Carcinoembryonic antigen (CEA) in the normal human small intestine: a light and electron microscopic study

Prognostic Significance of Carcinoembryonic Antigen Staining in Cancer Tissues of Gastric Cancer Patients

PURPOSE

The aim of this study was to assess the significance of the correlation among tissue carcinoembryonic antigen (CEA) expression with serum CEA (sCEA) levels and long-term survival to highlight the clinical prognostic significance of tissue CEA expression in gastric cancer patients.

METHODS

Immunohistological method and radioimmunoassay were used to assess tissue and sCEA expression, respectively. Univariate and multivariate analyses were performed to determine correlations, and the Kaplan-Meier method was used to investigate the prognostic significance.

RESULTS

Our results demonstrate that tissue CEA in gastric cancer is significantly correlated with preoperative sCEA levels (p = 0.031), depth of invasion (p = 0.001), lymph node metastasis (p < 0.001), distant metastasis (p = 0.001), and TNM staging (p < 0.001). The 5-year survival rates were 67.6, 53.9, and 40.1 % for negatively, moderately, and intensely positively stained tissues (p < 0.001), and 57.0 and 37.9 % for serum with normal and elevated CEA expression (p = 0.031). Multivariate analysis revealed that tissue CEA can be considered an independent prognostic factor. Further analysis illustrated that patients with negative expression in both tissue and serum had better prognosis compared with those positively expressing CEA in both tissue and serum and/or those positively expressing CEA in either tissue or serum (p < 0.001). Our results also demonstrated that patients with negative tissue CEA staining and elevated sCEA expression had a better 5-year survival.

CONCLUSION

Tissue CEA expression in gastric cancer is directly correlated with sCEA levels and long-term prognosis. Thus, tissue CEA expression can be considered as a useful biomarker to improve the interpretation of sCEA levels in predicting long-term survival.

Expression of the adhesion molecules L1, N-CAM and J1/tenascin during development of the murine small intestine

We have previously studied the immunohistological localization of the three adhesion molecules L1, N-CAM and J1/tenascin in adult mouse small intestine and shown that L1 expression in epithelial crypt cells underlies the adhesion of these cells to one another [63]. To obtain further insight into the functional roles of L1, N-CAM and J1/tenascin in this organ we studied their expression starting at embryonic day 14 during embryonic and early postnatal morphogenesis and during epithelial cell migration in the adult. Expression of L1 was restricted to neural cells until approximately postnatal day 5, when L1 started to be detectable on crypt but not on villus cells, predominantly on the basolateral membrane infoldings. As in brain, L1-specific mRNA was approximately 6 kb in size. L1 from intestine appears to differ from the brain-derived equivalent in possessing a higher level of glycosylation. N-CAM was detectable from embryonic day 14 onward in neural and also in mesenchymal cells. Expression by smooth muscle cells decreased during development. In the villus core, N-CAM was strongly detectable at contact sites between smooth muscle cells forming the cellular scaffold of the villus. From embryonic day 14 onward, N-CAM appeared in both 180- and 140-kDa forms. J1/tenascin was present in both neural and mesenchymal cells from embryonic day 14 onward. Starting at embryonic day 17, J1/tenascin appeared concentrated at the boundary between mesenchyme and epithelium in an increasing gradient from the crypt base to the villus top. From embryonic day 14 onward J1/tenascin consisted of the 190- and 220-kDa components. J1/tenascin from intestine differed from brain-derived J1 in its carbohydrate composition. These observations show that the three adhesion molecules are expressed by distinct cell populations and may serve as cell-type-specific markers in pathologically altered intestinal tissue.

Comparison of CEA distribution in lesions and tumors of salivary glands as determined with monoclonal and polyclonal antibodies

Immunohistochemical localization of carcinoembryonic antigen (CEA) with conventional antibody to CEA (anti-CEA), nonspecific crossreacting antigen (NCA)-absorbed polyclonal antibody to CEA (NCAa-CEA), and monoclonal antibody to CEA (Mono-CEA) have been compared in obstructive lesions and salivary gland tumors. Normal salivary glands gave strong staining of the luminal borders of acinar cells with anti-CEA, whereas no staining occurred with Mono-CEA. Obstructive lesions showed occasionally marked staining with anti-CEA in some acinar cells, but there was no reaction with Mono-CEA. Of 69 pleomorphic adenomas examined, 34 were positively stained with anti-CEA, 18 with NCAa-CEA and 8 with Mono-CEA along the luminal borders of the tumor cells. The frequency of positive staining of material within tubular lumina was similar with all three immunoreagents. Neoplastic cells were positive with Mono-CEA in only three cases, while eight cases were positive with NCAa-CEA and 11 cases with anti-CEA. In salivary gland tumors true CEA is be found mainly at the border of tumor cells, but the frequency of positive reactions is low.

