Ferritin Immunohistochemical Localization in Normal and Neoplastic Colonic Mucosa

High levels of ferritin have been detected in serum and tumoral extracts of gastrointestinal neoplasms. However, its histological localization is not well known. An immunoperoxidase technique (PAP) was used for detecting ferritin in 30 colorectal carcinomas, 20 polyps and 8 cases of non-neoplastic mucosae. Ferritin staining was detected in stromal cells (98%) much more than in epithelial cells (21%). Connective cells were positive in 5 cases of normal mucosae (62%), 19 polyps (95%) and all carcinomas (100%). The number of positive cells gradually rose from normal mucosa to carcinoma with an intermediate score in adenomas. However, no relation could be found between the stromal ferritin score and dysplasia in polyps. Likewise, no relation was found between the stromal ferritin score and the differentiation grade, invasion or metastases in carcinomas. The positive epithelial pattern seen in 12 cases (21%) suggests non-specific staining due to passive diffusion from the stroma. Thus, these immunohistochemical findings suggest that in colonic neoplasms, ferritin could be a tumor marker produced mainly by stromal cell reaction more than by the epithelial cells.

Value of immunohistochemical demonstration of several epithelial markers in hyperplastic and neoplastic endometrium

The distribution of prekeratin, vimentin, epithelial membrane antigen (EMA), and secretory component (SC) was demonstrated immunohistochemically in 31 patients with adenomatous hyperplasia (AH), 12 patients with atypical adenomatous hyperplasia (AAH), and 39 patients with endometrial carcinoma. Prekeratin was presented in 94% of AHs, 92% of AAHs, and 87% of adenocarcinomas. Vimentin was detected in 68% of AHs, 50% of AAHs, and 37% of adenocarcinomas, showing decreased expression as the lesion progressed to malignancy (P less than 0.05). EMA was detected in 26% of AHs, 67% of AAHs, and 95% of adenocarcinomas (P less than 0.001). SC demonstrated focal and weak expression in 29% of AHs, but showed increased staining intensity in 67% of adenocarcinomas (P less than 0.01). Well-differentiated tumors expressed SC better than poorly differentiated tumors (P less than 0.01). All markers showed a heterogeneous staining pattern and, for a given histologic hyperplastic or neoplastic state, corresponded to several phenotypes. In conclusion, prekeratin seems to be a good marker for epithelial differentiation in hyperplastic endometrium, and EMA is a good marker in neoplastic endometrium. In hyperplastic lesions, the loss of vimentin expression in the absence of secretory changes gives rise to suspicions regarding their benign process. Also, EMA can help in distinguishing between hyperplastic and neoplastic states, while detection of SC may be of help in more precise grading of endometrial carcinoma.

Immunohistochemical localization of parathyroid hormone-related protein in parathyroid adenoma and hyperplasia

Parathyroid hormone-related protein (PTHrP) is invoked as the cause of humoral hypercalcaemia of malignancy (HHM); it is contained in the keratinocyte layer of normal skin; and there is evidence that is is produced by fetal parathyroids. Antibodies against synthetic PTHrP peptides have been raised in rabbits and sheep. This immunohistochemical study has found that primary parathyroid adenomata and hyperplastic glands from patients with chronic renal failure stain positively with antisera against PTHrP(1-34) and PTHrP(50-69). Primary hyperplastic glands are negative. No staining with anti-PTHrP(106-141) antiserum could be detected immunohistochemically in any of the parathyroid adenomata or hyperplasia.

DNA analysis and parathyroid pathology

The nuclear DNA content of 85 parathyroid glands (4 carcinomas, 39 adenomas, 21 secondary parathyroid hyperplasias, and 21 normal parathyroid glands) were determined by flow cytometric analysis. All normal parathyroid glands, 85% of the adenomas, and 83.3% of the secondary hyperplastic glands had DNA indices within values of 0.85-1.1. Paraffin-embedded fixed glands showed less DNA staining than that found with fresh or normal glands. Glands from patients with carcinoma showed DNA indices outside the normal DNA index range. When the percent of nuclei within the G0/G1 phase of the cell cycle was compared between the study groups, highly significant results were found. While patients with secondary hyperplasia showed a similar distribution to the normal glands studied, only 48% of primary adenomas showed over 80% of cells within the G0/G1 region. A clear subgroup of adenomas was defined with more rapidly cycling tetraploid cells, and showing classical adenoma pathology. This group showed negative correlation with gland weight, plasma calcium, and ionized calcium. These findings suggested that a different etiology of the disease process occurs between secondary hyperplasia and parathyroid adenoma. Such abnormal adenomas may form a group worthy of long-term follow-up.

Glial fibrillary acidic protein expression in pleomorphic adenoma of salivary gland: an immunoelectron microscopic study

Previous immunocytochemical studies of pleomorphic adenomas have demonstrated consistent labeling with glial fibrillary acidic protein (GFAP). Cross-reactivity with other intermediate filaments of similar structure and chemical composition has been suggested to account for this seemingly inappropriate pattern of immunoreactivity. To investigate further this phenomenon, we examined five pleomorphic adenomas by immunoelectron microscopy. Ultrastructural features were similar to those described by other investigators, with ductal epithelium being surrounded by myoepithelial cells and modified cells becoming detached to form the isolated stellate and spindle cells of the stroma. As part of this process, many neoplastic myoepithelial cells appeared to lose their specialized ultrastructural features, assuming a rather undifferentiated appearance. Single and double immunoelectron microscopic labeling showed vimentin filaments in all these neoplastic myoepithelial cells. In contrast, GFAP filaments were identified only in the most undifferentiated cells. Such restriction of GFAP filaments to an ultrastructurally definable subset of neoplastic cells provides strong evidence against nonspecific staining due to cross-reactivity. Given the previously described coexpression of vimentin and GFAP by neoplastic cartilage, it appears likely that this immunophenotype in neoplastic myoepithelial cells reflects early chondroid differentiation.

