C16 laminin peptide increases angiotropic extravascular migration of human melanoma cells in a shell-less chick chorioallantoic membrane assay

BACKGROUND

As distinct from intravascular dissemination, extravascular migratory metastasis (EVMM) has been described as a potential additional mechanism of melanoma spread in which tumour cells migrate along the external surfaces of vessels. Recent experimental studies strongly suggest a correlation of angiotropism of melanoma cells with EVMM. Angiotropic melanoma cells are linked to the endothelium by an amorphous matrix confirmed to contain laminin.

OBJECTIVES

To investigate whether laminin plays a role in this extravascular mechanism of tumour spread.

METHODS

We tested the effect of the C16 laminin peptide on melanoma spread in a shell-less chick chorioallantoic membrane model.

RESULTS

After 3 days, green fluorescent protein-expressing melanoma cells were observed spreading along or in the immediate proximity of vessels. The C16 laminin peptide significantly lengthened the distance of extravascular, angiotropic migration of melanoma cells. Histopathology confirmed the angiotropism of melanoma cells without intravasation, compatible with that observed with human angiotropic melanoma.

CONCLUSIONS

The results of this study suggest that the C16 laminin gamma1 chain peptide has angiotropic, extravascular migration-promoting activity on human melanoma cells, and might be a molecular target for preventing melanoma metastasis.

Acanthamoeba infection in lung transplantation: report of a case and review of the literature

A 49-year-old woman underwent bilateral lung transplantation for advanced idiopathic pulmonary fibrosis. During the postoperative period she received immunosuppressive medications as well as corticosteroids. Aspergillus fumigatus grew from a sputum sample, and she was treated with nebulized amphotericin. She was discharged on tacrolimus and prednisone. After initially doing well, she required re-hospitalization for treatment of cytomegalovirus and Pseudomonas aeruginosa pneumonia. She was treated with ganciclovir and cefepime and, after a 2-week hospitalization, was discharged. Seven months after transplantation she developed progressive sinusitis, treated with antibiotics and sinus debridement surgery. Aspergillus organisms were recovered and, at the periphery of the tangled masses of Aspergillus hyphae, numerous amebic cysts were also identified, which were morphologically consistent with Acanthamoeba spp. Subsequent electron microscopy and immunofluorescent staining confirmed this impression. She was initially treated with intravenous amphotericin, later changed to voriconazole and caspofungin. Debridement of the sinuses 3 weeks later revealed fungal hyphae but no amebae. Infections with Acanthamoeba have rarely been reported in lung transplantation but have been recognized in bone-marrow and renal transplant patients, and have been lethal in many cases, particularly in patients with immunosuppression due to human immunodeficiency virus infection. More recently, aggressive antimicrobial therapy has resulted in successful outcomes, as discussed herein.

Clumping of erythroblasts simulating a metastatic neoplasm

I describe an unusual case of artifactual clumping of erythroid cells in aspirated bone marrow particles, simulating a metastatic malignant small cell neoplasm. This was felt to be due to a combination of the technique of preparation of the smears, as well as a possible immunologic phenomenon secondary to the presence of membrane-bound antibody. The patient's peripheral red blood cells were shown to be coated with an IgG-specific antibody, possibly drug induced.

Nodular pulmonary sarcoidosis. Diagnosis with fine needle aspiration biopsy

A case of sarcoidosis presenting as multiple pulmonary nodules and investigated by transthoracic fine needle aspiration biopsy is presented. Cohesive clusters of epithelial cells as well as multinucleated giant cells were observed. Special stains performed on the cell-block preparation were useful in ruling out an infectious etiology. The case demonstrates the value of fine needle aspiration biopsy in the investigation of pulmonary parenchymal disease and illustrates the cytologic findings in this unusual presentation of sarcoidosis.

Protothecosis in the southeastern United States

A case of olecranon bursitis due to the achlorophyllic algae Prototheca species in an otherwise healthy 74-year-old man prompted our review of reported cases occurring in the southeastern United States. Most cases have involved the olecranon bursa, have occurred in otherwise healthy individuals, and were cured by simple excision. Intensive therapy with amphotericin B has been used successfully in a few cases that required systemic antibiotic therapy. The histologic features of this infection are predominantly those of granulomatous inflammation, with relatively easy demonstration of organisms using routine fungal stains.

