Prostatic carcinoma with endocrine features. A report of a neoplasm containing multiple immunoreactive hormonal substances

A case of prostatic carcinoma with the cellular patterns of an adenocarcinoma and carcinoid tumor is reported. The tumor contained ultrastructural dense core neuroendocrine granules, and immunoperoxidase staining revealed prostatic acid phosphatase, prostatic-specific antigen, chromogranin, neuron-specific enolase, serotonin, adrenocorticotrophic hormone (ACTH), somatostatin, parathormone, calcitonin, bombesin, and glucagon but no insulin. The patient had exhibited hypercalcemia that may have been related to hormone production by the tumor. The literature on the endocrine aspect of the prostate and its tumor is reviewed.

Pituitary tumors containing cholecystokinin

We found small amounts of cholecystokinin in the normal human adenohypophysis and therefore examined pituitary tumors from 87 patients with acromegaly, Cushing's disease, Nelson's syndrome, prolactinoma, or inactive pituitary adenomas. Five adenomas associated with Nelson's syndrome contained increased amounts of cholecystokinin, the concentrations being extremely high in two: 8281 and 13,453 pmol per gram as compared with less than 30 pmol per gram in normal pituitary glands. The cholecystokinin concentrations were moderately increased in adenomas from another 12 patients, of whom 5 had Cushing's disease and 7 acromegaly with adenomas containing ACTH. The cholecystokinin peptides from the tumors were smaller and less sulfated than cholecystokinin from normal pituitary glands. We conclude that ACTH-producing pituitary cells may also produce an altered form of cholecystokinin.

Phosphorylation of the glycoprotein hormone alpha-subunit secreted by human tumor cell lines

The synthesis of ectopic proteins by tumors is thought to result from derepression of normally silent genes. One approach to a better understanding of this phenomenon is to characterize the physicochemical properties of the ectopic products, comparing them to their normal counterparts. In the following communication, evidence will be presented to indicate that the glycoprotein hormone alpha-subunits secreted by a number of human tumor cell lines are phosphorylated. This novel covalent modification occurs in cell lines derived from both trophoblastic (JAR, JEG) and nontrophoblastic (HeLa, ChaGo) tumors. A choriocarcinoma cell line (JAR), which secretes both hCG-alpha and hCG-beta, phosphorylates only the alpha-subunit.

Argyrophil cells in Brenner tumors: histochemical and immunohistochemical analysis

Argyrophil cells were identified by the single-impregnation Grimelius technique in 11 of 28 (39%) Brenner tumors, accounting for less than 1% of the tumor cell population in all the cases. All tumors with argyrophil cells were stained to demonstrate calcitonin, somatostatin, gastrin, adrenocorticotropic hormone, neurotensin, insulin, glucagon, and serotonin; and four of them (three benign and one borderline) were also stained for chromogranins with the monoclonal antibody LK2H10. Serotonin was present in nine of the 11 cases with argyrophil cells. Neurotensin and somatostatin were found in one borderline tumor, which also contained serotonin. Chromogranin reactivity was demonstrated in all four cases in which it was examined. Ultrastructural examination of one tumor revealed that the argyrophil cells contained secretory granules, 80 nm in diameter, and had elongated cytoplasmic processes that extended between the more numerous nonargyrophil tumor cells. The argyrophil cells of Brenner tumors are similar to those of urothelium in the frequency with which they are immunoreactive for serotonin and the rarity with which they are reactive for peptide hormones. These cells differ from those of mucinous ovarian tumors, which often contain both serotonin and peptide hormones. The findings of this study lend additional support to the close similarity of the epithelial components of Brenner tumors and urothelium.

Evidence of hybrid cell of thyroid follicular cell and carcinoid cell in strumal carcinoid

A strumal carcinoid associated with mature cystic teratoma of the ovary in a 59-year-old was investigated immunohistochemically and electron microscopically. Histologically it was composed largely of trabecular and partly of insular carcinoid and individual thyroid follicles. Intensive argyrophilia was shown in both the cells of carcinoid tumor and follicular structure. Thyroglobulin was strongly positive in the follicular lining epithelium and weakly positive in the carcinoid cells adjacent to the follicular area. Immunoreactive cells for somatostatin and prostatic acid phosphatase were strongly detected in the carcinoid area and gradually blended to the follicular epithelium. Methionine-enkephalin, glicentin, and pancreatic polypeptide were focally detected in the carcinoid area. Whereas calcitonin-positive cells were sparsely observed in the follicular area, carcinoembryonic antigen and serotonin were absolutely negative. Electron microscopic findings revealed abundant neurosecretory granules, microfilaments, and colloid-like droplets in the same cells. We suggest that these hybrid cells are the origin of strumal carcinoid.

