Buerger's disease: clinical and histomorphological study

There is an extremely high prevalence of Thromboangiitis Obliterans (TAO) or Buerger's disease (BD) in India among people of low socioeconomic class who smoke beedies (homemade cigarettes with raw tobacco). The aim of this study was to study the clinical and histo-morphological aspects of Buerger's disease with relevance to age at presentation in the local population. The study comprised of 25 cases (all were men and were smokers) of clinically diagnosed BD based on Shionoya's criteria. The mean age was 47 years. The specimens consisted of 21 biopsies, 2 end-arterectomies and 2 amputations. Formalin fixed, routinely processed, paraffin embedded tissue sections were stained with Haematoxylin and Eosin (H and E) and Verhoeff's elastic stain. They had claudication pain either in the ankle (5) or in the calf (2) or both (13). 24 had infrapopliteal disease and 9 showed upper limb involvement. 21 showed migratory thrombophlebitis also. Histomorphological presentation included the following features: Luminal thrombosis (14), fresh thrombosis (4), chronic inflammation in the vessel wall (10), within the thrombus (1) and around perivascular channels and nerve bundles (4). Internal elastic lamina showed reduplication in 13, undulation in 9 and fragmentation in 9 cases. Media of the vessel showed the following features: fibrosis (9), hypertrophy (9) and calcification (5) Adventitial haemorrhage, cholesterol clefts and atherosclerotic plaque formation were the other changes seen. In our study the following histopathological features were consistently seen. Thrombus (with or without recanalisation), inflammatory cell infiltrate (within the thrombus wall or periadventitial tissue), subintimal and medial fibrosis and changes in internal elastic lamina. These features were also highlighted in other studies. However in our study, medial hypertrophy and calcification were observed as additional features.

Tumour angiogenesis and C-myc expression in breast carcinomas

Angiogenesis in tumors has been widely studied and has been considered to be a prognostic factor particularly in breast carcinomas. The myc family of proto oncogenes has shown an amplification in breast carcinomas. The aim of this study was to assess MVD (micro vessel density) and the expression of c-myc in invasive breast carcinomas. Formalin fixed, routinely processed, paraffin embedded tissue was stained with H&E for classification and grading according to the Nottingham modification of Bloom and Richardson criteria. Immunohistochemical staining using primary antibody against F VIII antigen and anti C-myc were carried out. LSAB method was employed with AEC as chromogen and Gill's Haematoxylin as counter stain. Micro vessels were counted and positivity indicated by a cherry red staining in the cytoplasm of the tumour cells. Grades I, II and III showed 12.22 %, 20.9% and 24.5 % positivity of micro vessel density (MVD). Fifty percent of Grade 1, 69.2 % of Grade II and 24.5 % of Grade III tumours expressed c-myc proteins. In our study we found a positive association between tumour grade and micro vessel density, signifying a poor prognosis for tumours with high MVD. C-myc expression also showed a positive association with increasing grade.

Cytoprotective effect of piperine against benzo[a]pyrene induced lung cancer with reference to lipid peroxidation and antioxidant system in Swiss albino mice

The cytoprotective effect of piperine on benzo[a]pyrene (B[a]P) induced experimental lung cancer was investigated in male Swiss albino mice. Oral administration of piperine (100 mg/kg body wt.) effectively suppressed lung cancer initiated with B[a]P as revealed by the decrease in the extent of lipid peroxidation with concomitant increase in the activities of enzymatic antioxidants (superoxide dismutase, catalase and glutathione peroxidase) and non-enzymatic antioxidant (reduced glutathione, vitamin E and vitamin C) levels when compared to lung cancer bearing animals. Our data suggest that piperine may extend its chemopreventive effect by modulating lipid peroxidation and augmenting antioxidant defense system.

Multidrug resistance 1 gene expression in Indian patients with gastric carcinoma

BACKGROUND

Gastric carcinoma is frequently refractory to chemotherapy. The multidrug resistance 1 gene (MDR1) encodes for a protein (p-glycoprotein) that functions as a drug efflux pump and thus contributes to resistance to chemotherapeutic agents.

