Interest of Chromogranin A for diagnosis and follow-up of endocrine tumours

OBJECTIVE

To determine the interest of Chromogranin A (CgA) determination for diagnosis and follow-up in patients with gastroenteropancreatic endocrine tumours (GEP-ET) and multiple endocrine neoplasia type 1 (MEN-1).

PATIENTS AND METHODS

CgA levels were measured with an immunoradiometric assay in 124 sporadic GEP-ET, 34 MEN-1 and 127 controls. Serial determinations were performed in 56 patients (212 visits). Changes in CgA levels over 25% were considered as significant.

RESULTS

Using a cut-off value of 130 micro g/l, established from a receiver-operating characteristic curve, the specificity of CgA was 98.4%, with a sensitivity of 62.9%, higher in secreting than in nonsecreting tumours (73%vs. 45%; P < 0.003) and related to the extent of metastatic spreading (P < 0.001). In nonsecreting tumours, the positive predictive value (PPV) of CgA for the presence of metastases was 100% but the negative predictive value (NPV) was only 50%. In MEN-1, high CgA levels indicated a pancreatic tumour with a 100% specificity but the sensitivity was 59%. During the follow-up, the concordance between CgA and tumour evolution was 80%, whatever the secretory status. In patients with carcinoid tumours, the concordance was higher for CgA than for serotonin (81%vs. 54%; P < 0.001).

CONCLUSION

Due to its high specificity, CgA determination may help to discriminate the endocrine character of a GEP tumour and to indicate a pancreatic tumour in MEN-1. However, its low NPV in nonsecreting tumours limits its interest for diagnosis and staging. By contrast, serial evaluation of CgA seems of particular interest for the follow-up of GEP-ET tumours.

Polyunsaturated fatty acids in the blood of spontaneously or induced muricidal male Wistar rats

Serum levels of several n-6 and n-3 polyunsaturated fatty acids were compared in male Wistar muricidal (Mu) and non-Mu rats. The Mu behavior was either spontaneous or induced by long-term isolation, feeding with a starch-enriched polyunsaturated fatty acid diet (PUFA+S), water restriction, or adrenalectomy (ADX). Arachidonic acid (ARA) levels were lower in diet-induced (PUFA+S) Mu rats than in their non-Mu controls. Total n-6 fatty acid levels were also lower in spontaneously Mu rats than in spontaneously non-Mu rats. Docosahexaenoic acid (DHA) and total n-3 fatty acids levels were lower in rats with isolation-induced Mu behavior. The n-3/n-6 ratio was higher in spontaneously Mu rats than in spontaneously non-Mu rats. The changes in ARA levels were greater than those in DHA levels, possibly due to the higher blood-brain barrier passage of arachidonic acid. The results were analyzed in the light of recent results showing a role of PUFAs in human and animal behavior.

GC/MS detection of paraffins in a case of lipoid pneumonia following occupational exposure to oil spray

A case of lipoid pneumonia following occupational exposure to oil spray is described. Biological fluids (broncho-alveolar lavage and pleural fluid) are analyzed to determine if the compounds found in the industrial oils are present. The samples are purified using high-performance thin-layer chromatography, and after extraction, the compounds were submitted to infrared spectroscopy. Direct hexane extraction of biological fluids is also performed, followed by gas chromatography/mass spectrometry (GC/MS).