Arginine vasopressin in Cushing's disease

Bilateral simultaneous blood samples were taken from the inferior petrosal sinuses of nine patients with Cushing's disease for measurement of adrenocorticotropin (ACTH), vasopressin (AVP), prolactin, growth hormone, luteinising hormone (LH), and follicle stimulating hormone (FSH). Inter-sinus gradients for ACTH (range 3.3-18.2) and AVP (2.0-375) correctly lateralised the microadenoma in seven of these patients. One additional patient showed an increased gradient for AVP but not ACTH on the side of the tumour. The correlation between the AVP and ACTH concentrations in the petrosal sinus draining the microadenoma was significant. Petrosal sinus plasma concentrations of prolactin and growth hormone were also significantly higher on the side of the tumour than on the non-tumour side. Evidence against a non-specific tumour effect on the secretion of all pituitary hormones was the fact that in most cases the gradients for LH and FSH were not significant. It is proposed that increased delivery of AVP to part of the pituitary may result from an aberrant blood supply, and that AVP may interact with corticotropin releasing factor to promote tumour growth and ACTH release.

Tissue carcinoembryonic antigen and DNA aneuploidy in precancerous and cancerous colorectal lesions

Chronic inflammatory bowel disease (CIBD) and colorectal adenoma are considered as precancerous conditions and lesions of large bowel carcinoma, respectively. They, therefore, may be used to study the behavior of such different factors as tumor-associated antigens and nuclear DNA content abnormalities in colorectal carcinogenesis. Tissue concentrations of carcinoembryonic antigen (CEA) were significantly higher in those precancerous lesions (CIBD: 61 +/- 11.2 ng/mg, adenoma: 70 +/- 6 ng/mg; mean +/- standard error of the mean) than in normal colonic mucosa (36 +/- 4.7 ng/mg). Colorectal carcinoma had still higher tissue levels (437 +/- 108.2 ng/mg). No correlation between tissue CEA and tumor differentiation could be found, but there was a significant difference between aneuploid (747 +/- 354 ng/mg) and diploid (139 +/- 43 ng/mg) tumors. Using flow cytometry DNA aneuploidy was present in 31.6%, 10.5%, and 51.6% of CIBD, colorectal adenoma, and carcinoma, respectively. These data suggest that the occurrence of aneuploidy is not strongly dependent on a malignant transformation, but it may also be present in premalignant colorectal lesions without cellular dysplasia.

Pancreatic microcystic adenoma coexistent with pancreatic ductal carcinoma. A report of two cases

We report two cases of microcystic (glycogen-rich) adenoma of the pancreas with coexistent pancreatic adenocarcinoma. Both patients presented with an epigastric mass. On laparotomy, each had two separate pancreatic tumors. The benign tumors were composed of small cysts with a flattened to cuboidal glycogen-rich epithelium. Both malignant tumors were composed of mucinous epithelium and showed positive staining for CEA and Leu-M1. Although pancreatic microcystic adenoma and ductal adenocarcinoma are believed to arise from different precursor cells, the association reported here suggests a common predisposition to both tumors. Careful examination of the pancreas is warranted in cases of microcystic adenoma to rule out a possible coexistent pancreatic carcinoma.

Altered glycosaminoglycan composition in reactive and neoplastic human liver

We have investigated the glycosaminoglycan composition of normal human liver, focal nodular hyperplasia, hepatic adenoma, and hepatocellular carcinoma. Uronic acid increased about 4 fold in the benign and reactive lesions, and greater than 7 fold in the carcinoma. Whereas in focal nodular hyperplasia and adenoma dermatan sulfate was the predominant glycosaminoglycan, in hepatocellular carcinoma chondroitin sulfate was the predominant species; it increased 24 fold over normal liver and 3-5 fold over all the other tissues. HPLC analysis of chondroitinase ABC or AC digests showed a 58 fold increase in Delta-Di-OS disaccharides in hepatocellular carcinoma, indicating significant undersulfation of chondroitin sulfate. Surprisingly, the normal-appearing liver surrounding the carcinoma showed glycosaminoglycan changes similar to adenoma and nodular hyperplasia. These results thus indicate that specific glycosaminoglycan changes occur in hepatocellular carcinoma, and suggest for the first time that proteoglycan metabolism is also altered in the non-cirrhotic, hepatic parenchyma adjacent to liver carcinoma.

Prognostic significance of alpha-1-antitrypsin in early stage of colorectal carcinomas

We have previously shown that human colorectal carcinoma cell lines, RCM-1 and CoCM-1, synthesize alpha-1-antitrypsin (alpha 1-AT) in culture. We have studied immunohistochemically the incidence of alpha 1-AT on histologic sections from paraffin-embedded tissues of surgically resected colorectal carcinomas and their metastatic foci, polypectomized adenomas, and normal mucosae. alpha 1-AT was detected in 89 (61%) of 145 carcinomas (including 14 carcinomas in adenoma), and 12 (39%) of 31 adenomas. But only 2 (4%) of 55 normal colorectal mucosae were positive for alpha 1-AT. In metastatic tumor cells of colorectal carcinomas in lymph nodes and other organs, alpha 1-AT positivity was 60% and 82%, respectively. The incidence of alpha 1-AT was markedly higher in advanced adenocarcinomas than in early ones and more frequent in adenocarcinomas of right side (including transverse colon) than those of left side and rectum, regardless of their histological malignancy grades. In mucinous carcinomas the frequency was greater (8 of 9 cases) than in conventional adenocarcinomas. Clinical follow-up of the patients with colorectal carcinomas suggested that alpha 1-AT positivity in Dukes' stage A/B tends to correlate with unfavorable prognosis irrespective of the grade of histologic differentiation of carcinoma, but there is no significant relation in Dukes' stage C/D. Our findings suggest that alpha 1-AT in colorectal carcinoma is related to the invasive and metastatic capacity. It may thus serve as a biologic marker for prognosis of colorectal carcinomas at relatively early stages (Dukes' stage A/B).

[The pH and acidity of feces in colorectal neoplasms]

The pH and faecal titratable acidity in fresh faeces were measured in patients with colo-rectal carcinoma or adenoma and in normal individuals. Significantly higher pH values and lower acidity were found in patients with cancer than in normal individuals. Patients with cancer had pH greater than 6.90 more frequently than normal. Patients with adenomata did not differ significantly from normal individuals. These results support performance of intervention trials with lowering of the pH in the colon with the object of cancer prophylaxis even although the causal connection is obscure.

