AIM: To test which immunohistochemically detected tumour parameters are predictive of outcome in endometrial carcinoma. METHODS: A retrospective study of 300 patients diagnosed with endometrial carcinoma between 1980 and 1985, ensuring a follow up of at least 10 years. Paraffin wax embedded tissues from 236 patients with endometrial carcinoma were evaluated in terms of histological tumour type and grade, stage of disease, and certain immunohistochemical biological parameters. These parameters included the expression of oestrogen and progesterone receptors, the expression of p53 protein, the expression of the c-erbB-2 oncoprotein, and the expression of protease cathepsin D, together with the rate of cell proliferation. RESULTS: Using univariate analysis, the following parameters correlated significantly with adjusted survival: histological type (p = 0.025), grade (p = 0.00003), FIGO stage (p < 0.00001), proliferation rate (p = 0.00002), oestrogen receptor expression (p = 0.007), progesterone receptor expression (p = 0.0092), and p53 expression (p = 0.00028). These parameters also correlated significantly with both disease free and overall survival. There was a weak correlation of cathepsin D expression with survival, but no correlation of c-erb B-2 expression with survival. Using multivariate analysis, only FIGO stage (p = 0.0021), histological grade (p = 0.005), and proliferation rate (p = 0.0007) remained statistically significant prognosticators of adjusted survival as well as of disease free and overall survival. CONCLUSIONS: In addition to conventional histological parameters, the immunohistochemical determination of proliferative activity could contribute to the identification of a high risk subgroup of endometrial carcinomas. The other parameters tested were not of significant additional predictive value.

Adult↗

PubMed1997

Immunohistochemically detected HER-2/neu-expression and prognosis in endometrial carcinoma.

Expression of the HER-2/neu proto-oncogene product was looked for immunohistochemically in 222 endometrial carcinomas in a retrospective follow-up study. The intensity of protein expression was correlated with patient survival. Median follow-up time was 4.8 years. In 109 (49%) of 222 endometrial carcinomas there was aberrant expression of HER-2/neu. HER-2/neu-expression did not correlate with p53-expression and proliferation rate, as determined immunohistochemically by the monoclonal antibody Ki-S1. In univariate statistical analysis aberrant HER-2/neu expression was not predictive of adjusted survival (p = 0.18) and of disease-free survival (p = 0.42). In multivariate analysis HER-2/neu-expression was not found to be an independent prognosticator (p = 0.099) as compared to FIGO-stage (p = 0.0001), histologic grade (p = 0.00099) and proliferation rate (p = 0.0013). Therefore immunohistochemically detected expression of HER-2/neu seems not to be a clinical prognosticator in endometrial cancer.

Adult↗

PubMed1997

p53 protein in endometrial cancer is related to proliferative activity and prognosis but not to expression of p21 protein.

Expression of the tumor suppressor gene product p53 and the cyclin-dependent kinase inhibitor p21, which is transcriptionally activated by p53, was investigated and compared with patient survival in a retrospective longitudinal study of 202 cases of endometrial carcinoma. The median duration of follow-up was 4.3 years. P53 was observed immunohistochemically in 63 (31%) of the tumors and was found by univariate analysis to be related to reduced adjusted survival (p = 0.00028) and disease-free survival (p = 0.04). However, p53 expression was not found by multivariate analysis to be an independent prognostic factor when compared with FIGO stage, histologic grade, and proliferative activity, as determined by immunoreactivity for topoisomerase IIalpha with the antibody Ki-S1. Overexpression of p53 was related to histologic grade (p < 0.00001), proliferative activity (p = 0.0071), and inversely to progesterone receptor content (p = 0.042). Immunohistochemical identification of p21 was investigated in 95 cases and found to be positive in 19 (39%) of 49 tumors with p53 overexpression and in 13 (28%) of 46 tumors without p53 overexpression (p = 0.28). Expression of p21 is therefore not related to p53 expression, nor was it found to be related to proliferative activity. Strong expression of p21 was observed in tumors negative for progesterone receptors (p = 0.0028). P53 in endometrial carcinoma is not associated with induction of the cell cycle inhibitor p21, but is associated with an enhanced proliferative activity. The findings of multivariate analysis suggest that the prognostic significance of p53 is related mainly to cell proliferation.

Adult↗

PubMed1997

Primary biliary cirrhosis and gastric carcinoid: a rare association?

Primary biliary cirrhosis (PBC) is frequently associated with other autoimmune disorders. Although antibodies against gastric parietal cells are found in nearly all PBC patients, autoimmune gastritis is only very rarely associated. We describe a woman with PBC in whom chronic autoimmune gastritis complicated by a large pedunculated gastric carcinoid tumor was found. Additionally, the patient had autoimmune thyroiditis. This was interpreted as the rare association of PBC with Schmidt's syndrome type III. The carcinoid tumor was removed endoscopically. We conclude from the case that an endoscopic screening for autoimmune gastritis should at least be performed in patients with PBC and autoimmune thyroiditis, keeping in mind the possible occurrence of a polyendocrinopathy and the potentially serious complication of a gastric carcinoid tumor.

