Immunohistochemical Detection of Neuroendocrine Markers in Tumors of the Lungs and Gastrointestinal Tract:

Histopathological Evaluation and Molecular Diagnostic Tests for Peritoneal Metastases with Unknown Primary Site-a Review

Cancer of unknown primary (CUP) is a well-studied entity with guidelines available for the management of patients with CUP. The peritoneum represents one of the metastatic sites in CUP, and peritoneal metastases (PM) could present as CUP. PM of unknown origin remains a poorly studied clinical entity. There is only one series of 15 cases, one population-based study, and few other case reports on this subject. Studies on CUP, in general, cover some common tumour histological types like adenocarcinomas and squamous carcinomas. Some of these tumours may have a good prognosis though majority have high-grade disease with a poor long-term outcome. Some of the histological tumour types commonly seen in the clinical scenario of PM like mucinous carcinoma have not been studied. In this review, we divide PM into five histological types-adenocarcinomas, serous carcinomas, mucinous carcinomas, sarcomas and other rare varieties. We provide algorithms to identify the primary tumour site using immunohistochemistry when imaging, and endoscopy fails to establish the primary tumour site. The role of molecular diagnostic tests for PM or unknown origin is also discussed. Current literature on site-specific systemic therapy based on gene expression profiling does not show a clear benefit of this approach over empirical systemic therapies.

Application of immunohistochemistry to liver and gastrointestinal neoplasms: liver, stomach, colon, and pancreas

CONTEXT

Immunohistochemistry has become an integral component of the practice of pathology. Newer antibodies allow for increasingly precise diagnoses for tumors that previously could not be easily identified. Recently, immunohistochemical evaluations have begun to allow pathologists to actively assist in determining prognosis and even in selecting therapies.

OBJECTIVE

To summarize the usefulness of currently available immunostains for the study of liver and gastrointestinal system neoplasms and to make recommendations for panels of immunostains that can be particularly helpful.

DATA SOURCES

Information has been collected from recent literature as well as from personal experience and practice.

CONCLUSIONS

Many immunostains are now available for the practicing pathologist that allow for increasing accuracy in diagnosis of liver and gastrointestinal tract neoplasms. Panels of immunostains can be used to differentiate between various tumors and also to identify site of origin in the case of a metastatic neoplasm. Immunostains that allow for prognostic determinations and for guidance in the selection of chemotherapeutic agents can also be used by pathologists to assist in the management of patients with malignant tumors affecting the liver and gastrointestinal tract.

Undifferentiated tumor: true identity by immunohistochemistry

CONTEXT

"Undifferentiated tumor" refers to a heterogeneous group of neoplasms with little or no evidence of differentiation on routine light microscopic morphology.

OBJECTIVE

To identify the true identity of undifferentiated tumors by immunohistochemical analysis.

DATA SOURCES

Review of the pertinent literature and the authors' experience.

CONCLUSIONS

For treatment and prognostic evaluation, it is crucial to delineate whether an undifferentiated neoplasm is epithelial, mesenchymal, melanocytic, or hematopoietic in nature. Application of a screening panel to demonstrate the expression of markers of major lineages is fundamental for determination of the broad category of neoplasia. Because poorly differentiated carcinomas and in particular sarcomatoid carcinomas are known to be heterogeneous in their antigen expression, several epithelial markers in combination may be required to establish the carcinomatous nature of tumor. A diagnostic misinterpretation as a consequence of occasional aberrant or unexpected antigen expression is best avoided by using a broad panel that includes both antibodies that are anticipated to be positive and those that are expected to be negative. In this treatise, the immunohistochemical dissection of undifferentiated tumors on the basis of their morphologic features is outlined, supplemented with algorithmic immunohistochemical analysis for each morphologic category of small round cell tumors, carcinomatous tumors, sarcomatous (or sarcoma-like) tumors, and tumors with histologically overlapping features, including hematolymphoid malignancies, melanoma, and sarcomas with epithelioid appearance. The utility of several organ- or tissue-specific markers in the context of undifferentiated tumors is reviewed.

Effect of vasoactive intestinal peptide on gastric adenocarcinoma

BACKGROUND AND AIM

Vasoactive intestinal peptide (VIP) is a gastrointestinal hormone in the secretin-VIP family. It has been reported that VIP affects some tumor growth, and there is a VIP autocrine regulation in some cancers. However, the effect of VIP on gastric adenocarcinoma is not clear yet. The aim of the present study was to investigate the effect of VIP on gastric adenocarcinoma, especially autocrine regulation of VIP on gastric adenocarcinoma.

METHODS

VIP mRNA and protein, and its receptor mRNA (VIPR(1) and VIPR(2)) were measured in 15 normal antrum mucosa, 20 gastric adenocarcinoma tissues, and the SGC7901 gastric adenocarcinoma cell line by using reverse transcription polymerase chain reaction (RT-PCR), immunohistochemistry, or radioimmunoassay methods. The effect of the VIP protein and its antagonist (D-p-Cl-Phe6, Leu17)-VIP on SGC7901 cell growth was detected by methylthiazolyldiphenyl-tetrazolium bromide (MTT) method. The expressions of c-myc mRNA and ornithine decarboxylase (ODC) mRNA in SGC7901 cells before and after the incubated VIP protein and/or its antagonist were also measured by RT-PCR method.

RESULTS

The VIP mRNA expression in gastric adenocarcinoma tissues was significantly higher than that in normal antrum mucosa (P < 0.01). The VIP-positive immunoreactivity cells existed in 40% of gastric adenocarcinoma tissues, but not in normal tissues (P < 0.01). The VIP-positive immunoreactivity nerve fibers were observed in normal tissues, but not in adenocarcinoma tissues (P < 0.01). The expression rate of VIPR(1) mRNA in adenocarcinoma tissues was significantly lower than that in normal tissues, but that of VIPR(2) mRNA in the two kinds of tissues were similar (P > 0.05). In addition, the expression quantity of VIPR(1) mRNA and VIPR(2) mRNA in adenocarcinoma tissues was significantly lower than that in normal tissues (P < 0.05). SGC7901 cells expressed not only VIP mRNA and the VIP protein, but also VIPR(1) and VIPR(2) mRNA. 10(6) SGC7901 cells secreted 13.15 +/- 8.54 pg VIP on average. VIP did not affect the proliferation of SGC7901 cells, but the antagonist stimulated the proliferation of SGC7901 cells from 10(-5) to 10(-8) mol/L concentration incubated for 24-96 h. VIP downregulated the expressions of c-myc and ODC mRNA, but its antagonist upregulated their expressions.

CONCLUSIONS

The expression of VIP mRNA upregulates, but the expressions of VIPR mRNA downregulates in gastric adenocarcinoma tissues. The gastric adenocarcinoma tissues contain endocrine cells to secrete VIP, which show malignant specialities. The VIP autocrine regulation exists in SGC7901 cells, and potentially inhibits the proliferation of the cells by downregulating the expressions of c-myc and ODC mRNA. It suggests that VIP may play an important role in the regulation of the growth of gastric cancer cells.