Mucin histochemistry of virus-induced duodenal adenomas in guinea fowl

The type of mucoproteins in virus-induced duodenal adenomas in guinea fowl were compared with those in the normal duodenal mucosa. The mucin-producing cells in the latter contained a mixture of acid and neutral mucins. Neutral and sulphomucins prevailed in the crypts and in the lower part of the villi, while the amount of the sialomucins increased progressively toward the tip of the villi. In the adenomas, goblet cells were more numerous and were unevenly distributed. In their mucin profile the deeply located tumor glandular structures resembled normal crypts and lower parts of the villi and superficial portions of the adenomas were similar to the upper part of the villi. Qualitative changes in the mucin secretion with deviation from the normal vertical distribution of mucin types were rarely observed. The histochemical study carried out supplemented the histological characterization of the virus-induced duodenal adenomas and contributed to the elucidation of some aspects of their histogenesis.

DNA content of rectal scrapings from individuals at low and high risk for the development of colorectal cancer. A feasibility study

Scrapings of superficial rectal mucosa were collected from 31 patients with colorectal carcinoma, 66 patients with sporadic adenoma, and 53 control subjects with no personal or family history of colorectal cancer. The DNA ploidy level and proliferative patterns of each specimen were analyzed by flow cytometry (FCM). A GMS index, calculated as the ratio of G2 + M:S, was found to be significantly lower in control subjects than in any of the high-risk groups studied. Aneuploidy was more prevalent in rectal scrapings from cancer patients and adenoma patients than in those from control subjects. Aneuploid cell populations were detected in apparently normal rectal scrapings from two control subjects. Some high-risk individuals (i.e., cancer patients and patients with adenomas and a family history of cancer) exhibited higher proportions of tetraploid (designated G2/M) cells and a higher G2/M:S phase ratio than control subjects. The results accumulated thus far show that the rectal scraping procedure is safe and easy to perform. Our limited findings give hope that the DNA content analysis of cells obtained by rectal scraping may eventually prove useful in mass screening for colorectal cancer risk. However, definitive evaluation will require further refinement and elaboration of analytic technique and testing on more patients at various levels of predetermined risk.

Intermediate filament expression in pituitary adenomas

Seventy-five formalin-fixed and 18 alcohol-fixed pituitary adenomas were studied immunohistochemically using antibodies to keratin, vimentin, neurofilaments (NFs), glial fibrillary acidic protein, desmin, actin, S-100 protein and a variety of pituitary hormones. The pituitary adenoma cells were positive for keratin, vimentin and NFs (68 kDa and 160 kDa) and in a few instances there was co-expression of these three types of intermediate filaments (IMFs). The pattern of keratin-specific staining showed diffuse cytoplasmic or patchy paranuclear reactivity and of NF- or vimentin-specific staining showed fibrillar or patchy paranuclear reactivity. The patchy staining seemed to decorate the fibrous body. There was no correlation between the distribution of IMFs and pituitary hormones in pituitary adenomas except that melanocyte-stimulating-hormone-positive reactivity was limited to the NF-positive adenomas. The pattern of IMF staining did not depend on hormone production in adenomas.

Enzyme patterns and flow cytometric DNA measurements in colorectal hyperplastic polyps and tubular adenomas less than five millimeters

Glucose-6-phosphate dehydrogenase (G6PD) activity, lactate dehydrogenase (LD) activity, and cytometric flow measurement of nuclear size and cell cycle distributions were registered in biopsy specimens from adenomas and hyperplastic polyps less than 5 mm. The G6PD and LD activities in adenomas, 36.8 +/- 4 U/g protein and 1580 +/- 163 U/g, respectively, were significantly higher than in hyperplastic polyps, 17.9 +/- 2.6 U/g and 1080 +/- 107 U/g, or in normal mucosa, 14.7 +/- 0.8 U/g and 1174 +/- 56 U/g, respectively. G6PD activity was significantly higher in adenomas with moderate (44 +/- 5.8 U/g) than in those with mild (32 +/- 5.9 U/g) dysplasia, in contrast to LD. No difference in enzyme activity was observed between hyperplastic polyps and normal mucosa. The growth of adenomas and hyperplastic polyps was not significantly different during the 2 years of follow-up study before biopsy specimens were taken. Increased nuclear size, unrelated to grade of dysplasia, was registered in 12 of 20 adenomas, in 1 of 10 hyperplastic polyps, and in 2 of 42 specimens from normal mucosa. Adenomas and normal mucosa from individuals with adenomas showed a significantly increased number of cells in S-phase. The values were 10.2 +/- 3% and 8.8 +/- 4%, respectively. Normal control value was 6.8 +/- 2.2%. An increased number of cells in G2-phase was observed only in adenomas (6.9 +/- 2.7% compared with 4.9 +/- 1% in controls). None of the adenomas showed aneuploidy.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal adenoma. Clinicopathological and histochemical studies

We report the results of clinicopathological and histochemical studies on 64 renal adenomas found in 22 patients. We selected typical renal adenomas for these studies, discarding borderline lesions. The ages of the patients ranged from 42 to 84 years, with an average of 61 years. Male to female sex ratio was 6.3:1. The background conditions included renal cell carcinoma, long-term dialysis, chronic glomerulonephritis, pyelonephritis, hydronephrosis and polycystic kidney. The sizes of the tumors ranged from 0.1 to 2.3 mm in maximum diameter, with an average of 0.9 mm. All the tumors were located in the cortex, especially in the superficial one-third. The cytoplasm of the tumor cells was predominantly eosinophilic, and the tumor structure was predominantly papillary. Histochemical study of 19 adenomas from 13 patients demonstrated that all of the adenomas from 13 patients demonstrated that all of the adenomas were positive for EMA, and for at least one marker of the distal tubulus, i.e., DBA, PNA, SBA and PKK1, and that 9 adenomas were positive for at least one marker of the proximal tubulus, i.e., LM1 and LTA. Renal adenomas had predominant histochemical features of the distal tubulus, suggesting differentiation to a distal tubulus-like histology.

