ABH blood group isoantigen expression in breast carcinomas--an immunohistochemical evaluation using monoclonal antibodies

Clinical Associations with ABO Blood Group and Rhesus Blood Group Status in Patients with Breast Cancer: A Nationwide Retrospective Study of 3,944 Breast Cancer Patients in Turkey

Background

The aim of this study was to investigate the association between A, B, O, Rhesus (Rh)-positive and Rh-negative blood groups and breast cancer in a nationwide cohort of 3,944 patients in Turkey.

Material/Methods

A retrospective study included 3,944 patients diagnosed with breast cancer between 2004 and 2015 and with known blood type. Clinical and demographic patient data included age, sex, body mass index (BMI), menopausal status. The breast tumor type, size, grade, TNM stage, and the presence of lymph node and distant metastases were noted. Histopathology of the breast tumors had included routine detection of human epidermal growth factor receptor 2 (HER2) and estrogen receptor (ER) levels.

Results

The 3,944 patients with breast cancer were blood group, type A, B, O, and Rh-positive or Rh-negative; the median age was 47.9 years (range, 18.2–89.6 years); 99.5% (3923/3,844) were women, and 0.5% (21/3944) were men. Patients with blood type 0 had a significantly smaller tumor size compared with patients with blood types A or B. There were no significant differences between blood groups and patient age, BMI, menopausal status, tumor histology, ER status, HER2 status, lymph node and distant metastasis. However, there was a significant difference in the prevalence of lobular breast cancer, levels of ER-positive tumor cells, and prevalence of cases with tumor metastases in Rh-positive patients compared with Rh-negative patients.

Conclusions

The findings of this retrospective study showed that the type, grade, stage, and hormonal status of breast cancer showed no significant associations with ABO blood grouping.

Prognostic value of ABO blood types in young patients with breast cancer; a nationwide study in Korean Breast Cancer Society

The purpose of this study was to investigate the relationship between ABO blood types and breast cancer survival in young Korean patients. This was a retrospective study of 115,474 patients who were surgically treated for primary breast cancer between 1987 and 2011 in Korea. All data were collected by the Korean Breast Cancer Society (KBCS) online breast cancer registry. Each hospital serologically examined the ABO blood types of patients before surgery. There was no significant difference in overall survival (OS) or breast cancer-specific survival (BCSS) among ABO blood types. Type of surgery; T stage; N stage; histologic grade; status of estrogen receptor, progesterone receptor, and HER2; and chemotherapy were significant prognostic factors of OS and BCSS in univariate analysis and multivariate analyses. Compared to women with blood type O, there was a difference in OS and BCSS for blood type A, blood type B, or blood type AB. Compared to blood group non-O, patients with blood group O were more likely to have favorable prognosis when younger than 40 years. Further follow-up studies are necessary to clarify the role of the impact of ABO blood types on prognosis of breast cancer.

ABO blood type/Rh factor and the incidence and outcomes for patients with triple-negative breast cancer

INTRODUCTION

Triple-negative breast cancer (TNBC) has a poorer prognosis; the factors that contribute to this remain unclear. We hypothesized that TNBC is associated with ABO blood type/Rh factors that account for differences in survival.

METHODS

We identified 468 patients with stage I-III TNBC [estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2 nonamplified]. Patient/tumor characteristics, treatments, and outcomes were obtained. Data were examined for associations with specific ABO blood type/Rh factors. Descriptive statistics and χ (2) analysis were utilized for data summary and comparisons.

RESULTS

Of 468 TNBC patients, 283 had known ABO blood type [122 (43 %) O, 108 (38 %) A, 39 (14 %) B, and 14 (5 %) AB] and Rh factor [253 (89 %) positive and 30 (11 %) negative]. Mean patient age was 53.7 ± 12.5 years, and median follow-up was 30.2 ± 20.5 months. The incidence of each ABO blood type/Rh factor in our TNBC cohort was not different from the general population or a cohort of ER-positive breast cancers (P > 0.05). Compared with patients with blood type O, there was no difference in breast cancer-specific mortality for type A [hazard ratio (HR) 0.906; 95 % confidence interval (CI) 0.554-1.481], type B (HR 1.534; 95 % CI 0.792-2.972), or type AB (HR 0.488; 95 % CI 0.113-2.106). Compared with women with negative Rh, there was no difference in breast cancer-specific mortality for women with positive Rh (HR 1.161; 95 % CI 0.568-2.374).

