Cellular events accompanying regression of skin recurrences of breast carcinomas treated with intralesional injections of natural interferons alpha and gamma.

Cutaneous recurrences of breast carcinomas were treated with 10 i.l. injections of nIFNs alpha and gamma delivered in combination (7 lesions) or singly (11 with nIFN-alpha, one with nIFN-gamma). Histologically confirmed complete regressions occurred in 5 of 7 lesions treated with nIFN-alpha/nIFN-gamma and in 5 of 11 recurrences injected with nIFN-alpha alone. In all cases specimens were obtained before and after therapy. In addition, in some cases (4 treated with nIFN-alpha/nIFN-gamma, 2 with nIFN-alpha, one with nIFN-gamma) multiple recurrences were injected simultaneously and were excised 24 h after 1, 3, and 10 injections and 21 days after completion of therapy. The main findings observed in the treated lesions undergoing complete and partial regressions included: (a) inhibition of mitotic activity and up-regulation of antigenic expression (mammary epithelial membrane antigen, intercellular adhesion molecule 1, HLA-DR) by the carcinoma cells; (b) activation of macrophages and dendrocytes with marked expression of HLA-DR and HLA-A,B,C; (c) infiltration of the dermis and tumors by activated T-lymphocytes (CD3+, CD4+, CD8+); (d) questionable participation by B-lymphocytes and natural killer cells; (e) activation of endothelium with enhancement of antigenic expression (intercellular adhesion molecule 1, HLA-DR), procoagulant activity, and vascular permeability. The responses elicited by nIFN-alpha/nIFN-gamma were greater than those caused by either IFN used alone. It appears that in these patients the IFNs exerted an antiproliferative action and potentiated a cell-mediated immunological response liminally present in the neoplastic tissues prior to therapy.

Regression of human breast cancer xenografts in response to intralesional treatment with interferons alpha and gamma potentiated by tumor necrosis factor.

The potentiating effects of human recombinant tumor necrosis factor-alpha (rTNF-alpha) on the antitumor actions of recombinant interferon-gamma (rIFN-gamma) and of natural interferons alpha and gamma combined (nIFN-alpha/nIFN-gamma) were studied on human breast cancer xenografts growing bilaterally in nude mice. The cytokines were injected singly or in combination in one of the two tumors of each mouse to study local effects while the opposite tumor was left undisturbed to evaluate systemic effects. The tumors received 20 intralesional injections (four cycles of 5 daily injections each). In injected tumors the best results were obtained with nIFN-alpha/nIFN-gamma supplemented with rTNF-alpha. The responses were dose dependent, resulting in complete regression of 9 of 9 tumors with rTNF-alpha used at the dose of 5 micrograms per injection, of 6 of 8 tumors at the dose of 2.5 micrograms, and of 4 of 8 tumors at the dose of 0.5 microgram. Mostly mild to moderate partial responses were seen in the other groups. The systemic effects on the contralateral tumors were significantly less than the local effects on the corresponding tumors. Histologically, responding tumors showed reactive fibrosis and inflammatory cell infiltration. No vascular alterations were seen, presumably because of the immunodeficiency of nude mice. It was concluded that the potentiation of the antitumor actions of IFNs by rTNF-alpha was effective at the local but not at the systemic level.

Immunostaining of estrogen receptor in paraffin sections of breast carcinomas using monoclonal antibody D75P3 gamma: effects of fixation.

Immunostaining of estrogen receptor was carried out on paraffin sections of breast carcinomas using an anti-estrophilin monoclonal antibody (D75P3 gamma) and the avidin-biotin technique. The tumors were fixed in Bouin's solution or in formalin for varying periods of time at room temperature or at 4 degrees C. Best results were obtained following fixation in Bouin's at room temperature or in formalin at 4 degrees C. The staining was localized in the nuclei of carcinoma cells and was heterogeneous in intensity and extent. Prolonged fixation resulted in decreased immunoreactivity and in the appearance of nonspecific cytoplasmic and background staining. The estrogen receptor immunostaining on paraffin sections was found to be in concordance with that on frozen sections (Abbott ER-ICA) and with the steroid-binding assay (dextran-coated charcoal) in over 90% of the cases. This method is of easy and rapid execution and yields reliable and reproducible results.

