The impact of c-kit and ki-67 expression on patients prognosis in advanced ovarian serous carcinoma

The transmembrane-tyrosine-kinase receptor, c-kit, is involved in cell differentiation and has been found to be expressed in normal human cell types and solid tumors. This study was designed to investigate the effects of c-kit expression on: 1) tumor proliferation and apoptosis, and 2) survival in patients with high-grade advanced stage ovarian serous carcinoma (OSC). We identified 118 patients with high-grade advanced stage OSC from our files. Clinical data, including demographics and overall survival, were collected. Immunohistochemical panel consisting of c-kit, ki-67, p53, and bcl-2 was performed. C-kit was categorized as positive if any cytoplasmic or membranous staining pattern was identified. Correlation between c-kit expression and the other markers was performed. Survival analysis was performed using COX proportional hazards regression and Kaplan-Meier test. Of 118 cases, 25 (21.2%) expressed c-kit. Of 93 c-kit-negative tumors, 87.1% had a high proliferation index. High p53 and bcl-2 expression was identified in 96 (81.4%) and 59 (50%) cases respectively. No significant statistical correlation was identified between c-kit and apoptosis markers. Tumors lacking c-kit expression showed a trend toward having high proliferation index, but this did not achieve statistical significance (p = 0.07). Of the seven variables included in the multivariate survival analysis, only c-kit (odds ratio, 2.12; 95% confidence interval, 08-4.17; p = 0.02) and ki-67 (odds ratio, 1.9; 95% confidence interval, 1.1-3.1; p = 0.03) showed an independent statistically significant impact on survival. High-grade advanced stage OSC lacking c-kit expression correlates with poor outcome. Interestingly, cases lacking c-kit expression also showed a trend to have high proliferation index.

Clinical update of smooth muscle tumors of the uterus

Smooth muscle tumors of the uterus represent a spectrum of diseases that range from benign leiomyoma to malignant leiomyosarcoma. The leiomyoma is the most common of these neoplasms. Clinically, it is important to fully understand the differences in clinical presentation, biologic behavior, and management for patients with benign leiomyoma, smooth muscle tumors of uncertain malignant potential, and leiomyosarcoma. The goal of this review is to present the most recent information about common smooth muscle tumors of the uterus including their etiology, histopathology, radiographic and clinical presentations, and available treatment options.

Expression of cyclooxygenase-2 in advanced stage ovarian serous carcinoma: correlation with tumor cell proliferation, apoptosis, angiogenesis, and survival

OBJECTIVE

Cyclo-oxygenase-2 seems to be involved at various steps in the processes of tumor progression. The objective of this study was to examine the relationship between cyclo-oxygenase-2 expression and tumor proliferation, apoptosis and angiogenesis in patients with advanced stage high-grade ovarian carcinoma.

STUDY DESIGN

Specimens from 118 patients with high-grade and advanced stage (III, IV) serous ovarian carcinoma were evaluated by immunohistochemistry for cyclo-oxygenase-2, Ki-67, vascular endothelial growth factor, and bcl-2 expression. Tumor microvessel density was assessed with CD34 immunostaining. We investigated the relationships between cyclo-oxygenase-2 expression and clinicopathologic characteristics, tumor angiogenesis (tumor microvessel density and vascular endothelial growth factor expression), and tumor proliferation and apoptosis. The effect of cyclooxygenase-2 expression on patient survival was determined.

RESULTS

There was a significant positive correlation between cyclo-oxygenase-2 expression in tumor cells and markers of tumor proliferation and angiogenesis. In univariate survival analysis, high cyclo-oxygenase-2 and high Ki-67 expression showed a significant impact of on patient survival (P < .001). In multivariate regression analysis, only Ki-67 expression retained its significance as an independent poor prognostic factor (death hazard ratio, 2.0; 95% CI, 1.2-3.3; P < .001).

CONCLUSION

Expression of cyclo-oxygenase-2 correlates with tumor proliferation and tumor angiogenesis but not with apoptotic markers (bcl-2 expression) in high-grade, advanced-stage serous ovarian carcinoma.

COX-2: a protein with an active role in gynecological cancers

PURPOSE OF REVIEW

Emerging data suggest that COX-2 is involved at various steps of the process of malignant transformation and tumor progression. The current article reviews the latest data linking COX-2 with the various gynecological cancers.

