Cryostat section assay of oestrogen and progesterone receptors in meningiomas: a clinicopathological study

Estrogen and Progesterone Receptors in Human Colorectal Tumour Cells (Study of 70 Cases)

Estrogen and progesterone receptors were studied in 70 cases of human colorectal cancer by a cytochemical technique. 28.5% of the cases were estrogen-receptor positive and 42.8% progesterone-receptor positive.

There was no difference between the sexes for estrogen receptors but the women had more tumours with progesterone receptors than men.

The presence of receptors is unrelated to the differentiation of the tumour. More colon tumours were positive than those of the sigma and rectum. The concentration of cells with receptors in positive cancer cases tended to be low or medium-low.

Is progesteron receptor status really a prognostic factor for intracranial meningiomas?

OBJECTIVE

Presence of steroid hormone receptors in meningiomas is well-known, but their correlation with tumour behaviour is unclear. The purpose of this study was to assess the relation between steroid hormone receptor expression and tumour behaviour.

METHODS

We retrospectively reviewed 48 patients undergoing surgery for intracranial meningioma between January 2002 and December 2004. We included World Health Organization (WHO) Grade I meningiomas in Group 1 and WHO Grades II and III in Group 2. Tumour grade, progesterone receptor (PR), oestrogen receptor (ER) expressions, MIB-1 Index and Mitotic Index were assessed. We sought the correlation between tumour grade and MIB-1, Mitotic Indices, and also PR expression. Furthermore, the correlation between PR expression and MIB-1 and Mitotic Indices was assessed in Group 1 and Group 2, separately.

RESULTS

26 patients were in Group 1 and 22 patients in Group 2. PR expression was determined in 56% of the tumours while there was no ER expression. PR expression was found to be higher in Group 1 compared to Group 2. The Mean MIB-1 Index and the Mean Mitotic Index were significantly higher in Group 2 compared to Group 1. However, when Groups 1 and 2 were assessed separately, PR expression does not appear to be correlated with MIB-1 and Mitotic Indices in benign and also in non-benign meningioma groups.

CONCLUSION

Our findings suggest that tumour grade, but not PR expression, is correlated with meningioma behaviour.

Gonadotropin-releasing hormone (GnRH) and its receptor in human meningiomas

OBJECTIVE

Meningiomas are the most common neoplasms of the central nervous system and are more frequent in women than in men. Many studies have been conducted to determine whether the progesterone receptor (PR) and estrogen receptor (ER) are present or absent in meningiomas. No previous studies, however, have investigated the status (presence or absence) of gonadotropin-releasing hormone (GnRH) and its receptor (GnRH-R), two major factors related to PR and ER, in meningiomas. This study aims to determine the status of GnRH and GnRH-R and to elucidate the correlations of GnRH and GnRH-R with PR, ER, and clinical features in meningiomas.

METHODS

Eighty-two specimens of human meningiomas were obtained for immunohistochemical analysis with anti-GnRH, anti-GnRH-R, anti-PR, anti-ER, and anti-Ki-67 (MIB-1) antibodies, and for RT-PCR analysis of the mRNA expressions of GnRH and GnRH-R. Correlations of GnRH and GnRH-R with PR, ER, Ki-67, and clinical features such as age, sex, tumor grade, and tumor histology were assessed.

RESULTS

Seventy-eight (95.1%) of the 82 meningiomas reacted positively in the cytoplasm for the GnRH-R. Forty-nine (59.8%) of the 82 cases reacted positively in the cytoplasm for the GnRH. The positive immunoreactivity for GnRH-R and GnRH was confirmed by the RT-PCR analyses of mRNA. Forty-seven (96%) of the 49 cases with positive immunoreactivity for GnRH-R also had positive immunoreactivity for GnRH. PR expression was higher in the tumors positive for GnRH-R (p=0.002), and a significantly higher proportion of tumors from male patients exhibited positive immunoreactivity for GnRH (p=0.02). No significant correlations were found between the status of GnRH-R or GnRH with other clinicopathological features.

CONCLUSION

Over half of meningiomas may be regulated by GnRH-GnRH-R expression in an autocrine fashion. This unique expression profile of GnRH and GnRH-R may open the way to the development of GnRH analogs as a treatment tool in the future.

Long-term follow up of progesterone receptor status in benign meningioma: a prognostic indicator of recurrence?