Carcinoid Tumor↗

PubMed1997

[Rate of proliferation as a prognostic criterion in endometrial carcinoma--an immunohistochemical analysis with the monoclonal antibody KI-S1].

In a subset of 183 primarily operative treated patients of 300 patients with endometrial carcinoma an analysis of histological tumor type (n = 142), myometrial invasion (n = 115), stage (n = 114), immunohistochemically detected steroid receptor status, histologic grading (n = 152) and growth fraction, detected by immunohistochemical determination of antibody Ki-S1 (n = 130), was performed. The mean follow up was 9.1 years. By univariate analysis, age, myometrial invasion (< = 3/>3 mm), expression of steroid receptor, FIGO-stage, histologic grading and growth fraction were found to influence the overall survival rate significantly. Cox multivariate regression showed age, FIGO-stage and growth fraction to be independent predictors of overall survival. With respect to survival univariate analysis revealed progesterone receptor status, FIGO-stage, histologic grading and growth fraction as prognostic factors. By multivariate analysis FIGO-stage, histologic grading and growth fraction were found to be independent prognostic factors for survival. Multivariate and univariate analysis exhibited FIGO-stage, histologic grading and growth fraction rate to be independent predictors of a disease-free survival. Immunohistochemically detected growth fraction seems to be useful as an additional prognostic factor in endometrial cancer.

Adenocarcinoma↗

PubMed1997

[Adenoid cystic carcinoma of the breast].

The case of a 36 years-old patient suffering from an adenoidcystic carcinoma of the breast is described. This malignant tumor is very rare and often remains undetected because of its clinical resemblance to a fibroadenoma.

Adult↗

PubMed1996

[Primary extragenital manifestation of a malignant mixed Mullerian tumor of the major omentum].

Malignant mixed Müllerian tumours (MMMT) are tumours of the female genital tract which rarely occur in extragenital sites. We report a case of a 46-year-old female with MMMT with primary occurrence in the greater omentum. Only 19 cases of primary extragenital manifestations of this tumour are described in literature. The clinical appearance, diagnosis, therapy, histological evaluation and histogenesis are discussed.

Diagnosis, Differential↗

PubMed1995

Autoimmune hepatitis following hepatitis A virus infection.

A 7-year-old patient is reported who suffered from fatigue and jaundice due to chronic hepatitis. He had acquired hepatitis A virus infection in his community and communicated the disease to his German family 4 weeks later. While the other family members recovered from acute viral hepatitis A, the patient presented 10 weeks after the onset of hyperbilirubinemia (12 mg/dl) with the histology of chronic hepatitis, absence of markers for viral persistence, presence of autoantibodies against smooth muscle (1:320) and the asialoglycoprotein receptor (1:600), and marked hypergammaglobulinemia (3700 mg/dl), leading to the diagnosis of autoimmune hepatitis. The patient received immunosuppressive therapy, symptoms of liver disease disappeared, and autoantibodies cleared from circulation. The case is discussed in the context of a putative virus-induced autoimmune hepatitis in childhood. Autoimmune hepatitis may be induced by an external trigger. Hepatitis A virus infection is one of probably several triggers that may induce autoimmune hepatitis in predisposed individuals.

Asialoglycoprotein Receptor↗

PubMed1994

A comparison of preservation solutions for small bowel transplantation in the rat.

Explore the source record for details and available documents.

Animals↗

PubMed1994

Neurofibromatosis presenting as a severe systemic vasculopathy.

In a boy with neurofibromatosis type 1 (NF-1), hypertension, septic infection of an aneurysm in the deltoid muscle, bowel infarction, multiple arterial aneurysms and venous thrombosis occurred within a period of 6 weeks. Histologically, vascular neurofibromatosis of the small vessels of the gut was found. This unusual occurrence of a multitude of clinical features within a few weeks was caused by vascular neurofibromatosis. Awareness of this condition in patients with NF-1 may help the paediatrician to avoid unnecessary diagnostic procedures and to initiate appropriate symptomatic therapy.

Arteries↗

PubMed1994

[Granulomatous endocarditis caused by streptococcus].

Two cases of granulomatous endocarditis are reported. The patients developed aortal endocarditis refractory to antibiotics. Therefore, aortal valve replacement was performed. In both cases, Streptococcus viridans was demonstrated in culture and bacterioscopically to be the cause of infection. Histological examination of the valves showed characteristic endocarditis with fibrinoid necrosis and histiocytic granulomas. Streptococci were found in the cytoplasm of macrophages. The possible causes of this special form of infectious endocarditis are discussed.

Adolescent↗

PubMed1991

Malignant lymphoma of donor origin after renal transplantation: a case report.

A case of non-Hodgkin's lymphoma of polymorphous centroblastic type presenting in a renal allograft is reported. The kidney graft was explanted 10 months after transplantation because of chronic rejection. No other manifestations of lymphoma were found in the recipient. Since the human leukocyte antigen patterns of the renal allograft and the recipient differed at two loci, the donor origin of the malignancy could be clearly demonstrated by immunohistochemistry.

Adult↗