RECENT FINDINGS

COX-2 overexpression has been reported in most gynecological neoplasms, including breast, cervix, endometrial and epithelial ovarian cancers. COX-2 expression promotes tumor cell proliferation, reduces apoptosis and induces angiogenesis. As a result, tumors expressing COX-2 are reported to exhibit a more aggressive phenotype and clinical behavior. Women whose tumors over-express COX-2 tend to have a lower response to standard therapy and shorter survival times. In-vitro studies have shown that COX-2 inhibitors can inhibit tumor cell growth and reduce angiogenesis.

SUMMARY

On the basis of the current data and the clinical availability of safe inhibitors, COX-2 is a perfect target for cancer prevention and therapy. A number of trials are investigating the benefits of combining COX-2 inhibitors with existing treatment modalities in the management of breast, ovarian and cervical cancers. In addition, large prevention trials are in the planning stage.

Lycopene Supplementation Prevents the Development of Spontaneous Smooth Muscle Tumors of the Oviduct in Japanese Quail

Leiomyomas (fibroids) are benign tumors of the uterus affecting millions of women. Spontaneous leiomyomas of the oviduct are common tumors of the Japanese quail (Coturnix coturnix japonica), which makes it a good animal model for screening potential agents for testing in the prevention and treatment of human myoma uteri. Because dietary intake of lycopene has been associated with a reduced risk of a variety of human cancers, we investigated the effects of lycopene supplementation on the development of leiomyomas in the oviduct of Japanese quail. We also measured serum levels of oxidative stress markers [malondialdehyde (MDA) and homocysteine], lycopene, vitamins C, E, and A, and tissue biomarkers Bcl-2 and Bax expression. One hundred twenty quails (6 mo old) were assigned to 3 treatment groups consisting of 4 replicates of 10 birds in each group. Birds were fed either a basal diet (group C) or the basal diet supplemented with 100 mg (group L1) or 200 mg (group L2) of lycopene per kilogram of diet. The animals were sacrificed after 285 days and the tumors were identified. Lycopene supplementation decreased the number of leiomyomas compared with control subjects (P=0.056). The tumors in lycopene-fed birds were smaller than those found in control birds (P=0.01). There were no significant differences in the expression of tissue Bcl-2 and Bax among the study groups. Serum vitamins C, E, and A increased (P=0.01), whereas MDA and homocysteine concentrations decreased (P=0.01) with lycopene supplementation. No measurable lycopene could be detected in the serum of control birds, whereas a dose-dependent increase was observed in the serum of lycopene-supplemented birds. The results indicate that dietary supplementation with lycopene reduces the incidence and size of spontaneously occurring leiomyoma of the oviduct in the Japanese quail. Clinical trials should be conducted to investigate the efficacy of lycopene supplementation in the prevention and treatment of uterine leiomyoma in humans.

Expression of Cox-2, CD34, Bcl-2, and p53 and survival in patients with primary peritoneal serous carcinoma and primary ovarian serous carcinoma

The objective of this study was to compare the immunohistochemical profile and clinical course of primary peritoneal serous carcinoma (PPC) and primary ovarian serous carcinoma (OSC). These entities are virtually indistinguishable morphologically, but their differential molecular and clinical features are incompletely characterized. Twenty-nine cases of high-grade, high-stage PPC and 96 cases of stage matched OSCs were compared. PPC was identified based on the criteria proposed by the Gynecologic Oncology Group. The tumors were staged according to International Federation of Gynecology and Obstetrics criteria for ovarian cancer and graded according to World Health Organization criteria. Expression of Cox-2, CD-34, bcl-2, and p53 was compared in the two tumors and correlated with clinical data including stage, age, race, and overall survival. Although the median survival, using Kaplan-Meier test, of patients with OSC (1060 days, 35.3 months) was longer than those with PPC (708 days, 23.6 months) the difference was not statistically significant. However, Cox-2 expression was correlated with microvessel density in PPC (p=0.026) and OSC cases (p=0.005), and high expression of Cox-2 correlated with lower survival rate in OSC cases (p=0.045) but not in PPC cases (p=0.12). These findings, coupled with the morphologic overlap existing between OSC and PPC, support the view that they represent related pathologic entities.