OBJECT

A long-term prospective analysis of patients with benign meningioma was undertaken to determine whether progesterone receptor (PR) status of the excised tumor has any influence on recurrence.

METHODS

Between 1983 and 1985, a total of 62 meningiomas in 53 patients (age range 19-79 years, mean age 55.6 years) were studied for clinical, histological, and pathological characteristics, including hormone receptor status and DNA features. Progesterone receptor status was quantified by cryostat section assay, and then factors affecting recurrence were analyzed. During 1997 all case records were reviewed to determine whether tumor had recurred in any patient, and PR status was correlated with tumor recurrence. Of the 62 tumors, 60 were benign, and of the benign tumors 29 (48%) were PR positive. Patients harboring 14 of the 60 benign tumors were lost to follow up. Of the 46 tumors included in the final analysis, 13 were recurrent (all within 5 years) and 33 were nonrecurrent. Of the 33 nonrecurrent tumors, 14 had not recurred 5 to 10 years postresection and 19 had not recurred after more than 10 years. Chi-square analysis of the results did not show an association between recurrence and patient's sex, extent of resection, histological subtype, or tumor site but did show an association between recurrence and PR negativity (p = 0.013).

CONCLUSIONS

The results indicate that benign meningiomas that are PR positive are less likely to recur, a finding that has prognostic and therapeutic implications.

Meningiomas and hormonal receptors. Immunohistochemical study in typical and non-typical tumors

The authors assessed 116 cases of meningiomas classified as typical, atypical and anaplastic and they used an immunohistochemical technique for estrogen and progesterone receptors attempting to determine if there is any difference between typical and non-typical tumors in relation to hormone receptors. The immunohistochemical technique to estrogen receptors was negative in all meningiomas studied. Progesterone receptors were detected in 58.3% of typical, and in 48.2% of non-typical meningiomas. This difference was not statistically significant. However, individually considering the criteria used for selection of non-typical tumours, those that concurrently displayed brain invasion and increased mitotic activity or necrosis, as well as the summation of those three features, were predominantly negative for progesterone receptors (respectively p = 0.038; p = 0.001; and p = 0.044). The authors conclude that estrogen receptors were not present in meningiomas; that progresterone receptors in isolation are not enough to predict a higher tumoral malignancy but can be useful associated with other histological features.

Constitutive co-expression of estrogen and progesterone receptor mRNA in human meningiomas by RT-PCR and response of in vitro cell cultures to steroid hormones

Although it is well recognised that human meningiomas are rich in progesterone receptor (PgR), controversy has existed about the presence of the estrogen receptor (ER) in these tumours. We have investigated the presence of both ER and PgR in a series of 20 human meningiomas, spanning the main histological groups, using reverse transcription linked PCR (RT-PCR). Total RNA was extracted from whole tissues and reverse transcribed to yield cDNA. This was amplified using primers specifically designed to detect ER and PgR. All samples co-expressed ER and PgR mRNA, irrespective of tumour classification, patient age or sex. In general, transcripts for PgR appeared considerably stronger than those for ER, and although this was a purely qualitative study, it suggests increased expression of PgR. Addition of exogenous 17beta-estradiol or progesterone to meningioma cell cultures showed that 2/4 cultures responded to these steroids. Our results confirm that human meningiomas do express gene transcripts for ER, and that previous failures to detect ER in these tumours may be due to the lack of sensitivity of the techniques employed. However, these receptors may not be functional in all tumours.

