Chemotherapy of Chemically-induced Colorectal Tumours

Benign and malignant tumours were induced in the large bowel of rats by the carcinogen 1,2-dimethylhydrazine (DMH). Benign tumours appeared from week 20 onwards and malignant tumours from week 30. 5-Fluorouracil was administered intraperitoneally in maximally tolerated doses from week 26 onwards and failed to influence significantly the development of either benign or malignant tumours. Tumours induced by DMH are a close model of human colorectal cancer and suitable for testing anticancer drugs. Agents with greater activity against colorectal cancer are required.

Zonal biochemical and morphological characteristics in BPH

OBJECTIVE

To compare androgen, oestrogen, progesterone and epidermal growth factor receptor concentrations in the transition zone and peripheral zone of the prostate in benign prostatic hyperplasia (BPH), and to relate these findings to epithelial and stromal composition.

PATIENTS AND METHODS

Tissue from both the transition and peripheral zone of the prostate was obtained from 26 patients undergoing transurethral prostatectomy for benign prostatic obstruction and used for both receptor binding studies and morphometric analysis. Androgen receptor (AR), oestrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor (EGFR) concentrations were assayed by saturation binding with a competitive inhibitor. The epithelial, stromal and luminal composition of the tissue was determined using a Zeiss AxioHOME microscope workstation.

RESULTS

The epithelial content was significantly greater in the transition zone than in the peripheral zone. No overall zonal difference in AR concentration was detected; however, when values were expressed relative to the epithelial component, the AR content was significantly higher in the peripheral zone. Conversely, overall EGFR concentrations were significantly greater in the transition zone, although not when expressed per unit epithelium. Higher concentrations of oestrogen receptor were measured in the transition zone per unit stroma. No zonal difference in PR was detected. However, there was a significant correlation between AR and PR in the peripheral zone and between EGFR and AR in the transition zone.

CONCLUSION

These data demonstrate that receptor concentrations should be related to tissue composition. Concentrations of AR were higher in the peripheral zone epithelium than in transition zone epithelium, suggesting greater androgen dependence. This may be important in determining its greater propensity for malignancy. Although EGFR concentrations were greater in the transition zone, there was no zonal difference after correction for the amount of epithelium. Finally, higher concentrations of ER were detected in the transition zone stroma which may reflect important zonal differences in regulating growth and provides further evidence of a role for oestrogens in BPH.

Successful purging of murine plasmacytoma by mafosfamide (ASTA-Z)

Mafosfamide (ASTA-Z) is a chemotherapeutic agent currently in use for in vitro purging of tumor-bearing human BM cells prior to autologous bone marrow transplantation (ABMT). We tested the efficacy of ASTA-Z against mouse plasmacytoma cells MOPC-315 (MOPC), a model of human multiple myeloma. BALB/c mice were injected intraperitoneally with different doses of MOPC preincubated with ASTA-Z. All control mice receiving > or = 10(4) MOPC intraperitoneally (ip) died within 23 days. All recipients of ASTA-Z pretreated MOPC remained healthy for > 180 days. To simulate the clinical situation, BALB/c mice received lethal doses of 10(3) MOPC ip prior to ABMT. Subsequently, mice were treated with cyclophosphamide 200 mg/kg one day prior to syngeneic BMT with 10(7) BMC containing 10(6) MOPC; 90% of the mice receiving unpurged syngeneic BMC died within 45 days whereas all mice transplanted with ASTA-Z-treated BMC/MOPC mixtures remained disease-free for > 100 days. Our results suggest that a similar approach may be successful in patients with multiple myeloma and residual disease prior to cryopreservation of their BM for ABMT. Bone marrow purging with ASTA-Z is effective and under certain conditions could be critical for prevention of relapse following ABMT, provided that effective elimination of residual disease in the host can be achieved by the conditioning regimen prior to ABMT.

Epstein-Barr virus infection and bcl-2 proto-oncogene expression. Separate events in the pathogenesis of Hodgkin's disease?

