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The glial fibrillary acidic protein (GFAP) have been quantitatively determined in over 200 samples of liquid content of brain tumours and in cerebrospinal fluid (CSF) of cases with various tumours of the cerebral nervous system. For establishing the GFAP value, the rocket radioimmunoelectrophoresis was used. The studies were performed in three series of patients. The GFAP value of fluids from 26 cysts of both neoplastic and non-neoplastic type had a wide range of 0.6 microgram/ml to 40 micrograms/ml. Significant elevation of GFAP was usually recorded in fluid from cysts of anaplastic tumour with astroglial differentiation. In this series of 24 cases with various brain tumours, the GFAP value of the CSF ranged from 0.2 microgram/ml to 50 micrograms/ml. In gliomas, as in astrocytoma and glioblastoma, these values were on a higher level, of over 4 micrograms/ml. In other tumours and in cerebral lesions of other aetiology, the GFAP values were lower, below 3 micrograms/ml and 0.3 microgram/ml respectively. In another series of 32 patients with brain tumour treated surgically, a significant increase of GFAP (to 30 micrograms/ml) was noted in the CSF during the first week after operation, and that was always associated with an increase of the total protein of the CSF. During the second and third week after operation, when the total protein of the CSF was reduced to a normal level, the values of GFAP were still elevated, first of all in those cases of astrocytoma and glioblastoma which were not radically excised. These findings suggest that investigation of GFAP in the CSF of patients with brain tumour may be helpful in diagnosis and prognosis.
Cyst fluid from a patient with polycystic liver disease was obtained by needle aspiration using ultrasound guidance. The constituents of the fluid resembled the "bile salt-independent" fraction of human bile and supports the hypothesis that such cysts are lined by a functioning, secretory bile duct epithelium.
High erythropoietin (EPO) levels in cyst fluid and blood plasma in patients with autosomal dominant polycystic kidney disease (ADPKD) have been reported. In the present study we assessed EPO levels and the biochemical composition of cyst fluid obtained from 50 simple renal cysts. Basing on cyst fluid/plasma sodium ratio 38 cysts were classified as cysts of proximal origin, and 12 as cysts of undetermined origin. EPO concentrations in cyst fluid obtained from proximal cysts were significantly higher than in fluid from cysts of undetermined origin (472.9 +/- 116.2 vs. 112.1 +/- 33.3 mU/ml, p < 0.05). Patients with proximal cysts had significantly higher plasma EPO levels (31.8 +/- 3.5 mU/ml) than healthy subjects (17.3 +/- 1.96 mU/ml, p < 0.005). We conclude that: (1) simple renal cysts of distal origin seem to be rare; (2) the presence of high EPO level in cyst fluid suggests its proximal origin; (3) estimation of cyst fluid EPO levels seems to be of similar pathogenetic value as the assessment of the cyst fluid/plasma sodium ratio.
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In breast cyst fluid obtained from 50 patients age (47.1 +/- 2.3) sodium, potassium, oestrone (E1), oestradiol (E2) androgens, progesterone, (P) and Epidermal Growth Factor--EGF were determined. Markedly higher oestrogens, progesterone, testosterone, and EGF-levels were detected in cyst fluid than in blood. These data have confirmed previous results and have clearly shown that breast cyst fluid with high potassium (ratio K/Na > 1.0) contains more oestrogens, progesterone, testosterone, androstenedione and EGF than the group with low electrolyte ratio. This finding might be put in correlation with the fact that patients with high ratio K/Na may a higher risk of breast cancer than those with low electrolyte ratio.
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Testosterone was estimated by radioimmunoassay in molar vesicle fluid in 41 patients and theca-lutein cyst fluid in three patients with hydatidiform moles. The testosterone concentration in the molar vesicle fluid ranged from 0.4 ng/ml to 28.1 ng/ml with a mean+/-SEM of 6.0+/-1.0 ng/ml while in the theca-lutein cyst fluid, it ranged from 4.7 ng/ml to 23.5 ng/ml. Oestradiol-17beta and human chorionic gonadotrophin (HCG) were also estimated in the molar vesicle fluid. The oestradiol-17beta concentration ranged from 0.1 ng/ml to 26.2 ng/ml with a mean+/-SEM of 10.7+/-1.1 ng/ml. HCG concentration ranged from 18 000 to 150 000 mIU/ml with a mean+/-SEM of 49 800+/-5 000 mIU/ml. A positive correlation was found between testosterone and oestradiol-17beta (r = +0.37; P less than 0.01) but not between testosterone and HCG (r = 0.32; 0.1 greater than P greater than 0.05). Our findings suggest that molar trophoblast is the major source of testosterone.
