Expression of proliferation markers Ki67, cyclin A, geminin and aurora-kinase A in primary breast carcinomas and corresponding distant metastases

Aims

To assess the expression of the following cell cycle regulatory proteins in primary metastatic breast carcinomas (MBCs) and on availability in matched distant metastases (DMs): Ki67, cyclin A, geminin and aurora-kinase A (aurkA); and to compare the expression of these markers in early MBC (EMBC) and late MBC separated into groups according to median time point on metastatic event occurred (28 months).

Methods

The expression of the above mentioned markers was analysed in a total of 47 primary MBCs and 59 DMs (out of which 37 were pairs) by immunohistochemistry. Fourteen breast carcinomas with no relapse over a 10-year follow-up period were utilised as control cases (CBC).

Results

Among the MBCs, 22 metastasised to the bone, 4 to the lung and 21 to the central nervous system (CNS). Geminin (p<0.001) and Ki67 (p=0.001) were increased in the MBCs while aurkA and cyclin A showed no difference when compared with CBCs. There were no differences between aurkA, cyclin A and geminin expression in MBCs and DMs in general. Expression of Ki67 was, however, elevated (p=0.027) in DMs. In CNS metastases all markers showed elevated expression as compared to MBCs. In bone metastases, geminin was lower (p<0.001) compared with primary MBCs. In the metastases of the lung, the evaluated markers did not show different expression. According to the median follow-up until the metastatic event, Ki67 was found to be significantly elevated in EMBC (p=0.018).

Conclusions

Ki67 index and geminin distinguish a fraction of MBC with worse prognosis, showing increased levels in the latter in comparison to CBC being tumour-free over a 10-year follow-up period. Ki67 could possibly identify a group of MBCs that develop early DMs.

Gait analysis following TKA: comparison of conventional technique, computer-assisted navigation and minimally invasive technique combined with computer-assisted navigation

PURPOSE

there are questions concerning the influence of computer-assisted surgery and the minimal invasive surgical technique on the outcome of total knee arthroplasty. The authors followed up the rehabilitation of patients during the first postoperative year.

METHODS

the ZEBRIS gait analysis system was used to obtain numerical data of kinetic and kinematic gait parameters. There were three groups of patients: patients operated by the conventional technique (Group I), patients operated on using computer-assisted surgery (Group II), and patients who underwent the surgical procedure by a minimally invasive technique and computer-assisted surgery (Group III). Both groups consisted of 15 patients. Gait analysis was performed preoperatively and 3, 6, 9, and 12 months after the surgery. The range of motion of the pelvis, the hip and the knee, the step width and the stride length were measured during walking.

RESULTS

results were compared with the parameters measured in a group of healthy subjects of the same age (control group). The value of the measured parameters in Group I and in Group II reached the value of the control group 6 months after surgery. In Group III, this occurred 3 months after surgery.

CONCLUSIONS

the results of the study confirm that navigation does not influence the length of rehabilitation. However, in case of minimal invasive surgery, rehabilitation is faster than in Groups I and II.

11-year survival of a renal cell cancer patient following multiple metastasectomy

CASE REPORT

A renal cell cancer patient with late onset of multiorgan metastases showed an unusually long survival following surgical resection. Femoral metastasis appeared 11 years, and contra lateral kidney and adrenal gland metastasis 19 years after the primary nephrectomy, respectively. Following the resection of the femur and implantation of endoprosthesis and removal of adrenal gland and partial nephrectomy, the patient was disease-free 20 years after the first diagnosis of cancer.

CONCLUSION

The long survival and successful treatment underline the importance and efficiency of radical metastasectomy even in the case of late onset multiorgan metastases of renal cell cancer. The life expectancies are better in the late onset of bone metastasis following the nephrectomy. The very late onset of metastases in this case shows however the importance of lifelong follow up.

Centrosome abnormalities in giant cell tumour of bone: possible association with chromosomal instability