Pre-treatment and post-treatment evaluation of prostatic adenocarcinoma for prostatic specific acid phosphatase and prostatic specific antigen by immunohistochemistry

Prostatic specific acid phosphatase and prostatic specific antigen have been used as specific markers of prostatic adenocarcinoma in immunohistochemical studies, particularly when seeking the primary site of a poorly differentiated metastasis. We herein evaluate the effect of therapy on the persistence of these markers in surgically obtained tissues. Prostatic biopsies from 30 patients with adenocarcinoma of the prostate gland before and after treatment with orchiectomy alone, diethylstilbestrol, external beam radiation or combined radiation and diethylstilbestrol were studied for prostatic specific acid phosphatase and prostatic specific antigen using the indirect immunoperoxidase technique. The interval between biopsies ranged from 3 to 72 months, with an average of 28 months. All pre-treatment biopsies stained positively for prostatic specific acid phosphatase and prostatic specific antigen. Staining for prostatic specific antigen and prostatic specific acid phosphatase was seen easily in 29 of 30 post-treatment biopsies, while in 1 case infiltrating anaplastic cells surrounded by stroma showed staining for these antigens in an extremely small percentage of cells, which were overlooked easily unless examined carefully. In view of this small number of positively staining cells this case was designated as equivocal. While some cases demonstrated less intense staining in post-treatment biopsies compared to pre-treatment, this finding was by no means constant. With these primary antisera a higher percentage of cytologically malignant cells stained positively for prostatic specific acid phosphatase than for prostatic specific antigen in adjacent tissue sections in some cases. Prostatic specific acid phosphatase and prostatic specific antigen appear to be sensitive and persistent markers of prostatic adenocarcinoma despite morphologic changes accompanying various therapies.

Transformation of "signet ring cell" lymphoma to typical nodular, poorly differentiated lymphocytic lymphoma: light microscopic, immunohistochemical and electron microscopic observations

Malignant lymphoma with intracellular immunoglobulins giving a "signet ring" appearance to the lymphocytes is a recently described morphologic variant with specific ultrastructural and immunohistochemical characteristics. We report a case that had this distinctive morphology when initially biopsied but on subsequent biopsy 2 1/2 years later had the typical appearance of a poorly differentiated lymphocytic lymphoma without "signet ring" cells. The same monoclonal immunoglobulin class and light chain type was demonstrated in both biopsies using immunohistochemical techniques. Rare cells in the second biopsy showed the characteristic ultrastructural findings. These findings support the concept of a continuum of cell types in malignant lymphoma, with transformation toward a cell line lacking the peculiar characteristics resulting in this unique appearance.

Amyloid colitis

Amyloidosis not infrequently involves the gastrointestinal tract and may result in a variety of symptoms, including those related to impaired motility, malabsorption, and ulceration due to ischemia. This report describes the case of a 74-year-old man with systemic amyloidosis secondary to multiple myeloma, with striking gross morphologic findings involving the colon, seen at autopsy, resembling severe inflammatory bowel disease. Microscopically, the small arterioles of the lamina propria were markedly narrowed or occluded by massive deposition of amyloid, presumably leading to diffuse ischemia and mucosal necrosis. Although the radiologic appearance of this condition has been well recognized, and ischemia due to amyloidosis has been described, this case is presented to demonstrate the gross anatomic changes not illustrated in previous reviews of the subject.

Herpetic tracheobronchitis: immunohistologic demonstration of herpes simplex virus antigen

A patient with no evidence of underlying malignancy or immunosuppression was found to have herpetic tracheobronchitis by bronchial brushing cytologic examination and bronchial biopsy. Herpes simplex type I antigens were localized in infected cells by means of the unlabeled antibody enzyme technique. Occasional cases of herpes simplex viral tracheobronchitis or pneumonitis have been reported in patients with severe burns or with malignancy. This is an unusual finding in otherwise health individuals.

Cytologic features of nonfatal herpesvirus tracheobronchitis

Herpesvirus infections of the lower respiratory tract have most commonly been reported in patients with severe burns, immunosuppression or malignancies. Two patients without any of these underlying conditions developed severe herpetic tracheobronchitis, diagnosed by cytologic examination and confirmed by serologic studies. Serial examination of sputum, bronchial brushings and bronchial washings permitted observation of the evolution and progression of cellular changes found in herpesvirus infection of the lower respiratory tract. both patients recovered without specific antiviral therapy, but both developed superinfection with gram-negative organisms, requiring intensive antibiotic therapy. The distinctive features of herpesvirus infection in the tracheobronchial tree are similar to those recognized elsewhere in the body. Early findings include a variety of nonspecific changes in nuclear chromatin configurations; multinucleated cells may be common but do not often contain the central intranuclear inclusion bodies seen in later stages. These distinctive central intranuclear inclusions disappear in a few days, leaving only reparative changes in the surface epithelium. Herpesviruses are increasingly being reported in the literature as an etiologic agent of acute tracheobronchitis in otherwise healthy individuals.