CONCLUSIONS

TNBC was not associated with a specific ABO blood type or Rh factor. Our results failed to demonstrate an association between ABO blood type/Rh factor and breast cancer mortality in patients with TNBC.

ABH and Lewis histo-blood group antigens in cancer

Antigens of the ABH and Lewis histo-blood group family can be found on many normal cells, mainly of epithelial type. In carcinomas, altered expression of the various carbohydrate epitopes of this family occur, and are often strongly associated with either a good or bad prognosis. A review of the available data on these tumor-associated markers, their biosynthesis and their prognostic value is proposed here. For a long time it has been unclear whether their presence could affect the behavior of carcinoma cells. Recent data, however, indicate that they play biological roles in the course of tumor progression. The presence of sialyl-Le(a) or sialyl-Le(x), which are ligands for selectins, promotes the metastatic process by facilitating interaction with the endothelium of distant organs. The loss of A and B antigens increases cellular motility, while the presence of H epitopes increases resistance to apoptosis by mechanisms that remain to be defined. The Le(y) antigen has procoagulant and angiogenic activities. All these observations are used to present a model that may account for the described associations between the presence or loss of these markers and the outcome of disease. Finally, their potential clinical applications as tumor-associated markers or as targets of immunotherapy are reviewed.

Inhibition of MT-450 rat mammary tumour growth by antibodies recognising subtypes of blood group antigen B

Using subtractive immunization to identify cell surface epitopes expressed in a metastasis-specific fashion on cells of the rat MT-W9 mammary carcinoma model, we generated a monoclonal antibody called M-N#1. This antibody binds specifically to metastasizing cells of the MT-W9 series and also to certain other metastasizing rat mammary carcinoma cell lines. We demonstrate that the M-N#1 antibody recognizes a fucosylated N-glycosyl sugar modification, and furthermore show that the epitope specificity of the M-N#1 antibody is for blood group antigen B subtypes 2, 3 and 4 with slight cross-reactivity with blood group antigen A subtype 2. The expression of these carbohydrate epitopes on MT-450 cells is functionally important, because the M-N#1 antibody efficiently inhibits MT-450 tumour growth in spontaneous metastasis assays. These results suggest that expression of the subtypes of blood group antigen B recognized by the M-N#1 antibody does not directly participate in the metastatic cascade but rather confers a growth or survival advantage on the tumour cells.

Immunohistochemical expression of ABH/Lewis-related antigens in primary breast carcinomas and metastatic lymph node lesions

The expression of blood group antigens A, B, and H, as well as sialylated and nonsialylated forms of Lewis(a) and Lewis(x), was studied using immunohistochemical methods in normal and tumor tissues in the following cohort of patients: 51 patients with primary breast carcinoma, 13 with metastatic lymph node lesions, and 16 with benign tumors of the breast. As a control, normal tissue was obtained from a similar group of 22 patients with breast cancer. The noncancerous tissues expressed the same A/B/H antigens as the patients' red blood cells and also usually expressed Lewis-related antigens. Seventy-six percent of primary carcinomas failed to express the appropriate A/B/H antigens, and in one blood group A patient the tumor tissue expressed B antigen. In the metastatic lesions, Lewis(a)/sialyl Lewis(a) expression was reduced when compared with the primary tumors, but Lewis(x)/sialyl Lewis(x) antigens were still expressed. These results suggest a possible relationship between the metastatic behavior of the tumor and expression of the blood group antigens.