Expression of keratin 19 distinguishes papillary thyroid carcinoma from follicular carcinomas and follicular thyroid adenoma

Keratin expression with the use of chain-specific monoclonal antikeratin antibodies was investigated in normal thyroid tissue (n = 4), colloid nodules (n = 19), follicular thyroid adenomas (n = 18), follicular carcinomas (n = 10), and papillary carcinomas (n = 12). Frozen sections were stained with monoclonal antibodies M20 (keratin 8), M9 (keratin 18), and LP2K (keratin 19) with the use of the indirect immunoperoxidase technique. The immunohistochemical findings showed that the expression of keratins 8 and 18 was equally extensive in all normal, benign, and malignant lesions tested. In contrast, different staining patterns were observed with the use of monoclonal antibody to keratin 19. Follicular carcinomas were only focally stained with this antibody or were not reactive at all. Keratin 19, however, was present in all the tumor cells of papillary tissues and in a moderate amount of cells of nonneoplastic thyroid lesions and follicular adenomas. In papillary carcinoma, an identical homogeneous expression of keratin 19 was observed in both papillary and follicular structures, which suggests a common cellular origin. These results show that immunohistochemical staining with the use of monoclonal antibody against keratin 19 is useful to distinguish papillary thyroid carcinomas from follicular adenomas and follicular thyroid carcinomas.

Different opinions on classification of DNA histograms produced from paraffin-embedded tissue

Flow cytometric DNA ploidy determination has been regarded as an objective prognostic parameter in several types of human cancer. To test whether DNA histograms are similarly interpreted, a series of flow cytometric DNA histograms was posted to six investigators working in the field for independent classification. The histograms were produced from paraffin-embedded adrenal adenomas or non-neoplastic tissue and had several different patterns. Only 44% of the histograms were similarly classified by all investigators, and 85% by five of the six participants, when DNA ploidy was evaluated. Different criteria for tetraploidy existed, and also some uncertainty in classifying peridiploid and small aneuploid peaks. It is concluded that lack of consensus on histogram classification may result in widely varying percentages of DNA aneuploid tumors found even if the data are similar. Until general agreement is reached on the definition of DNA aneuploidy and its subclasses, classification of DNA histograms is variable and subjective.

Middle ear adenoma. A tumor displaying mucinous and neuroendocrine differentiation

Middle ear adenoma (MEA) is a distinctive, rare entity that appears to be derived from the lining epithelium of the middle ear mucosa. We report four cases of MEA displaying the typical histologic growth pattern. Two distinct tumor cell immunophenotypes were identified in all cases; the first type exhibited positivity with anti-epithelial membrane antigen and anti-keratin antibodies, and the second type showed immunoreactivity with anti-keratin, anti-vimentin, and anti-neuron-specific enolase antibodies. Ultrastructural studies revealed bidirectional mucinous and neuroendocrine differentiation, demonstrated by the presence of two distinct cell types containing apically located mucous granules and basally concentrated neuroendocrine granules, respectively. The presence of neuroendocrine differentiation was supported by the immunohistochemical detection of vasoactive intestinal polypeptide in the tumor cells in one case and neuron-specific enolase in three cases. These findings suggest that the potential for mixed mucinous/neuroendocrine differentiation described in other endodermally derived tumors also exists in middle ear mucosa. We also believe that the rare lesions diagnosed as primary carcinoid tumors of the middle ear might in fact be MEA with predominant or only neuroendocrine differentiation. The clinical course of our four cases and our review of the pertinent literature confirm the benign nature of MEA and indicate that these tumors should be treated by complete local excision without additional therapy.

In vivo MR spectroscopic imaging of the adrenal glands: distinction between adenomas and carcinomas larger than 15 mm based on lipid content

The usefulness of MR spectroscopic imaging for discriminating between lipid and water was applied to the in vivo differentiation of adrenal adenomas from carcinomas. By using the Dixon sequence in 20 patients, the lipid content of 22 adrenal tumors larger than 15 mm was determined. The mean percentage of lipid in 15 adenomas was 13.4% (standard deviation, 8%), compared with 3.5% lipid (standard deviation, 2%) in seven carcinomas. Only one lesion would have been misclassified on the basis of in vivo measurements of lipid content. After surgery, in vitro MR spectroscopy was used to determine the percentage of lipid in excised samples of nine of the 22 tumors. These in vitro measurements confirmed the in vivo results on lesions larger than 20 mm in diameter. Respiratory artifacts appeared to decrease the accuracy of in vivo measurements in smaller lesions. In vivo MR spectroscopic imaging of adrenal tumors appears to be useful for differentiating between adrenal carcinomas and adenomas.

In vitro NMR evaluation of human thyroid lesions

In vitro analysis of spin-lattice relaxation times (T1), water self-diffusion coefficients (DH2O), and proton NMR spectroscopy were performed in a study of 88 patients with thyroid lesions in order to determine the usefulness of these parameters in the differentiation of benign and malignant tissues. Thyroid tissue sample proton NMR spectral patterns were examined at 360 MHz. Proton NMR spectra were different for normal thyroid tissues, benign, and cancerous lesions. Significantly prolonged T1 (0.5T) and decreased DH2O were found in cancerous thyroid lesions relative to normal thyroid tissues. Considerable overlap was found, however, in comparing T1 and DH2O values for benign and malignant thyroid lesions. This study suggests that proton NMR spectroscopy may be more useful than T1 and DH2O in differentiating benign and malignant thyroid lesions.

The expression of intermediate filaments in canine mammary glands and their tumors

Monoclonal antibodies specific for different types of intermediate filaments (cytokeratin, vimentin, desmin and neurofilaments) were used to study the histogenesis of canine mammary glands and 57 canine mammary tumors by immunocytochemistry. The intra- and interlobular duct epithelium, acinar, and intralobular myoepithelial cells stained positively for cytokeratin. Peripheral ductal and acinar cells, as well as interstitial cells, stained positively for vimentin. A similar staining pattern was seen in adenomas, complex adenomas, benign mixed tumors, ductular carcinomas, and one myoepithelioma-like tumor. Additionally, cytokeratin positive cells were scattered interstitially in one single adenoma, most complex adenomas, some benign mixed tumors, complex carcinomas, and in the malignant mixed tumors. All stromal cells stained positively for vimentin. The fibrosarcomas were positive only for vimentin, while the following expressed both desmin and cytokeratin: epithelial-like cells in one adenoma, three complex adenomas, the myoepithelioma-like tumor, the single comedo carcinoma, two complex carcinomas, the single lobular carcinoma, one malignant mixed tumor, and three osteosarcomas. Epithelial-like cells in one adenoma, six complex adenomas, two benign mixed tumors, two complex carcinomas, the lobular carcinoma, and the malignant schwannoma stained for neurofilaments. Three tumors, one adenoma, one complex adenoma, and the lobular carcinoma expressed both desmin and neurofilaments in addition to cytokeratin and vimentin. The results show the expression of different types of intermediate filaments and indicate that there might be a stem cell origin in most of the canine mammary tumors.