Somatostatin and adrenocorticotrophic hormone like immunoreactivity in small cell carcinoma of the lung

The immunocytological detection of adrenocorticotrophic hormone (ACTH) and somatotropin release inhibitor factor (SRIF) like immunoreactivity was carried out on tumour cells from bronchial brush smears in 39 cases of lung tumours. Results obtained were compared with the cytological and histological diagnosis and confirmed the high incidence of ACTH synthesis by malignant bronchial carcinoma cells: the same phenomenon also seems to occur for somatostatin. The concomitant detection of ACTH and SRIF like immunoreactivity seems to be highly suggestive of small cell carcinoma and indicates that the immunocytological detection of hormones carried out at the same time as cytological examination can improve the accuracy of the diagnosis.

Immunocytochemical demonstration of growth hormone-releasing factor in gastrointestinal and pancreatic endocrine tumors

Growth hormone-releasing factor (GRF), a linear peptide that exists in a number of different molecular forms (GRF-44, -40, -37, and-31) has been shown to be responsible for the acromegaly associated with certain endocrine tumors of the pancreas and other foregut-derived structures. With the use of two anti-sera (#1A850 and G59/901) directed against different segments of the GRF molecule, a series of 24 pancreatic and 35 gastrointestinal endocrine tumors, not associated with acromegaly, were surveyed systematically for immunocytochemical localization of GRF in the tumor cells. Strong immunoreactivity for GRF was encountered in 10 tumors (6 pancreatic and 4 gastrointestinal). While all ten tumors were immunoreactive against G59/901, which recognizes GRF-44, -40, and -37, two jejunal carcinoids showed additional immunostaining with 1A850 that is specific for GRF-44. Seven of these ten tumors were also immunoreactive for a variety of other regulatory peptides and neurotransmitters, including gastrin, insulin, glucagon, serotonin, substance P, somatostatin, pancreatic polypeptide, vasoactive intestinal peptide (VIP), and adrenocorticotropic hormone (ACTH). No consistent pattern of association between GRF and the other regulatory substances was evident. These findings indicate that, even in the absence of associated acromegaly, up to 17% of endocrine tumors of the gastro-entero-pancreatic (GEP) axis show immunoreactivity for GRF and that such reactivity is associated more frequently with pancreatic (25%) than with gastrointestinal (11%) endocrine tumors.

Immunoreactive somatostatin and calcitonin in pulmonary neuroendocrine tumor

A well-differentiated neuroendocrine carcinoma of the lung that secreted immunoreactive somatostatin (IR-SRIF) and IR-calcitonin (CT) in a 72-year-old women is described. The plasma concentrations of IR-SRIF (57.5 pg/ml) and IR-CT (340 pg/ml) before operation were significantly higher than the respective normal ranges. After resection of the tumor, the plasma CT level (105 pg/ml) decreased to within the normal range, and the SRIF level (32.7 pg/ml) also decreased, but was still abnormally higher, which suggested the presence of an unidentified remnant of the tumor. Abnormal accumulation of technetium 99m (99mTc) in the lumbar vertebrae was found 6 months after the operation, which indicated a metastatic tumor. The tissue concentrations of IR-SRIF and IR-CT were 103 and 94 ng/g wet weight, respectively, and SRIF-IR tumor cells and CT-IR tumor cells were demonstrated immunohistochemically. On gel-filtration chromatography of the tumor tissue, two peaks of SRIF immunoreactivity were eluted in the positions of synthetic SRIF-28 and SRIF-14, respectively. Conversion of SRIF-28 to SRIF-14 was suggested from results on changes in the two IR-SRIF components during incubation with a crude enzyme preparation extracted from the tumor tissue.

Immunohistochemical localization and chromatographic characterization of human chorionic gonadotropin in a bladder carcinoma

We describe a patient with advanced bladder carcinoma, in which ectopic synthesis and secretion of human chorionic gonadotropinlike immunoreactivity (ihCG) was demonstrated. Concanavalin A-sepharose affinity chromatography of serum revealed that the ihCG differed from placental human chorionic gonadotropin in its carbohydrate moiety. Treatment of the patient with a cisplatin-containing regimen did not result in regression of the tumor. Since immunohistochemistry revealed ihCG in five of 13 additional cases of bladder carcinoma, it is concluded that ectopic production of ihCG by bladder carcinomas is probably not rare.

Production of beta-human chorionic gonadotrophin by human squamous carcinoma cell lines

Eight out of 9 human squamous carcinoma cell lines ectopically secrete the beta subunit of human chorionic gonadotrophin (beta-HCG) in amounts detectable by radioimmunoassay. In contrast, both normal and SV40-transformed keratinocytes show no such evidence of beta-HCG secretion. Ectopic beta-HCG is identical in its gel exclusion and high-performance liquid chromatographic properties to placental beta-HCG and, in radioimmunoassay, yields a dilution curve parallel to that of placental beta-HCG. Dibutyryl cyclic AMP, but not sodium butyrate, stimulates beta-HCG secretion by the one human cell line examined, LICR-LON-HN-5, suggesting that ectopic production by these cells is similar to trophoblastic beta-HCG secretion, and differs from most other non-trophoblastic cell lines previously examined.