Obvious peritumoral emboli: an elusive prognostic factor reappraised. Multivariate analysis of 1320 node-negative breast cancers

This study was conducted to determine the prognostic influence of obvious peritumoral vascular emboli as prospectively determined by a simple routine slide examination in patients with operable node-negative breast cancer. Obvious peritumoral emboli (OPE) were defined by the presence of neoplastic emboli within unequivocal vascular lumina (including both lymphatic spaces and blood capillaries) in areas adjacent to but outside the margins of the carcinoma. OPE were assessed routinely on 5 microns thick haematoxylin and eosin-stained sections for each of 1320 primary operable node-negative breast cancers from 1975 to 1992 at our institution. OPE and other prognostic variables (tumour size, SBR grade, oestrogen and progesterone receptor status) were correlated to overall survival (OS) and metastasis-free interval (MFI) by means of univariate and multivariate analysis with a median follow-up of 103 months. OPE were found in 19.5% of tumours. In univariate analysis, OPE were related to tumour size (P = 6.3 x 10(-5)) and histologic grade (P = 4.9 x 10(-7)). Statistically significant correlations were found with OS (P = 4.6 x 10(-5)) and MFI (P = 6.4 x 10(-9)). Furthermore, in multivariate analysis, OPE was an independent prognostic variable, the most predictive factor for MFI (P = 7.7 x 10(-7)) before tumour size and grade, and was second after tumour grade for OS (P = 0.002). This study on a large unicentric series and with a long follow-up confirms the prognostic significance of vascular emboli in patients with operable node-negative breast carcinoma. Importantly, vascular emboli were found to be accurately detectable by a simple routine and non-time-consuming method. Therefore, such obvious vascular emboli should be considered as an important cost-effective, prognostic variable in patients with node-negative breast carcinoma.

Enzymatic basis for the accumulation of Lewis(b) antigen in uterine endometrial cancer

In order to clarify the mechanism of the abnormal expression of Lewis(b) antigen, which was specific for uterine endometrial cancer tissue, the activities of alpha 1-->2fucosyltransferase, alpha 1-->3fucosyltransferase, and alpha 1-->4fucosyltransferase in normal endometrial tissues and uterine endometrial cancer tissues were determined. Further, an immunocytochemical study of the expression of blood group-related carbohydrate antigens in 6 cultured cell lines derived from various gynecologic malignant tumors was performed and the alpha 1-->2fucosyltransferase, alpha 1-->3fucosyltransferase, and alpha 1-->4fucosyltransferase activities of these cell lines were determined. Compared with normal endometrium, uterine endometrial cancer tissues showed significantly higher values of alpha 1-->2fucosyltransferase, alpha 1-->3fucosyltransferase, and alpha 1-->4fucosyltransferase activities. The specifically strong expression of type I carbohydrate chains, particularly the Lewis(b) antigen, was recognized in cultured cell lines derived from uterine endometrial cancer. Compared with those cell lines derived from uterine cervical cancer and ovarian cancer, the cultured cell lines derived from uterine endometrial cancer showed higher activities of alpha 1-->2fucosyltransferase and alpha 1-->4fucosyltransferase, which are enzymes related to the synthesis of Lewis(b) antigen. The cell lines derived from uterine endometrial cancer showed specifically high values of alpha 1-->4fucosyltransferase activity. These results suggest that the alpha 1-->2fucosyltransferase and alpha 1-->4fucosyltransferase activities, especially the alpha 1-->4fucosyltransferase activity, contribute to the abnormal expression of the Lewisb antigen in uterine endometrial cancer.

An immunohistochemical study of the distribution of blood group substances and related antigens in primary colorectal carcinomas and metastatic lymph node and liver lesions, using monoclonal antibodies against A, B, H type 2, Le(a), and Le(x) antigens

Using indirect immunoperoxidase staining, we examined the distribution of blood group substances and related antigens, including Le(a), A, B, H type 2, and Le(x), in 87 carcinomas and 42 normal mucosal specimens of colon and rectum, as well as in metastatic lesions of 32 lymph nodes and 9 liver specimens. The compatible expression rate of A/B/H type 2 antigens was 33.3% (3/9) in proximal normal colon, but only 6.1% (2/33) in distal normal colon. Compatible expression was observed in 14 of 25 carcinomas in the proximal colon (56.0%), but these antigens in distal colon cancers reappeared with a high positive rate, 62.9% (39/62). The rate of H type 2 accumulation with the deletion of A and/or B antigens was 6.9% (6/87). Incompatible expression was not observed in colorectal cancer. Le(a) and Le(x) antigens were expressed in normal mucosa and primary carcinoma throughout the colon. Le(a) and Le(x) in primary carcinoma that showed A/B deletion with/without H type 2 accumulation was expressed more than in carcinoma with A/B/H type 2 compatible expression (88.2% vs 71.7% for Le(a); 94.1% vs 88.7% for Le(x), respectively). In 16 of 32 patients (50.0%), A/B/H type 2 antigen expression in metastatic lesions had disappeared or was decreased compared with that in primary carcinoma, followed by metastasis to regional lymph nodes. These results suggested that: (a) A/B/H type 2 blood group substances in the distal colon behave as tumor-associated antigens in colorectal carcinoma. (b) Most frequently, A/B/H type 2 antigens expressed in primary carcinoma were weakened or had disappeared in metastatic lymph nodes. Further investigation of the biological function of carbohydrate chains, such as those of blood group substances and related antigens on cancer cell surfaces may lead to a solution of the problem of the metastatic behavior of tumor cells.