Giant cell tumour of bone, a benign but potentially aggressive neoplasm, shows an increasing rate of chromosomal aneusomy that correlates with clinical course. Mechanisms that generate chromosomal instability in giant cell tumour of bone are poorly understood. One possible cause of chromosomal instability is an error in mitotic segregation due to numeric and/or functional abnormalities of centrosomes. Centrosome alteration is a common phenomenon in many cancers and has a major role in the development of chromosomal instability in cancer cells. To gain an insight into the possible mechanism for the generation of chromosomal instability in giant cell tumour of bone, we analysed 100 cases, including 57 primary nonrecurrent, 35 recurrent and 8 malignant giant cell tumour of bone cases. gamma-Tubulin immunohistochemistry was performed on tissue microarrays of 59 formalin-fixed paraffin-embedded cases, whereas pericentrin and gamma-tubulin fluorescent immunocytochemistry was carried out on 41 frozen smears. Fluorescent in situ hybridization was performed on 23 cases of pericentrin immunostained smears, allowing the simultaneous analysis of centrosomes and chromosome aberrations. Centrosome amplification was significantly higher in recurrent and malignant giant cell tumour of bones compared with nonrecurrent tumours (P<0.001). A comparison of the percentage of aneusomic cells with a normal centrosome content (4.7%) with that of aneusomic cells with centrosome amplification (6.4%) revealed no significant association between chromosome number alterations and centrosome aberrations (P=0.31). These findings indicate that centrosome alteration and frequency of aneusomy correlate with clinical behaviour; the lack of an association between centrosome amplification and chromosome number alteration suggests that alternative causative mechanisms produce genetic instability in giant cell tumour of bone.

Microvascular density of breast cancer in bone metastasis: influence of therapy

BACKGROUND

Bone is the most frequent site of systemic progression of breast cancer (BRC). Angiosuppressive therapy has now entered the management of progressing cancers, therefore it is clinically important to obtain information on vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) of bone metastasis of BRC.

MATERIALS AND METHODS

VEGF expression and MVD were evaluated in bone metastases of BRC immunohistochemically in paraffin samples of 18 patients and compared to their primary tumors. MVD was determined by using the hot-spot method and the endothelial marker, CD34.

RESULTS

Chemo- and/or endocrine therapy-naïve BRC cases progressed to the bone with a concomitant increase in their angiogenic potential, suggesting that this is the "natural history" of BRC progression. On the other hand, this study revealed that vascularization of the bone metastases of BRC patients that had received adjuvant (chemo- and/or endocrine) therapy was significantly decreased compared to the corresponding primary tumors, also supported by a decreased VEGF expression in metastases, both suggesting that the treatment significantly affected the angiogenic phenotype of the progressing disease.

CONCLUSION

Angiosuppressive therapy is a new approach to cancer management including BRC and is frequently applied in the advanced stage of disease. Tumors with a prominent angiogenic phenotype (high MVD and VEGF) are primary candidates for such regimes. The fact that chemo-endocrine adjuvant therapy of BRC resulted in a weaker angiogenic phenotype in bone metastases compared to non-treated cases may suggest that these latter patients are better candidates for angiosuppressive interventions.

Surgical treatment and prognostic factors in giant-cell tumor of bone

The rate of local recurrence in the giant-cell tumor of bone (GCT) is influenced by many factors. GCT aggressiveness is related to mitotic activity, aneuploidy of tumor cells, chromosomal abnormality, excessive metalloproteinase expression and alterations in different oncogenes. Statistically, there was no correlation between the recurrence rate and the size and site of tumor, stage of disease and involvement of subchondral bone. However, statistical analysis revealed that the use of adjuvants (phenol, bone cement, etc) and the type of surgical intervention (en block resection versus curettage and grafting) were factors with a prognostic value. Although recurrence or malignant transformation in GCT cannot be predicted yet, about 96% of the patients can be cured. In the majority of cases, recurrences have no fatal consequences for the patient but may lead to various degrees of disability due to repeated and more radical surgical procedures. Joint-sparing surgery and careful curettage with the use of adjuvants should be the treatment of choice whenever possible. In the future, modern instruments of molecular biology will be used to aid the evaluation of primary and recurrent tumors and will have an increasing influence on surgical planning.

[Giant-cell tumor of the bone]

The giant-cell tumor of bone (GCT) is an aggressive benign, potentially malignant lesion, which biological behaviour is unpredictable. Its aggressivity is usually increasing through the recurrences and is related to the mitotic activity, the excessive metalloproteinase expression and to the alterations in different oncogens of the tumor cells. Statistically, 80% of the GCT-s have a benign course, with a local recurrence rate of 10-50%; about 10% of GCT-s undergo malignant transformation through their recurrences and 1-4% give pulmonary metastases even in case of a benign histology. Despite of the frequent recurrences, adequate treatment results in 96% to 98% cure in patients with GCT. The goal of surgery should be both in primary and recurrent cases: joint-sparing and careful curettage with use of adjuvants (bone cement and phenol, etc.) for decreasing the rate of recurrences. Resection is only in case of extensive joint destruction or malignancy indicated. Radiotherapy with modern supervoltage equipment minimalized the occurrence of secondary malignant transformation, however, its use is only in locations difficult for surgery (vertebra, sacrum, pelvis) recommended.

