Identification of prekeratin by immunofluorescence staining in the differential diagnosis of tumors.

Fibrillar proteins with a role in cellular shape and motility are present in the cytoplasm of most animal cells. They vary greatly in size, organization, and reactivity according to cell type and can be separately identified by the use of recently developed monospecific antisera and indirect immunofluorescence staining. Prekeratin, a structural protein in the form of intermediate sized filaments is present exclusively in cells of epithelial origin. In the present study 41 human tumors of various organs and their normal tissue counterparts were reacted with prekeratin antiserum and examined by immunofluorescence staining in paraffin embedded sections. Prekeratin was identified in all epithelial cells of the squamous type, which gave the strongest staining reaction, and in smaller amounts in epithelial cells of other histologic types. Cells of lymphoid, melanic, neural, and connective tissue origin were not stained. Thus, combining the specificity of antiprekeratin sera with the selectivity of immunofluorescence staining resulted in a new method of identifying tissues that is applicable to the differential diagnosis of tumors.

Drill biopsy in the diagnosis of metastic and primary neoplasms of lymph nodes.

The author analyses the results of 300 drill biopsies, performed on peripheral lymph nodes of 266 patients. The usefulness of this method in the histological diagnosis of metastatic and primary neoplasms of lymph nodes is assessed. Drill biopsy proves to be especially valuable in the diagnosis of metastatic cancer. By means of the first biopsy, 90.4% of cases of metastatic cancer were diagnosed. In the great majority of cases, the histological type of metastatic neoplasms was precisely defined. Accuracy in the diagnosis of malignant lymphomas was lower. Drill biopsy of peripheral lymph nodes can be performed in outpatients.

Immunohistological patterns of immunoglobulins in dysplasias, benign neoplasms and carcinomas of the breast.

IgA, IgG, IgM and IgE were studied in 61 carcinomas, 24 tissues peripheral to carcinomas, 16 benign neoplasms and 15 dysplasias of the breast. Mono- and double-layer direct immunofluorescence procedures applying FITC- and TRITC-conjugated antisera were used on cryostat and paraffin sections for evaluation of immunoglobulins in plasma cells, cancer cells and ductal epithelium. Plasma cells of all Ig classes were more frequent in carcinomas, especially of medullary and poorly differentiated ductal types, than in benign lesions. In all groups of benign lesions and in carcinomas with scanty lymphocytes and plasma cells there was a predominance of IgA-synthesizing plasma cells. Carcinomas with marked local response had an increased proportion of IgG cells. IgE plasma cells were rare. IgA and IgM were more frequent in ductal epithelium than in cancer cells, especially of poorly differentiated tumors. No appreciable IgG was observed in ductal or cancer cells. Our results indicate a correlation between immunohistologic patterns of immunoglobulins and histologic characteristics of carcinomas.

Estrogen and progestin receptor levels in uterine leiomyomata: relation to the tumour histology and the phase of menstrual cycle.

Estrogen receptor (ER) and progestin receptor (PR) levels in the myometria and uterine leiomyomata of 26 normally menstruating women were studied. No significant menstrual cycle-related change in ER level was found in the leiomyomata or normal myometria. The ER levels in normal myometria and in cellular leiomyomata, but not in usual leiomyomata, tended to be higher in the follicular phase than in the luteal one. The "cytosolic" PR levels in cellular leiomyomata and in usual leiomyomata with no or with slight hyalinization as well as in their parental myometria were significantly lower in the luteal than in the follicular phase. This was not the case in usual leiomyomata with more intense hyalinization. The findings show that the reactivity of uterine leiomyomata to estrogens and/or progestins may be related to the histological features of the tumors. This should be realized when studying the steroid receptor levels in the tumours and possibly also when planning an endocrine therapy for the leiomyomata.

Immunoreactive and estrogen-binding estrogen receptors, and progestin receptor levels in uterine leiomyomata and their parental myometrium.

Estrogen receptor (ER) and progestin receptor (PR) levels in the myometria and uterine leiomyomata of forty-four women were studied. A radio-ligand method and an immuno-enzymatic method were used for ER measurement, and only a radio-ligand method was used for PR measurement. The leiomyomata contained significantly more PR and estrogen-binding ER than their parental myometria but not the immunoreactive ER per mg of DNA. Nuclear extracts from the myometria contained a high amount of the estrogen-nonbinding immunoreactive ER; in the leiomyomata, the bulk of this particular ER fraction was extracted with cytosol. Dissimilar distribution patterns of immunoreactive, estrogen-nonbinding ER in leiomyomata and normal myometria suggest that an impaired metabolism of ER may contribute to myoma growth.

Sebaceous metaplasia in the uterine cervix.

Three cases of an extremely rare occurrence of sebaceous glands in the cervix have been reported. Our findings suggest that these glands develop by sebaceous metaplasia in the regenerative epithelium of ectocervical origin.