Microfluorometric measurements of cytoplasmic calcium in chief and oxyphil parathyroid cells of adenomatous and hyperplastic glands and of normal-sized glands associated with adenomas

The effects of extracellular calcium on the cytoplasmic Ca2+ concentration (Ca2+i) were studied by dual-wavelength microfluorometry in individual human parathyroid cells obtained from adenomatous glands and normal-sized glands associated with adenomas in hypercalcemic hyperparathyroidism (HPT), as well as from enlarged glands of patients with uremia with HPT. In comparison with the normal parathyroid tissue, chief cells of the adenomatous and hyperplastic glands showed significantly lower Ca2+, and also right-shifted responses of Ca2+i to increases in the extracellular calcium concentration within the 0.5 to 3.0 mmol/L range. This pathophysiologic disturbance apparently was independent of the cell size. Oxyphil cells of nodules from the hyperplastic glands had lower Ca2+i and responded less to increments in extracellular Ca2+ than the chief cells from the surrounding parts of the same glands. Also the chief cells from the normal-sized glands associated with single adenomas exhibited a disturbance of the regulation of Ca2+i, which was less pronounced than that in the cells of the adenomas. These findings support the presence of relative calcium insensitivity of Ca2+i in chief and oxyphil parathyroid cells from adenomatous and hyperplastic glands. This derangement may also be found in all parathyroid glands of individuals with adenomatous HPT.

DNA evaluation in growth hormone producing pituitary adenomas: flow cytometry versus single cell analysis

DNA patterns were analysed in 26 GH-producing pituitary adenomas by flow cytometry as well as by microspectrophotometry. Twelve tumours (46%) were diploid according to both methods, whereas 5 tumours (19%) showed aneuploid DNA patterns. Nine tumours were classified differently by the two methods: flow cytometry resulted in diploidy in 2 and aneuploidy in 7 patients, whereas microspectrophotometry showed diploidy in 5 tumours, tetraploidy in 3 and aneuploidy in 1. Methodological limitations may explain the discrepancy in the results obtained by the two methods. However, both the flow cytometry and the microspectrophotometry method show the presence of aneuploid DNA patterns in GH-producing pituitary adenomas despite their benign growth characteristics and the clinically benign course of the disease. This comparative study with two methods measuring DNA content, shows that depending on the criteria used for diploidy-aneuploidy, the frequency of aneuploidy will vary. In this material of 26 GH-producing adenomas, 46% were aneuploid according to flow cytometry and 23% according to microspectrophotometric. However, no correlation to tumour size or GH levels was found with either method when patients with aneuploid and diploid tumours were compared. Therefore, no clinical significance can so far be drawn from these results.

[Therapeutic strategy for adenomatous goiter from the viewpoint of postoperative outcome and epidermal growth factor receptor study]

Adenomatous goiter (AG) is regarded as a benign tumor-like lesion. In the present study, both the postoperative outcome and the localization of epidermal growth factor receptor (EGF-R) were investigated to determine proper therapeutic modalities for AG. In this series, 377 surgical patients were studied. Immunohistochemical observation was carried out according to the ABC procedure. Results were as follows: 1) among the all 377 patients, primary cases were 343 and the remainder, 34 cases (9%), recurrent, 2) majority of the 34 recurrent patients showed multinodular goiter type occupying one whole lobe or both sides. Initial surgical strategy for these cases was only enucleation of the all nodules confirmed macroscopically, 3) coexistence of cancer in AG was observed in 18 cases (5%). Seventeen out of them were latent carcinomas found in the multinodular goiter, and 4) those multinodular patients associated with latent carcinoma revealed presence of EGF-R not only in the malignant lesions but also in the hyperplastic parts. These observations suggest that surgical treatment should be considered for multinodular AG patients. In addition, near-total lobectomy of the diseased side might be recommended as an operative procedure because of the prevention of postoperative recurrence and complications.

Histopathologic and flow cytometric analysis of adenomatous colonic polyps

We evaluated the histopathology, DNA content, and proliferative activity of colonic polyps independently. Paraffin-embedded specimens were used as source material. In each case, additional sections were cut at 3 microns and stained with hematoxylin-eosin and trichrome for histopathologic analysis. For DNA analysis and measurement of proliferative activity, the polyp parts were dissected and the nonpolypoid tissue was discarded. The study was limited to those specimens that were received in our department in the years 1972 and 1977. Of the 104 polyps that were submitted for flow cytometric analysis, 36 could not be analyzed owing to excessive debris or insufficient nuclei. DNA aneuploidy was identified in 32% of the cases, with a higher value noted in larger polyps and in severely dysplastic polyps, but these values were not statistically significant. Multiple adenomas from the same patient often showed different DNA histograms. When analyzed according to the percentage of cells in S phase, no significant difference was found in proliferative activity of polyps according to DNA content or size of the polyps. These results suggest that the diagnostic significance of aneuploidy and proliferative activity in polyps must be interpreted with caution.

Immunocytochemical localization of vitamin D-dependent calcium-binding protein (calbindin) in thyroid parafollicular cells of guinea pig

The presence of the 28K vitamin D-dependent, calcium-binding protein (28K calbindin) was investigated by immunocytochemistry in normal thyroid glands and parathyroid glands of rats, guinea pigs, rabbits and men, as well as in human thyroid medullary carcinomas and human parathyroid adenomas. In addition, thyroid glands and parathyroid glands of rats and guinea pigs were studied after treatment with vitamin D3 injected intramuscularly at a total dose of 1.2 x 10(6) IU per 100 g body weight. 28K calbindin was found exclusively in parafollicular cells of guinea pigs and never in those of other species investigated. It was present predominantly in the cytoplasm and in lower concentration in nuclei. After vitamin D3 treatment, increased immunoreactivity of 28K calbindin was observed in the cytoplasm and, even more pronounced, in the nuclei. In normal parathyroid cells and in parathyroid tumors and medullary thyroid carcinomas, 28K calbindin was not demonstrable. Our findings suggest an important function of calbindin in the cellular calcium processing of parafollicular cells of guinea pigs.

