[On the problem of sentinel lymphatic nodes examination in mammary cancer]

OBJECTIVE

Evaluation of present approaches to the investigation of sentinel lymph nodes in breast cancer.

DESIGN

A review article.

SETTING

Obstetrics and Gynecology Department, Institute of Pathology and Department of Clinical Oncology of 1st Faculty of Medicine and General Teaching Hospital, Prague.

SUBJECT

Sentinel lymph node biopsy can change surgical management of breast cancer and evaluation of regional lymph nodes. Sentinel nodes are reached first by the process of metastasis. Their status has been shown to rather accurately reflect the presence or absence of metastases in the axillary lymph nodes. The macrometastases (larger than 2 mm) are the most important ones. Step or serial sectioning and cytokeratins detection are necessary for findings of micrometastases (0.2-2 mm) or isolated tumor cells. Their prognostic significance is until now unclear and standard examination does not exist.

CONCLUSION

Pathological examination of sentinel lymph nodes ought to identity all macrometastases (larger than 2 mm) as a minimum standard. Further investigations are necessary in order to evaluate the significance of micrometastases and isolated tumor cells and to find an optimal and standard processing.

[Oncocytic adrenocortical neoplasms]

Oncocytic neoplasms of the adrenal gland are rare, as described in literature. Only 27 cases have been reported up to now in world literature. Here we describe our experience. In this report we discuss the clinicopathologic and immunohistochemical findings of three oncocytic tumors of the adrenal cortex. Two tumors were found during examination of the patients for other reasons. These tumors were hormonally inactive. One tumor manifested by the virilization of the patient. Immunohistochemical examination demonstrated in all tumors focal positivity with antibodies to neuron-specific enolase and synaptophysin and mostly focally weak positivity for cytokeratins. Very low mitotic activity was found in two tumors. Criteria for evaluation of biological character of this type of tumors are not established.

Disseminated intestinal hypoganglionosis treated by colectomy and tapering of the small intestine. A case report

A girl suffering from chronic constipation and abdominal distension from her first year of life underwent internal anal sphincter myectomies at 5 and 7 years of age without resolution of her symptoms. At the age of 8, an ileostomy was performed because of excessive colonic dilation and hypomotility. Biopsies from the colon and distal ileum showed intestinal neuronal dysplasia TYPE B (INDB) with hypoganglionic areas. Colectomy and ileorectal anastomosis were done at the age of 10. Three years later, however, an ileostomy was re-established because of recurrent episodes of pseudo-obstruction. In the hope of improving intestinal motility, the dilated small intestine was tapered over its entire length of 3.6 meters. Histological findings still demonstrated oligoneuronal hypoganglionosis and INDB all along the resected strip of bowel wall. After 6 months, the stoma was closed. At the age of 15 years, tapering of the distal 80 cm of the ileum was repeated in combination with cholecystectomy for cholecystolithiasis. Intestinal transit time decreased from 55 hours before the first to 18 hours after the second tapering procedure. Now, 7 years after the last operation, the patient passes 3 - 4 soft stools daily, is physically active, on a normal diet and not on any regular medication.

Large expansion of morphologically heterogeneous mammary epithelial cells, including the luminal phenotype, from human breast tumours

