Chromogranin A immunoreactivity and Grimelius' argyrophilia

Surgical pathology in cancer diagnosis: implications for quaternary prevention

Surgical pathology is the medical specialty in charge of cancer diagnosis. Although very important since oncology development, its link with overdiagnosis and overtreatment remains understudied. Despite big mediatisation, molecular biology has not brought much progress to tumour classifications. On the contrary, the silent apparition of immunohistochemistry at the end of the 1980's improved much of tumour classifications so significantly that it could cast doubts in some trials’ results of that period. This article discusses how the booming and abuse of immunohistochemistry might have led to overdiagnosis. It also highlights that the ISO 15189 standardization, as well as the tumour classification complexity, might function to induce overtreatment. In summary, critical reading and understanding of pathology reports by general practitioners are essential. Therefore, family doctors should not hesitate to discuss the cancer diagnosis with the pathologist, and in some cases also question the oncologist decision. This approach can be considered a quaternary prevention action which can prevent overtreatment.

Histochemical features of the Muscovy duck small intestine during development

We demonstrated for the first time the distribution and morphology of argyrophil and of goblet cells in the mucosa of the small intestine of the Muscovy duck during development using the Grimelius silver staining and alcian blue/periodic acid-Schiff (AB/PAS) staining technique. The argyrophil cells distribution was variable over the length of the small intestine from embryonic day 24 (24E) to post-hatching day 13 (13d). In the villi most argyrophil cells belonged to the open-type, while in the crypts they belonged to the closed-type. In the duodenum the density of argyrophil cells was highest at hatching, while in the jejunum and in the ileum the highest density value was at hatching and 13d. AB/PAS-positive goblet cells appeared on the villi and crypts of the duodenum and jejunum at 30E, and in the ileum at hatching. The density of AB/PAS-positive cells was the highest in the three segments at hatching. The AB-positive cells, compared with the PAS-positive cells, predominated in villi and crypts of the three segments, moreover the rate of AB-positive cells to PAS-positive cells significantly decreased from 30E to 9d. An increase in argyrophil and goblet cells number during the later incubation and at hatching, could indicate the small intestine in that period is being prepared to face a new diet.

Immunohistochemical study of enterochromaffin-like cell in human gastric mucosa

Enterochromaffin-like (ECL) cell has been identified as the histamine-containing argyrophil cell in rat gastric mucosa and vigorously studied. However, there are few reports of the distribution of ECL cell in human stomach. The aim of the present study was to determine the precise distribution of ECL cell by immunohistochemical staining of histidine decarboxylase (HDC) and gastrin-cholecystokinin B receptor (CCK-BR) in human stomach, and the correlation between their distribution and that of parietal cells. Thirty specimens of surgically resected stomach were used. Parietal cell, Grimelius-silver-positive cell, gastrin, HDC- and CCK-BR-immunoreactive cell were studied on continuous cell counting in the restricted field along the lamina muscularis from the oral to the anal ends. The percentage of HDC-immunoreactive cells of endocrine cells was smaller (15%) than that of a previous report (35%) in the fundic region. HDC- and CCK-BR-immunoreactive cells were found not only in the fundic region, but also in the intermediate and pyloric regions. In the pyloric region, HDC- and CCK-BR-immunoreactive cells were found mainly in the mucosa with intestinal metaplasia. Double-positive cells were also found, but only in small numbers. This suggests that ECL cell, or a cell sharing its function, is present in the pyloric region.