Estrogen receptor in normal and neoplastic human thyroid tissue

Clinical evidence suggests the possible influence of estrogen on the biologic behavior of thyroid neoplasm. In this study we evaluated the distribution and characteristics of intracellular receptors for estrogen in normal and neoplastic thyroid tissue obtained from 54 patients. Forty-two percent of all specimens assayed by the protamine sulfate precipitation technique had a detectable intracellular binding site for estrogen. Differentiated carcinomas (eight of eight) and adenomas (seven of nine) had high incidences of receptors compared with goiter (five of 23) and normal thyroid (three of eight). However, there were no detectable receptors for estrogen in medullary carcinomas of the thyroid (0 of six). Also, carcinomas and adenomas had higher receptor contents than did goiter and normal differentiated thyroid tissue. There was no significant difference in the affinity of estrogen for receptors among the different histologic groups. There were both 4S and 8S receptor types, which were specific for estrogen. The binding of estrogen to thyroid tissue and differentiated neoplasm originating from thyroid tissue were comparable to the binding of estrogen to other hormone-dependent normal and neoplastic tissues.

Immunocytochemical detection of lactoferrin in human gastric carcinomas and adenomas

In gastric carcinomas, including 20 cases of intestinal type and 10 cases of diffuse type, in adenomas with mild to severe dysplasia (20 cases), and in hyperplastic polyps (10 cases), the presence of lactoferrin was investigated by immunohistochemistry. Incomplete or complete intestinal metaplasia or both and normal gastric mucosa were also tested. Preoperative hematocrit and serum iron levels (18 patients) were recorded. An evident reactivity for lactoferrin was encountered in intestinal type carcinomas, adenomas, and incomplete intestinal metaplasia, whereas diffuse-type carcinomas, hyperplastic polyps, and complete intestinal metaplasia were always unstained; mucous neck cells of the antrum and body were also positive for lactoferrin. The results are discussed in relation to the increased requirement of iron by neoplastic cells, although in gastric carcinomas serum iron levels appear to be unrelated to the immunohistochemical presence of lactoferrin.

Orcein-alcian blue staining: a new technique for demonstrating acid mucins in gastrointestinal epithelium

Orcein-alcian blue staining, a new method for the simultaneous demonstration of sulphated and sialomucins in gastrointestinal epithelium was compared with the standard high iron diamine-alcian blue technique. Sections were oxidised with potassium permanganate and decolourised in oxalic acid. They were stained with orcein for four hours, differentiated for a few seconds in acid alcohol, and then counterstained with alcian blue for half to one minute. There was a good correlation of results between the two methods. Orcein-alcian blue is a safer, cheaper, and quicker method than high iron diamine-alcian blue which can be safely introduced into routine laboratories for the study of acid mucins in the gastrointestinal diseases.

Altered balance between thyrotropin-releasing hormone and dopamine in prolactinomas and other pituitary tumors compared to normal pituitaries

We measured TRH and dopamine (DA) concentrations in prolactinomas and other pituitary tumors in order to further understand the roles of these two factors in the hormone hypersecretion and growth of these tumors. The mean TRH concentration (by RIA) in 16 prolactinomas was 247 +/- 92 (+/- SE) fmol/mg cell protein (range, 10-1297), near that found in normal pituitary tissue. The prolactinoma TRH content did not correlate with the patient's tumor size or plasma PRL level. By contrast, DA assayed by high pressure liquid chromatography was present in normal pituitary tissue (7.3 +/- 3.5 pmol/mg cell protein), but was very low or undetectable in the prolactinomas (23 fmol/mg cell protein or less). 3,4-Dihydroxyphenylacetic acid, also assayed by high pressure liquid chromatography, was undetectable in both normal pituitary tissue and prolactinomas. This imbalance between TRH and DA content also was found in GH-secreting and nonsecreting adenomas. The TRH content in 18 GH-secreting tumors (24 +/- 6 fmol/mg) was considerably lower than that in the prolactinomas (P less than 0.001). In 8 nonsecreting adenomas, the mean TRH concentration was 109 +/- 28 fmol/mg, about half of that in the prolactinomas. In those 2 types of adenomas, DA also was nearly undetectable (less than or equal to 73 fmol/mg cell protein). We conclude that the imbalance between TRH and DA contents in prolactinomas compared to those in normal pituitary tissue might participate in the mechanisms leading to hypersecretion of PRL and the growth of all types of pituitary adenomas.

Lysozyme and mucins in gastric adenomas

A method for the simultaneous demonstration of lysozyme and mucins in 39 cases of gastric adenomas differentiated two intermediate cell types. The first was similar to a columnar cell comprising a single cell population which covered extensive areas of the adenomas. This cell type often showed supranuclear lysozyme reactivity and apical neutral mucins, sialomucins, and sulphomucins in variable amounts. The second cell type was found in 11 adenomas, located mainly in the fundal area. It seemed to be a transitional form between the goblet cell and the Paneth cell. This cell type was scattered among columnar cells, occasional Paneth-like cells, and small goblet cells. These two types of intermediate cells may be regarded as abnormally differentiated integral elements of gastric adenomas. They may be associated with the neck stem cells in the cytogenesis of gastric adenomas.

[Ornithine decarboxylase activity and polyamine levels in human thyroid tumor tissue]

Production of polyamines such as putrescine (PUT), spermidine (SPD) and spermine (SPM) primarily from ornithine by ornithine decarboxylase (ODC) is correlated with cell proliferation. Polyamine levels and ODC activities were measured to determine the degree of biological malignancy in 186 thyroid tumor tissues. Carcinoma showed significantly higher ODC activity and higher levels of PUT, SPD and SPM than benign tumors. PUT levels showed 2.28 nmol/mg protein in anaplastic carcinoma, 0.66 in papillary carcinoma, 0.11 in follicular adenoma, 0.06 in adenomatous goiter and 0.04 in normal thyroid tissue. Anaplastic and papillary carcinomas showed higher PUT/SPD and SPD/SPM ratios than benign tumors. Poorly differentiated carcinoma showed significantly higher PUT level and PUT/SPD and SPD/SPM ratios than well differentiated carcinoma. No correlation was found among polyamine levels, ages and sex in papillary carcinoma. In female patients with papillary carcinoma, no significant difference in polyamine levels was observed between patients above and below 50 years old. These results suggest that ODC activity and polyamine levels may provide useful information to determine the degree of biological malignancy of thyroid tumors.