Immunohistochemical expression of sialyl Lex antigen in relation to survival of patients with colorectal carcinoma

BACKGROUND

The alterations of carbohydrate chains in cancer cell membrane can be related, not only to the formation of tumor-associated antigens, but also to cell biologic significance. There is, furthermore, a possibility of their relationship to tumor metastatic behavior and subsequent survival of patients with cancer. Recent clinical studies elucidated that a carbohydrate antigen, sialyl Lex, is a useful tumor marker in colorectal cancer. However, the sialyl Lex antigen immunoreactivity in colorectal carcinoma in relation to patient survival is unknown. The aim of the study was to elucidate whether sialyl Lex expression in tumors was correlated with patient survival.

METHODS

Immunohistochemical expression of sialyl Lex antigen, as detected by monoclonal antibody CSLEX1, was studied in 175 specimens of primary colorectal carcinoma from 120 patients who received radical surgery.

RESULTS

The positive expression of sialyl Lex was observed in 87 of 120 patients (72.5%). There was no statistically significant association between the negative or positive of sialyl Lex and clinicopathologic factors, excluding Dukes stage and histologic type. The difference between overall 5-year survival of patients with sialyl Lex-negative tumors and that of patients with sialyl Lex-positive tumors (81.2% versus 60.6%) was statistically significant (P = 0.0263). In proportion to staining intensity that was expressed as a score based on the percentage of the total field stained positive with CSLEX1, 5-year survival of patients indicated a worse outcome (P = 0.0113). The prognostic value was then studied in a Cox regression model. Dukes stage had the strongest association with patient survival, whereas sialyl Lex expression was found to be the second-ranking parameter.

CONCLUSIONS

When examining the expression of sialyl Lex antigen, as detected by monoclonal antibody CSLEX1, clinically useful information for patient survival after radical resection of colorectal cancer is given.

Correlation of expression of ABH blood group carbohydrate antigens with metastatic potential in human lung carcinomas

METHODS. The expression of ABH blood group carbohydrate antigens was examined histochemically in tumors and adjacent nontumorous tissues of 89 cases of human lung carcinoma in which nontumorous tissues expressed blood group carbohydrate antigens compatible with the erythrocyte blood group types. RESULTS AND CONCLUSIONS. Loss of ABH blood group antigens in lung carcinomas correlated with their metastatic potential, especially with the recurrence of hematogenous metastasis. Consequently, patients with tumors that retained compatible ABH blood group antigens showed a better prognosis than patients with tumors of altered antigenic profiles. The loss of blood group B antigen more significantly affected both the hematogenous metastasis and prognosis than that of A and H antigens.

Peritumoral lymphatic vessel invasion compared with DNA ploidy, proliferative activity, and other pathologic features as prognostic indicators in operable breast cancer

In 164 breast carcinomas the presence of peritumoral lymphatic vessel invasion (PLVI) was evaluated and correlated with other known indicators of prognosis and with the clinical outcome of the patients. Overall 22% of tumors were PLVI-positive. The presence of PLVI was significantly associated with axillary node involvement (p less than 0.0001) and tumor size (p = 0.005), and tended toward an association with grading (p = 0.065). No significant association was found between PLVI and steroid hormone receptors, DNA ploidy, or proliferative activity. Univariate analysis shows that peritumoral vessel invasion was significantly associated with a higher risk of recurrence (p = 0.012) and with a trend toward shorter survival (p = 0.074). Besides the presence of PLVI, prognosis was significantly worse also for patients with high proliferative aneuploid tumors and with axillary node metastases. Moreover, within the subsets of patients generally considered to have good prognosis, the presence of PLVI identified patients with a trend for higher risk such as those with PLVI-positive diploid tumors, PLVI-positive low-proliferative tumors, and PLVI-positive node-negative tumors. Adopting multivariate analysis, PLVI failed to retain prognostic importance when adjusted for node status, DNA ploidy, and proliferative activity. In conclusion, we found that the presence of PLVI has prognostic significance when singly evaluated. Multivariate analysis shows that PLVI is not an independent prognostic factor in stage I-II breast cancer.