Cell proliferation in pathogenesis of esophagogastric lesions in pigs

Esophagogastric ulcer is an independent disease in swine that is characterized by ulcerous autodigestion of the cutaneous mucosa, which does not exhibit a tendency to recover, but, on the contrary, a tendency toward severe hemorrhaging, with a predominantly lethal outcome. Since it develops in the part of the stomach that is morphologically and functionally different from other glandular mucosa, it was questioned earlier whether it could be a peptic ulcer based on its nature. Spontaneous ulcers, usually of the stomach, commonly occur in many domestic animals. Some of these lesions are chronic and they may occur in either the glandular or squamous-lined regions of the stomach. As with the human disease, the pathogenesis in domestic animals is multifactorial, poorly understood, and variable between and within species. Environmental stress and dietary factors are very important in the ulcer disease in swine. It has been shown that the Helicobacter spp. is strongly associated with naturally occurring ulcer and preulcer lesions of the pars esophagea in swine, which raises the possibility that Helicobacter spp. is an important factor in the pathogenesis of these lesions. The dynamics of the development of esophagogastric ulcers imply hyperplastic lesions (parakeratosis and hyperkeratosis), keratolysis, erosions, peptic necrosis, and the development of ulcers with all the characteristics of peptic ulcerations in other localities. In addition, K6 is expressed in association with the mucosal changes. The pattern of the intermediate filaments of keratin suggests that epithelial proliferation, which leads to visible hyperkeratosis, constitutes the essence of gastric ulcers in swine.

Stereologic estimation of the number of neuroendocrine cells in normal human prostate detected by immunohistochemistry

Neuroendocrine cells may play a role in both normal and pathologic conditions of the human prostate. It may be interesting to investigate 1) whether there are significant amounts of neuroendocrine cells in human adult normal prostate, and 2) whether the distribution of these cells shows regional differences. This study estimates both absolute and relative amounts of neuroendocrine cells immunostained for two neuronal markers (chromogranin A and protein gene product 9.5) and for serotonin in the three regions of human prostate, transition zone, central zone, and peripheral zone, using unbiased stereologic measurements. There was observed a predominance of neuroendocrine cells in the transition zone of the normal prostate. The neuroendocrine cells of this region may play a role in the genesis of benign prostate hyperplasia. The significant presence of neuroendocrine cells secreting neuropeptides in peripheral zone could be correlated with the induction of androgen-independent growth in prostate carcinogenesis. The wolffian origin attributed to the central zone can explain its poor population of neuroendocrine cells.

Immunohistochemical localization of protein gene product 9.5, ubiquitin, and neuropeptide Y immunoreactivities in epithelial and neuroendocrine cells from normal and hyperplastic human prostate

This study was designed to investigate (a) the presence of protein gene product 9.5 (PGP 9.5), ubiquitin, and neuropeptide Y (NPY) in the neuroendocrine and secretory epithelium of the human normal prostate and its secretions, and (b) the changes in immunoreactivity to these proteins in men with benign prostatic hyperplasia. Western blotting and light microscopic immunohistochemistry techniques were used and the numerical density of immunoreactive neuroendocrine cells, and the volume fractions of immunostained secretory epithelium were evaluated. Western blotting revealed the presence of the three antigens in both tissue homogenates and prostate secretion. Some neuroendocrine cells immunoreacted to PGP 9.5 and NPY in all the prostate regions of control specimens. Ubiquitin immunoreactivity was detected in the nuclei from both basal cells and secretory epithelial cells. The cytoplasm of the secretory cells and the glandular lumen also showed immunostaining for the three proteins. The numerical densities of both PGP 9.5 and NPY neuroendocrine cells were lower in hyperplasia than in controls. No differences in the volume fraction occupied by epithelial immunostaining to both proteins was found between hyperplastic and control prostates. We concluded that (a) PGP 9.5 and NPY, but not ubiquitin, are common antigens in both neuroendocrine and secretory prostate cells, (b) the three immunoreactive proteins contribute to the prostate secretions, and (c) the secretion of ubiquitin is markedly diminished in the hyperplastic epithelium.(J Histochem Cytochem 48:1121-1130, 2000)

Intestinal endocrine cells in myotonic dystrophy: an immunocytochemical and computed image analytical study

OBJECTIVES

To study intestinal endocrine cell types in patients suffering from myotonic dystrophy (MD) and diarrhoea.

DESIGN

Comparative study between MD patients and matched controls.

SETTING

Departments of Medicine, Central Hospital, Boden, and University Hospital, Umeå, Sweden.

SUBJECTS

Ten patients with MD (four males and six females) and suffering from diarrhoea. Ten healthy volunteers served as controls for the duodenal study and 13 patients under investigation for rectal bleeding and with endoscopically normal mucosa were controls for the rectal study.