[Fibronectin in gastrointestinal tumors and its relation to biological characteristics of tumor]

Through immunohistochemical technique, distribution of FN in normal mucosa, benign and malignant tumors of human gastrointestinal tract were studied. In normal and adenoma tissues, FN was found in both basement membrane (BN) and interstitial tissue. While in cancer tissue, there was a consistent decrease of BM FN content around the tumor nests particularly more apparently in cases of invading carcinoma. Statistical analysis showed that the reduction of BM FN was correlated with the degree of tumor dedifferentiation but not with the incidence of regional metastases. No association was noticed between the stroma FN and tumor behaviors. Since small blood vessels were usually delineated clearly by the staining for FN, FN might be considered as a marker in identifying the invasion of blood vessel wall by tumor cells. It is suggested that lack of BM FN in tumor tissues might be mainly due to decrease of FN synthesis by the tumor cells.

Serum and thyroid tissue lipids in patients with thyroid tumors in euthyroidism

Plasma lipids of 24 euthyroid subjects with thyroid adenoma and non-toxic primary differentiated thyroid carcinoma (papillary and follicular types) were assessed and compared with a similar investigation conducted on 20 normal subjects. A parallel study with thyroid tumor tissues examined the lipid changes which occurred in the same group of patients. These were compared with the picture seen in 5 normal thyroids. The investigations examined the changes in total lipids; total, free and esterified cholesterol; total phospholipids; lecithin; cephalin and sphingomyelin; triglycerides and free fatty acids in both serum and thyroid tissue. Compared with normal subjects, the serum lipids were almost identical except for the concentration of free fatty acids which showed significantly lower values in the group with neoplastic changes. Tissue analysis of the cancerous thyroid however revealed a marked rise in virtually all lipid fractions but the cholesterol seemed to dominate the picture. The differential studies of total phospholipids for thyroid tissue membrane lipids further revealed a significant increase in the lecithin and sphingomyelin components of total phospholipids as well as the esterified cholesterol fraction in thyroid carcinoma. The changes in thyrophospholipids were more marked in females normal thyroids than males. An attempt has been made through evaluation of the results derived from differential lipid studies to elucidate the role of some of the various fractions determined and the possible effect of the changes described on thyroid hormone metabolism.

Cushing's disease in two sisters

Hereditary Cushing's syndrome is an uncommon clinical entity, and most reported cases have been described in families with nodular adrenocortical dysplasia. Isolated cases of Cushing's disease (pituitary-dependent bilateral adrenal hyperplasia) have been reported in association with the multiple endocrine neoplasia syndrome, Type I (MEN I), but there are no published reports of pedigrees with more than one affected family member. Within a period of 8 months, two sisters presented with clinical findings suggestive of hypercortisolism, and Cushing's disease was confirmed by appropriate diagnostic studies. There was no evidence of any other endocrine excess syndrome in either patient. Transsphenoidal pituitary surgery confirmed the presence of an ACTH-immunostaining pituitary adenoma in each woman. The authors think this is the first report in the English literature of Cushing's disease in first-degree relatives.

ABO blood group antigens in parathyroid adenoma and hyperplasia

Immunohistochemical determination of ABO blood group antigens was performed on parathyroid tissue to see if the presence or absence of such antigens could be used as an aid to distinguish adenoma from hyperplasia in primary hyperparathyroidism. Material from nine cases of solitary adenoma and seven cases of hyperplasia fixed in formalin and embedded in paraffin was studied using monoclonal antibodies and avidin-biotin-peroxidase complex technique. The two categories of tissue did not show any consistent differences in the extent or intensity of immunoreactivity, and the method tested did not permit distinction between adenomatous and hyperplastic disease of the parathyroid glands.

The DNA content in rectal adenomas

Flow cytometric DNA analysis was performed in 67 tubular, tubulovilous and villous rectal adenomas with different degree of dysplasia. One of the adenomas contained a focus of early invasive carcinoma. All but one of the 67 adenomas had near diploid DNA histograms; the exception was a tubular adenoma with severe dysplasia but without signs of early invasion. Flow cytometric DNA analyses of adenomas may in some cases provide valuable information. The low frequency of aneuploidy indicates, however, that routine DNA measurements are questionable. Rather, the analysis should be restricted to certain cases like those with high malignant potential, cases with suspected early invasive carcinoma, and adenomas not radically removed.

Argyrophil organizer region proteins (AgNORs) in adenohypophysial cells and adenomas of the human pituitary

Nucleolar organizer regions (NORs), claimed to represent valuable markers of tumor proliferation, were visualized on paraffin sections by an argyrophil method and counted in 18 nontumorous adenohypophyses and 132 pituitary tumors. The AgNOR counts could not be correlated with the hormonal activity of nontumorous and adenoma cells. In pituitary adenomas, the mean AgNOR values were higher than in their corresponding nontumorous cell types. Some adenomas, especially growth hormone (GH), and prolactin (PRL) cell adenomas, however, had AgNOR readings in the range of nontumorous cells. Long-acting somatostatin analog and bromocriptine treatment decreased AgNOR counts in GR- and PRL-producing tumors. Most, but not all invasive and/or recurrent adenomas had high AgNOR counts. In a corticotroph carcinoma, AgNORs were not higher than in the adenomas. These inconsistent results limit, at the present time, the use of AgNORs as reliable markers of cell proliferation in pituitary tumors. Further studies may help to establish the value of this promising method in pituitary pathology.

In situ detection of c-myc mRNA in adenocarcinomas, adenomas, and mucosa of human colon

We used a sensitive RNA:RNA in situ hybridization technique to study steady-state levels of c-myc proto-oncogene mRNA in primary human colon adenocarcinomas, villous adenomas, and normal mucosa samples. Frozen tissue sections, fixed in 4% buffered paraformaldehyde, were hybridized to 35S-labeled anti-sense transcripts of a c-myc clone and processed for autoradiography. The specificity of the hybridization was controlled by using 35S-labeled plasmid transcripts as a negative control, while RNA preservation in the tissue sample was assessed by using 35S-labeled anti-sense transcripts of a murine 28S rRNA clone. c-myc RNA was detectable in all the carcinomas (eight) and villous adenomas (four), but steady-state levels varied from high to low in different tumors with similar histology. Low levels of c-myc RNA were detected in epithelial stem cells of some of the normal mucosa samples (five). No genetic alterations of the c-myc locus were found by Southern analysis of DNAs extracted from the carcinomas.