METHODS

We studied gastric tissues from 28 patients with gastric cancer for MDR1 expression, using immunohistochemistry.

RESULTS

Sixteen (57%) of 28 cases showed MDR1 expression. Sections of normal mucosa away from the tumor showed perinuclear staining for MDR1 in surface epithelial cells, whereas tumor cells showed diffuse cytoplasmic positivity.

CONCLUSIONS

Over one half of gastric carcinoma specimens at our center show MDR1 gene expression.

The Epstein Barr virus and gastric carcinoma

The Epstein Barr Virus (EBV) is one of the viruses implicated in the pathogenesis of malignant tumors. Its association with Burkitt's Lymphoma, nasopharyngeal carcinoma and certain cases of Hodgkin's lymphoma is well known. More recently this virus has been found to be associated with gastric carcinoma. Studies on this association, in our country are lacking. We have studied 37 cases of carcinoma using immunohistochemistry for LMP1 protein. Most workers have found an expression of latency type I antigens in gastric adenocarcinomas, with only a few cases being LMP1 positive. In the 37 cases studied by us, 24.14% of cases were positive for LMP1. LMP1 is known to have oncogenic properties. In addition, it has been demonstrated earlier that the EBV particles in gastric carcinoma are monoclonal. These two factors support a pathogenetic role for EBV in gastric carcinoma.

P 53 and PCNA in Non Hodgkin's lymphoma--an immunohistochemical evaluation

P 53 positivity and PCNA labelling index were studied in 50 cases of node based Non Hodgkin's lymphomas, P 53 positivity was observed in a spectrum of these disorders, suggesting that P 53 mutations play a role in the genesis of these tumours. P 53 positivity incresed from low through intermediate to high grade tumours and thus may be of prognostic value in these lesions. PCNA labelling index (LI) was higher in high grade tumours. P 53 and PCNA immunoreactivity showed a relationship in that PCNA LI was seen to be more than 30% in P 53 positive tumours. P 53 positivity appears to be related to the subtype and proliferation rate of NHL.

Protein C levels in ischaemic heart disease

Protein C is a circulating glycoprotein with anticoagulant properties. Functional and immunological levels of protein C were determined in 34 cases of ischaemic heart disease and 12 healthy age-matched controls. The sensitive colorimetric assay was used to determine the functional levels and ELISA for antigenic levels. Mean protein C activity and antigenic levels were found to be elevated in these patients as compared to controls. Protein C levels in the three individual subgroups-acute myocardial infarction, previous myocardial infarction and chronic stable angina pectoris-were also raised as compared to controls. The elevation was significant in the case of the acute myocardial infarction group. These results further support the hypothesis that the body synthesises increased amounts of protein C in ischaemic heart disease to compensate for the hypercoagulable state that exists in this disorder, thus playing a protective role.

Cell marker studies in undifferentiated soft tissue sarcoma

100 cases of undifferentiated soft tissue sarcomas were studied using cell markers by immunoperoxidase technique with DAB as substrate. Vimentin, Desmin, Myoglobin, Actin, Keratin, Epithelial Membrane Antigen, S-100 protein, F VIII R Ag, A1 Antitrypsin, A1 Antichymotrypsin, Collagen-IV and UEA-1 lectin were used as markers. Fibrosarcoma was consistently positive for Vimentin and Collagen-IV. The undifferentiated Rhabdomyosarcoma showed strong and consistent positivity for Vimentin Actin and Myoglobin. Desmin positivity was the hallmark of leiomyosarcoma, whereas the malignant schwannomas were identified by their S-100 positivity. This marker along with A1AT and A1ACT reactivity was of great use in the identification of malignant fibrous histiocytoma. Angiosarcoma/malignant haemangioendothelioma could be identified with great accuracy by their strong positivity for F VIII RAg and UEA-1 lectin. Other miscellaneous sarcomas also could be identified by their specific reactivity to the markers used. We consider immunohistochemistry to be an important and essential adjunct to routine stains in the diagnosis of undifferentiated soft tissue sarcomas.