Pathogenesis of invasive micropapillary carcinoma: role of MUC1 glycoprotein

Invasive micropapillary carcinoma, a tumor with highly infiltrative characteristics is defined by a distinctive cleft formation around the neoplastic cell clusters which is presumably a result of the detachment of the cells from the stroma due to as yet undetermined factors. Ultrastructural examination performed on a handful of cases demonstrated an unexpected secretory activity in the stroma-facing surface of the cells. MUC1 is a glycoprotein typically expressed in the apical surface of normal epithelial cells, responsible for maintaining lumen formation. In conventional adenocarcinomas, MUC1 expression is largely intracytoplasmic, intercellular, or apical (in glandular areas). The MUC1 expression pattern was investigated by immunohistochemical staining in invasive micropapillary carcinoma of breast (n=11), pancreas (n=5), gynecologic tract (n=11) and urinary bladder (n=10). The results were contrasted with the staining pattern in conventional carcinomas of the same organs (n=202). In all invasive micropapillary carcinoma, MUC1 expression was predominantly in the stroma-facing surface of the cell clusters (basal), accentuating the outlines of the micropapillary units by forming a distinct band on this surface. In conventional carcinoma the labeling was mostly apical in areas with lumen formation and intracytoplasmic and intercellular in the poorly differentiated areas. In conclusion, in the micropapillary pattern of invasive carcinoma, the expression of MUC1, is largely limited to the basal surface of the cells in contrast to conventional carcinomas in which MUC1 is largely apical, intracytoplasmic or intercellular. This provides support for the reversal of cell orientation as an important factor of the morphogenesis and possibly the pathogenesis of invasive micropapillary carcinoma. Since MUC1 is known to have a role in lumen formation, and has an inhibitory role in the cell to stroma interaction, it is conceivable that it is a key factor in the detachment of cells from stroma allowing for the dissection of the connective tissue and easing the spread of cells.

Apoptosis, Proliferation, and Expression of p53 and bcl-2 in Endocervical Glandular Intraepithelial Lesions and Invasive Endocervical Adenocarcinoma

We evaluated apoptosis, proliferation, and p53 and bcl-2 expression in a spectrum of intraepithelial and invasive endocervical glandular lesions currently recognized by the World Health Organization as adenocarcinoma in situ, lesions with atypia "less than adenocarcinoma in situ" (endocervical glandular dysplasia and endocervical glandular atypia), and invasive adenocarcinoma. Aside from nuclear atypia, increased mitotic activity and apoptosis are consistent and closely correlated morphologic features of endocervical adenocarcinoma in situ. Apoptotic bodies and mitotic figures were counted in 32 examples of normal endocervical glands, 35 of endocervical glandular atypia, 30 of endocervical glandular dysplasia, 34 of adenocarcinoma in situ, and 30 of invasive adenocarcinoma. These results were correlated with immunohistochemical staining for MIB1, bcl-2, and p53 performed on 20 examples of each. Mitotic counts, p53 expression, and bcl-2 expression all increased significantly and in proportion to the degree of atypia in the spectrum of endocervical lesions. Apoptotic body counts and MIB1 expression also increased significantly with increasing atypia, but showed higher levels in adenocarcinoma in situ than in invasive adenocarcinoma. Apoptosis correlates with proliferation as measured by mitotic counts and MIB1, and also with p53 and bcl-2 expression. Apoptosis appears to be an important mechanism in the pathogenesis of endocervical glandular lesions and may be useful as an aid in their evaluation and diagnosis.

The effect of cyclooxygenase-2 expression on tumor vascularity in advanced stage ovarian serous carcinoma

BACKGROUND

Cyclooxygenase-2 (COX-2) seems to be involved at various steps in the processes of malignant transformation and tumor progression. Investigations have shown that COX-2 overexpression is associated with increased proliferation, reduced apoptosis, and angiogenesis.

METHODS

Specimens from 125 patients with high-grade, advanced-stage (Stage III-IV) serous ovarian carcinoma were evaluated by immunohistochemistry for COX-2, p53, bcl-2, epidermal growth factor receptor (EGFR), and Her-2/neu expression and for CD34-stained microvessel density (MVD). Statistical analysis was performed to investigate the correlations between COX-2 expression and 1) clinicopathologic characteristics, 2) tumor MVD, and 3) expression of other molecular markers. The effect of COX-2 expression on survival was determined using survival analysis.