Epithelial hyperplasia of the breast. Comparison of incidence between cases of breast carcinoma and control autopsy specimens with immunohistochemical observation of blood group antigens

Epithelial hyperplasia in the duct, ductule or lobule of the breast is a very common lesion and has been considered to carry a risk of subsequent invasive carcinoma. However, it is not known whether epithelial hyperplasia can transform into carcinoma or whether malignant change occurs de novo. We analyzed the incidence of epithelial hyperplasia of the breast by making a comparison between cases of breast carcinoma and control autopsy specimens, and studied differences in the membrane antigens of the constituent cells using immunohistochemical staining of blood group antigens. It was found that the frequency of epithelial hyperplasia was higher in the cases of breast carcinoma. The lesions showed loss of A, B and H antigens at high frequency, and the proportion of lesions showing loss of these antigens became higher as the atypia of the lesion increased. On the other hand, expression of Lea antigen was observed more frequently in atypical epithelial hyperplasia or in situ carcinoma than in ordinary epithelial hyperplasia. These findings suggest possible transformation from epithelial hyperplasia to carcinoma, and indicate that atypical epithelial hyperplasia may be precancerous in nature.

Quantitative dot blot analyses of blood-group-related antigens in paired normal and malignant human breast tissues

Membranes were prepared from 31 breast-cancer specimens and adjacent mammary tissues, dot-blotted to nitrocellulose paper, and reacted with monoclonal antibodies (MAbs) (A, B, Lewis a, Lewis b, sialylated Lewis a, Lewis x, and Lewis y) and lectins (Ulex europaeus, peanut agglutinin) having various blood-group specificities. The expression of epithelial membrane antigen was assayed with MAb MA5. The ratio of breast-cancer to normal mammary membrane preparations (C/N ratios) of these reagents was measured by densitometric scanning. We observed a decrease in the levels of A, B, Lewis a, Lewis b, sialylated Lewis a, and Lewis y antigens and an increase of Lewis x, T, and MA5-reactive determinants in breast cancers. The incidence of incompatible A, as well as A and B, antigens was demonstrated for 2 patients of blood group B and O respectively. When the receptor content was plotted against the C/N ratio of these various reagents, a significant inverse relationship between the C/N ratio of Lewis x antigen and estrogen (ER) and progesterone receptor (PR) content was observed in breast cancers. The mean C/N ratio of Lewis x antigen was significantly higher in the ER-negative/PR-negative (ER-/PR-; 2.33 +/- 1.17), as compared with the ER-positive/PR-positive (ER+/PR+; 0.97 +/- 0.80). According to these observations, Lewis x antigen expression may be influenced by hormonal stimuli such as estrogen and progesterone.

Abnormal expression of blood group-related antigens in uterine endometrial cancers

The expression of A, B, and H group antigens, Lewis group antigens (Lewis(a), Lewis(b), Lewis(x), and Lewis(y)), and Lc4 and nLc4 antigens, the precursor antigens of both groups, was examined immunohistochemically with monoclonal antibodies in 9 normal endometria, 6 endometrial hyperplasias, and 31 endometrial cancers. 1) A, B and/or H antigens were detected in endometrial cancers at an incidence of 51.6%, while no distinct localization of these antigens was observed in normal endometria. H antigen, the precursor of A and B antigens, was particularly frequently detected in endometrial cancers. 2) An increased rate of expression of Lewis group antigens, particularly Lewis(b) antigen, was observed in endometrial cancers compared with its expression in normal endometria. 3) Lc4 and nLc4 antigens were detected in endometrial cancers at rates of 41.9% and 38.7%, respectively, these expressions being increased compared with those in normal endometria. 4) These results suggest that a highly abnormal expression of blood group-related antigens in endometrial cancers occurs not only at the level of A, B, and H antigens and Lewis group antigens, but also at the level of their precursor Lc4 and nLc4 antigens. 5) Lewis(a), Lewis(b), and Lc4 antigens, built on the type-1 chain, are more specific to endometrial cancers than their respective positional isomers, Lewis(x), Lewis(y), and nLc4 antigens, built on the type-2 chain.