The present study was undertaken to investigate whether Epstein-Barr virus-(EBV) encoded latent membrane protein (LMP) induces the expression of BCL-2 in Hodgkin and Reed-Sternberg (HRS) cells of Hodgkin's disease (HD) and thereby provide a possible mechanism for the role of EBV in the pathogenesis of this disease. Fifty-three cases of HD were studied for the presence of EBV using EBV-encoded RNA in situ hybridization and LMP immunohistochemistry. Immunostaining for BCL-2 on paraffin material was performed using microwave treatment of tissue sections before the application of the primary monoclonal antibody. EBV was located in HRS cells in 16 cases (30%). All cases that were EBV-encoded RNA in situ hybridization positive, also expressed LMP. BCL-2 expression in HRS cells was detected in 16 cases (30%), but only two of these were also EBV-positive. In both of these cases, only occasional HRS cells expressed BCL-2, in contrast to LMP, which was detected in nearly all such cells. BCL-2 staining was predominantly cytoplasmic with some membrane pattern. These results demonstrate that BCL-2 expression can be detected in HRS cells in routinely processed HD tissue and that whereas EBV does not induce the expression of BCL-2 in HD, BCL-2 may have a role in the pathogenesis of EBV-negative cases of HD.

Epstein-Barr virus in Hodgkin disease. Relation to age and subtype

BACKGROUND

Epstein-Barr virus (EBV) has been associated with Hodgkin disease (HD), but its relationship to the age of the patients and the histologic subtype is not well defined. The possibility that other lymphotropic herpesviruses, such as cytomegalovirus (CMV) and human herpesvirus type 6 (HHV-6) could be involved in the pathogenesis of HD is also unclear.

METHODS

Paraffin-embedded material from 77 cases of HD was studied. This consisted of 24 specimens from children (mean age, 11.4 years), 36 from young adults (mean age, 28.8 years), and 17 from older adults (mean age, 53.8 years). EBV was detected in Hodgkin and Reed-Sternberg cells (HR-S) by a sensitive in situ hybridization technique based on the detection of Epstein-Barr-encoded RNA. Viral activity was subsequently demonstrated in HR-S cells by using monoclonal antibodies to EBV latent membrane protein.

RESULTS

EBV was found in a total of 25 of 77 cases (32%). There was no significant difference in EBV positivity between the different age groups. However, the prevalence of EBV varied between different subtypes: 68% of mixed cellularity cases were found to be positive by contrast with 24% nodular sclerosis, 0% lymphocyte predominant, and 14% lymphocyte depleted. Analysis of the histologic reports of a further 783 cases of HD to determine the age distribution of the different subtypes revealed an absence of an older adult second peak in the age distribution curve. In situ hybridization for CMV and HHV-6 was negative in all cases.

CONCLUSIONS

It was concluded that EBV is predominantly associated with mixed cellularity HD, and there is no correlation with the age of the patient.

Epstein-Barr virus in angioimmunoblastic T-cell lymphomas

Epstein-Barr virus (EBV) has been proposed as a possible infective agent involved in the pathogenesis of angioimmunoblastic lymphadenopathy (AIL), a progressive and often fatal lymphoproliferative disorder. We have studied 19 cases of AIL-like lymphomas for the presence of EBV using a sensitive in situ hybridization technique based on the detection of Epstein-Barr encoded RNAs with digoxigenin-labelled oligonucleotide probes. EBV was found in 11 cases; in seven of these EBV was detected in occasional cells. Immunocytochemical studies to investigate viral gene expression, revealed the presence of EBV-encoded latent membrane protein only in those cases which had appreciable numbers of positive cells by in situ hybridization. The intensity of staining varied from case to case and the overall proportion of cells staining for latent membrane protein in a given case was considerably less than that by in situ hybridization. In situ hybridization for cytomegalovirus and human herpes virus type-6 was negative in all cases. We discuss these findings in the light of the proposed role of EBV in the pathogenesis of AIL and conclude that the presence of EBV is a consequence of the disease rather than the cause.