MEASUREMENTS

The duodenal and rectal endocrine cell types were identified by immunohistochemical investigation and quantified by computed image analysis.

RESULTS

The total endocrine cell area in the duodenum as demonstrated by chromogranin A-immunoreactivity was significantly increased in MD as compared with the controls (126 +/- 58 vs. 48 +/- 22 x 10(3) microns 2 mm-2 in crypts and 230 +/- 183 vs. 28 +/- 22 in villi, respectively, P < 0.01). The increase included all types of endocrine cells studied, namely those positive for serotonin, cholecystokinin (CCK)/gastrin, secretin, gastric inhibitory peptide (GIP) and somatostatin. In the rectum, the total endocrine cell area as determined by chromogranin A-immunoreactivity was also significantly increased, but there was no statistical difference between the controls and patients with respect to the area of serotonin-, peptide YY (PYY)-, pancreatic polypeptide (PP)- or somatostatin-immunoreactive cells.

CONCLUSIONS

The increase in endocrine cell area indicates a disturbed endocrine regulation of the gastrointestinal tract that may contribute to the development of gastrointestinal symptoms encountered in MD patients.

Application of computer image analysis in endocrine cell quantification

Computer image analysis was applied for quantifying endocrine cells by using an automatic standard sequence analysis operation. Two parameters were used, namely the number of cells per mm3 of epithelial cells and the cell secretory index (the volume of the immunoreactive secretory granules per cell). The first indicates the variation in the anatomical peptide-producing unit and the second the synthesis and secretion activity of the cell. The endocrine cells chosen in this study were chromogranin-immunoreactive cells and secretin-immunoreactive cells in the human duodenum. The measurements were made by five different investigators with different backgrounds in order to evaluate the effect of the intra- and inter-individual variation. This study showed that the intra- and inter-individual variation had no impact on the results. Comparisons with the classical point-counting method considered to be easy and most efficient in volumetry showed that the present approach is between two and three times faster and less strenuous for the performer. It is concluded that this approach seems to be suitable for adaptation in morphometric studies when information is required about the changes in the number of endocrine cells and about changes in secretory activities.

Merkel cells are absent in basal cell carcinomas but frequently found in trichoblastomas. An immunohistochemical study

The possibility of a neuroendocrine differentiation in basal cell carcinomas (BCCs) has been a matter of debate for many years. In the present immunohistochemical study, applying the cytokeratins 8, 18 and 20 as the most established markers for Merkel cells (MCs), we did not find elevated numbers of MCs in any of 205 BCCs. This speaks against a neuroendocrine line of differentiation in BCCs. In contrast, we found various amounts of MCs in 15 of 36 trichoblastomas, which are the main benign differential diagnosis of BCC. In 4 trichoblastomas abundant MCs were spread over the whole epithelial tumor area. Additionally, the trichoblastomas' overlying epidermis exhibited significantly much higher numbers of MCs than the uninvolved adjacent skin or the epidermis overlying the BCCs. These findings might be an additional aid in the distinction between trichoblastomas and BCCs. Furthermore, concerning the recent discussion about the role of MC in growth and development of follicular germ, our observations are another sign of regulative influences of the MC, also in follicular germ under pathological conditions. Trichoblastomas with high numbers of MCs could be characterized as showing advanced differentiation toward the neuroendocrine component of the hair follicle, i.e., the MCs.

Systemic, metastatic, eu- and heterotope tumours of the heart in necropsied dogs

10,090 dissections of dogs exhibited 2631 neoplastic processes of which 309 involved the heart in the form of eu- and heteropic tumours. The most common primary and/or secondary heart tumour type was hemangiosarcoma (n = 187), followed by paraganglioma (n = 46), carcinoma (n = 33), malignant lymphoma (n = 12), thyroid heart base tumour (n = 9), melanoma (n = 7), mast cell tumour (n = 3) and blastoma (n = 2). The tumour diagnoses were immunohistochemically proved by various antibodies to cytokeratins, vimentin, GFAP, NSE, von Willebrand factor, CD3, CD45RA, S100, thyroglobulin as well as histochemically with argyrophilic, Fontana-Masson and heterochromatic reactions. The odds ratio (OR) for breed and tumour prevalences were determined: German shepherds showed the highest OR for hemangiosarcomas and boxers for paragangliomas.

