressing and control cells into the intraperitoneal space of mice. We examined the effect of ERC/mesothelin overexpression on mouse survival and tumor phenotype.

Results

In vitro cell culture manipulations of ERC/mesothelin expression did not affect cellular morphology or proliferation, although its overexpression enhanced cellular adhesion and the migration/invasion activity of mesothelioma cells. The survival rate of mice following intraperitoneal transplantation of ERC/mesothelin-overexpressing mesothelioma cells was significantly lower than that of mice with control cells. The histological evaluation of the tumors, however, did not show any morphological difference between two groups, and our hypothesis was not validated. Unexpectedly, both groups (ERC/mesothelin-overexpressing and control) of mesothelioma cells that were morphologically monophasic and spindle-like in vitro differentiated into a biphasic type consisting of polygonal and spindle-like components in the transplanted tumor, irrespective of ERC/mesothelin expression.

Conclusions

These results suggested that the histological transition of mesothelioma between epithelioid and sarcomatoid types may be reversible and regulated not by ERC/mesothelin, but by other unknown mechanisms.

Colorectal metastasis to the gallbladder mimicking a primary gallbladder malignancy: histopathological and molecular characteristics

AIMS

Outcomes of colorectal cancer (CRC) treatment and survival have steadily improved during the past decades, accompanied by an increased risk of developing second primary tumours and metastatic tumours at unusual sites. Metastatic CRC can show mucosal colonisation, thereby mimicking a second primary tumour. This potential confusion could lead to incorrect diagnosis and consequently inadequate treatment of the patient. The aim of this study was to differentiate between metastatic CRC and a second primary (gallbladder cancer, GBC) using a combination of standard histopathology and molecular techniques.

METHODS AND RESULTS

Ten consecutive patients with both CRC and GBC were identified in our region using the Dutch National Pathology Archive (PALGA). Two patients served as negative controls. Histology of GBC was reviewed by nine pathologists. A combination of immunohistochemistry, microsatellite analysis, genomewide DNA copy number analysis and targeted somatic mutation analysis was used to aid in differential diagnosis. In two patients, CRC and GBC were clonally related, as confirmed by somatic mutation analysis. For one case, this was confirmed by genomewide DNA copy number analysis. However, in both cases, pathologists initially considered the GBC as a second primary tumour.

CONCLUSIONS

Metastatic CRC displaying mucosal colonisation is often misinterpreted as a second primary tumour. A combination of traditional histopathology and molecular techniques improves this interpretation, and lowers the risk of inadequate treatment.

Intrabiliary growth of liver metastases: clinicopathologic features, prevalence, and outcome

Intrabiliary growth by metastatic colorectal carcinoma (CRC) is an unusual finding that can clinically mimic cholangiocarcinoma. We evaluated prevalence of intrabiliary growth by retrospective review of 1596 diagnostic reports and by prospective evaluation of 223 hepatectomies. Positive cases were scored for extent of intrabiliary growth (major vs. minor duct involvement), architectural pattern (colonization of biliary epithelium and/or intrabiliary tumor plugs), and secondary sclerosing cholangitis in non-neoplastic parenchyma. By retrospective review, we identified intrabiliary growth in 41 (3.6%) of 1144 metastatic CRCs but only 3 (0.7%) of 452 noncolorectal tumors (P<0.001). Prospectively, we found intrabiliary growth in 18 (10.6%) of 170 metastatic CRCs and 1 (1.9%) of 53 other tumors (P=0.05). Among our final population of 43 CRCs with intrabiliary growth, 24 (56%) had major and 19 (44%) had minor duct involvement, 35 (81%) showed colonization of biliary epithelium, and 35 (81%) showed intrabiliary tumor plugs. Compared with minor duct involvement and 51 controls without intrabiliary growth, major duct involvement was more likely to produce obstructive liver chemistries (P=0.004), radiographic evidence of biliary disease (P<0.0001), and sclerosing cholangitis in non-neoplastic liver (P<0.0001). However, there was no impact on overall survival. Clinically, 5 (21%) cases of major duct involvement resulted in diagnostic uncertainty between metastatic CRC and cholangiocarcinoma. These findings underscore the frequency of intrabiliary growth by metastatic CRCs and its rarity with other metastases. Major duct involvement should be recognized because of its distinctive clinical features, which can overlap with cholangiocarcinoma.

