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[Evaluation of a new punction needle for transthoracic pulmonary biopsy].

A new percutaneous needle for pulmonary biopsy is described in this report, as well as its clinical applications--showing the different types of material that may be obtained--and the restrictions for its use. The results of using this biopsy needle were examined in 29 cases. Among these patients diagnoses of neoplastic processes--an accuracy of 82.75%--were established, being false or negative only 8.33% of the cases. In the rest of the patients, different kinds of pathological processes were examined (17.25 percent), which were mostly infectious cases. There was a low rate of clinically detectable complications (10.34%), all of them corresponding to pneumothorax.

Adult↗

p53 immunostaining in the differentiation of inflammatory pseudotumor from sarcoma involving the lung.

Inflammatory pseudotumor (IPT) of the lung is a non-neoplastic process that consists of proliferating spindle cells (fibroblasts and myoblasts), with variable numbers of mitoses, and inflammatory cells, particularly plasma cells. These lesions clinically, radiographically, and grossly mimic malignant neoplasms but are usually easily distinguished from malignancy on routine histopathology. However, in occasional cases the proliferating spindle cells may histopathologically mimic sarcoma, particularly on small biopsies and needle aspirates. Strong intranuclear immunopositivity for p53 protein is presumed to be indirect evidence of mutation of the p53 tumor suppressor gene and can be detected in many malignancies. In order to determine the utility of p53 immunostaining in differentiating IPT occurring in the lung from sarcoma involving the lung, we immunostained eight solitary IPTs, one IPT that recurred repeatedly over a 10-year period, six sarcomas (two malignant fibrous histiocytomas, two metastatic high-grade sarcomas, one metastatic alveolar soft part sarcoma, and one fibrosarcoma) involving the lung, and one IPT from which a sarcoma arose 10 years after radiation therapy. Immunohistochemistry was performed on 5-microns formalin-fixed sections using a commercially available antibody to the p53 protein (Biogenex, monoclonal 1:200) and a standard antigen retrieval technique. Weak intranuclear staining occurring in less than 10% of proliferating cells was not considered a true immunopositive. All eight of the solitary IPTs were immunonegative for p53 protein by our criteria. The IPT that recurred a number of times and the IPT from which a sarcoma later developed were also immunonegative for p53 protein. Four of the six sarcomas were immunopositive, as was the postradiation sarcoma arising from a p53-immunonegative IPT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Localized amyloidosis of the genito-urinary tract.

Localized amyloidosis of the uro-genital tract is uncommon. It often simulates a neoplastic process. We describe our experience with three cases of localized amyloid of the bladder and one each of the ureter, prostate and corpora spongiosa.

Adult↗

Waldenström's macroglobulinemia with the AML/MDS-associated t(1;3)(p36;q21).

Two unusual, and perhaps causally related, clinical and cytogenetic features in a patient with Waldenström's macroglobulinemia are presented. Firstly, during the progression of the primary macroglobulinemia bone destruction and hypercalcemia occurred. Secondly, a t(1;3)(p36;q21) was found as the sole clonal chromosomal abnormality. This translocation is characteristic of acute myeloid leukemia (AML) and myelodysplastic syndromes with a high propensity for progressing to AML. The t(1;3) has previously never been reported in a lymphoproliferative disorder. Since the abnormality is associated with acute transformation of cells of the myelopoietic lineages, it is possible that the t(1;3), found in cells of lymphoid origin in the present case, not only induced the neoplastic process as such but also brought about the unusually malignant tumor progression.

Chromosomes, Human, Pair 1↗

99mTc-ADP: a potential agent for in vivo tumor detection.

The possibility of using 99mTc-labelled nucleotides as tumour seeking agents has been proposed by different research groups. We have recently reported the preparation of a 99mTc-ADP complex with a high radiochemical purity (> 95%), good in vitro and in vivo stability and promising biodistribution results when injected in mice bearing spontaneous mammary adenocarcinomas. Here we report the results of further investigations in animals with spontaneous neoplastic processes, including whole-body autoradiography in mice (20 minutes and 60 minutes post injection) and gamma-camera imaging studies in Wistar rats. Dynamic studies (up to 45 minutes) and static images (up to 18 hours) were acquired to determine the pharmacokinetics of 99mTc-ADP and the tumour/muscle and tumour/blood ratios. Blood-pool studies were also performed as a control. Tumours were visualized by autoradiography as was to be expected from the biodistribution studies. Dynamic studies showed a rapid blood clearance and a behaviour that fitted to a tricompartimental model. Radioactivity was rapidly taken up by the kidneys and excreted in the urine. No evidence of in vivo instability of the complex was observed. Tumour uptake reached the maximum values after 20 minutes post-injection. Tumour/blood and tumour/muscle ratios improved over time, enhancing tumour visualization. The best images were obtained after 3 hours post injection. In summary, our studies suggest that 99mTc-ADP is a promising radiopharmaceutical for tumour diagnosis.