Immunohistochemical expression of blood group substances and related carbohydrate antigens in breast carcinoma

In forty-one carcinomas and sixteen benign lesions (fibroadenoma and mastopathy) of the human breast, immunohistochemical expression of sialylated and non-sialylated forms of both Lea and Lex, and the A, B, and H type 2 blood group substances were studied by using an indirect immunoperoxidase staining. In normal ductal epithelium and benign lesion of breast, Lewis-related antigens were mostly expressed. Breast carcinomas showed these antigens with the following frequencies: Lea, 31.7% (13/41); sialyl Lea, 56.1% (23/41); Lex, 46.3% (19/41); sialyl Lex, 68.3% (28/41); A/B/H type 2, 38.1% (16/41). Sialylated forms of Lea and Lex were observed more frequently than their respective non-sialylated forms in breast carcinomas. In both one normal epithelium and four carcinomas of breast with Le(a-b-) phenotype, the expressions of type 2 antigens were observed, while type 1 antigens were not consistently expressed. Although compatible expression was observed in all specimens of both normal epithelium and benign lesion of breast, twenty-four cases with the deletion of A and/or B antigens, six cases with H type 2 accumulation and one case with incompatible expression were demonstrated in breast carcinoma. Thirty-one breast carcinomas which showed the deletion of A/B/H type 2 expressed the Lewis-related antigens more frequently than nine cases which showed compatible expression. These results suggested that the activation of terminal fucosyltransferase and sialyltransferase as well as inactivation of some glycosyltransferases had occurred in cancer cell membrane, and sialyl Lex, defined by a new monoclonal antibody CSLEX1, may be useful as a tumor-associated antigen independent of Lewis blood group type in breast cancer.

ABO (H) blood group antigen expression in gastric mucosa

The A, B, O (H) blood group antigens (BGA) are glycolipids present in the plasma membranes of many different epithelial cells. Alterations in BGA expression have been described in malignant tumors and premalignant lesions. We have studied ABO (H) BGA expression in paraffin sections of gastric specimens using immunofluorescence techniques with monoclonal antibodies. 102 patients were studied. 15 with normal mucosa (NM); 16 with duodenal ulcer (DU); 23 with gastric ulcer (GU); 11 with pernicious anaemia (PA) and 37 with adenocarcinoma (AC). The expression of BGA in normal gastric mucosa is detected in surface epithelium, mucoid cell neck glands and parietal cells as well as 2/3 of antral glands. BGA expression in DU gastritis is very similar to that seen in NM. In atrophic chronic gastritis associated with GU and PA there is a significant decrease in BGA expression. In patients with PA, BGA expression is greater in antral mucosa than in fundic mucosa. Loss of BGA expression is more pronounced in atrophic chronic gastritis surrounding AC. Intestinal metaplasia shows variable BGA expression. Our results support the hypothesis that loss of BGA expression by epithelial gastric mucosal cells may be related to alterations in cellular differentiation and premalignant potential.

Tumor-associated blood group antigen expressions and immunoglobulins associated with tumors