Progesterone and estrogen receptors in meningiomas: prognostic considerations

Meningiomas often contain steroid hormone receptors, but the correlation of receptor presence with patient outcome or mitotic index is unclear. Intracranial meningiomas from 70 patients (27 males and 43 females, mean age 52.9 + 1.7 years [mean +/- standard error of the mean], range 15-78 years) were evaluated immunocytochemically for female sex hormone receptors using specific monoclonal antibodies. Prognostic correlations were determined using statistical analyses that included clinical and histological variables. Twenty-eight tumors were benign, 27 had atypical features, and 15 were malignant. Thirty tumors were meningotheliomatous, 11 were fibroblastic, 28 were transitional, and one was secretory. Twenty-nine of the 70 primary tumors recurred (mean interval to recurrence 50.1 +/- 10 months). The mean progression-free follow-up period for patients without recurrence was 82.1 +/- 7.7 months. Nuclear staining for the progesterone receptor (PR) was found in 58 cases (83%) and PR status was scored as 0 (0% nuclei positive), 1 (< 1%), 2 (1-9%), 3 (10-49%), or 4 (> 50%). Only six tumors (8.6%) contained nuclear estrogen receptor (ER) staining, which was limited to a small number of nuclei (< 1%). Fisher's exact test (two-tailed) showed an inverse correlation between tumor grade and PR staining score (p < or = 0.001), with 96% of benign and 40% of malignant meningiomas containing PR-positive nuclei. No correlation between age or histological subtype and PR score was detected. Meningiomas from female patients had more PRs (p < or = 0.05). Analysis of variance revealed that the mitotic index (total counts of mitoses per 10 high-power fields) for tumors with 0 PR staining (18 +/- 4.4) was higher (p < or = 0.0001) than for those with PR scores of 1 to 4 (4.3 +/- 1.9, 5.1 +/- 2, 2.2 +/- 0.8, and 1.7 +/- 0.9, respectively). Univariate analysis indicated that the absence of PR, high mitotic index, and higher tumor grade were significant factors for shorter disease-free intervals. Multivariate analysis showed that a three-factor interaction model, with a PR score of 0, mitotic index greater than 6, and malignant tumor grade, was a highly significant predictor (p < or = 0.0001) for worse outcome in patients harboring meningiomas. These data indicate that the presence of PRs, even in a small number of tumor cells, is a favorable prognostic factor for meningiomas.

Immunohistochemical detection of female sex hormone receptors in meningiomas: correlation with clinical and histological features

Sixty-one meningiomas from 60 patients were screened for estrogen receptors and progesterone receptors (PgR) with monoclonal antibodies in an immunohistochemical assay. In addition, 43 of the cases were evaluated for tumor size and peritumoral edema, as seen on computed tomographic scans and magnetic resonance images. Sixty-one percent of the tumors contained significant amounts of PgR, whereas no estrogen receptor-positive tumor was observed. Thirteen percent of all tumors were classified as nonbenign variants (atypical and anaplastic meningiomas) and were more frequently found in male patients (P < 0.05). Nonbenign tumors more frequently showed an absence of PgR (P < 0.05), and there was a tendency for PgR-negative tumors to be larger than PgR-positive ones. No correlation was found between PgR status and edema. It is concluded that PgR status in meningiomas is related to tumor differentiation and may be of prognostic value with regard to biological behavior and clinical outcome.

Orbital meningiomas: surgery, radiotherapy, or hormones?

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Meningiomas

This article reviews the recent literature on the pathogenesis and pathology of meningiomas, contemporary techniques of surgical resection, and new nonsurgical treatments, including radiation and hormone therapy. Factors predisposing to meningioma formation include female sex, previous ionizing radiation, and Type 2 neurofibromatosis. The first factor may act through the expression of sex hormone receptors, especially the progesterone receptor, in these tumors; the other two probably act by causing a deletion on Chromosome 22. The pathological classifications of meningiomas include the traditional division into histological subtypes and the World Health Organization classification that selects characteristics that may lead to recurrence. There is an increasing emphasis on proliferative indices and other characteristics that may predict aggressive behavior in these tumors. On computed tomography, meningiomas are enhancing, well-marginated, dural-based lesions that may have considerable surrounding edema; the cause of the edema is uncertain but may result from secretory products of the tumor. Magnetic resonance imaging with enhancement will demonstrate these lesions accurately and can be used for three-dimensional reconstruction as well. Computed tomography and magnetic resonance imaging have largely replaced angiography in the preoperative diagnosis of meningiomas, but angiographic embolization may be a useful operative adjunct. Although meningioma surgery is sometimes thought of as benign and curative, the reported surgical mortality rate is as high as 14.3% and the reported 10-year survival rate after surgery varies from 43 to 77%. Surgery has advanced most in the management of suprasellar, cavernous sinus, clivus, tentorial, and posterior fossa meningiomas, because new approaches and a better understanding of anatomy have allowed more radical resection. There is still substantial morbidity associated with surgery in these regions, however, and the long-term recurrence rates are still unknown for these new radical techniques. For convexity, parasagittal, lateral sphenoid wing, and olfactory groove meningiomas, complete resection should be the goal and operative morbidity appears to be low. There is a high recurrence rate after surgery. With apparent total removal, the recurrence rate varies from 9 to 20% at 10 years, with subtotal resection varying from 18.4 to 50%. The degree of resection appears to be most important in recurrence, but histopathological features are also important. Recently, radiation therapy has been recognized as a useful adjunct to surgery, and with radiosurgical techniques may become more important in the future. Antiprogesterone therapy appears to have had some success as well, and it or other hormonal therapy may be another future option for residual or recurrent meningiomas.