Adenosine Diphosphate↗

Glutathione S-transferase isoenzymes and glutathione in renal cell carcinoma and kidney tissue.

Many studies have established the role of the glutathione S-transferases (GSTs) and glutathione (GSH) in the neoplastic process and the drug resistance of tumor. Using isoelectric focusing we separated different forms of GSTs in 28 renal cell carcinomas (RCCs) and in morphologically unchanged adjacent kidney. In addition we determined in RCCs and adjacent kidney the level of GSH and the activities of enzymes participating in synthesis and uptake of this thiol compound. We found higher activity of acidic GSTs and higher level of GSH in RCCs versus kidney. Therefore we suggest that both parameters may play the significant role in the well known phenomenon of intrinsic cytostatic drug resistance of RCC. We also observed the elevation of GSH synthetase activity in tumor tissues in comparison to the kidneys. It may indicate that GSH synthetase, catalysing the final step in GSH synthesis, may participate in the elevation of GSH concentration in RCCs. In this work we also compared the tested parameters in RCCs in relation to the size and local extent of primary tumor (T). We found significantly lower activity of gamma-glutamyl transpeptidase (GGT) as well as GSH synthetase in the group of T3 and T4 tumors than in T2 tumors. However, no substantial differences in GSH concentrations were observed between these distinguished groups.

Adult↗

Retroperitoneal fibrosis treated with tamoxifen.

Retroperitoneal fibrosis, although histologically benign, has a malignant course due to encasement and compression of tubular retroperitoneal structures, particularly the urinary system. The etiology of this neoplastic process is unclear, but clinical symptoms result from fibroblast proliferation with excessive collagen deposition. Because of the diffuse nature of this disease, surgical resection is technically impossible, and past medical therapies have been inconsistent. Tamoxifen has been shown to be effective in the treatment of desmoid tumors, and we present a patient with retroperitoneal fibrosis who was treated successfully with this anti-estrogen. Because of its minimal side effects and simplicity of dosing, tamoxifen may be a useful treatment in this disease.

Female↗

Mature teratoma of the uterine cervix with pulmonary differentiation.

Teratomas of the uterus are very rare, and a uterine teratoma with pulmonary differentiation has not, to our knowledge, been described previously. In this article, we report such a case in a 33-year-old woman, who presented with heavy vaginal bleeding and a polypoid mass of the uterine cervix. The cervical lesion was composed entirely of mature lung tissue, including bronchial, bronchiolar, and alveolar structures. The presence of well-differentiated respiratory epithelial cells, ie, Clara cells and alveolar type II cells, is confirmed by immunohistochemistry. The patient had no history of dilatation and curettage; therefore, implantation of fetal tissue could be excluded from the differential diagnoses. Since this is a newly developed mass in an adult individual, we favor a neoplastic process over heterotopia and interpret the lesion as unilateral lung development in an extragonadal mature teratoma.

Adult↗

Aberrant antigen presentation by macrophages from tumor-bearing mice is involved in the down-regulation of their T cell responses.

Splenic T cells from BALB/c mice bearing mammary adenocarcinomas initially demonstrate a primed response to tumor-associated Ags (TAA), which declines to presensitization levels within 4 wk after tumor implantation. Associated with this decline in responses to TAA is the expansion of a subpopulation of Mac-1+ 2+ splenic macrophages (M phi). These Mac-1+ 2+ cells present TAA inefficiently to normal T cells primed to TAA by footpad injection, as compared with the Ag presenting ability of M phi from normal mice. The addition of anti-I-Ed, but not anti-I-Ad, Ab blocked the ability of Ag-pulsed Mac-1+ 2+ cells to present TAA to primed T cells. The converse was observed with macrophages from normal mice. However, presentation of human gamma-globulin or OVA was restricted by I-Ad molecules when APC from normal mice or tumor bearers were used, although less efficiently in the latter. Using cell depletion techniques, it was determined that the I-Ed-restricted presentation preferentially expanded CD8+ T cells, and not CD4+ cells, as was the case for I-Ad-restricted normal macrophages. These CD8+ cells were poor effectors of cytotoxicity against tumor cells; instead they down-regulated the proliferative activity of T cells. Limiting dilution assays indicated that Mac-1+ 2+ macrophages preferentially present TAA to a low frequency inhibitory T cell population that expanded and inhibited further responses to TAA. Thus, alterations of Ag presentation in tumor bearers may help the tumor to subvert potential beneficial host responses and allow the progression of the neoplastic process.