Diagnosis of soft tissue tumors by fine-needle aspiration with combined cytopathology and ancillary techniques

The diagnosis of mesenchymal neoplasm by fine-needle aspiration biopsy (FNAB) has presented a diagnostic challenge. Most reports claim an accuracy approaching 95%, but while they distinguish benign and malignant lesions, the most problematic group, the intermediary malignant group, is omitted. The purpose of this study was to determine whether rapid cytologic diagnosis of soft-tissue tumors could guide surgeons in therapeutic decisions without the need for a tissue biopsy. Ninety-four FNA cytologic specimens were examined by the National Soft Tissue Consortium of Hungary and compared with the corresponding histology. Ordinary lipomas were excluded. Morphologic evaluation was supplemented by ancillary techniques such as fluorescence in situ hybridization (FISH), DNA cytometry, and immunocytochemistry. From a practical clinicopathological point of view, the cases were grouped in the following categories: 1) tumors with definitive diagnosis: a) high-grade malignant neoplasms (high-grade sarcomas, metastatic carcinomas, lymphoma), b) tumors with precise histogenetic origin by cytogenetics, c) benign tumors; 2) tumors of questionable nature. In the first group there were 74 tumors: 22 high-grade sarcomas, six metastatic carcinomas, one malignant lymphoma, 16 malignant tumors in which the precise histogenetic origin could be established by cytogenetic studies, and 29 benign soft-tissue tumors other than lipomas. In the second group there were 20 tumors comprising benign and malignant soft tissue tumors of low grade, wherein the precise nature of the neoplasm could not be established with confidence on cytologic study, even using ancillary techniques. FNAB of soft-tissue tumors combined with ancillary techniques should be considered a viable diagnostic technique for therapeutic protocols. Although the second group is fairly large, we have reliable, well-characterized categories which provide great freedom for preoperative and surgical treatment, thus providing the best chance for healing.

Mid-foot reconstruction following involvement of five bones by giant cell tumor

We report on a patient who had giant cell tumor involving multiple bones of the mid-foot. The tumor originated from the navicular bone, but also destroyed the cuboid, and all cuneiform bones. This unusual presentation of giant cell tumor presented a therapeutic challenge for the surgeons. The patient was treated with en bloc resection and the bony defect replaced with a massive iliac crest graft which united within 9 months and has remained stable for 7 years without local recurrence, and with excellent function of the foot.

The prognostic significance of DNA cytophotometry and proliferation index (Ki-67) in giant cell tumors of bone

We studied DNA ploidy by smear cytophotometry and proliferation activity by Ki-67 MIB immunohistochemistry in 69 primary and recurrent giant cell tumors (GCT) from 50 randomly selected patients. The obtained results were evaluated with comparisons made to the available clinical data. From the 46 primary tumors 63% showed diploidy and 37% aneuploidy. A significantly (P=0.026) higher recurrence rate (64%) was observed in aneuploid than in diploid tumors (31%). In the course of the recurrences, both the ratio of aneuploid tumors as well as the proliferation index of the tumors increased, though the degree of the latter was non-significant. Aneuploidy did not mean an unambiguous tendency towards malignant transformation; however, a close follow-up of recurrent aneuploid tumors, and wide excision of the recurrence instead of intralesional curettage are the recommended procedures. The DNA cytophotometry and proliferation index of GCTs--as compared to other histologic examinations--are of prognostic value in the evaluation of the recurrence potential of the GCTs.

[Dual fluorescence in situ hybridization analysis of synovial sarcoma]

Synovial sarcoma have (about in 95% of the cases) the specific and characteristic reciprocal chromosomal translocation t(X; 18) (p11.2; q 11.2). Application of dual-colour fluorescence in situ hybridization (FISH) on interphase nuclei to identify the specific translocation has a diagnostic importance for daily pathological practice. For visualisation of the translocated chromosomal fragments of synovial sarcoma cells on imprint smears, chromosome X painting probes and chromosome 18 centromeric probes were used. Our present study indicates that the precise preoperative diagnosis of synovial sarcoma using dual-colour FISH is possible on smears and this possibility (to identify specific chromosomal translocations in soft tissue tumours) is a landmark in the preoperative diagnosis of soft tissue sarcomas.