Immunocytochemical colocalizations of insulin, aromatic L-amino acid decarboxylase, dopamine beta-hydroxylase, S-100 protein and chromogranin A in B-cells of the chicken endocrine pancreas

The colocalization of aromatic L-amino acid decarboxylase (AADC), dopamine beta-hydroxylase (DBH), S-100 protein and chromogranin A (CgA) in the insulin-containing B-cells of the chicken endocrine pancreas was investigated by using light microscopic immunohistochemistry and combined pre-embedding immunoperoxidase and post-embedding immunogold electron microscopic immunocytochemistry. Using the post-embedding method, immunoreactivity against the anti-insulin serum by protein A-gold technique was observed in the core of all types of B-cell granules. Immunoreaction with anti-S-100 protein serum was detected in the core of all types of B-cell granules. Immunoreaction with anti-S-100 protein serum was detected in the core of all types of B-cell granules from non-osmicated tissues even by post-embedding method, but immunoreactivities against the anti-AADC, DBH and CgA sera were only demonstrable in crystalloid granules of B-cells by pre-embedding method. Immunoreaction with the anti-CgA serum was also detected in the cytoplasmic matrix around crystalloid granules and also in the dense bodies showing immunonegative with anti-insulin serum. From these results, it seems likely that S-100 protein co-stored all types of B-cell granules involved in the maturation of granules, and AADC, DBH and CgA are related to the synthesis of noradrenaline in crystalloid granules of B-cells.

Impact of familial amyloid associated polyneuropathy on duodenal endocrine cells

Duodenal endocrine cells in 11 patients with familial amyloid associated polyneuropathy (FAP) were compared with those in 12 healthy volunteers by means of immunohistochemistry and morphometry. The total endocrine cell content, determined by the argyrophilic reaction and chromogranin A immunoreactivity, was significantly reduced in FAP patients compared with controls. There was a significant reduction in the serotonin, cholecystokinin/gastrin, and secretin immunoreactive cell content. A decreased cell content was also noted for somatostatin and gastric inhibitory polypeptide immunoreactive cells but this was not statistically significant. Amyloid deposits were noted in seven of the 11 biopsy specimens from FAP patients, but otherwise the duodenum was histologically normal in both groups. The reduction in endocrine cell content was not correlated with the degree of amyloid deposit in the duodenum. These findings indicate that patients with FAP have reduced intestinal endocrine cells. This does not seem to be related to amyloid deposits in the mucosa or to villous or crypt abnormalities. The observed changes in endocrine cells may contribute to the development of intestinal motility dysfunction and maldigestion in these patients.

Immunohistochemical localization of chromogranin A and B in the endocrine cells of the alimentary tract of the green frog, Rana esculenta

Novel monoclonal antibodies to human chromogranin A (CgA) and chromogranin B (CgB) were used to investigate the presence of immunoreactive (-IR) elements in the alimentary tract of the green frog Rana esculenta. Numerous CgA-IR and a few CgB-IR endocrine cells were found within the gut mucosa, from the oesophagus to the cloaca, with some local differences in density. Co-localization studies demonstrated that they were co-stored in almost all the serotonin-IR, the amylin-IR or islet amyloid polypeptide-IR cells and in the peptide tyrosine tyrosine-IR cells located proximal to the pylorus, but not in those located in more caudal tracts. No other co-localization was demonstrated; substances investigated included somatostatin, substance P, gastrin/cholecystokinin, glucagon, glycentin, bombesin, secretin and neurotensin. CgA-IR and CgB-IR cells nearly always displayed argyrophilia with the Grimelius silver method.