Predicting the outcome of radical radiotherapy for invasive bladder cancer

The correlation between T stage, histological grade, the presence of squamous metaplasia, and nuclear morphometry scores and response to radiotherapy and survival was investigated in 60 patients with muscle invasive transitional cell carcinomas of the bladder. Patients with T2 tumours showed a complete response significantly more often than those with T3 lesions. Multivariate analysis showed that T stage and initial response to radiotherapy were very strong predictors of survival though they were not independent variables. Histological grade, the presence of squamous metaplasia, and nuclear morphometry scores were not found to have any predictive value.

Detection of Epstein-Barr virus in Reed-Sternberg cells of Hodgkin's disease arising in children

Nonisotopic in situ hybridization has been used to investigate the role of Epstein-Barr virus (EBV) in the aetiology of pediatric Hodgkin's disease. Sections from 24 cases arising in children under the age of 15 years were hybridised with digoxigenin-labelled probes for both EBV and cytomegalovirus, and reactive sites were identified by a sensitive three-layer immunoperoxidase technique. EBV was identified in Reed-Sternberg and mononuclear Hodgkin's cells in five samples (21%). No samples were positive when the cytomegalovirus probe was employed. The specific identification of EBV in the malignant cells of Hodgkin's disease arising in children lends further support for a role of EBV in the aetiology of this disorder.

Epstein-Barr virus in Reed-Sternberg-like cells in non-Hodgkin's lymphomas

In the course of our study on Hodgkin's disease (HD), ten cases of non-Hodgkin's lymphomas (NHL) containing Hodgkin and Reed-Sternberg-like (HRS) cells were encountered. Many of these cases had initially been diagnosed as HD, but on careful review of the histology, with the aid of immunophenotyping studies, they were reclassified as NHL. The presence of Epstein-Barr virus (EBV) in these HRS-like cells was investigated using a combination of EBER in situ hybridization (ISH) and immunostaining for the detection of EBV-encoded latent membrane protein (LMP). HRS-like cells in four cases (two lymphoplasmacytoid lymphomas, one Richter's transformation of lymphoplasmacytoid lymphoma, and one immunoblastic lymphoma of T-cell type) were found to be EBV-positive. In two of these cases, a second biopsy taken up to 10 years later also contained EBV in the HRS-like cells. In three of the four cases, HRS-like cells expressed the activation antigen CD30, but the expression of B- or T-cell antigens was variable. All cases of T-cell-rich B-cell lymphomas were negative for EBV. In conclusion, EBV may play a role in the development of HRS-like cells in some cases of NHL. The relationship of HRS-like cells to HRS cells of HD is discussed.

Recurrent abdominal pain of gastro-intestinal origin

A consecutive series of 71 children (mean age 8.6 years) with recurrent abdominal pain underwent endoscopic oesophageal, gastric and duodenal biopsy in order to determine whether the pain was of gastro-intestinal origin. Of these 71 children, 27 (38%) showed oesophagitis, 14 (20%) cardiac gastritis, 29 (41%) body gastritis, 38 (54%) antral gastritis, and 29 (41%) duodenitis. Thus, 66 of the 71 children studied had an inflammatory lesion explaining their complaints. One of the patients had a gastric ulcer. Helicobacter pylori colonisation was found in 5 of the children: One had H. pylori associated antral and body gastritis and 4 H. pylori associated antral gastritis only. Body gastritis without H. pylori was present in three of these four children. Our data do not support the widespread assumption that recurrent abdominal pain for which no medical cause can be found, is psychogenic; neither do they establish an association between H. pylori antral gastritis and recurrent abdominal pain. However, our data provide strong evidence that there is a gastro-intestinal origin of these patients' complaints.

Epstein Barr virus (EBV) encoded small RNAs: targets for detection by in situ hybridisation with oligonucleotide probes

AIMS

To develop a rapid, sensitive, and specific non-isotopic in situ hybridisation (NISH) procedure for the detection of Epstein-Barr virus in formalin fixed, paraffin wax embedded tissues.

METHODS

Two low molecular weight RNAs, designated EBER-1 and EBER-2 (Epstein-Barr encoded RNA), were used: cells latently infected with EBV secrete large amounts of EBERs. The method uses digoxigenin labelled anti-sense oligonucleotides, corresponding to sequences in EBER-1 and EBER-2.