Eutopic and ectopic macromolecular human placental lactogen

Macromolecular forms of human placental lactogen have received little attention because it has been thought that such forms either compose only a small fraction of total immunoactive placental lactogen or are merely laboratory artifacts. We examined serum and placental tissue from women with normal pregnancy (first and third trimesters), serum and tissue from women with eutopic tumors (mole and choriocarcinoma), and serum from men with ectopic placental lactogen production. Samples were chromatographed on dextran gel (Sephadex G-100), and placental lactogen was measured in the fractions by radioimmunoassay. In all specimens examined, immunoactive placental lactogen was found at the void volume of the column (molecular weight greater than 150,000 daltons). This macromolecular placental lactogen comprised less than 4% of total placental lactogen in the third trimester, in mole, and in 16 of 18 first-trimester samples but was significantly higher, up to 19%, in the malignant cases. In two first-trimester placental extracts (but not in their matched sera) macromolecular placental lactogen was the dominant (greater than 45% of the total placental lactogen) immunoactive species. Authentic monomeric placental lactogen was not converted to macromolecular placental lactogen by repeated freezing and thawing. Third-trimester placental macromolecular placental lactogen was unstable; only 13% remained at the void on rechromatography. First-trimester placental macromolecular placental lactogen, on the other hand, was stable to rechromatography. The behavior of immunochemical dilutions of macromolecular placental lactogen from first-trimester placenta was similar to that of monomeric placental lactogen in the same sample. Macromolecular placental lactogen is probably not artifact, and it can comprise a large fraction of the total immunoactive placental lactogen in certain conditions.

The carbohydrate on human chorionic gonadotropin produced by cancer cells

Using the methods described, it is not possible to determine the number of N- and O-linked oligosaccharides on ectopic hCG beta. On standard hCG beta there are two NeuAc residues on each N- and O-linked oligosaccharide, so that the number of NeuAc residues is proportional to the number of oligosaccharides. Ectopic hCG beta and desialylated ectopic hCG beta are of similar molecular size to the standard preparations (gel filtration and RIA with anti-CTP antisera, data not presented). This suggests that ectopic hCG beta is sialylated to a similar extent as standard hCG beta, so the number of oligosaccharides on ectopic hCG beta could be similar to the number on standard hCG beta. There is a Fuc attached to the N-linked oligosaccharides of standard hCG beta (Fig. 3). Using the methods described, it was not possible to determine if this residue is also found on the N-linked oligosaccharides of ectopic hCG beta. Recently, a second form of ectopic hCG beta was identified (22). This form lacks the characteristic hCG beta carboxyterminal peptide, and as such is unrecognized by the RIA used in this study. Like the ectopic hCG beta described herein, and that produced by other cancers, this molecule only partially binds to Con A, and binds to Ricinus communis-120 following neuraminidase digestion. Intact hCG and free hCG subunits, which only partially bind to Con A, are found in cancer tissues, cancer sera, and the medium of cultured trophoblastic and nontrophoblastic cancer cells (Table 1). Our studies with DoT cancer of the cervix cells clearly indicate that the partial binding could be the consequence of the linkage of extra beta G1cNAc residues.

New horizons in hCG detection

The advent of high technology in the field of hCG measurement has created a greater requirement for high expertise in the analysis and evaluation of hCG levels, particularly low-positive levels, and for the concomitant clinical management of the patient. This implies an imperative to treat trophoblastic disease patients in trophoblast disease referral centers.

Human hypothalamic growth hormone releasing factor (GRF): evidence for two forms identical to tumor derived GRF-44-NH2 and GRF-40

Human hypothalamic growth hormone-releasing factor (GRF) was purified by gel filtration and reverse-phase HPLC. Bioassay and two radioimmunoassays of different specificity revealed the presence of two major forms of GRF-activity which coelute with human pancreas GRFs, hpGRF-44-NH2 and hpGRF-40 previously characterized in pancreas tumors. The bioactive material coeluting with hpGRF-44-NH2 is recognized by two antibodies which are directed against the amidated COOH-terminal sequence and the central portion of the GRF-44 peptide. The bioactive GRF which coelutes with hpGRF-40 reacts only with the antibody directed against the central portion of hpGRF. These data strongly suggest that the human hypothalamus contains the same major forms of GRF that were identified in pancreas tumors responsible for acromegaly in the absence of a pituitary tumor.

Endocrine tumors of the duodenum. Clinical characteristics and hormone content

Nineteen patients with primary duodenal carcinoid were analysed retrospectively, and eight of the tumors were immunocytochemically examined. One tumor contained somatostatin, two tumors gastrin, two tumors both these peptides, and one tumor contained serotonin. In two tumors no peptide or amine could be demonstrated. Eight patients had ulcer symptoms and nine had gallstone disease. Only four patients had metastatic spread in spite of long delay. Five-year survival was 75% in 12 operated patients. No patient died of the tumor per se. It is concluded that a simple excision seems justified when the tumor is smaller than 2 cm, while probably more extensive surgery is needed when the tumor is larger or when there is local spread. Modern techniques of histofluorescence and immunocytochemistry facilitating a more precise classification will probably result in a better understanding as to symptomatology, prognosis, and making possible better treatment in the heterogenous group of carcinoid tumors.