OBJECTIVE: This study was undertaken to answer the following question: Does cytologic evaluation of nonbloody fluid aspirated from breast cysts contribute to appropriate clinical management? STUDY DESIGN: A retrospective review of palpable breast cyst fluid cytologic reports and associated medical records was undertaken to determine whether the cytologic findings affected patient management. Breast cyst size, fluid volume, fluid color, and patient age were abstracted from 689 medical records (1988-1999) of women whose palpable cysts had been aspirated at the Breast Diagnostic Center, Women's and Children's Hospital, Los Angeles. These observations were correlated with the fluid cytologic reports. RESULTS: Except for frankly bloody fluid, all breast fluid cytologic reports listed the results as acellular, inadequate for cytologic diagnosis, or no malignant cells identified. CONCLUSION: In clinical practice only frankly bloody fluid should be submitted for cytologic analysis. All other cyst fluid should be discarded.
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Anti-normal brain antibodies were studied in glioma cyst fluids. Cyst fluids were obtained by stereotaxic puncture from 34 patients with cystic gliomas. Immunoglobulins were analyzed by immunohistochemistry, immuno-Western blotting, concentration measures, and isoelectrofocalization. 80% of cyst fluids stained astrocytes and/or microvessels in non-tumoral white matter. In white matter extracts, cyst fluids recognized five immunoreactive bands having apparent molecular masses of 50-75 kDa. Although cyst proteins could be of systemic origin, isoelectrofocalization analysis suggests an additional local immune response. These antibody activities could be involved in certain peritumoral events such as brain edema.
Chronic infection by Echinococcus granulosus results in establishment of fluid-filled cysts (hydatid cysts) in liver or lungs of infected hosts, which can escape destruction by the host immune system for long periods. This study explores the modulation by hydatid cyst fluid of the in vitro human monocyte to dendritic cell (DC) transition induced by granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4). Addition of the fluid to adherent peripheral blood monocytes cultured in GM-CSF/IL-4 stimulates release of prostaglandin E2 (PGE2) and IL-6. Exposure of differentiating DC to the fluid during the 7-day culture in GM-CSF/IL-4 impairs their subsequent ability to secrete IL-12, IL-6 or PGE2 in response to lipopolysaccharide (LPS) stimulation. This inhibition is not dependent on the initial release of PGE2. The presence of hydatid cyst fluid also modulates the phenotype of the cells generated during culture, resulting in increased CD14 expression and decreased expression of CD1a. Finally, hydatid fluid can stimulate predifferentiated DC to mature, as evidenced by release of IL-12 and IL-6, and by up-regulation of class II major histocompatibility complex and CD86. The possible role of dendritic cell modulation in regulating the host immune response to hydatid cysts is discussed.
In view of the reported disagreement in the physicochemical properties of ovarian carcinoembryonic antigen (CEA), this study was undertaken to compare the properties of CEA obtained from extracts of ovarian tumour tissue, ascitic fluid and cyst fluid. On the basis of molecular weight estimation and binding properties with Concanavalin A and wheat germ lectin, ovarian CEA from these three sources appeared similar, and also possessed similar properties to those of colonic CEA. On isoelectric focusing, however, it was found that the isoelectric point of CEA from tumour tissue and cyst fluid differed from that from ascitic fluid. It is most likely that this is due to a loss of sialic acid from the CEA released into ascitic fluid.
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive renal enlargement, culminating in renal insufficiency in over one half of affected individuals. The highly variable onset and clinical course of ADPKD may be due to factors extrinsic to the genetically defined renal cysts. In this study, cyst fluid samples from 12 nonazotemic and 18 azotemic ADPKD subjects were examined for in vitro biologic activity that promotes cellular proliferation and the secretion of fluid by renal epithelial monolayers, two pathogenetic mechanisms that have critical roles in the formation and the rate of expansion of renal cysts. Cyst fluid added to culture medium (final concentrations, 1 to 20%) caused Madin-Darby canine kidney cells and human kidney cortex (HKC) cells derived from primary cultures to form cysts in Type I collagen matrix. Cyst fluid stimulated the net transepithelial secretion of fluid by polarized monolayers composed of these same cells. Absolute levels of fluid secretory activity determined by MDCK bioassay were correlated directly with the rate of fluid secretion by HKC cell monolayers and with the extent of cyst formation by MDCK and HKC cells embedded in collagen matrix. The secretory activity of urine was negligible; secretory activity was detectable in the serum of normal and ADPKD subjects, but the levels were much lower than in cyst fluid. cAMP agonists prostaglandins E1 and E2, arginine vasopressin, and 8-Br-cAMP stimulated fluid secretion by MDCK and HKC monolayers, but these substances did not cause HKC cells to form cysts in collagen matrix, whereas cyst fluid did. Among other naturally occurring growth factors and autacoids, only epidermal growth factor and transforming growth factor alpha stimulated cyst formation by HKC cells; however, the capacity of cyst fluid to stimulate fluid secretion was not affected by treatment with antiserum to epidermal growth factor. It was concluded that potent, and possibly unique, substances in the cyst fluids of individuals with ADPKD support and augment biologic processes in renal epithelial cells that may be important in the promotion of progressive cyst expansion.