RESULTS

The use of these probes, in conjunction with high temperature microwave denaturation, ensured that the technique was considerably more sensitive than other in situ hybridisation techniques for detecting EBV. Furthermore, the hybridisation signal was morphologically distinct in that only the nucleus and not the nucleolus give a positive signal. No cross-hybridisation was observed with cells infected with other lymphotropic herpes viruses.

CONCLUSION

The sensitivity, simplicity, and rapidity of this technique make it ideal for diagnostic use, and for studies investigating the role of this virus in neoplastic disease.

Presence of Epstein-Barr virus in Hodgkin's disease is not exclusive to Reed-Sternberg cells

Thirty-three cases of Hodgkin's disease (HD) have been studied for the presence of Epstein-Barr virus (EBV) using a novel nonisotopic in situ hybridization procedure, based on the detection of Epstein-Barr encoded RNAs with oligonucleotide probes. An intense and morphologically distinct nuclear staining, sparing the nucleolus was seen in a total of 12 cases (36%). In six of these cases, the signal was located to the Hodgkin and Reed-Sternberg cells (HR-S); in the other six positive cases, the signal was observed only in the non-neoplastic small lymphocytes. These lymphocytes were few in number and immunocytochemistry results were consistent with a B-cell phenotype. The presence of EBV in those cases characterized by nuclear staining of small lymphocytes was confirmed by the polymerase chain reaction (PCR) analysis. The authors report the detection of EBV in small lymphocytes in HD by in situ hybridization and discuss the implications of these findings in relation to the proposed etiologic association between EBV and HD.

Persistence of Epstein-Barr virus in Reed-Sternberg cells throughout the course of Hodgkin's disease

Non-isotopic in situ hybridization employing digoxigenin-labelled DNA probes has been used to localize Epstein-Barr virus (EBV) in 55 cases of Hodgkin's disease (HD). The virus was found in Reed-Sternberg (RS) and mononuclear Hodgkin's cells in nine patients (16 per cent). Further samples taken at different times from three patients also showed the presence of EBV in the malignant cell population. Estimations of the number of EBV genomes present per cell suggested wide variations between different patients, but relatively constant amounts in different samples from the same patient. These findings are compatible with a stable infection of the neoplastic cells and support the notion that EBV may play a role in the development of HD in these patients. We also found evidence for the presence of EBV in a small percentage of non-neoplastic cells in 8 of the 55 samples. This suggests that isolation of EBV from HD tissue does not always signify a pathogenetic role for the virus. Furthermore, it is apparent that a high percentage of HD tissues do not contain demonstrable EBV, and the virus is therefore unlikely to be a causative agent for all cases of HD.

Detection of single copies of Epstein-Barr virus in paraffin wax sections by non-radioactive in situ hybridisation

A highly sensitive non-isotopic in situ hybridisation technique was developed for the localisation of Epstein-Barr virus (EBV) in paraffin wax embedded tissue sections. The method uses a repeated sequence of the EBV genome as a probe, labelled with the novel reporter molecule, digoxigenin. The method can identify individual copies of EBV by detection of both EBV DNA and highly localised RNA transcripts. A combination of careful proteolytic digestion of tissue sections, high temperature denaturation of probe and target DNA, and sensitive immunocytochemical detection are used to attain single copy sensitivity. The technique is quicker and simpler to perform than some other methods used for the identification of EBV, and provides simultaneous morphological information which cannot be obtained by methods using tissue extracts. This method permits the investigation of the role of EBV in neoplastic conditions of lymphoid and epithelial cells, and may prove valuable in determining the sites of latent virus in healthy subjects.