[Immunohistochemical classification of hypophyseal adenomas]

Immunohistochemical analysis showed production of hormones in more than half of 88 pituitary adenomas that were classified mostly as chromophobe in basic staining during 3 years. Prolactin was the most often detected. A combined production of hormones especially of prolactin and growth hormone was not exceptional. Using a sensitive double indirect immunoperoxidase technique enables economy in spending primary antibodies. Evaluation of hormonal production is important for selection of therapy, as well as for settlement of prognosis.

Peptides related to alpha-melanocyte-stimulating hormone are commonly produced by human pituitary corticotroph adenomas: no relationship with pars intermedia origin

The presence of immunoreactive (ir)-alpha-MSH has been investigated by immunocytochemistry in 24 pituitary adenomas and one case of corticotroph hyperplasia causing Cushing's disease, in four adenomas causing Nelson's syndrome, and in ten 'silent' corticotroph adenomas. It was found that a high proportion of these adenomas have a population of cells containing ir-alpha-MSH in addition to ir-ACTH. In some instances, these adenomas were clearly not associated with the residual intermediate lobe of the pituitary. Radioimmunoassay of plasma from patients with Cushing's disease or Nelson's syndrome showed elevated levels of ir-alpha-MSH in the majority of cases. Characterization of the ir-alpha-MSH in adenoma cells by immunocytochemistry, using an antiserum selective for acetylated forms of alpha-MSH, suggested that only the desacetyl form was present in each case examined. High-performance liquid chromatography of adenoma tissue extracts revealed material co-eluting with acetylated forms of alpha-MSH in only one of six cases. These results have been compared with corticotroph adenomas in animal pituitary glands, and it is concluded that the presence of alpha-MSH peptides cannot be used as a marker for intermediate lobe tumours, and that desacetyl alpha-MSH is commonly produced by corticotroph adenomas.

Expression of the nuclear oncogene p53 in colon tumours

The nuclear tumour antigen p53 is expressed by a gene localized on the p-arm of human chromosome 17, a region frequently deleted in colon carcinomas. Using a monoclonal antibody to p53 antigen, immunohistochemical analysis of carcinomas and dysplastic tubular adenomas of the colon has been performed to study the relation between p53 expression and dysplasia or malignancy. With this methods p53 was detectable in 55 per cent of colon carcinomas (n = 29). In 8 per cent of adenomas (n = 74), focal nuclear p53 expression was found in dysplastic epithelial cells. In general, these p53-positive regions of the polyps were histologically indistinguishable from the neighbouring tubuli. Sometimes the p53-positive nuclei were found in a focus of more highly dysplastic epithelium. The results suggest that expression of the p53 gene may be part of the process of malignant transformation of dysplastic colon polyps.

A case of multiple endocrine neoplasia (MEN) type 1; the immunohistochemical and ultrastructural studies of its tumors and the analysis of hormones in tumor extracts

We reported a case of sporadic multiple endocrine neoplasia type 1, with multiple insulinoma, parathyroid adenoma, and pituitary tumor. Measurement of hormone contents and immunohistochemical studies of the pancreatic tumors showed that the tumors contained insulin, glucagon, somatostatin, and pancreatic polypeptide. Furthermore, the concentrations of these hormones were different in each tumor. Insulin extracted from the pancreatic tumors analyzed by reversed-phase high performance liquid chromatography revealed no structural abnormalities. On the other hand, in gel filtration evaluation of the extract of the parathyroid adenoma, it was found that the tumor extract contained a macromolecular parathyroid hormone (molecular weight 20,000 to 25,000).

Fecal diglycerides as selective endogenous mitogens for premalignant and malignant human colonic epithelial cells

Diglycerides (DGs) have been found in fecal extracts at concentrations which induce mitogenesis of adenoma and some carcinoma cells but not normal cells in primary culture. DGs containing stearic, oleic, palmitic, and myristic acid side chains were found in fecal extracts from each of eight subjects. Synthetic 1,2-DGs, containing the fatty acids found in endogenous fecal DGs, induced mitogenesis in cultures of premalignant cells from each of 13 adenomas, covering all histological classes, and in cultures from two of four carcinomas. The potent adenoma mitogen, dimyristin, had no mitogenic activity on cultures of normal colonic epithelial cells from seven different subjects. These results suggest DGs may act as endogenous mitogens in the development of human colon cancer. The extent of adenoma mitogenesis was correlated with the chain length of the saturated R-groups: 16 greater than 14 greater than 12 greater than 10 greater than 8 much greater than 18. DGs with oleic acid residues, C18:1, were among the most active, while substitution of even one fatty acid residue with a stearic acid residue, C18:0, reduced or eliminated mitogenic activity. Dimyristin also induced enhanced levels of urokinase secretion from carcinoma cells, in parallel to the phorbol ester tumor promoter, 12-O-tetradecanoylphorbol-13-acetate. These results imply that DGs found in the colon induce a selective growth of benign colonic tumors and some carcinomas, and may enhance the invasive capacity of carcinomas, while leaving normal cells unaffected.

Enzyme-immunoassay for estrogen receptors in human pituitary adenomas

We have performed an enzyme-immunoassay for estrogen receptor on 56 human pituitary adenomas and compared the results with a single point estradiol binding assay. There was a significant positive correlation between the two assays of cytoplasmic estrogen receptor (r = 0.960). Normal human pituitaries (N = 2) had an estrogen receptor concentration of 17 fmol/mg protein by enzyme-immunoassay. Of 14 prolactinomas, 6 (43%) contained estrogen receptor with a concentration of 33.5 +/- 7.4 (mean +/- SEM) fmol/mg protein. Six of 11 (55%) macroprolactinomas were estrogen receptor-positive, whereas all 3 microprolactinomas were estrogen receptor-negative. Only one (13%) of 8 GH- and PRL-secreting adenomas, and 3 of 6 (50%) gonadotropin-secreting adenomas were estrogen receptor-positive; the latter had a concentration of 13.5 +/- 1.6 fmol/mg protein. Estrogen receptor was not detected in 21 pure GH-secreting adenomas and 7 nonsecreting adenomas. These results demonstrate the precise frequency of estrogen receptor in various human pituitary adenomas, since enzyme-immunoassay as well as single point estradiol binding assay could detect estrogen receptor even in small specimens. Enzyme-immunoassay is suitable for evaluation of estrogen receptor status in human pituitary adenomas.