Tumor surgery of the pelvic region

During the past ten years the authors operated on 27 tumors of the pelvic region, 12 of them involving the pelvic blade, 6 the periacetabular region, further 9 the os pubis and ischii, respectively. Most of the cases (16) were chondrosarcomas. The mean age of the patients--13 male and 14 female--was 41 years. As to surgical radicality 11 wide, 10 marginal and 6 intralesional resections were performed. After a mean follow-up period of 3 years (0.5-11 years) 19 patients are alive tumor-free, 2 with tumor, 4 died and 2 were lost to follow-up. As postsurgical complication wound-healing disorder and inguinal hernia occurred in 5 cases, on the surgical field thrombosis with secondary compartment syndrome and renal insufficiency developed in one case. The authors draw the attention to the difficulties and indications of the pelvic resections (internal hemipelvectomies).

Multicentric extraabdominal desmoid tumour: a case report

The very rare condition of multicentric desmoid tumours involving two distant and apparently independent sites is reported in a 17-year-old man. The tumours grew simultaneously and reached approximately equal size. No evidence of familiar polyposis or any other feature of Gardner's syndrome were noted. The proximal desmoid tumour developed from the left hip region and extended into the femoral bone, whereas the distal mass was attached to the left popliteal fossa infiltrating the flexor muscles, the nerves and vessels. On the basis of the good results published recently in the literature and our own earlier experiences, the intralesional resection of the desmoid tumours was completed with postoperative fractionated radiotherapy.

Examination and evaluation of surgical margins in bone tumours. Comparative pre- and postoperative CT and MR imaging

An objective method of evaluating surgical margins and the extent of limb-preserving surgery is described in a study of 10 malignant bone tumours. The resected specimen was imaged by computerised tomography and magnetic resonance, and the appearances compared with the preoperative images of the tumour. CT was better than MR for detecting bony changes, but MR was more satisfactory for showing the extraosseous and intramedullary outline of the tumour. These two methods should therefore be combined. Intralesional excision is an absolute indication; marginal excision a relative indication for reoperation.

[Results with endoprostheses and bone transplantation in surgery for bone tumors]

Seventy six bone tumor patients were treated by limb salvage operations at the Orthopaedic Department of the Semmelweis Medical School in Budapest from 1981 through 1991. The bone defect was reconstructed with endoprostheses in 25 cases and with bone grafts in 51 cases. The mean follow-up period of 72 patients was 51 months (min. 12 months). There were local recurrences in 11% of the patients. Two complications occurred at the tumor endoprostheses, which functional rating were excellent or good in 75%. The most common complications at the bone grafting were infection (9.8%), fracture (11.8%), which did not influence the end result, and nonunion (9.8%) occurring often in homografts of resection-arthrodesis during the chemotherapy. This complications could be managed in all but two cases without loss of the limb. The bone grafts performed acceptable (excellent or good) functional result in 66% of the patients. Authors suggest reconstruction of the bone defect with bone grafting in cases of semimalignant and low malignant tumors, prefer, however, tumor endoprosthesis implantation in high malignant bone tumors which need chemotherapy.

[Experience with surgical treatment of osteosarcoma]

The authors treated 79 patients with osteosarcoma by surgery and chemotherapy 1975 through 1991. The appearance, localization and differential diagnosis are discussed. Attention is called to the doctor's delay. The effective pre- and postoperative chemotherapy decreased the incidence of the lung metastases and increased the survival rate (71% 3 years overall survival and 41% 5 years survival) and made the limb-sparing surgery possible. The development of the reconstructive surgical technique and new designs of tumor endoprostheses enabled us to perform limb-sparing surgery in more than one third of the cases at the same survival chance. The limb-sparing means a decisive change in the quality of the rehabilitation of the osteosarcoma patients.

Aneurysmal bone cysts treated by superselective embolization

A series of 7 cases of aneurysmal bone cysts (ABC), all but 1 located in the pelvic bones, which were treated by transcatheter embolization is presented. Five embolizations were performed for primary treatment, while in 2 patients they were performed preoperatively. In all patients a definite histological diagnosis was established by open biopsy, and plain radiographs as well as computerized tomography (CT) were applied for evaluation of the results. The embolizing materials were tissue adhesive for permanent, and Gelfoam for preoperative vessel occlusions. Of 5 lesions treated for the purpose of definitive embolization, 3 (all located in the superior pubic ramus) showed complete ossification; in one, partial remineralization and progression occurred. In a further patient with a secondary ABC, partial reconstitution was recorded. Both preoperative embolizations resulted in successful en bloc resection with minimal blood loss. Transcatheter embolization is the treatment of choice for the highly vascular ABC in unfavorable anatomical locations.

