Medullary thyroid carcinoma: search for histological predictors of survival (109 proband cases analysis).

A group of 13 pathologists belonging to the French Calcitonin Tumor Study Group (GETC: Groupe d'Etude des Tumeurs à Calcitonine) examined the histological slides and medical records of 109 proband cases of medullary thyroid carcinoma (MTC) diagnosed on clinical features. The cases belonged to the various forms of the disease (80 sporadic and 29 familial MTC). The aim of the study was to detect histological predictors for survival by comparing morphological data from patients killed by the disease versus the others. Twenty-seven histological parameters were considered, including cellular heterogeneity, shape of the cells, and cytoplasmic characteristics. Other parameters such as sex, age, and phenotype of the disease were also studied. First, predictive parameters of interest on survival function were selected by univariate analysis (Mantel-Cox test). Then, the extracted parameters were tested in a multifactorial analysis using the Cox's forward stepping proportional hazard model. Five parameters were significantly associated with a lower survival function: presence of necrosis in the tumor (P = .001), squamous pattern (P = .002), age over 45 years (P = .004), presence of oxyphil cells in the tumor and absence of cells with intermediate cytoplasm (P = .025), less than 50% of calcitonin immunoreactive cells in the tumor (P = .04).

X chromosome variations of Bacillus thuringiensis supernatant resistance and ribosomal DNA content in Drosophila melanogaster wild-type Oregon R lines.

We have used the supernatant of Bacillus thuringiensis cultures to follow variations of the ribosomal DNA content in a wild-type Oregon R line of Drosophila melanogaster. These variations are revealed by differences in the degree of resistance to the lethal effect of the supernatant added in the culture medium. Different X chromosomes, all originated from the same X chromosome, confer different degrees of resistance. Increases and reductions in the number of the X ribosomal DNA transcriptional units have been found and are correlated with variations in the degree of supernatant resistance. However, no significant variations in X rDNA content were observed between the initial line and this line tested 20 generations later. These results show that the X rDNA is subjected to frequent modifications that must be essentially complementary and thus originate from reciprocal molecular events. Variations of resistance have been observed in the absence of recombination between homologous chromosomes; this is in agreement with the hypothesis that unequal recombinations between sister chromatids are largely involved in the variations of the X ribosomal DNA in Oregon R wild-type strains.

High temperature of development and selection of Bacillus thuringiensis-supernatant-resistant females in a Drosophila melanogaster Oregon R strain.

The supernatant of Bacillus thuringiensis cultures contains a thermostable toxin: the beta exotoxin or thuringiensin, which in vivo acts as a preferential inhibitor of ribosomal RNA synthesis. Added to Drosophila melanogaster culture medium, it induces, during the flies' development, a lethal effect that is, in our Oregon R strain, greater for females than for males. The authors have previously shown that a diminution of the ribosomal DNA amount increases the sensitivity to the lethal effect of the supernatant. From a stock subjected for several generations to a 28 degrees C temperature and more, they have spontaneously obtained a variant population where males and females have similar resistance. It is shown here that this difference between the two populations is expressed in the X/X female genotypes, and that there is a correlation between the sensitivity to the lethal effect of the Berliner Bacillus thuringiensis supernatant and the sensitivity to the effect of the 28 degrees C developmental temperature; genotypes resistant to the lethal effect of the temperature were positively selected when the temperature of development was increased. The better resistance of these genotypes could be related to more active ribosomal units on the X chromosome.

Increase in the resistance to the Bacillus thuringiensis supernatant effect in a Drosophila melanogaster wild type Oregon R line.

We report here the genetical and X chromosome rDNA molecular study of two Drosophila melanogaster Oregon R lines. These lines differ extensively in the degree of resistance of the females both to the lethal effect of an increased temperature and to that of Bacillus thuringiensis beta-exotoxin, which is an inhibitor of the nucleolar RNA polymerase. The 3B line, whose females are resistant, came from an Oregon R population subjected over several generations to increased temperature, 28 degrees C or over, while the other line is derived from the initial stock. Twofold variation was observed in the total number of ribosomal genes between the two lines. This variation applied to most ribosomal units, including the active ones. Variations among X chromosome rDNA content in a wild type population have thus been revealed using tests of resistance to the Bacillus thuringiensis beta-exotoxin. Additive variations in specific unit types between the two lines indicate that modifications to the rDNA content are not rare events.

Comparative study of molecular characteristics of X and Y nucleolar organizers of various lines of Drosophila melanogaster.