Treatment of unresectable meningiomas with the antiprogesterone agent mifepristone

The possibility that meningioma growth may be related to female sex hormone levels is suggested by several lines of evidence. Meningiomas are twice as common in women as in men, have been observed to wax and wane with pregnancy, and are positively associated with breast cancer. A physiological explanation for these phenomena is provided by the finding of steroid hormone receptors in meningiomas. However, unlike breast cancer, meningiomas are much more commonly positive for progesterone receptors than for estrogen receptors. The authors initiated a study on long-term oral therapy of unresectable meningiomas with the antiprogesterone mifepristone (RU486). Fourteen patients received mifepristone in daily doses of 200 mg for periods ranging from 2 to 31+ months (greater than or equal to 6 months in 12 patients). Five patients have shown signs of objective response (reduced tumor measurement on computerized tomography scan or magnetic resonance image, or improved visual field examination). Three have also experienced subjective improvement (improved extraocular muscle function or relief from headache). The side effects of long-term mifepristone therapy have been mild. Fatigue was noted in 11 of the 14 patients. Other side effects included hot flashes in five patients, gynecomastia in three, partial alopecia in two, and cessation of menses in two. Long-term therapy with mifepristone is a new therapeutic option that may have efficacy in cases of unresectable benign meningioma.

Hormonal dependency of cerebral meningiomas. Part 1: Female sex steroid receptors and their significance as specific markers for adjuvant medical therapy

Female sex steroid receptors were examined in 50 human cerebral meningiomas. For estrogen receptors, high-affinity binding sites (dissociation constant (Kd): 0.05 to 0.2 nM) were found in the cytosolic fraction with a capacity of less than 4 fmol/mg protein in 10 meningiomas using a dextran-coated charcoal (DCC) assay. In the same cytosolic fraction, the solid-phase enzyme immunoassay revealed only one cytosol with a positive colorimetric reaction equal to 5 fmol/mg protein. However, in the nuclear compartment, none of the tumors stained positively for estrogen receptors with immunohistochemical techniques. In addition, the most convincing evidence for the absence of estrogen receptors was obtained by in situ hybridization using an oligonucleotide probe complementary to a fraction of the human receptor messenger ribonucleic acid (mRNA). In none of the 50 meningiomas was the expression of estrogen mRNA coding for the estrogen receptor detected. For progesterone receptors, high-affinity binding sites (Kd: 0.3 to 2.6 nM) were found in 49 of the 50 tumors using a DCC assay. In the same cytosols, solid-phase enzyme immunoassay revealed that each tumor was positive for progesterone receptors. However, in the nuclear compartment, only five tumors had partially positive staining for progesterone receptors with immunohistochemical techniques. Within the confines of this study, it is concluded that: 1) the estrogen receptor is generally absent in meningioma tissue, and 2) the progesterone receptor is mainly absent in the nuclear compartment, leading to the conclusion that the cytosolic progesterone receptor may be an inactive form. This study suggests that female sex steroid receptors are not primarily involved in the proliferative rate of cerebral meningiomas and that they are of no current significance as markers for adjuvant medical therapy of most meningiomas.

Immunolocalization of cathepsin D in the human central nervous system and central nervous system neoplasms

The cellular distribution of the lysosomal proteinase cathepsin D was studied in a series of 76 neoplasms and 18 non-neoplastic tissues from the human central nervous system, using a well-characterized polyclonal antibody in a peroxidase-antiperoxidase technique. In the normal and developing brain, cathepsin D is confined to neurons and choroid plexus epithelium. Strong granular cytoplasmic staining was present in neuronal and choroid plexus neoplasms, and in reactive macrophages. A large variety of other neoplasms also exhibited positive cytoplasmic staining, albeit usually of a weaker diffuse type. Cathepsin D cannot be considered a specific marker for neuronal or choroid plexus neoplasms, but the antiserum used in this study may be of value in antibody panels for the investigation of these tumours. Its localization may also be of value in embryological studies, particularly in the cerebellum, and in investigations of steroid hormone receptor-associated proteins in meningiomas and Schwannomas.