Basal cell carcinoma of the scrotum: a case report and literature review

Basal cell carcinoma of the scrotum is a rarely occurring lesion that must be differentiated from the more common squamous cell carcinoma, as well as chronic dermatitis or chronic fungal infection. We report a case of basal cell carcinoma of the scrotum and review the literature. This case serves as a reminder that these lesions do occur on the scrotal skin and that, unlike squamous cell carcinomas, they are curable with simple wide excision.

Immunoglobulin light chain staining of lymph node biopsies: an interlaboratory comparison

In recent years, the demonstration of cell surface or cytoplasmic monoclonal immunoglobulin kappa or lambda light chains in lymphoid tissues has been considered evidence of their B-cell origin. In an effort to evaluate the reproducibility of results among various laboratories performing immunoperoxidase immunostaining of lymph node specimens, 12 lymph node biopsies were similarly fixed and processed, and serial sections submitted to four laboratories for staining by the unlabelled antibody (peroxidase-antiperoxidase conjugate) technique. Seven of these were malignant lymphomas four were negative, and one was metastatic carcinoma. Participants were not told the diagnosis and were asked to evaluate each specimen for the presence of monoclonal light chain staining. While the overall agreement in results were good, one of four laboratories differed from the other three in four out of the 12 cases. The significance of this finding and its implications are discussed.

Cytodiagnosis of "signet-ring"-cell lymphoma

An unusual case of malignant lymphoma with vacuolated cells was discovered during examination of pulmonary cytologic specimens. The diagnosis was confirmed by light and electron microscopic study of biopsy specimens. This variant of malignant lymphoma could be mistaken for adenocarcinoma or carcinoid tumor, but certain cytologic features common to malignant lymphomas should help to differentiate these neoplasms. The histologic, immunohistochemical and electron microscopic findings confirm the diagnosis. As more pathologists and cytologists become aware of this entity, additional cases will probably be reported. The significance of the morphologic findings is as yet uncertain.

Lung cancer in younger patients

Carcinoma of the lung is rare in younger patients, but occasional reports of this condition have appeared in the literature. This article reviews the clinical and pathological patterns of bronchogenic carcinoma in 96 patients, 40 years old or younger seen at UCLA (University of California, Los Angeles) Hospital between 1956 and 1976. This review confirms the finding in other reports of a higher proportion of women among younger patients with lung cancer as well as a relatively low incidence of squamous cell carcinoma. Using comparative data from the UCLA and California tumor registries, we could find no significant difference in survival of the younger patients when compared with the general population of patients with lung cancer.

Immunoperoxidase and immunofluorescence in lymph node biopsies: a comparative study

A comparison study was made of staining for immunoglobulin by immunofluorescence and immunoperoxidase in 23 lymph node biopsies. Cryostat sections were stained for immunoglobulins using a direct technique while paraffin-embedded sections were stained for immunoglobulins using the peroxidase-antiperoxidase (PAP) technique. Of 23 cases studied, including seven reactive hyperplasias and 16 lymphoid cancers, there was agreement between the two techniques in 18 cases. Nine of 14 non-Hodgkin's lymphomas showed agreement of results. All reactive hyperplasias showed complete agreement and had a distinctive pattern by both immunofluorescence and immunoperoxidase. Fixation, reagent specificity, and sensitivity of the methods may account for some of the discrepancies noted. Immunoperoxidase staining may be a useful diagnostic aid, particularly when immunofluorescent staining is not possible.

Pulmonary resection for metastatic sarcoma

Surgical resection plays an important role in the treatment of sarcoma that is metastatic to the lung. Multiple bilateral metastases are not contraindications to surgery. The rapidity of growth and the response to chemotherapy can be accurately determined by the tumor doubling time. Preoperative chemotherapy provides an in vivo measurement of tumor sensitivity, and the response to chemotherapy correlates with prognosis. Since residual microscopic pulmonary disease appears to be responsible for most failures after thoracotomy, attention should be directed toward delivering more effective adjuvant therapy to the lungs.

Sézary cells in ascitic fluid

Sézary's syndrome is a neoplasm of T-lymphocytes characterized by skin lesions histologically typical of mycosis fungoides together with the presence of malignant (Sézary) cells in the peripheral blood. These cells have a characteristic appearance in tissues, peripheral blood and body fluids, and their presence in large numbers in ascitic fluid is an indicator of disseminated disease. A patient with Sézary's syndrome was found to have the distinctive malignant lymphocytes in ascitic fluid. We believe that this report is the first to document the appearance of the cells in a body cavity fluid. Treatment modalities in Sézary's syndrome may be determined by the stage of the disease, and the presence of the distinctive "convoluted" or "cerebreform" lymphocytes should be noted.