Adenocarcinoma↗

p53 expression in colorectal adenomas.

To assess the expression of p53 in premalignant lesions, we examined by immunohistochemistry benign colorectal adenomas (n = 72, measuring more than 6 mm and less than 95 mm in diameter) from patients without (group I, n = 23) or with (group II, n = 49) concurrent sporadic colorectal carcinomas. Using a panel of three monoclonal antibodies (PAb 240, PAb 421, PAb 1801) and two polyclonal antibodies (CM1, C19) immunohistological staining was demonstrated in 26% of the cases (19 of 72 adenomas, 7 of 23 from group I and 12 of 49 from group II). In the majority of the cases, p53 positive foci in the adenomas occurred in the most dysplastic areas, although focal positivity was detected in glands that were histologically normal. Expression of p53 protein was also detected in 21 of 30 (70%) colorectal carcinomas of group II. In two cases focal positive staining was observed in the polyps but not in the concurrent carcinomas. Non-neoplastic colonic mucosa and stromal lymphoid cells were negative in all cases examined. Over-expression of p53 in neoplastic tissues detected by immunocytochemistry is generally believed to correlate with the presence of mutation in the gene. This may not be an absolute rule, because in some hemopoietic malignancies, there is evidence that p53 protein may be detectable in the absence of an underlying mutation. These findings therefore represent the highest incidence in colorectal adenomas of abnormalities in the p53 protein expression, probably largely due to underlying mutations. This study also suggests that immunocytochemical demonstration of p53 protein may be a suitable method for the routine detection of subpopulations of cells which, by clonal expansion, could acquire a growth advantage within an adenoma during the neoplastic process.

Adenoma↗

Expression of isoforms of the human receptor tyrosine kinase c-kit in leukemic cell lines and acute myeloid leukemia.

Because mutations in receptor tyrosine kinases may contribute to cellular transformation, studies were undertaken to examine c-kit in human leukemia. Isoforms of c-kit have been characterized in the human megakaryoblastic leukemia cell line M-07. Deletion of the four amino acids Gly-Asn-Asn-Lys in the extracellular domain represents an alternatively spliced isoform that has been shown by others, in mice, to be associated with constitutive receptor autophosphorylation (Reith et al, EMBO J 10:2451, 1991). Additional isoforms differ in the inclusion or exclusion of a serine residue in the interkinase domain, a region that contains the binding site for phosphatidylinositol 3-kinase. By RNase protection analysis, we have shown coexpression of the Gly-Asn-Asn-Lys+ and Gly-Asn-Asn-Lys- isoforms, with dominance of the Gly-Asn-Asn-Lys- transcript, in normal human bone marrow, normal melanocytes, a range of tumor cell lines, and the blasts of 23 patients with acute myeloid leukemia. Analysis of transcripts for the Ser+ and Ser- isoforms also showed coexpression in all normal and leukemic cells examined. The ratios of isoform expression for both the Gly-Asn-Asn-Lys and Ser variants were relatively constant, providing no evidence in the tumors examined that upregulation of one isoform contributes to the neoplastic process.

Amino Acid Sequence↗

[Morphologic and applied aspects of mitotic pathology].

The author presents a classification and descriptions of various forms of pathology of mitosis. Changes in the mitotic regimen following administration of some drugs and under the effect of extreme factors are considered. Data on changes in the number and character of pathological mitoses in viral infection and radiation damage are discussed. Particular attention is given to the analysis of shifts in the mitotic regimen in various benign and malignant hyperplasia. It is shown that malignization (precancer and cancer of the larynx, endometrium, cervix uteri and stomach) is characterized by a rise of the mitotic activity, detection of division in metaphase and by a drastic increase in the number of pathological mitoses. These indices are used in the differential diagnosis of neoplastic processes and for early detection of possible malignization pf precancer hyperplasia.

Cell Line↗

[Use of ifosfamide in multidrug therapy of small cell lung carcinoma].

Own concept of small cell lung carcinoma (SCLC) chemotherapy with multidrug regimen including ifosfamide, adriamycin, and etoposide is presented. In the pilot trial, 67% of remissions in patients with localized, and 33% in patients with disseminated neoplastic process were achieved. Proposed therapy has moderate toxicity, markedly lower than that of the regimen including cis-platin. No nephrotoxicity is worth emphasizing. The authors suggest that proposed regimen may be of value in patients in whom combined chemo- and radiotherapy is foreseen.

Adult↗

[Problems in diagnosis of localized Wegener's lung granuloma].