Vimentin in oral squamous cell carcinoma

The relationship between the histological grading of malignancy and the expression of vimentin and cytokeratin was studied in 43 cases of oral squamous cell carcinoma. Immunohistochemical analysis was carried out with the avidin-biotin method using monoclonal antibody anti-vimentin, and the peroxidase anti-peroxidase method using the polyclonal antibody anti-cytokeratin. All cases were classified according to the histological malignancy grading system proposed by Anneroth. All of the carcinomas were found to express cytokeratin, while 60.4% expressed vimentin. Vimentin was particularly noted in all tumors scored to have highly malignant cells.

Differentiation-associated changes in mucin glycoprotein antigenicity in mucosa adjacent to rare gastrointestinal tract tumours of non-mucosal origin

We have investigated changes in mucin antigenicity and morphology in the perineoplastic mucosa adjacent to rare, predominantly non-mucosal gastrointestinal (GI) tumours. Twenty-nine tumours of small and large intestine, including primary mesenchymal and ectodermal tumours, were examined immunohistochemically using 11 monoclonal antibodies (MAbs) raised against SIMA and LIMA (small and large intestinal mucin antigens). Non-epithelial GI tumours were essentially non-reactive, while adjacent mucosa showed altered mucin expression and morphology, in particular, features of transitional mucosa (TM). Combinations of different SIMA epitopes were detected adjacent to all colorectal tumours, and, similarly, LIMA epitopes adjacent to small intestinal tumours. Specific patterns adjacent to certain tumours may reflect influences of factors produced by individual tumours on mucin composition. Altered antigenicity and morphology in TM thus appear to be reactive changes in response to a wide range of GI tumours, presumably as a consequence of factors secreted by the tumour and/or a host response to the tumour.

Molecular pathology of gastric carcinoma: progress and prospects

Gastric carcinoma is the fourth most common malignancy in Western Europe and a major cause of cancer morbidity and mortality worldwide, particularly in the Far East and in areas of South America. The natural history of the disease is not fully established, and there is a need to elucidate the molecular mechanisms of gastric carcinogenesis in order to understand its pathogenesis and to develop molecular markers for clinical diagnostic use. Molecular analysis of colonic carcinogenesis has increased our understanding of its pathogenesis and has demonstrated multistage carcinogenesis in a human cancer. Research in gastric carcinoma has not achieved such significant progress, although a start has been made. We analyze some of the interpretation problems in molecular pathology affecting progress that are of interest to the histopathologist and review recent studies on the molecular biology of gastric carcinoma involving flow cytometry, cytogenetics, allele loss analysis, and transfection. We also summarize current knowledge about each of the major oncogenes and suppressor genes, attempting, in particular, to correlate gene abnormalities with morphologic appearances. The expanding field of cell proliferation and growth factors is outlined, gastric and colon carcinomas are compared, and gastric carcinoma is considered as a model system for the study of differentiation. This report concludes by suggesting directions for future research.

Control of differentiation in a rectal adenocarcinoma cell line: the role of diffusable and cell-associated factors

The rectal adenocarcinoma cell line, HRA-19a1.1, was cultured in a three-dimensional type I collagen gel and then xenografted in nu/nu mice to determine whether the in vivo environment could induce further morphological differentiation of the in vitro collagen gel cultures. Three phenotypic changes were observed. Type I collagen induces glandular differentiation in vitro in which well polarized cells are organized around a central lumen, as has been previously reported. Seven days after xenografting this structure in nu/nu mice, the glandular structures appeared to have 'ballooned' forming cyst-like structures lined by a monolayer of flattened cells. There were no stromal cells associated with the graft at this stage, but with time stromal cells invaded the collagen. At points where these cells were closely associated with the HRA-19 cells there was a marked phenotypic change, with the flattened lining cells seen at day 7 becoming columnar. By 21 days the stromal cells had replaced the collagen and the histology of the graft now resembled that of an adenocarcinoma. Placing this cell-collagen culture in a Millipore chamber prior to grafting resulted in cyst-like structures only. Here we provide conclusive evidence that heterologous connective tissue cells can induce differentiation of a rectal adenocarcinoma cell line by a non- or poorly diffusible factor(s). Furthermore, we show that this cell-collagen xenograft method has certain advantages over conventional xenograft methods: notably, a consistent 100 per cent take rate; considerably fewer cells are required to form a tumour; and the time taken to form a tumour is dramatically reduced.