MRI findings in two cases of acute facial paralysis.

This article describes the use of magnetic resonance imaging (MRI) in the evaluation of the facial nerve paralysis of Bell's palsy and herpes zoster oticus. Identification of the nature of inflammatory facial nerve paralysis often presents a diagnostic dilemma. The site of involvement along the course of the nerve may have importance when treatment options are being considered. We have found MRI to be a unique method for localizing the site of nerve injury in both Bell's palsy and Ramsay Hunt syndrome.

Interferon crosses blood-cerebrospinal fluid barrier in monkeys.

Interferon was detected in the cerebrospinal fluid (CSF) of monkeys injected iv or im with 30 million units of human leukocyte interferon. The im injection maintained a long-lasting plateau at about 1/30th of the corresponding level of interferon in the serum. Interferon injected into the serum. Interferon injected into the cerebrospinal canal was cleared from CSF at a similar rate as it disappeared from blood after iv administration of a high dose. A relatively stable serum level was maintained for 12-24 hr after the injection of interferon into the CSF space.

Antiproliferative effects of natural interferon beta alone and in combination with natural interferon gamma on human breast carcinomas in nude mice.

Nude mice bearing bilateral xenografts of human breast carcinoma cells (MCF-7 and BT20) were treated with 2 or 45-day cycles of intralesional (i.l.) injections of human natural interferon beta (nIFN-beta) alone or in combination with human natural interferon gamma (nIFN-gamma). The injections were administered to only 1 of the 2 tumors in each animal, thus making it possible to assess at the same time local therapeutic effects in the injected tumors and systemic effects in the contralateral ones. When n-IFN-beta was used as a single agent only mild local antitumor effects and virtually no systemic effects were observed. In contrast, the combined administration of nIFN-beta/nIFN-gamma produced marked antiproliferative effects, presumably as a result of the synergistic action of type I and type II IFNs. These effects ranged from complete regression documented histologically in 2 MCF-7 tumors to varying degrees of growth inhibition with persistence of residual microscopic or grossly detectable tumor. Local effects were more pronounced than systemic effects. The therapeutic efficacy of nIFN-beta proved to be greater than that of recombinant interferon beta (rIFN-beta). In MCF-7 tumors nIFN-beta appeared to be less effective than nIFN-alpha, whereas the opposite was true for BT20 tumors.

Treatment of human breast cancer xenografts using natural interferons-alpha and -gamma injected singly or in combination.

Natural interferons (nIFNs) -alpha and -gamma were used to treat nude mice bearing bilateral xenografts of human breast cancer cells (MCF-7 and BT 20). The IFNs were administered singly or in combination by means of intralesional (i.l.) or intraperitoneal (i.p.) injections. In the animals treated intralesionally 1 of the 2 tumors was injected to study the local therapeutic effects, while the contralateral one was left undisturbed and used to assess systemic effects. Treatment of MCF-7 tumors with i.l. injections of nIFN-alpha and nIFN-gamma combined resulted in complete regression of the injected tumors in 8 of 20 mice treated for 2 weeks and in 10 of 10 mice of an additional group treated for 4 weeks. The corresponding contralateral tumors showed complete regression in 2 mice treated for 4 weeks and partial responses in the others. Incomplete responses were also observed when the IFNs were used singly or when they were delivered intraperitoneally. Similarly, in BT 20 xenografts the best results were obtained with i.l. injections of the 2 IFNs combined, but no complete regressions were achieved. These experiments provide further evidence for a synergistic interaction of nIFN-alpha and nIFN-gamma in vivo and indicate that the potentiated antitumoral activity is greater when these interferons are administered i.l.

Effects of intralesional injections of interferons-alpha on xenografts of human mammary carcinoma cells (BT20 and MCF-7).