As outlined in Figures 1 and 2, the biosynthetic pathways for the expression of the A, B and H, and the Lewis determinant carbohydrate sequence structures, as well as sialylated structures, involves both type 1 and type 2 precursor chains (which may be present as glycolipids and N- or O-linked glycoproteins), and many glycosyltransferases. For tumor cells, there appears to be increased expressions of fucosyl- and sialyltransferases yielding such structures as the Le(x), sialyl-Le(a), and many other similar determinants, which are not found on the normal cell progenitor of the tumor. The types of structures expressed on tumor cells is dependent on the particular fucosyl-, sialyl- and other glycosyltransferase genes activated in the transformation and tumor progression events, the availability of the substrates for the glycosyltransferases (both the precursor sequences and the nucleotide-sugar substrates) which is partly dependent on metabolites available to the tumor mass, and on the genotype of the individual regarding particular glycosyltransferases. Both the loss of A, B and/or H blood group antigen expressions of tumor cells and the relative expressions of the Lewis and sialylated-oligosaccharide determinants may be a consequence of the competing biosynthetic pathways and the glycosyltransferases for common substrate sequences, as well as due to the loss of particular glycosyltransferases concomitant with transformation. All of these factors probably account for the variable expressions of the complex of carbohydrate sequence determinants when comparing tumor sections of different individuals as well as the heterogeneity of expression of particular determinants within a single tumor tissue section. As described above, the A, B and/or H determinants, and the precursor sequences, are also expressed to differing extents on epithelial cells depending on the tissue type and cellular location in the tissue. Thus, the differentiation state of the particular epithelial cell also determines the quantity and types of carbohydrate sequences expressed. However, because of the complex nature of the competing biosynthetic pathways for the carbohydrate sequences of glycolipids and glycoproteins, and the relative activations of fucosyl- and sialyltransferases of tumor cells, it would seem that simple deductions as to the state of differentiation of particular tumors with A, B, H and precursor sequence expressions is not warranted.(ABSTRACT TRUNCATED AT 400 WORDS)

The application of immunohistochemical stains to identify endothelial-lined channels in mammary carcinoma

The identification of lymphatic and vascular channels with immunohistochemical reagents directed against antigens of the endothelial cells was undertaken in formalin-fixed breast tissues from 100 women with infiltrating mammary duct carcinoma. Fifty women had had lymphatic tumor emboli identified in the original review of their slides. Each case was matched with a control of similar size and laterality. From each case one section containing tumor and normal tissue was stained with antibodies directed against Factor VIII-related antigen, blood group antigen A, blood group antigen B and with Ulex europaeus I agglutinin. All specimens with a reaction displayed variation in the intensity of the stain as well as in the propensity of a given endothelial lined channel to stain at all. Factor VIII-related antigen was identified in 96 tissue samples and Ulex europaeus I agglutinin reacted with 75 specimens. Reactivity of endothelium to blood group antigens either A, B, or both was found in 63 samples. Twenty-one of 26 (81%) samples with endothelial-lined channels which contained tumor emboli in the hematoxylin and eosin (H & E) section showed a reaction to one or more of the reagents. In six other cases involvement of endothelial-lined channels was detected only in the specially stained sections, but in three of these, the tumor emboli appeared only in these deeper sections and could have been detected by serial sections stained with H & E. The results of this study indicate that examination of H & E sections is a reliable method of identifying tumor involvement of endothelial-lined channels. Immunohistochemical stains may be of assistance in occasional cases, but with the reagents currently available this methodology is subject to false-positive and false-negative results.

Blood group-related antigens as markers of malignant potential and heterogeneity in human carcinomas

The expression of BGR-Ags is often aberrant in human carcinomas. The observation that BGR-Ag expression in human bladder carcinomas correlates with prognosis for patients with these tumors is especially interesting in light of the numerous reports of correlations between cell surface glycosylation and malignant phenotype in experimental animal tumors. Many observations suggest how this relation might be mediated. It seems reasonable to anticipate that the study of the BGR-Ags and their expression in carcinoma may emerge from its current predominantly descriptive phase and become an important part of the investigation of human tumor biology.

Staining for factor VIII related antigen and Ulex europaeus agglutinin I (UEA-I) in 230 tumours. An assessment of their specificity for angiosarcoma and Kaposi's sarcoma

In this study we examined the staining reactivity of commercially available antisera to factor VIII related antigen (F VIII RAg) and Ulex europaeus agglutinin I (UEA-I) on sections from 230 formalin fixed paraffin embedded tumours. These included 196 sarcomas, 20 carcinomas and 14 angiomas. All angiomas showed positive staining for F VIII RAg; all carcinomas showed negative staining; the vasoformative areas of all angiosarcomas stained positively but only four of six angiosarcomas showed positive staining of their solid areas; of seven Kaposi's sarcomas, all showed positive staining of vessels and six showed positive staining of the spindle cell component. In the remaining 181 non-vascular sarcomas there was a false positive result in four tumours (2.2%), three of which had a history of irradiation. Pre-radiotherapy biopsies of these three tumours stained negatively with anti-F VIII RAg. UEA-I was demonstrated in all the angiomas studied, in all angiosarcomas (including the solid components) and in well-formed vessels of all Kaposi's sarcomas, but only in the spindle cell component of 3/6. However, there was an unacceptably high rate of false positive staining amongst the carcinomas and non-vascular sarcomas. In conclusion, F VIII RAg is a specific but not a sensitive marker of angiosarcomas; UEA-I is a sensitive but not a specific marker of angiosarcomas.