[Adjuvant therapy (phenol, bone cement) in giant cell tumors]

69 patients were treated with giant-cell tumors in the Orthopaedic Department of the Semmelweis Medical School in Budapest between 1975-1989. The recurrence rate was 15 cases in 36 patients who were treated with curettage and spongiosa plasty only. In 11 cases the curettage was combined with adjuvants (phenol and/or filling with bone cement). This way the recurrence rate could be decreased to 1 case out of 11. The use of phenol and bone cement proved to be useful adjuvants to the surgical curettage at the giant-cell tumors and without complications.

Characterization of bone forming cells in posttraumatic myositis ossificans by lectins

Lectins were used to characterize bone forming cells in posttraumatic myositis ossificans. The lectins applied were as follows: Arachis hypogaea (PNA): specific for beta-D-galactose (1,3)N-acetyl-D-galactosamine (Gal-1,3 GalNac), Canavalia ensiformis (Con A): specific for alpha-D-glucose (D-Glc) and alpha-D-mannose (D-Man) and Wheat germ (WGA): specific for N-acetyl(1,4)D-glucosamine (Glc-NaC) and neuraminic acid. The development of myositis ossificans was characterized by the appearance of a WGA binding cell population. The lectin-binding sites appeared as a cluster in the supranuclear cytoplasm, corresponding to the Golgi-complex. However, the WGA lectin-binding sites disappeared in the mature form of myositis ossificans. We assume that these lectin binding cells may be the bone marrow derived precursors of myofibroblast-like cells which are responsible for bone formation within the damaged muscle.

[Results of using bone cement and phenol lavage in the surgical management of giant cell bone tumors]

Authors report on experiences gained with phenol lavage used as adjuvant and filling with bone cement in the surgical treatment of giant cell tumors of the bone. The effect of the adjuvant therapy was a considerable decrease in the rate of relapses: in 11 patients 1 relapse was found only in contrary to the 15 relapses in the control material (41 per cent) after 36 excochleations. They think that with adequate indications both the phenol lavage and filling with bone cement are useful supplements to the surgical therapy.

Aneurysmal bone cyst. A review of 52 primary and 16 secondary cases

Authors report on the results of treatment of 52 primary and 16 secondary aneurysmal bone cysts (ABC). ABC grow rapidly; 84% of them have already destroyed more than the half of the bone width at recognition. En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. Careful curettage and bone grafting still remains the surgical method of choice in the majority of cases, when the ABC is more destructive and affects the subchondral bone of the joints. Segmental resection is only indicated when removal of the affected bone does not influence the function of the extremity. Superselective embolization of the cyst was performed in seven cases with excellent results. This method is suggested for ABC in certain locations inaccessible to surgical intervention, e.g., the pelvis, or to avoid excessive bleeding in hypervascularized tumors. In one case, however, an incomplete rebuilding of the ABC could only be achieved by the administration of calcitonin. The 16 cases of secondary ABC were observed mostly in association with osteoblastomas, giant-cell tumors, and osteosarcomas. The incidence of the secondary ABC was 23% in the whole ABC group but not more than 2-4% among the osteosarcomas and giant-cell tumors. Secondary ABC may confuse the histological and clinical diagnoses and that, especially in cases of osteosarcoma, may have fatal consequences.

[Experience with modular system tumor prostheses]

Authors elaborated a modular tumor prosthesis by the use of which the bone segment lost after the resection of hip, femur, knee and proximal tibial tumors can be supplemented in the desired measure. The components of the prosthesis set and the field of its use are described. In the last one and half year modular tumor prostheses were inserted in 10 patients: in 6 primary bone tumors and 4 solitary metastases. One shoulder, 5 hip, 3 stiff knee and 1 tibia diaphysis supplementing modular prostheses were inserted. In spite of 2 complications the initial experiences are encouraging, and in adequate indication the possibility of retaining limb and articular function beside good functional results is given.

Calcitonin therapy of aneurysmal bone cysts

Seven aneurysmal bone cysts (ABC) were treated with the hormone calcitonin. Six of the cysts, which were hypovascular responded well to the calcitonin administered directly into the cyst. Ossification and rebuilding of the ABC occurred after some months in every case. One hypervascularized ABC, however, failed to respond either to embolo-therapy or to the calcitonin hormone treatment. The authors recommend calcitonin administration as a useful non-invasive method for the treatment of hypovascular ABC.