The effects of intralesional injections of human natural and recombinant interferons-alpha (nIFN-alpha and rIFN-alpha A) were studied in nude mice bearing bilateral xenografts of human mammary carcinoma cells (BT 20, MCF-7). One tumor of each animal received intralesional injections, while the contralateral tumor was left undisturbed. Thus, the injected tumors were subjected to the local action of the IFNs whereas the opposite ones were exposed to the systemic effects of the IFNs seeping into the subcutaneous tissue following the intratumoral injection. When used singly these IFNs exerted an inhibitory effect on the growth of both injected and contralateral tumors, but failed to cause complete regression. Many of the cells of treated BT 20 xenografts showed significant morphological alterations (increased cell volume and nuclear pleomorphism) as compared to the untreated controls. Morphological alterations in MCF-7 tumors were difficult to assess because of the inherent pleomorphism of these cells. The immunoreactivity of BT 20 and MCF-7 tumors to monoclonal antibodies directed against milk fat globule proteins and against HLA antigens was not appreciably affected by treatment with these IFNs. This study confirms that intralesional injections of human IFNs-alpha partially inhibit the growth of human breast cancer xenografts, probably through a direct effect on the carcinoma cells. Under the present experimental conditions, the intralesional and the subcutaneous routes of administration appear to offer comparable antitumor effectiveness.

Tumor to fascia margin as a factor in local recurrence after modified radical mastectomy.

A new problem has arisen for surgeons now that the pectoralis major muscle is routinely left in place after mastectomy. When the pathologist reports a tumor close to the fascial margin, there has been uncertainty regarding the significance of this finding. In the present study, the histories of 346 women with negative nodes who underwent modified radical mastectomy and had an uninvolved plane under the breast were reviewed. The distance from tumor to fascia was recorded by the pathologist, and the patients were divided into "Close" and "Not Close" groups. The "Close" group (90 patients) had tumors within one low power field (4 millimeters) of the fascia while the "Not Close" group (256 patients) had tumors more than 4 millimeters from the fascial margin. Twelve of the patients had local recurrence within an average follow-up period of 47 months, and a variety of analyses failed to show a statistically significant difference in local recurrence rates between the two groups. The results of this study indicate that tumor to fascia margin, as recorded by the pathologist, is not a strong determinant of local recurrence provided the areolar plane between the breast and the underlying fascia appears uninvolved at the time of mastectomy.

The extent and distribution of cancer in breasts with palpable primary tumors.

The term multicentricity has been employed to describe cancer cells beyond the borders of the primary tumor. However, it is not clear if there are multiple independent sites of origin or if the process simply represents spread of the cancer. The present study was designed to examine the distribution and extent of cancer in the breast and identify factors that bear on these events. All mastectomy specimens between 1980 and 1983 were systematically examined by means of multiple sections. One hundred seventy-nine of 657 patients (27%) were found to have separate foci. The most common histologic type (invasive ductal) was least likely to have multifocal disease (19%), while it was extremely common in the small group of patients with intraductal lesions (81%). Size was a factor in ductal but not in lobular lesions. Ninety per cent of the secondary foci were found in close proximity to the primary, suggesting spread rather than multicentricity. This implies a more limited and predictable distribution of cancer cells and opens the way to more rational selection and surgical preparation of patients for breast preservation.

Immunohistochemical assessment of estrogen and progesterone receptors in stored imprints and cryostat sections of breast carcinomas.

A peroxidase-antiperoxidase technique was used to visualize estrogen and progesterone receptors in stored imprints and cryostat sections of breast carcinomas that were prepared at the time of biopsy or frozen section diagnosis. This was done to provide an alternate technique for the assessment of the receptor status of tumors that could not be adequately assayed with other biochemical or immunocytological methods. Fixation in Zamboni's fixative followed by passage through cold methanol and acetone before storage at -80 C insured good preservation of the receptor proteins over extended periods of time (up to 56 weeks). Immunostaining of these stored preparations with monoclonal antibodies against estrogen receptor (H222) and progesterone receptor (JZB39 and KD68) showed a high degree of correspondence with immunocytochemical assays (ER-ICA and PR-ICA) and biochemical analysis. This technique is easy to perform and provides reliable information, even in tumors that are too small and/or ill defined to permit separate sampling for receptor assays.