Regular expansion of heterogeneous populations of epithelial cells, including the luminal phenotype, was achieved from small biopsies of human breast tumours and cutaneous metastases by optimized feeder layer technique based on irradiated NIH 3T3 cells. Forty-one out of 47 primary tumour specimens and all three cutaneous metastases grew successfully for two to 10 passages in vitro. The main phenotypes of cultured cells and their changes in subcultures were characterized using immunocytochemistry and phase contrast microscopy (in few cases also time-lapse recording). In the majority of cultured cell populations a fraction of cells positive for keratin 19 (K19+), typical for the luminal phenotype, was detected. This is the cell type from which breast carcinoma is supposed to arise. While in cultures derived from benign lesions only basic phenotypes of luminal and myoepithelial cells were found, in cultures derived from malignant tumours unusual phenotypes of epithelial cells, in their majority K19+, were detected. The growth properties of cells from six benign and seven malignant samples were analyzed in detail. In the analyzed cell populations the culture lifetime - related to the number of colony-forming cells varied for cells from malignant tumours between 21 and 51 and from benign tumours between 22 and 40 cell generations. The total number of passages achieved was three to seven for malignant or four to nine for benign cultures. In spite of negative results of tumourigenicity testing in immunologically compromised Nu/nu mice the potential to culture apparently neoplastic cells was indicated by positive immunostaining for the p53 oncoprotein (seven of 23 tested malignant cases), the src oncoprotein (five of eight), and overexpression of the c-erbB-2 protein (five of 26). This was further confirmed by successful cultivation of malignant cells from cutaneous metastases. Two of the three metastasis-derived cultures were nearly homogeneously positive for K19 while the third was almost negative. The results proved the optimized feeder layer technique to be useful for regular yielding of large amounts of epithelial cells from small tumour biopsies and for supporting the majority of cell phenotypes present in the original tumour. Therefore, it appeared to be a promising tool for further analysis of interactions between luminal and myoepithelial cells in the development of human breast carcinoma and for the study of individual tumours.

Temporal in vitro expansion of the luminal lineage of human mammary epithelial cells achieved with the 3T3 feeder layer technique

Human mammary epithelial cells from reduction mammoplasties were serially propagated in vitro from single cells and/or cell clusters using the NIH 3T3 cell feeder layer technique. In seven passages 46 cell population doublings, corrected for plating efficiency were achieved. The plating efficiency of epithelial cells in the primary culture was 0.2%. During subsequent passages it rose to 10-12% and decreased sharply towards the end of the culture life. In the third and fourth passages temporal prevalence of luminal cells was observed. The critical conditions for prevalence of the luminal phenotype were found to be the initial dissociation and optimum seeding density during subculturing. In primary cultures, after optimum dissociation of 0.15 cm3 mammary tissue with 0.05% collagenase A (Boehringher-Mannheim) in Eagle's MEM for 16 h at 37 degrees C, the yield on day 13 was 20 large colonies of 8-10 mm diameter. About 30% of the epithelial cells, which stained positively for the luminal cell marker cytokeratin 19, occupied colony centres. The remaining 70% were actin positive myoepithelial cells at the periphery. In subsequent passages, when using the optimum seeding density of 2 x 10(5) cells per 60 mm culture dish, the proportion of luminal cells gradually increased to 90% on day 35 in the fourth passage. A sudden rise in the proportion of rapidly growing myoepithelial cells to 65% was observed in the fifth passage. In the sixth and seventh passage small colonies were formed, most of which contained at least one keratin-19-positive (luminal) cell. Cells of human breast carcinomas are considered to be of luminal origin. Therefore, the described approach can be useful in studies of cell and molecular biology of mammary carcinomas.

Clonal expansion of epithelial cells from primary human breast carcinoma with 3T3 feeder layer technique

3T3 feeder layer technique provided support for clonal growth and serial propagation of two apparently single epithelial cells isolated from a peroperative biopsy of a primary ductal breast carcinoma. The total culture lifetime was estimated to be more than 30 doublings, 21 of which took place during the primary culture. The two cells were the only survivors of two-week exposure to stressing conditions that resembled the microenvironment in a tumour (low pH, depleted nutrition and accumulation of metabolic waste). The epithelial character of the cells was proved by positive immunostaining for keratins 7/17. The majority of growing cells did not express keratin 19. Only quiescent cells in some colonies, which appeared to reach a more advanced stage of differentiation, expressed keratin 19. These features correspond with the characteristics of mammary luminal cells which in vivo undergo differentiation from the stem K19- to secretory K19+ cells. The luminal cells are supposed to be the target of malignant transformation in the mammary gland. The described technique opens a regular way for the in vitro clonal growth of individual primary cells from breast tumours. Such an approach can improve our understanding of the biology of breast cancer cell populations and also simplify the predictive chemosensitivity assay on breast cancer cells from individual patients.