Tumor-like intravascular proliferations of the stroma in adenomyosis.

Two hundred cases of adenomyosis have been studied in order to clarify the origin and significance of intravascular endometrial tissue in adenomyosis. A tumor-like intravascular proliferation of the adenomyotic stroma (IVSP) has been found in 17.5% of the cases. An endolymphatic proliferation (35 cases) was occasionally accompanied by an intravenous proliferation (3 cases). IVSP originated from a perivascular stromal proliferation (PVSP) and occurred only in deep adenomyosis. IVSP was focal and showed no atypia. It was significantly most frequent in patients 50-53 years of age and more frequent in patients up to 53 years than in those over 53. The frequency of occurrence of PVSP and IVSP was related to the histologic features of adenomyosis and the endometrium and was highest in hyperplastic adenomyosis and in adenomyosis accompanied by hyperplasia of the endometrium. The study suggests that PVSP and IVSP develop in the areas of adenomyotic stroma stimulated by estrogen and nonresponsive to progesterone. The differential diagnosis of tumor-like and sarcomatous IVSP, and histogenesis of adenomyosis are discussed.

Endometrial stromal neoplasms of the uterus. A clinicopathologic study.

A clinicopathologic study of uterine endometrial stromal tumors (EST) has been performed with special emphasis on histologic and immunohistochemical differential criteria and prognostic factors. The material comprised three stromal nodules (SN), twelve low grade stromal sarcomas (LGESS) and five high grade stromal sarcomas (HGESS). Previously unreported endolymphatic growth was found within one SN. EST showed an association of mitotic index (IM) with atypia, degree of stromal differentiation, additional non-stromal differentiation and venous invasion. IM was the best criterion in the differential diagnosis of LGESS and HGESS and the most significant histologic prognosticator. The present study shows that a histologic grade of stromal sarcoma was a more significant prognostic factor than pTNM stage. The results suggested that clinicopathologic classification of EST could be supplemented by including the following subgroups: a) SN--without intravascular growth, and potentially malignant SN--with endolymphatic growth within the tumor; b) LGESS with IM < 2 and no atypia, and LGESS with 2 > IM < 10 and mild atypia; c) HGESS with 10 > IM < 20 and moderate atypia, and HGESS with IM > 20 and marked atypia. Contrary to common view these observations indicate that the distinction of some SN and LGESS from stromal hyperplasia is possible in an endometrial curretage material.

Malignant giant cell tumor associated with leiomyosarcoma of the uterus.

A unique association of uterine malignant giant cell tumor (MGCT) with leiomyosarcoma (LMS) is described. Contrary to the true mixed sarcomas, they appeared as two adjacent tumors with distinctly different gross, histologic, ultrastructural, and immunohistochemical features and little intermixing at their border. The dissemination of MGCT resulted in the fatal outcome 81 days after hysterectomy. Malignant giant cell tumor and LMS were coexistent neoplasms, which derived probably from different progenitor cells. It is suggested that MGCT could develop in association with preexisting LMS.

Lipomatous neometaplasia of the uterus. Report of 11 cases with discussion of histogenesis and pathogenesis.

Eleven cases of uterine lipomatous neometaplasia were studied. The patients ranged in age from 41 to 74 years (mean, 56.6 years). There were eight lipoleiomyomas and 3 angiolipoleiomyomas. In eight tumors the lipomatous component consisted only of mature lipocytes. In three tumors, pericapillary differentiating lipocytes also occurred. No correlation between the proportion of the lipomatous and leiomyomatous components and the size of tumor was observed. There was also no correlation between the amount and distribution of the lipomatous component and the hyalinized fibrous stroma. The levels of cytosolic estrogen and progesterone receptors, studied in one case, were lower in the lipoleiomyoma than in the myometrium. Leiomyomas and adenomyosis were the most frequent accompanying lesions. The study supports a notion that uterine lipomatous neometaplasia originates from pericapillary pluripotential mesenchymal cells. Present findings suggest that lipomatous differentiation of immature neoplastic cells can occur in a preexisting leiomyoma, as well as simultaneously with leiomyomatous differentiation.

Usefulness of drill biopsy in the diagnosis of breast tumors.

A retrospective study was undertaken to analyze the usefulness of 600 drill biopsies taken from 557 breast tumors. Based on the first biopsy, the malignant or benign nature of the tumor was accurately estimated in 93.6% of the cases. A diagnosis of cancer was established microscopically in 87.4% of the tumors. In our opinion, this method proved to be valuable and is recommended for outpatient clinics.

Bartholin's gland mixed carcinoma predominantly of the transitional cell type following radiotherapy for a cervical carcinoma.

An unusual case is described of Bartholin's gland carcinoma which developed 28 years after radiotherapy for a cervical carcinoma. The tumor showed three-directional differentiation with predominance of the papillary non-invasive transitional cell pattern.