Simplified procedures for applying the polymerase chain reaction to routinely fixed paraffin wax sections

The polymerase chain reaction was applied to the analysis of DNA contained in archival paraffin wax embedded material. DNA suitable for the reaction was obtained from these tissues by simple extraction methods, without previous dewaxing of tissue sections. When compared with unfixed material, the reaction efficiency was compromised, so that an increased number of amplification cycles were required to produce equivalent amounts of amplified product. This in turn led to an increase in amplification artefacts, which can be minimised by a simple modification of the standard reaction. Amplification of relatively large DNA fragments was not always successful, and it seems prudent to bear this in mind when designing oligonucleotide primers which are to be used for the amplification of archival material. The efficiency of the procedure can be improved by dividing the amplification cycles into two parts: this reduces the amount of reagent needed, is relatively simple and inexpensive, and can be performed in one working day.

Morphometry of bladder carcinoma: morphometry and grading complement each other

Subjective grading of bladder carcinoma is a good predictor of the clinical outcome in those patients whose tumours are grade 1 or grade 3. However, in grade 2 tumours, which account for 45% of cases, grading has little predictive value in an individual patient. We have complemented the use of subjective grading with measurement of nuclear area and used a calculation of the distribution of nuclear sizes as a predictor of the clinical course. When subjective grading was complemented by morphometry the outcome was correctly predicted in 55 of 58 cases and all cases with poor clinical outcome were identified.

Morphometry of bladder carcinoma: definition of a new variable

In this study two measurements of nuclear size, the mean area and the size distribution curve of nuclear area, were used to differentiate between two polar groups: nuclei from non-neoplastic urothelium and nuclei from transitional cell carcinomas of bladder with a poor clinical outcome. Wide separation of these groups is necessary if a measurement is to be used to assess tumour grade where the morphometric differences are intermediate between such polar groupings. Separation between two groups was best achieved using a weighted distribution of nuclear size and this is a means of objective scoring of urothelial tumours.

Barium studies and ileoscopy compared in children with suspected Crohn's disease

The findings on barium follow through, ileoscopy and biopsy of the terminal ileum in 46 children with suspected chronic inflammatory bowel disease have been compared to the final clinical diagnosis. Ileoscopy and barium follow through agreed in 91%, barium follow through and biopsy in 80% and barium follow through, ileoscopy and biopsy in 76% of cases. A pronounced lymphoid hyperplasia pattern was present radiologically in 24%, and was a source of error in two cases. Barium follow through compared favourably to ileoscopy or biopsy individually, detecting 18 of 20 and 17 of 20 cases respectively; however, ileoscopy combined with biopsy diagnosed every case. The sensitivity of the barium follow through was 0.90 with a specificity 0.96 for the diagnosis of Crohn's disease in the terminal ileum.

Morphometry of bladder carcinoma: I. The automatic delineation of urothelial nuclei in tissue sections using an IBAS II image array processor

Semi-automatic methods of morphometry require the boundaries of the objects under study to be drawn by hand. This is slow, tedious and does not guarantee accuracy. Complete automation, with recognition, detection and verification by computer is not yet feasible. Automatic detection of nuclear boundaries with observer verification provides a means of obtaining large amounts of data for analysis, quickly and with similar accuracy to manual tracing.

Immunohistochemistry in district general hospitals in England and Wales

The findings of a survey on the use of immunohistochemistry in district general hospitals in England and Wales are reported. Immunohistochemistry is used in most district hospitals, contributes to the accuracy and objectivity of some histopathological diagnoses, and is considered to be generally useful though not without drawbacks. Its expansion is being hindered by lack of funds for reagents and staff. In a few regions attempts are being made to rationalise expenditure and coordinate development of the service. We believe that if this can be done at a regional or national level then the relatively small cost entailed will be justified by a resulting improvement in the quality of patient care.

Isolated atrial amyloid contains atrial natriuretic peptide: a report of six cases

Twenty five specimens of the human right atrial appendage were examined for immunoreactivity to alpha human atrial natriuretic peptide. In the electron microscope characteristic amyloid fibrils were identified around small blood vessels and adjacent to atrial muscle cells in eight of the surgical cases and in two necropsy cases. In six cases, four surgical and two necropsy, these fibrils contained immunoreactive alpha human atrial natriuretic peptide. Amyloid is known to occur in peptide secreting endocrine tumours and immunoreactive peptide may be incorporated in the amyloid matrix. The demonstration of atrial amyloid containing immunoreactive alpha human atrial natriuretic peptide suggests that some deposits of cardiac amyloid are of a type analogous to that found in other endocrine organs.

