The prognostic significance of beta human chorionic gonadotrophin and its metabolites in women with cervical carcinoma.

AIMS: To examine long term survival of women with primary and recurrent cervical carcinoma in relation to (1) excretion of beta-core (a urinary metabolite of beta human chorionic gonadotrophin (beta hCG)) and (2) beta hCG immunostaining of the tumours, to determine the suitability of these markers for assessing prognosis. METHODS: This was a prospective observational study undertaken in a gynaecological oncology centre: 57 women with primary cervical cancer and 42 with recurrent disease were recruited between January 1990 and September 1992. Kaplan-Meier survival analysis with the log rank test was used to assess survival differences with survival rate given per year of follow up. RESULTS: In primary disease, the four year survival for the beta-core negative group was 79%, compared with 14% for the beta-core positive group (p = 0.001). This was still significant for early stage disease or squamous lesions alone. In recurrent disease, beta-core positivity was not prognostically significant. Immunohistochemistry was of no prognostic significance in either group. CONCLUSIONS: beta-core excretion appears to be useful in assessing prognosis of primary cervical cancer but not of recurrent disease. A large prospective study of urinary beta-core in early stage cervical cancer is needed to determine whether it can be used as an index for modifying treatment.

The relationship of Ki67 and involucrin expression in proliferative, pre-neoplastic and neoplastic skin.

In normal skin, proliferation and differentiation are tightly coupled in order to maintain normal architecture in a continually renewing tissue. The temporal and spatial relationships between these two processes in normal, psoriatic, pre-neoplastic and neoplastic skin were investigated by a double immunolabelling technique with Ki67 as a marker of proliferation and involucrin as a marker of terminal differentiation. In normal skin, expression of the two antigens was strictly spatially segregated. In the abnormal, the proportions of cells expressing the antigens were increased with some loss of the spatial segregation, while small numbers of cells showed dual expression suggesting loss of the normal control between proliferation and differentiation. However, the quantitative ratio of proliferation to differentiation in psoriatic and pre-neoplastic skin was similar to the normal; transition to an invasive phenotype, however, was associated with a reversal of this ratio, and this correlated well with the degree of histological differentiation.

Is the incidence of primary adenocarcinoma of the lung increasing?

Primary carcinoma of the bronchus is a major cause of death in males and females. Several studies report an increase in the incidence of adenocarcinoma and have suggested that this reflects changes in smoking habits or, alternatively, that it is a spurious rise due to changes in diagnostic criteria. To examine the latter suggestion we reviewed three cohorts of bronchial carcinoma from 1970, 1980 and 1990, using immunocytochemical techniques to refine diagnosis. We found that squamous cell carcinoma had been consistently overdiagnosed and adenocarcinoma and adenosquamous carcinoma consistently underdiagnosed in all groups. Also, many tumours showed evidence of divergent differentiation with both squamous and glandular components present. There was a small, but real temporal increase in the proportion of adenocarcinoma over the 10 years between 1970 and 1980, but this was not sustained between 1980 and 1990.

HTLV-1 polymyositis.

The case is described of an HTLV-1 seropositive Jamaican woman who presented with signs and symptoms of polymyositis and myelopathy. A muscle biopsy showed features of myositis with a mononuclear inflammatory infiltrate, variation in fibre size and evidence of regeneration. Immunocytochemistry showed the mononuclear cells were composed of macrophages and T-lymphocytes suggesting a cell-mediated response. Multiplex PCR demonstrated the presence of the HTLV-1 tax gene within the muscle.

HTLV-1 polymyositis

The case is described of an HTLV-1 seropositive Jamaican woman who presented with signs and symptoms of polymyositis and myelopathy. A muscle biopsy showed features of myositis with a mononuclear inflammatory infiltrate, variation in fibre size and evidence of regeneration. Immunocytochemistry showed the mononuclear cells were composed of macrophages and T-lymphocytes suggesting a cell-mediated response. Multiplex PCR demonstrated the presence of the HTLV-I tax gene within the muscle. (AU)

Focal myositis: a clinicopathological study.

Focal myositis is a rare, benign inflammatory condition that may clinically simulate a soft tissue sarcoma. It was first described in 1977 and around 30 cases have been reported to date. We report two further cases on which we have performed immunocytochemistry and electron microscopy. Histology of both lesions was identical, showing a destructive inflammatory myopathy with evidence of regeneration. Stains for micro-organisms were negative and no viral particles were seen on electron microscopy. The immunocytochemical profile of our two cases differed from that of polymyositis: with a panel of T- and B-cell markers the cellular infiltrate was found to be composed of T-lymphocytes and variable numbers of macrophages: sub-typing in one case revealed the T-cells to be predominantly CD4+ cells. Use of antibodies to MHC class 1 and 2 antigens showed occasional positive inflammatory cells only. Clinicopathological correlations and the differential diagnosis are discussed.

Sebaceous carcinoma arising within an ovarian cystic mature teratoma.

A 77-year-old woman presented with an abdominal swelling and underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy for a left ovarian tumor. This was an ovarian mature cystic teratoma in which had developed a sebaceous cell carcinoma. This is a rare form of ovarian malignancy whose behavior is poorly documented. The treatment and follow-up of this case are discussed.

Role of the basement membrane in the regeneration of skeletal muscle.

In many experimental models of skeletal muscle damage and in human muscle disease, empty basement membrane tubes remain following the destruction of muscle fibres. In the present study we test the hypothesis that the empty basement membrane tubes play an essential role in the orientation of regenerating muscle fibres. Two groups of 15 Wistar rats were used. In one group, aqueous barium chloride (BaCl2) solution was injected into the right quadriceps muscle; in the other group, freshly prepared 2% trypsin solution was similarly injected. The different stages of muscle cell necrosis and regeneration were observed by histology, by immunofluorescence using an anti-basement membrane antibody, and by transmission (TEM) and scanning electron microscopy (SEM) in animals killed 1-77 days following injection. Although there was muscle fibre necrosis at sites of BaCl2 injection, empty basement membrane tubes were well preserved. Myoblasts grew along the empty basement membrane tubes and by 77 days, the regenerated muscle fibres at the site of the injection were well oriented. Trypsin not only destroyed muscle fibres but also destroyed the basement membrane tubes; in the early stages of regeneration the myoblasts were disorientated but by 77 days, regeneration was comparable to that seen in the barium chloride injected muscle. The results of this study suggest that preservation of empty basement membrane tubes is not essential for the orientation of regenerating myoblasts in skeletal muscle.