We have determined for the X chromosomes of 10 laboratory strains and the Y chromosomes of 4 of them both the total number of ribosomal units and the relative percentages of uninterrupted (ins-), type 1 (ins1: with distinction between small ins1S and large ins1L) and type 2 (ins2) interrupted ribosomal units. These studies were made with the DNA extracted from third instar larval diploid tissues (brains and imaginal discs) of X/X female lines or XNO-/Y male lineages (devoid of X ribosomal genes) whose members possess copies of the same initial X or Y chromosome. Between the X chromosomes as well as the Y chromosomes an approximately equal to 2-fold variation was observed in the total number of ribosomal genes: from approximately equal to 200 to 420 for the X chromosomes and from approximately equal to 150 to 330 for the Y ones. The Y chromosomes are devoid of insertion 1 interrupted units, but one can observe some variation in the percentage and hence the absolute numbers of uninterrupted and insertion 2 interrupted units. Among the X chromosomes a very large variation exists between the percentage and absolute number of all the ribosomal unit types; it is to be noted especially that the number of uninterrupted units, which are the only kind of ribosomal genes actively transcribed, can vary from about 20 to 140 without any differences in the development of the different strains.

Comparison between the molecular characteristics and the potential activity of X and Y nucleolar organizers from various Drosophila melanogaster laboratory lines.

The molecular characteristics of nucleolar organizers from X and Y chromosomes of different Drosophila melanogaster lines have previously been studied (17). By analysis of appropriate genetic crosses we show in the present study that the X and Y chromosomes of these lines can confer different degrees of resistance on an inhibitor of ribosomal RNA synthesis (beta exotoxin or thuringiensin) present in the thermostable supernatant of Bacillus thuringiensis cultures. None of the lines studied gives rise to any particular phenotype under normal culture conditions; variations in the degree of supernatant resistance of these lines provide a relative measure of what can be called the potential activity of the nucleolar organizers of the different X and/or Y chromosomes. The potential activity of the Y nucleolar organizers is found to be generally higher than that of the X organizers. This result can be correlated with the fact that the number of uninterrupted ribosomal units is much greater on the Y chromosomes than on the Xs. Significant variations in potential activity have been shown to occur among the X as also among the Y nucleolar organizers. Comparison between the molecular characteristics of the nucleolar organizers and their level of activity shows that among the different ribosomal units, only those devoid of insertion interfere with the level of activity. However, some of our results could also indicate that not all the uninterrupted units have the same level of activity; this level could be related to the size of the nontranscribed spacer of the ribosomal units.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormal genetic segregation associated with the presence of a Y. w+ chromosome in Drosophila melanogaster.

We have observed an abnormal genetic segregation in the progeny of crosses between males of the F71 (y wa/Y.w+) strain and females of various strains carrying marker mutations on their chromosome 2. The Y.w+ chromosome, previously described as possibly being associated with a translocation of the 22D region of chromosome 2, was shown to carry the 21A1-22E4 tip of the 2L chromosome. One chromosome 2 of F71 had a deletion of this region. The abnormal genetic segregation observed in the progeny of different crosses can be explained both by the partial lethality (which becomes severe in some homogeneous genetic backgrounds) due to trisomy of the 21A1-22E4 chromosome 2 fragment and by the lethality associated with monosomy of this 21A1-22E4 segment.

Phaeochromocytoma in multiple endocrine neoplasia type 2 A: survey of 100 cases.

OBJECTIVE: We report clinical, biochemical, morphological and histological data of phaeochromocytoma in 40 French families and in apparently sporadic cases of multiple endocrine neoplasia (MEN) type 2 A (medullary thyroid carcinoma, phaeochromocytoma, with or without hyperparathyroidism). DESIGN: This retrospective study was obtained from cases registered by the 'Groupe d'Etudes des Tumeurs à Calcitonine' from 1968 to 1990. We analysed the cases having sufficiently precise data on phaeochromocytoma with Pigas Software. PATIENTS: Characteristics of phaeochromocytoma in 100 patients with MEN 2 A were reviewed. Phaeochromocytoma was bilateral in 51%. The disease was inherited in 94 patients from 40 families (40 probands, 54 relatives), and was apparently sporadic in six. RESULTS: In this series, diagnostic circumstances were highly suggestive of phaeochromocytoma in 39.8% of the cases, whereas in 43.2%, diagnosis was made through systematic investigations of patients, either before (27.3%) or after (13.6%) thyroidectomy, or after discovery of hyperparathyroidism (2.3%). Fifteen per cent of patients were detected by family screening. Sudden death occurred in 8.9%, malignant phaeochromocytoma in 3%, and ectopic tissue in 4% of the cases. Urinary metanephrines appeared to be the most sensitive screening test. The extent of clinical symptoms was not associated with a particular hormonal pattern. Bilateral adrenalectomy was performed in 60% (in one step in 50%, in two steps in 10%). In these patients, bilateral histological lesions were observed in 92.5%. Simultaneous diagnosis for adrenal and thyroid disease was made in 73.4%, but phaeochromocytoma may be diagnosed before (9.6%) or after (17%) medullary thyroid carcinoma, with an interval greater than 2 years in 25 cases. CONCLUSION: Owing to variable clinical symptoms of phaeochromocytoma in these 100 cases of MEN 2 A, systemic biological adrenal assay is required. The search for phaeochromocytoma in medullary thyroid carcinoma (and vice versa) has to be systematically performed, even in apparently sporadic cases. Screening for phaeochromocytoma must be repeated for years, owing to the frequency of bilateral adrenal disease.