[Chronic gastritis in Helicobacter heilmannii infection]

BACKGROUND

The presence of Helicobacter pylori in the gastric mucosa used to be associated with gastritis and peptic ulcer. Helicobacter heilmannii is a similar but much less frequent and less known gastric pathogen.

METHODS AND RESULTS

We evaluated 1250 gastric biopsies. Helicobacteria were detected after silver impregnation. Helicobacter pylori was found in 62%. In 3 cases (0.24%), we found Helicobacter heilmannii. In one of the cases, also Helicobacter pylori was present. All patients had gastrointestinal symptoms and histological chronic active gastritis.

CONCLUSIONS

Helicobacter heilmannii is an uncommon pathogen which appears to be a cause of gastric inflammation. It can be differentiated from Helicobacter pylori by routine histology examination.

Histiocytosis of regional lymph nodes associated with hip replacement

Five cases of pronounced histiocytic reaction in pelvic lymph nodes after hip replacement are demonstrated. Two patients subsequently underwent radical prostatectomies with bilateral lymph node dissections for adenocarcinoma. In three patients, the change was found during autopsy. The sinuses and interfollicular spaces were distended by numerous large macrophages that had bulky eosinophilic cytoplasm. The cells displayed immunoreactivity to KP1 antigen, alpha-1-antitrypsin and lysozyme, providing support for their histiocytic derivation. Polarization microscopy revealed birefringent needle-like particles in their cytoplasm. We think that the histologic appearance of lymph nodes represents a foreign body reaction to fragments of polyester or polyethylene derived from joint prostheses. It is necessary to be aware of this characteristic foreign body reaction in order to avoid confusion with other types of lymph node histiocytosis or with a metastatic tumor.

[Histiocytic reaction in the lymph nodes after total hip joint endoprosthesis surgery]

In two patients with hip replacement, the pelvic lymph nodes were resected during prostatectomy for carcinoma. The striking histiocytosis was present in lymph nodes. The cytoplasm of histiocytes was bulky, granular, PAS positive, with KP1, lysozyme and alfa-1-antitrypsin positivity. In polarized light microscopy, the birefringent, needle-like particles corresponding to polyethylene or polyester respectively were seen. Those changes are characteristic for reactive lymphadenopathy in regional lymph nodes following joint endoprosthesis.

[Pheochromocytoma-ganglioneuroma of the adrenal gland]

Two cases of a rare neuroectodermal compound tumor (pheochromocytoma-ganglioneuroma) of the adrenal were described. They were found in 2.85% of all neuroectodermal adrenal tumors investigated during 20 years. One tumor was diagnosed bioptically in a patient with hypertension. The other one was found incidentally in an autopsy. In both of the them, the major part was feochromocytoma. The structures of ganglioneuroma were only focal. Chromogranin A was relatively strongly positive in pheochromocytes which contained neurosecretory granules. In gangliocytes, the neuron-specific enolase was strongly and serotonin weakly expressed.

Application of NADH tetrazolium reductase reaction in perioperative biopsy of dysganglionic large bowel

A reaction for NADH tetrazolium reductase was used to demonstrate the presence of ganglion cells in myenteric plexus during dysganglionic bowel operations in 24 patients. The advantages of this method are the quick preparation of an incubation medium, a short incubation time and the good demonstration of ganglion cells. It was possible to determine the extent of the aganglionic and prominently hypoganglionic parts of the bowel and in this way achieve improved results. The NADH tetrazolium reductase reaction can be recommended for the perioperative biopsy of a dysganglionic bowel.

[The brown bowel syndrome]

A 37-year-old woman with brown bowel syndrome had yellowish-brown pigment in muscularis propria cells of removed intestine. The pigment occurred here and there in muscularis mucosae, in some arterial walls and in macrophages of submucosa. Its tinctorial characteristics were those of low oxidized lipofuscin. Its probably lysosomal localization was shown by electron microscopy.