Microassay for prostatic androgen receptors correlated with quantitative histological assessment

A new microassay in which cryostat sections of prostate tissue were used to provide the source of soluble androgen receptor for biochemical assay, was devised using an isoelectric focusing method, with [3H]-mibolerone as the androgenic radioligand. Adjacent cryostat sections from the same tissue block were stained for diagnostic and quantitative histological assessment. The assay was used to illustrate variations in tissue androgen receptor concentration for correlation with epithelial cell content in benign prostate hyperplasia and prostatic cancer, and to show the effects of androgen receptor concentration of resection of prostatic tissue by electroresection. The results indicate that the heat in electroresection renders prostatic tissue unsuitable for androgen receptor assays, and suggest that knowledge of the cellular composition of carcinomatous prostates may be of importance in the full assessment of androgen receptor assay results. This method incorporates both a biochemical assay and histological assessment of the assayed tissue on near-facsimile sections, an advantage over conventional biochemical assays.

Immunohistological demonstration of progesterone receptor in breast carcinomas: correlation with radioligand binding assays and oestrogen receptor immunohistology

The validity of determining the progesterone receptor status of breast carcinomas with a monoclonal antibody was investigated by comparison with data from a radioligand binding assay on adjacent cryostat sections of 103 tumours. Significant nuclear staining for progesterone receptor was observed in 37 (36%) of the tumours studied and this showed a close correlation with the results of radioligand binding assays for progesterone receptor. In three progesterone receptor positive tumours there was an apparent paradoxical absence of oestrogen receptor; progesterone receptor normally depends on the presence of oestrogen receptor, but these rare tumours may be essentially progesterone receptor positive. It is concluded that this monoclonal antibody is an appropriate reagent for use in the immunohistological determination of progesterone receptor status of breast carcinomas; that it advantageously identifies both the occupied and unoccupied receptor sites; and that it provides information about tumour cell heterogeneity with respect to receptor status.

DNA in meningioma tissues and explant cell cultures. A flow cytometric study with clinicopathological correlates

Flow cytometry was performed on stored frozen tissues and explant cell cultures from 39 meningiomas using ethidium bromide and mithramycin in a selective staining technique for deoxyribonucleic acid (DNA). The ploidy index and percentage of cells in the G0/G1, S, and G2/M phases were calculated for each specimen. The results were compared with the age and sex of the patients; the site, the histological subtype, and mitotic rate of the neoplasms; and the estrogen- and progesterone-receptor levels assayed in cytosol-enriched supernatants from cryostat-cut sections. Sixteen neoplasms (41%) were aneuploid. These included two recurrent neoplasms, seven of the eight neoplasms from patients with multiple meningiomas, and three clinically aggressive neoplasms (one hemangiopericytic and two anaplastic meningiomas). Significant correlations were found between values for the ploidy index (r = 0.75, p less than 0.01), the percentage of S-phase cells (r = 0.82, p less than 0.01), and the percentage of G2/M-phase cells (r = 0.69, p less than 0.05) in vivo and in vitro. The results support the suggestion that flow cytometry for DNA in meningiomas may be of value in predicting the behavior of these neoplasms, and indicate that under controlled conditions explant cell cultures may provide a useful model for the proliferative characteristics of meningiomas in vivo.

Steroid hormone receptors in pituitary adenomas: a biochemical, immunohistochemical and morphometric study on cryostat sections

Oestrogen receptors and progesterone receptors were measured by an isoelectric focussing technique in cytosols from cryostat sections of eight human pituitary adenomas. Cryostat sections adjacent to the assayed sample were stained for anterior pituitary hormones using the peroxidase-antiperoxidase technique, and the cellularity of each neoplasm was calculated with the aid of a computerized image analysis system. The results of ER and PR assays were adjusted to compensate for variations in cellularity. ER were present in three prolactin adenomas, one growth hormone adenoma and one gonadotrophin adenoma. The latter also contained PR. Steroid hormone receptors were not detected in two null cell adenomas and one non-secretory oncocytoma. The results support the suggestion that antihormonal chemotherapy may be valuable in the treatment of certain pituitary adenomas.