Identification of immunoreactive atrial natriuretic peptide in atrial amyloid

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Diverticular disease (adenomyomatosis) of the gallbladder: a radiological-pathological survey

Seventy consecutive gallbladders removed at surgery were examined radiologically and pathologically. Fifteen (21%) of the operative specimens showed naked-eye changes of adenomyomatosis. The main conclusions drawn from this study are that this abnormality is present in a much higher proportion of gallbladders removed at surgery than is generally realised, and that the pathogenesis is primarily an abnormality of muscle contractions, with a strong similarity to diverticular disease of the colon. Diverticular disease of the gallbladder might well be the most appropriate name for this condition. The results of a post-operative clinical assessment of patients with diverticular disease are also presented. But this represents a small number of patients and larger, perhaps multicentre, surveys would be required in order to assess the clinical significance of this interesting abnormality.

Comparison of prevalence of human papillomavirus antigen in biopsies from women with cervical intraepithelial neoplasia

Human papillomavirus antigen was found in 39 (16%) of 253 colposcopic biopsies from a group of women at high risk for cervical cancer who had been examined in the early 1970s. Immunohistochemical evidence of papillomavirus infection was found in 20 (30%) of 67 cervical intraepithelial neoplasia lesions infected with wart virus from these patients. When these results were compared with results of a similar study carried out in the early 1980s there was no significant difference in the prevalence of human papillomavirus antigen in cervical intraepithelial neoplasia lesions infected with wart virus from women who had been examined over a decade apart.

Density of mucosal mast cells in the lamina propria of the colon and terminal ileum of children

Ileal and colonic biopsies from children observed to be histologically normal were fixed in Carnoy's fluid, sectioned, and stained by the chloroacetate esterase reaction. The density of mucosal mast cells was higher in the terminal ileum than the colon, but did not vary significantly within the colon.

Alcoholic skeletal myopathy, a clinical and pathological study

One hundred and fifty-one inpatients with a history of chronic heavy alcohol intake were examined for evidence of muscle disease. Ninety-two patients (60 per cent) had histologically abnormal biopsies of the quadriceps muscle. The most common abnormality, which was often severe, was type II muscle fibre atrophy. Seven patients (5 per cent) had histological evidence of acute myopathy, one of whom presented with the full clinical picture of acute rhabdomyolysis. Twenty-three patients had cirrhosis, 36 were significantly malnourished and 98 had evidence of a peripheral neuropathy. None of these features, however, were sufficient to account for the muscle abnormalities. There was no clear relationship between musculo-skeletal symptoms and muscle biopsy histology. Serum creatine kinase activity was elevated in only 23 subjects and was an insensitive indicator of subclinical acute myopathy and of chronic alcoholic myopathy. Follow-up studies after abstinence from alcohol invariably showed both objective and subjective improvement of muscle function - often in the absence of any clinical recovery from the peripheral neuropathy. Continued alcohol consumption was accompanied by persistence and often deterioration of muscle fibre atrophy. It is concluded that chronic skeletal myopathy is a frequent consequence of alcohol abuse and may result from a direct toxic effect of ethanol on muscle fibres.

Quantitation in inflammatory bowel disease using computerised interactive image analysis

Objective measurements of various histological features in rectal biopsy material were made using computerised interactive image analysis. Analysis of the resulting data by forward stepwise discriminant analysis showed that biopsies from patients with ulcerative colitis and infective diarrhoea could be distinguished from each other and from normal biopsies; they could not, however, be distinguished from biopsies of patients with Crohn's disease, which behaves as a heterogeneous entity rather than a single disease. The measurements showed that the crypt atrophy described in active ulcerative colitis may be a misnomer, the appearances being due to an increase in mucosal depth and alteration in crypt configuration rather than a true atrophy. Unexpectedly, the ratio of crypt cell height to surface cell height gave the best separation of Crohn's disease from ulcerative colitis.