[Anomalies in the development of the sinus venosus as a probable cause of heart rhythm disorders and fetal hydrops]

Prenatal ultrasonic examination during the 28th week of gestation revealed a transient disorder of the cardiac rhythm in the foetus. Subsequently repeated echocardiographic examinations confirmed foetal hydrops which together with signs of EP gestosis of the mother was an indication to terminate pregnancy during the 29th week by Caesarean section. In the severely hydropic male foetus in the enlarged anterior wall of the right atrium an atypical vascular canal was found which was in the close vicinity of the sinoatrial node. The latter most probably caused intermittent intrauterine supraventricular tachycardia in a heart with a normal configuration in other respects.

Histochemistry of the atrioventricular conducting system during postnatal development

The atrioventricular conduction system of 27 infants coming to autopsy was examined by histochemical methods. Twenty one were sudden infant deaths; six were explained deaths. A decrease of oxidoreductases and hydrolases activities was found in clusters of conducting cells protruding from the atrioventricular (AV) node and His bundle left into the collagen of the septum. These findings reflect regressive changes connected with reduction of the AV conducting system during postnatal development.

[Personal experience with the use of peroperative biopsy in surgery for intestinal aganglionosis]

The authors examined peroperatively 41 excisions from the muscularis externa of the large bowel in 20 patients operated on account of intestinal dysganglionosis. For visualization of the ganglion cells the reaction for NADH tetrazolium reductase was used. The advantage of this method is that the incubation medium can be very rapidly prepared from a stock solution and that the incubation period is short. The visualization of ganglion cells is by contrast. In all instances it was possible to assess the length of the aganglionic and markedly hypoganglionic portion of the gut and make thus the result of the operation safer.

[Histochemical findings in the atrioventricular conduction system in congenital heart defects]

The authors examined, using histochemical methods, the AV conduction system in five infants and two children who died unexpectedly with a congenital heart disease. The activity of "glycogen dependent" phosphorylase in the AV conduction system was mostly negative or weak. The probable cause of this finding is hypoxia, although the effect of hypotrophy must be admitted. In groups of cells penetrating into connective septal tissue a decrease of oxidoreductases and hydrolases was found. These findings may be associated with regressive changes in the postnatal reduction of the AV conduction system.

[Findings in the atrioventricular node and the bundle of His in sudden and unexpected death in childhood. Histochemical study]

In 21 sudden and unexpected deaths of infants and three young children who died unexpectedly with known pathological conditions the authors examined by histochemical methods the atrioventricular node and bundle of His. The activity of "glycogen dependent" phosphorylase and the PAS reaction was in the majority week or negative. The probable cause of this finding is hypoxia, although other influences cannot be ruled out (inflammation, hypotrophy, autolysis). The activities of other enzymes (oxido-reductases ATPase, acetylcholine sterase, non-specific 1-naphtyl acetate esterase and acid phosphatase) were similar as in the normal conduction system.

[Pancreatic tumors with endocrine activity in adolescents]

The authors demonstrate three patients--two with a nesidioma of the B-cells with insulin production, the third had a nesidioma made up of non-B cells with clinical manifestations of gastrin hypersecretion. The surgical solution was successful in the patients with B-cell nesiodiomas.

[Enzyme activity in the normal atrioventricular node and in the bundle of His in young children]

The authors examined by histochemical methods the atrioventricular node and the bundle of His in five infants who died from unnatural deaths and in a four-and-half-year-old child who died immediately following haemorrhagic infarction of the gut. Both structures differed, similarly as in adult age, from working muscle by a lower oxidation capacity, higher activity of the pentose-phosphate shunt and a high acetylcholine esterase activity.

[Evaluation of the incidence of waves in myocardial muscle cells in children]

In a group of 84 children who died at the age of 3 weeks to 15 years, icl. 37 sudden deaths, 16 unexpected deaths, 12 deaths immediately after an accident and 19 children who died some time after an accident, the authors investigated and evaluated by statistical methods the incidence of waves of myocardial cells in left and right ventricle. Waves in the right ventricle were significantly more marked (at the 5% level) than in the left ventricle. Their presence was inversely related to the presence of haemorrhage and cellular infiltration of the myocardial interstitium. The author did not detect a significant relationship with sex, age, duration of the disease, diagnosis, manifestations of cardiac failure and oedema or pneumonia. The findings suggest that waves of myocardial cells cannot be considered quite specific for ischaemic heart damage.