Lymphatic and blood vessel invasion in breast carcinoma: a useful prognostic indicator?

Recent studies have presented compelling evidence to support the prognostic importance of peritumoral lymphatic and blood vessel invasion in breast cancer. This parameter appears to be particularly valuable in the hands of pathologists who are experienced in diseases of the breast and who have developed standardized criteria and expertise in their recognition. However, its application is seriously hampered by various factors, especially interobserver and intraobserver differences in interpretation. A more uniform and objective approach, such as the use of immunohistochemical techniques, may be helpful in overcoming these obstacles. This may render lymphatic and blood vessel invasion a reliably reproducible indicator that a practicing pathologist can utilize to recognize high-risk patients and recommend appropriate therapy. The extension of this approach to evaluate neoplasms of other organs--such as malignant melanomas and thyroid, uterine, and cervical carcinomas--should also be explored.

The occurrence of blood group substances (A, B, H, Le-a, Le-b) in salivary glands and salivary gland tumors. An immunohistochemical investigation

The distribution of blood group substances A, B, H, Le-a and Le-b in normal and neoplastic salivary gland tissue was evaluated by means of immunohistochemistry. The serological ABH blood group status of one third of the patients was known. Lewis blood group and secretory status were not known. In normal tissue, expression of blood group antigens corresponded to the serological blood group. Blood group substance H was present in almost every gland, regardless of the serological blood group. In submandibular glands, Le-b was rather selective for mucous acini. In tumors, a relationship of blood group expression to a glandular pattern and a high differentiation could be observed. Blood group substances were expressed at a high level in benign and highly differentiated malignant tumors. In poorly differentiated malignant tumors, they were mostly absent. Blood group expression evaluation could be of value in establishing the level of functional differentiation in salivary gland tumors.

Endothelial cell markers in vascular neoplasms: an immunohistochemical study comparing factor VIII-related antigen, blood group specific antigens, 6-keto-PGF1 alpha, and Ulex europaeus 1 lectin

Markers for endothelial cells including Ulex europaeus 1 lectin, blood group A, B, and H, and the prostaglandin metabolite 6-keto-PGF1 alpha were evaluated in paraffin secretions from formalin-fixed benign and malignant vascular neoplasms using a variety of immunohistochemical techniques, and results compared with staining for factor VIII-related antigen. Staining for Ulex appeared more sensitive than factor VIII-related antigen in identifying poorly differentiated neoplasms including haemangiosarcomas and spindle cell proliferations in Kaposi's sarcoma. Staining for blood group related antigens correlated with blood group in all cases. Ulex europaeus 1 lectin was the only marker for endothelial cells in lymphangiomas.

The expression of fucosylated type 2 blood group chains in human breast and their significance

Monoclonal antibodies directed against O(H) blood group antigen and 3-fucosyl-N-acetyllactosamine have been used to investigate the incidence and significance of these type 2 blood group chains in non-malignant and malignant human breast tissue. The findings have been compared with those obtained with the fucose-binding lectins, Ulex europeus I and Lotus tetragonolobus. The expression of O(H) antigen in non-malignant breast is heterogeneous and shows no relationship to blood group status. Its expression in carcinomas shows no relationship to prognostic parameters such as differentiation and node status, whereas loss of Ulex europeus I binding is related to metastasis. The presence of 3-fucosyl-N-acetyllactosamine is limited in non-malignant breast, apart from pregnancy, but in carcinomas shows a relationship to differentiation, a feature not seen with fucose-binding lectins. It is apparent that to obtain the maximum amount of information about the modifications occurring in fuco-substances that appear to be of significance in breast malignancy, it is important to use monospecific probes as well as reagents with broader specificities, such as lectins.