RESULTS

Increased COX-2 expression was significantly correlated with tumor MVD (Spearman rank correlation test: r = 0.41; P < 0.001). There was no association observed between COX-2 expression and expression levels of EGFR, Her-2/neu, bcl-2, or p53. Patients who had tumors that showed high COX-2 expression had a worse prognosis compared with patients who had tumors with low expression (death hazard ratio, 2.0; 95% confidence interval, 1.2-3.5; P < 0.001). A multivariate analysis revealed that COX-2 expression was the strongest predictor of survival among the different prognostic factors analyzed.

CONCLUSIONS

The current study demonstrated that COX-2 expression was correlated significantly with survival in patients with high-grade, high-stage serous ovarian carcinoma. Expression of COX-2 also was correlated with tumor angiogenesis but not with EGFR, Her-2/neu, or p53 expression. In addition to their prognostic significance, a better understanding of the biology of these molecular changes may help identify new targets for therapy in patients with ovarian carcinoma.

Use of ThinPrep monolayer technique and cytospin preparation in urine cytology: a comparative analysis

We compared the ThinPrep (TP) technique to the cytospin (CS) preparation in the cytological diagnosis of urine by processing 79 specimens by these two techniques. Ten cases were positive for malignancy (six high grade (HG)/carcinoma in situ; four low grade (LG) transitional cell carcinomas (TCC)). Forty-eight cases were within normal limits (59%) and 21 cases had atypical cytological features (19%). The TP technique was better in terms of a cleaner background with fewer obscuring inflammatory cells and blood and with a more even distribution of cells. In general, the cytomorphology was comparable in both techniques. However, in cases with malignancy, CS was relatively superior in the cytomorphologic details; in TP, the diagnostic cells were mostly dispersed as single cells with loss of architectural features and were difficult to find. Artifactual empty spaces and air-drying were more frequently present in TP. In cases contaminated with squamous cells, the urothelial cells were difficult to find in TP. Screening time was comparable for both techniques. In conclusion, to avoid false-negative diagnosis, CS would be complementary to the TP technique in malignant cases and, in particular, those with low cellularity.

Clinicopathologic analysis of breast lesions associated with multiple papillomas

We performed a retrospective clinicopathologic study of 28 patients with breast lesions characterized by the presence of multiple (at least 5) papillomas (MPs) in at least 2 nonconsecutive blocks. All histologic sections were assessed for the presence of coexisting fibrocystic lesions, including atypical hyperplasia (atypical ductal hyperplasia [ADH] or atypical lobular hyperplasia [ALH]), lobular carcinoma in situ (LCIS), and papillary atypia (defined as nuclear hyperchromatism, stratification, and architectural complexity of a lesser degree than in papillary carcinoma). All of the lesions were compared with a set of cases in which ductal carcinoma in situ (DCIS) (n = 20) or invasive carcinoma (INV)(n = 13) was accompanied by MPs. The MP cases had a characteristic morphologic appearance, typically presenting as a mass comprising multiple adjacent ducts filled by papillomas, accompanied by dense fibrosis and intermingled with various proliferative fibrocystic lesions, particularly florid adenosis. Atypical hyperplasia was a frequent finding (in 12 of 28 cases; 43%), particularly in cases with atypical papillomas (7 of 11; 63.6%). Although contralateral lesions occurred in 4 of 28 patients (14.2%; 3 MPs and 1 INV), only 1 patient (4%) has developed ipsilateral breast carcinoma (mean follow-up, 47 months). DCIS associated with MP was typically low grade (17 of 20; 85%) and arose from areas within or immediately adjacent to preexisting benign lesions. None has recurred (mean follow-up, 41 months), although 1 patient has contralateral MP and 3 patients (23%) have developed carcinomas in the opposite breast. INVs developing in a background of (ipsilateral) MPs were mostly small (8 of 11 <2.0 cm), node negative (7 of 10), and estrogen receptor (ER) positive (8 of 8). Only 1 of 13 patients (8%) has died from disease (mean follow-up, 59 months), but 5 (38%) have developed contralateral breast lesions (including 1 MP, 1 MP-DCIS, 1 DCIS, 1 LCIS, and 1 INV). We conclude that the frequent associations with ADH, ALH/LCIS, malignant lesions, and bilaterality imply that MP may represent a marker of constitutionally increased breast cancer risk. Because carcinomas arose within or close to areas involved by preexisting benign MP lesions, it may also be appropriate to excise segments of tissue involved by MP, particularly cases with atypia, and closely monitor for contralateral disease.