A case of the localized Wegener's lung granuloma diagnosed with an open lung biopsy in alive patient is presented. Despite the treatment with cyclophosphamide and corticosteroids patient died--probably due to postoperative bacterial complications. This case was discussed on the background of other reports on this rare form of Wegener's lung granuloma frequently simulating neoplastic process. The authors did not find a description of similar localized Wegener's lung granuloma in the Polish literature.

Adult↗

[Lymph-node inflammatory pseudotumor with granulomatous component. Report of a case and review of the literature].

A case of inflammatory pseudotumor of lymph node in a 65 year-old man is described. The case is striking because of a granulomatous component within the lesion, a finding unpreviously described. This lesion, benign by nature, should not be misinterpreted as a neoplastic process, especially lymphomas or soft tissue tumors; problems related to the differential diagnosis are also discussed.

Aged↗

Coexpression of multiple estrogen receptor variant messenger RNAs in normal and neoplastic breast tissues and in MCF-7 cells.

Mammary cancers often develop into a hormone-independent and antagonist-resistant growth phase. The molecular mechanisms of this transition are not clear. Recently, it has been proposed that estrogen receptor variants derived from alternative splicing might lead to dominant positive transcription factors acting on estrogen response elements, even in the absence of the hormone. We show here the comprehensive analysis of expression of estrogen receptor variants lacking internal exons in the estrogen receptor-positive mammary carcinoma cell line MCF-7, in a tumor sample, and in healthy breast tissue taken from reduction surgery. Variants are identified by reverse transcription PCR and hybridization to exon-specific oligonucleotide probes. In MCF-7 cells we detected 10 variants including 5 that have not been described before. Skipping one, two, or three exons occurs. The major variants detected in the cell line are also present in normal and neoplastic tissues. Quantitative variations allow no conclusions of a potential involvement of the variants in neoplastic processes. Rather, the variants appear to be present normally and thus might have a physiological role. Given the expression of the variants in normal tissue, and given the expression of potentially dominant positive variants in conjunction with potentially dominant negative ones, we suggest that these variants do not account for hormone antagonist resistance.

Amino Acid Sequence↗

[Complications of biliary cysts. Apropos of 10 cases].

Ten cases of complications of simple biliary cysts were reported: 4 intracystic haemorrhages including 1 intraperitoneal rupture, 3 bacterial infections including 1 case with invalidating pain. Complications of biliary cysts raises the problem of the differential diagnosis with cysts caused parasites, neoplastic processes (cystadenomas and pseudocysts of the liver) and with intrahepatic collections of pancreatic or traumatic origin. Imaging and echo-guided puncture are the most appropriate exploration techniques. MRI has been particularly helpful to evaluate bleeding in an intrahepatic cyst. A pathology examination of the cyst wall and its contents should always be performed. Theoretically, partial cystectomy (performed here in 8 cases) is the indicated treatment. Total cystectomy (1 case) is justified when the diagnosis of cystadenoma cannot be excluded. The role of liver resection is very limited. Preventive resection of a simple biliary cyst greater than 8 cm can be indicated, particularly with videolaparoscopy.

Adult↗

Growth factors, cytokines and soluble forms of receptor molecules in cancer patients.

A wide range of growth factors has been identified in recent years, some of which have been found to play a crucial role in neoplastic processes. Some tumours produce considerable amounts of these peptides and their requirement for growth factors is often much reduced leading to a degree of autonomy which may itself contribute to tumourigenicity. In addition, growth factors such as TGF-alpha, PDGF, FGF and IGFs have been found to be overexpressed in tumours. The growth factor effector pathway is thus open to intervention, e.g. by blocking the receptor using specific antibodies or interfering with posttranscriptional activation. This is even more evident as oncogenes such as erbB and v-sis encode for growth factor receptors. Soluble receptors, due to high affinity binding, might also be used to sequester growth factors from its specific membrane-bound receptors. Tyrosine-specific protein kinase activity may be inhibited by tyrosine analogues such as erbstatin or by more specific tyrosine-kinase inhibitors. Some therapeutical concepts have already been developed in clinical trials. Tumour necrosis factor (TNF) has successfully been used in extremity melanoma and sarcoma and monoclonal antibodies directed against the EGF receptor has also been applied in patients with advanced squamous lung cancer. Synthetic growth factor analogues which bind to the receptor without eliciting a signal may soon become a supplementary part in cancer treatment. Growth factor action is also blocked by suramin and its analogues and clinical phase I and II trials are underway. These novel therapeutical aspects will profoundly change the nature of cancer treatment.

Antineoplastic Agents↗