Isolation, identification and quantitative evaluation of specific cell types from the mammalian gastric mucosa

Functional in vitro studies with isolated gastric mucosal cells require cytological identification of different cell types in suspension or primary culture. Since suitable techniques have not been well established, different staining methods for the discrimination of dispersed pig and guinea pig gastric cells have been developed on the basis of modified previous protocols for enzymatic cell dispersion. Chief and parietal cells were visualized by combined periodic acid-Schiff stains. Surface mucous and mucous neck cells were identified by affinity-labelling, using lectins with selective staining properties in situ. Two of the lectins were found to be specific markers for gastric polymorphonuclear cells. The following vital tests were found to be useful: succinic dehydrogenase for parietal cells, Nile blue/brilliant cresyl blue stains for chief cells, and different phagocytosis assays for endothelial cells and gastric phagocytes. Endocrine cells were characterized by immunocytochemistry using specific antibodies against gastrin, somatostatin, histamine and serotonin. The same technique using a vimentin antibody was performed for the identification of fibroblasts. Proliferation of mucosal cells in primary culture was monitored by the incorporation of bromo-deoxyuridine, which was subsequently detected by a monoclonal antibody.

Peptidergic innervation and endocrine cells in the human liver

Histologically normal liver biopsy specimens from patients with Hodgkin's lymphoma were investigated with three immunohistochemical methods for the occurrence of peptidergic nerve fibers and endocrine cells. Numerous immunoreactive nerve fibers were seen with antisera against peripheral nerves markers (neuron-specific enolase, neurofilament protein, and S-100). These nerve fibers were localized in the tunica media of branches of both the hepatic artery and portal vein, around the bile ducts, and in the connective tissue of the interlobular septa. In the liver, 10 types of peptidergic nerve fibers were detected: glucagon-, glucagon-like peptide- (GLP), somatostatin-, neuropeptide Y- (NPY), vasoactive intestinal polypeptide-, neurotensin-, gastrin/cholecystokinin C-terminus-, substance P-, serotonin-, and galanin-immunoreactive nerve fibers. GLP-, somatostatin-, NPY-, neurotensin-, substance P-, and galanin-immunoreactive nerve fibers were abundant; the other nerve fibers were scarce. The nerve fibers showed two distinct patterns of distribution: they occurred in the blood vessel wall and in connective tissue of the interlobular septum. Pancreatic polypeptide- and NPY-immunoreactive cells were found among the lining epithelial cells of the bile ducts in the interlobular septum.

Protein gene product 9.5 and ubiquitin immunoreactivities in rat epididymis epithelium

A quantitative immunohistochemical study was performed of the distribution of protein gene product 9.5 (PGP, a soluble protein localized in neurons and neuroendocrine cells as well as in some non-nervous cells) and ubiquitin along the rat epididymis. In the ductuli efferents, PGP immunoreaction was observed in the whole cytoplasm of some columnar cells; a smaller number of columnar cells showed ubiquitin immunoreactivity with limited apical and basal cytoplasmic localization. In the proximal caput epididymidis, the whole cytoplasm of all columnar cells showed PGP immunoreactivity, ubiquitin immunostaining was negative in this region. In the middle and distal caput epididymidis and the distal cauda, the apical cytoplasm of some columnar cells and the whole cytoplasm of some basal cells showed immunoreactivity to PGP. In these regions, immunoreactivity to ubiquitin was positive in the supranuclear cytoplasm of some columnar cells but not in the basal cells. No immunoreactivity to PGP or ubiquitin was detected in the corpus epididymis and the proximal cauda. Double immunostaining revealed that all the epididymal ubiquitin immunoreactive cells were also PGP immunoreactive, whereas most PGP immunoreactive cells did not immunoreact to ubiquitin. In ubiquitin-PGP immunoreactive cells, the site of the PGP immunoreaction differed from that of the ubiquitin immunoreaction. PGP-ubiquitin immunoreactive cells also seemed to be immunoreactive to anti-AE1/AE3 keratin antibodies. The spermatozoal heads were immunoreactive to PGP antibodies in the epididymal regions from proximal caput to distal cauda but not in the ductuli efferents. The findings suggest that non-ubiquitinated PGP immunoreactive proteins are secreted in the epididymis, mainly in the proximal caput, and attach to spermatozoa.