Serum carcinoembryonic antigen in relation to survival, DNA ploidy pattern, and recurrent disease in 406 colorectal carcinoma patients.

Serum carcinoembryonic antigen (CEA) levels in relation to survival, flow cytometric DNA ploidy pattern, Dukes stage, and recurrent disease was prospectively evaluated in 406 patients with colorectal carcinoma. In 246 patients (61%) the carcinomas were DNA aneuploid. Increased preoperative CEA levels (> 5 micrograms/l) were found in 151 of 363 evaluable patients (42%). Dukes stage-B patients with preoperative CEA elevation showed significantly poorer prognosis than those with normal CEA values (p = 0.001). A weak but significant correlation was found between preoperative CEA level and Dukes stage (Kendall's tau = 0.25, p < 0.01). Of 50 evaluable patients with clinical recurrence and postoperative normal or normalized CEA levels, 28 (56%) had a rise in CEA before or at the time of clinical recurrence. The sensitivity of the CEA test for primary and for recurrent disease was not significantly different in the DNA aneuploid and the DNA near-diploid groups.

Association between DNA ploidy pattern and cellular atypia in colorectal carcinomas. A new clinical application of DNA flow cytometric study?

Fresh tissue specimens from 406 colorectal carcinomas were analyzed by DNA flow cytometric study, and the DNA ploidy pattern was compared with Dukes' stage, histologic grade, and degree of cellular atypia. Sixty-one percent of the carcinomas had a distinct aneuploid DNA pattern. The proportion of aneuploid carcinomas was significantly higher in the advanced Dukes' stages than in the localized ones. A highly significant association was found between DNA ploidy pattern and degree of cellular atypia, whereas no association was demonstrated between DNA ploidy pattern and histologic grade. This finding might indicate that cellular atypia has a stronger prognostic impact than the growth pattern of the tumor. The authors suggest that flow cytometric DNA quantification may replace assessment of cellular atypia in the histologic evaluation. Furthermore, together with earlier findings by others, these results indicate that the degree of cellular atypia may be conserved during the development from adenomas to carcinomas.

[Cancer of the pancreatic head and the periampullary region]. / Karsinom i caput pancreatis og periampullaert.

Between 1976 and 1988, 16 patients underwent a Whipple resection or total pancreatectomy for carcinoma of the head of the pancreas, the ampulla of Vater or the distal common bile duct. Nine patients had carcinoma of the pancreas. Two of these patients are long-term survivors. The tumors in these patients were highly differentiated and localized close to the common bile duct. Four had ampullary lesions, and are all alive today. Three patients had carcinoma of the common bile duct. One of these patients is alive.

[The polyposis project]. / Polyposeprosjektet.

A research project initiated in 1978 comprised establishment of a national polyposis registry, a genetic linkage study using classical and DNA markers, an in vitro study of fibroblasts for transformation parameters and chromosome instability, and a comparative study of DNA-RFLPs in cancer and constitutional tissue. The linkage study (to be reported elsewhere) confirmed the recently reported close linkage between the polyposis gene locus APC and D5S71. No in vitro test for the presence of the APC gene has been confirmed or revealed, but we detected increased chromosomal instability on a statistical basis and also recorded abnormal DNA-repair. As per 1. January 1988 the prevalence of adenomatosis of colon and rectum in Norway was 1/43,500. Among patients born in the period 1931-1950 the incidence at birth of developing the disease is 1/20,000 and the mutation rate is 1/72,000 per gamete per generation. In Norway new mutants in healthy families will comprise 1/3-1/2 of all new cases in the coming two decades, or one of 36,000 births.

Plasma CEA in large bowel carcinoma: which patients should be followed by regular postoperative measurements? Preliminary follow-up results in 100 patients with different tumor DNA-ploidy patterns.

In 100 patients with large bowel carcinomas, the tumors were divided into a distinctly aneuploid (AN) group (63) and a near diploid (ND) group (37) by flow cytometric (FCM) DNA quantitation of cell suspensions. Preoperative plasma CEA levels were determined in all patients. Thirty-eight patients with AN and 28 patients with ND tumors were operated on for cure and had normal plasma CEA levels postoperatively. These two groups had regular CEA plasma measurements as part of the clinical follow-up. In the AN group, 12 of 15 patients have had recurrence preceded by CEA elevation. In the ND group, however, only one of eight recurrences was preceded by a rise in CEA level; the one with elevation also had increased plasma CEA prior to operation. It thus seems that a low CEA output of ND tumors explains many of the "false-negative" CEA measurements in disseminated cases. It is concluded that, in addition to patients with an elevated preoperative plasma CEA level, all patients with aneuploid tumors should be subjected to repeated plasma CEA measurements as part of the follow-up program.

Immunohistochemical study of secretory component, secretory IgA and carcinoembryonic antigen in large bowel carcinomas.

The epithelium of 41 large bowel carcinomas was scored immunohistochemically on a semiquantitative basis for the presence of secretory component (SC), secretory IgA, and carcinoembryonic antigen (CEA). Both the tumour and the adjacent "transitional mucosa" were evaluated. The various immunofluorescence scores obtained, the histological grades of the tumours, their Dukes' stages, and the plasma CEA levels were subjected to non-parametric correlation analyses. Tumour SC was positively correlated with histological tumour grade and inversely related to Dukes' stage. Tumour secretory IgA generally showed a pattern similar to that of SC. Tumour CEA showed no correlation with any of the other parameters. The contents of SC and secretory IgA in the transitional mucosa were negatively correlated with Dukes' stage and plasma CEA. Whether the variations observed in the epithelial cell markers reflected primary events in the malignant development or secondary alterations is unknown. Nevertheless, especially the amount of tumour SC may turn out to be of prognostic value.

Giant pseudopolyposis causing colonic obstruction. Report of a case seemingly associated with Crohn's disease of the colon.

Gian pseudopolyposis is uncommon and only one obstructive case has previously been reported. In that case the underlying disease was ulcerative colitis while the present case seemed associated with Crohn's disease. Clinically this condition imitates a malignant tumour, and because of the rarity we failed to reach the right preoperative diagnosis in spite of correct colonoscopy and biopsy findings.

Hyperparathyroidism in uremia and after kidney transplantation.

From 1969 until the end of 1976, 376 patients have had kidney transplants in our department. Fourteen patients have had subtotal parathyroidectomy done, either in their uremic phase or after a successfull kidney transplantation. All patients, except one, who had an adenoma, had varying degrees of hyperplasia of the glands. The postoperative results were satisfying in 10 patients. 3 patients is medically substituted for hypoparathyroidism while one still is hypercalcemic. There was no operative mortality and no surgical complications.

Colon perforation in renal transplant patients.

Six patients with spontaneous colonic perforation after cadaveric kidney transplantation are described. Five perforations occurred in a diverticulum of the sigmoid colon, while one was at the suture line after a colotomy performed 5 months previously. Four patients died. Clinical diagnosis was difficult, but on x-ray examination free air in the abdominal cavity was found in 3 patients. Explorative laparotomy should be performed promptly when the diagnosis is suspected. All patients above the age of 4o should be screened with a barium enema prior to transplantation.