Tumor endoprostheses vs. bone grafts in bone tumor surgery: experiences in Hungary

From 1981 through 1991, 76 bone tumor patients were treated by limb salvage operations at the Orthopaedic Department of the Semmelweis Medical University in Budapest. The bone defect was reconstructed with endoprostheses in 25 cases and with bone grafts in 51 cases. The mean follow-up period of 72 patients was 51 months (minimum 12 months). There were local recurrences in 11% of the patients. The functional rating of the tumor endoprostheses was "excellent" or "good" in 74%. Complications occurred in two cases. The most common complications with bone grafting were infection (9.8%), fracture (11.8%), which did not influence the end result, and nonunion (9.8%), which often occurred in homografts of resection-arthrodesis during chemotherapy. These complications were successfully managed without loss of the limb in all but two cases. The bone grafts were rated as functionally acceptable ("excellent" or "good") in 66% of the patients. The reconstruction of bone defect with bone grafting is suggested in cases of semimalignant and low malignant tumors; however, tumor endoprostheses implantation is preferred in high malignant tumors that need chemotherapy.

[Periosteal chondroma]

Ten cases of periosteal (juxtacortical) chondroma were observed in a series of 234 benign cartilaginous tumors of the hand recorded in the Bone Tumor Register of the Orthopaedic Department of the Semmelweis Medical School, Budapest. The X-rays and histology of this slowly growing, juxtacortical, locally active tumor may simulate a chondrosarcoma and may often lead to difficulties in the differential diagnosis. The adequate assessment of the X-ray and histological finding prevents overdiagnosis and unjustified radical surgical therapy.

Desmoid tumours of the extremities

The authors report seven cases of desmoid tumors of the extremities. A tumour less than a few centimetres in size is best removed by wide local excision. Large growths should also be excised, but efforts should be made to preserve the vessels and nerves, since malignant transformation and metastases do not occur. Irradiation therapy should be considered for tumours which are surgically inaccessible. The problems of differential diagnosis between a desmoid tumour and a fibrosarcoma are discussed.

Polarization colours of collagen fibres: a sign of collagen production activity in fibrotic processes

The maturation process of collagen fibres was investigated by the picro-sirius red/polarization light technique in experimental wound healing, in allyl-alcohol induced subacute and chronic liver fibrosis and in human biopsy material. Evidence was obtained that collagen fibres undergo a rapid maturation in fibrotic processes; the intensity of their birefringence increases and, at the same time, their polarization colour changes. Newly formed collagen fibres appear on the 4-6 mum thick sections in green polarization colour. Later, in a more mature stage, they became yellow, orange or red under crossed polaroids. The findings suggest that the simple picro-sirius red/polarizing light technique may be useful to form an opinion about the activity of the fibrotic process.

Immunohistochemical detection of fibronectin using different fixatives in paraffin embedded sections

Different fixatives and immunohistochemical methods were tested for detection of fibronectin in various paraffin embedded tissues: rat kidney, spleen, gastro-intestinal tract, muscle, normal and fibrotic liver and human skin. Using cryostat sections, localisation with immunofluorescence and peroxidase technics comparable to those obtained in unfixed tissue sections, could be obtained with the following fixatives: 10% formalin in PBS containing 4% sucrose; 96% ethanol; 96% ethanol + 1% acetic acid; a series of ethanol solutions of increasing strength: 70-80-96%. These fixatives also proved to be the best for paraffin embedding. Without enzyme digestion, however, satisfactory results could not be obtained with either indirect peroxidase or immunofluorescence methods in paraffin embedded tissues. Following digestions with the enzymes at the concentrations described in the literature, the alteration of tissues made the morphological localization of fibronectin difficult. The self-sandwich peroxidase method following a gentle pepsin digestion gave results closest to those of unfixed cryostat sections; however a slight increase in background staining was observed but without interfering with the evaluation of results.

Asbestos bodies in a bile duct cancer after occupational exposure

A case of asbestosis after 5 years of occupational asbestos exposure is presented. At the postmortem examination, cholelithiasis and a cancer developing from the cystic duct were found and identified histologically as a squamous cell carcinoma. After digesting the tumor tissue, short asbestos bodies and fragments could be identified having a similar shape as those observed in the lung. The possible role of asbestos in the carcinogenesis of the observed bile duct cancer is proposed. The digestive examination of all malignant tumors of any origin after an asbestos exposure is suggested for the identification of the possible presence of ingested asbestos fibers, and to obtain further comprehensive human pathological data.