The frequency of gross cystic breast disease in premenopausal women and its possible association with increased breast cancer risk emphasize the importance of investigations relating to breast cyst fluid composition. In order to contribute to a better analysis of this medium, we have measured four proteins the presence of which in human milk was well documented. Breast cyst fluid specimens from 266 breast cyst disease patients were assayed and compared as to concentrations of alpha-lactalbumin, gross cystic disease fluid protein (GCDFP-15), epidermal growth factor (EGF), and epithelial membrane antigen (EMA). All the analyzed cyst fluids contained GCDFP-15, EMA, and EGF whereas alpha-lactalbumin was detected in only 14.2% of fluids assayed. Positive correlations were observed between GCDFP-15 and EMA concentrations (P less than 0.005), as well as GCDFP-15 and EGF concentrations (P less than 0.0005). The cyst fluid GCDFP-15 and EGF levels were higher when alpha-lactalbumin concentrations were below detection limits. This association was statistically significant for GCDFP-15 (P less than 0.03) and for EGF (P less than 0.001). These results suggest that GCDFP-15 and EMA could be the biochemical expression of apocrine metaplasia and epithelial hyperplasia, respectively, two histopathological features which characterize breast cystic disease. On the other hand, the occasional presence of alpha-lactalbumin in the cyst fluid would reflect the persistence of differentiated cells in the epithelium surrounding the cyst and would be inversely proportional to the degree of cellular proliferation. The omnipresence of EGF in the cyst fluid argues for the hypothesis of its production by the mammary gland. The highly significant relationship between GCDFP-15 and EGF levels in the medium remains to be elucidated but may be related to an androgen sensitivity in the breast epithelium surrounding the cyst.
Pancreatic cysts include inflammatory pseudocysts, cystic tumors (serous and mucinous), and various rare cystic lesions. We report a case of a ciliated enteric duplication cyst that presented on computed tomographic scan as a pancreatic cystic neoplasm. Cyst fluid analysis revealed markedly increased concentrations of carcinoembryonic antigen and CA 125 and increased fluid viscosity. These features are typical for a mucinous cystic neoplasm of the pancreas and demonstrate a potential pitfall associated with the diagnosis of pancreatic cysts by chemical analyses. Enteric duplications involving the pancreas are rare, usually of gastric origin, and usually communicate with their enteric source. Morphological and histochemical analysis suggest that this cyst was of caudal foregut origin. This is the first reported case of a ciliated foregut cyst involving the pancreas. The chemical characteristics of the cyst fluid of these lesions have not been described previously.
Although the availability of thyroid cyst fluid is easy by fine-needle aspiration, less is known about the biochemical composition of thyroid cyst fluid. The authors have, therefore, determined the biochemical composition of 18 benign thyroid cyst fluid specimens. They found that the activities of aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and the concentrations of total protein, total bilirubin, and uric acid were highly increased in thyroid cyst fluid specimens when compared with normal human serum specimens. The concentrations of glucose, cholesterol, and triglycerides in cyst fluid were within normal serum limits. Selenium (Se) concentrations in most cyst fluids were low. Moreover, there was no correlation between Se and other biochemical parameters. Protein electrophoresis of cyst fluid specimens yielded high concentrations of alpha 1 and especially alpha 2 globulin fractions indicating an inflammation. The concentrations or activities of biochemical analytes were not significantly different in pure and mixed cysts. Those parameters were also not significantly different between cyst fluids of different colors. The gross appearance of the fluid and the presence of certain biochemical analytes were consistent with a hemorrhagic origin of most of the cyst fluid specimens. However, some biochemical markers indicate that autolysis or necrosis of thyroid tissue may also contribute the composition of thyroid cyst fluid. The reason for lower Se concentration in the thyroid cyst fluid may be the lower Se concentration in the Turkish population. These results also suggest that the fluid color or nature of cyst, e.g., pure or mixed cyst, is not a main determinant of biochemical composition of benign thyroid cyst fluid.
We used sodium dodecyl sulfate-polyacrylamide gel electrophoresis to study cyst fluids from women with breast gross cystic disease. The subjects could be classified into two categories according to the concentrations of protein GCDFP-70 in the cyst fluid: those with Type I cysts had a very low content of this protein; those with Type II cysts had very high concentrations. Analysis of the amino acid sequence of GCDFP-70 from both cyst fluid types confirmed that this protein is human plasma albumin. The average concentration of albumin found in Type I cyst fluids was 0.32 g/L and that corresponding to Type II was 10.16 g/L. Thus, albumin quantification from cyst fluids or analysis by either polyacrylamide or agarose gel electrophoresis provides a simple procedure for classifying these fluids, yielding results that correlate well with previous classifications based on other measurements such as sodium, potassium, and chloride concentrations. This albumin-based quantification method may improve the classification of breast cysts and might be useful in further studies on functional changes in the cysts and their relationship to breast cancer.