Comparison of sporadic and hereditary forms of medullary thyroid carcinoma.

Between 1960 and 1988, 185 patients with medullary thyroid carcinoma (MTC) were followed at the Institut Gustave Roussy in France. The screening of the family members by calcitonin measurement (basal or after pentagastrin stimulation) has led to the characterization of 38 sporadic cases and 44 hereditary cases. Among the hereditary cases are seven families with MTC only and two families with multiple endocrine neoplasia type 2A (MEN 2A). MTC only cases and MEN 2B cases are present as apparently sporadic forms. Hereditary cases consisted of 26 females and 18 males; the male:female ratio was 21:17 in sporadic cases. Ten of the sporadic patients were deceased (mean age 46 years) compared to three of the hereditary cases (mean age 59 years). The age at diagnosis was 44 years for the sporadic patients and 35 years for the hereditary MTC only patients with clinical manifestations. Histologic data from the sporadic and hereditary patients showed that the tumor is mostly unilateral without C-cell hyperplasia in sporadic cases and bilateral with C-cell hyperplasia in hereditary cases. The location of tumors was quite variable among the sporadic cases and mostly localized to the middle part of the thyroid lobes in the hereditary cases. Our data suggest that the age at diagnosis is later in sporadic forms of MTC and that the age at diagnosis is later in the hereditary forms of MTC only compared to those with MEN 2A.

A second locus for familial generalized epilepsy with febrile seizures plus maps to chromosome 2q21-q33.

We report a clinical and genetic study of a family with a phenotype resembling generalized epilepsy with febrile seizures plus (GEFS+), described by Berkovic and colleagues. Patients express a very variable phenotype combining febrile seizures, generalized seizures often precipitated by fever at age >6 years, and partial seizures, with a variable degree of severity. Linkage analysis has excluded both the beta 1 subunit gene (SCN1B) of a voltage-gated sodium (Na+) channel responsible for GEFS+ and the two loci, FEB1 and FEB2, previously implicated in febrile seizures. A genomewide search, under the assumption of incomplete penetrance at 85% and a phenocopy rate of 5%, permitted identification of a new locus on chromosome 2q21-q33. The maximum pairwise LOD score was 3.00 at recombination fraction 0 for marker D2S2330. Haplotype reconstruction defined a large (22-cM) candidate interval flanked by markers D2S156 and D2S2314. Four genes coding for different isoforms of the alpha-subunit voltage-gated sodium channels (SCN1A, SCN2A1, SCN2A2, and SCN3A) located in this region are strong candidates for the disease gene.

Statistical analysis of histomorphological findings in medullary thyroid carcinoma: distinction between the different familial forms of the disease. G.E.T.C. Groupe d'Etude des Tumeurs a Calcitonine.

A multifactorial analysis of morphological findings was performed on 153 cases of medullary thyroid carcinoma (MTC). The aim of the study was to utilize histological criteria to discriminate between MTC associated with multiple endocrine neoplasia type 2A (MEN 2A) and that associated with the inherited MTC only syndrome. The presence of fusiform cells associated with several other markers seemed to be more predictive of MEN 2A. A comparison of inherited MTC only and sporadic MTC only showed fusiform cells to be significantly less common in inherited MTC only. These results suggest that the inherited MTC only syndrome is a distinct clinical and morphological entity. Further investigations are needed to confirm the findings and understand its implications.

Linkage analysis of 5 novel van der Woude syndrome kindreds to 1q32-q41 markers further supports locus homogeneity of the disease trait.

van der Woude syndrome (vWS, MIM 119300) is a rare autosomal dominant clefting condition with cardinal features of mucous cysts (lower-lip pits) and clefts to the lip and/or palate. The vWS gene has been assigned to a locus in 1q32-q41 by linkage analysis and physical mapping. We have investigated 5 novel vWS families through probands attended for cleft lip and/or palate repair at the Department of Maxillofacial Surgery of Hôpital Trousseau, Paris, in order to tentatively refine the genetic map of the vWS region in 1q32-q41 and possibly identify unlinked pedigrees. Linkage analysis was carried out to 6 microsatellite markers (D1S249, D1S425, D1S491, D1S205, D1S414, D1S425), yielding a maximum cumulative LOD score of Z = 3.27 at theta = 0.00 for D1S245. The innermost four markers were found to be tightly linked to one another, with no evidence for recombination. Our results support linkage of vWS within a region of tightly linked markers and do not favour locus heterogeneity of the disease trait.