CEA and carbohydrate antigens in normal and neoplastic colon mucosa. An immunohistochemical study

Antibodies raised against tumour-associated antigens have been assessed for tumour selectivity using an indirect immunohistochemical peroxidase staining of formalin-fixed, paraffin-embedded tissue from colon carcinomas, colon polyps and normal mucosa. The following antibodies were used: 1) Unabsorbed polyclonal antibody to carcinoembryonic antigen (poly-CEA). 2) Monoclonal antibodies to CEA (mabs 3851 and 27). 3) Monoclonal antibodies to protein-bound carbohydrates (mabs C 216 and C 242) or to lipid- and protein-bound carbohydrates (C 50 and 19-9). These antibodies had been produced by hybridization of lymphocytes from mice, immunized with colon carcinoma cell lines or colon cancer tissue. All antibodies were used in one concentration only, preselected by initial titration experiments. No antibody was completely tumour-specific, but four antibodies, mabs 3851, 27, C 216 and C 242, showed statistically significant tumour selectivity. Using these antibodies, respectively 19, 19, 19, and 18 of 20 colon cancer were stained compared with 3, 4, 4, and 8 of 15 specimens of colon mucosa from normal controls. An increased frequency of staining was also noted in dysplastic polyps (statistically significant using mabs 3851 and C 216) and in dysplastic mucosa adjacent to a tumour (statistically significant using mabs 3851 and 27). The staining frequency of normal colon mucosa in cases of colon cancer did not differ from that in the normal controls. Poly-CEA and the anti-ganglioside mabs C 50 and 19-9 revealed no tumour selectivity. A pronounced goblet cell staining was seen using C 50, C 242 and 19-9.

Carcinoembryonic antigen in mucoceles of oral mucosa

Immunohistochemical detection of carcinoembryonic antigen (CEA) was reported in mucocele and associated minor salivary glands of oral mucosa. Higher levels of staining for CEA occurred in salivary glands with attached mucoceles, in which acinar cells and ductal segments in the gland displayed concentrations of CEA higher than those in normal minor salivary glands. Floating cells also gave positive CEA staining, whereas epithelial fragments and connective tissue in the mucocele wall were lacking in CEA. It was suggested that mucoceles in oral mucosa accumulated CEA in associated minor salivary glands.

Characterization of cells in salivary gland lesions by immunohistochemical identification of carcinoembryonic antigens

Immunohistochemical demonstration of carcinoembryonic antigen (CEA) was reported in normal salivary glands and in pathologic lesions. Staining patterns of CEA and nonspecific cross-reacting antigen-absorbed CEA (NCAa-CEA) were compared. Normal salivary glands disclosed positive staining by CEA on border and luminal sides of acinar cells and occasionally in components secreted into ductal spaces with both antigens used. Chronic obstructive lesions displayed an intense CEA staining in ductlike structures and in material secreted into their lumina in the two antigens used. Pleomorphic adenoma exhibited varying intensities of CEA in neoplastic epithelial cells of ductal structures. In contrast, they showed a slight staining reaction to NCAa-CEA. Squamous-cell carcinomas showed a strong CEA reaction, whereas they showed no reaction or a trace reaction to NCAa-CEA. Positive staining to CEA in squamous neoplastic lesions was related to nonspecific reacting antigens.

Biological and pathobiological aspects of the glycocalyx of the small intestinal epithelium. A review

The literature on the glycocalyx of small intestinal epithelium is reviewed. The structure, general and barrier functions, synthesis, and degradation of the glycocalyx, and pathobiological aspects of the glycocalyx in relation to its barrier function are mentioned. Topics for future research are indicated.

Ultrastructural localization of carcinoembryonic antigen in normal intestine and colon cancer: abnormal distribution of CEA on the surfaces of colon cancer cells

The distribution of carcinoembryonic antigen (CEA) in normal small intestine, normal colon, and colon cancer of humans was determined immunocytochemically by the peroxidase-labeled antibody method at the light and electron microscopic levels. In the small intestine, CEA was found in protein synthetic organelles, in the mucus, on the microvilli of goblet cells, and on some microvilli of columnar cells adjacent to goblet cells. In the normal colon, CEA was found in protein synthetic organelles of the fully differentiated columnar cells and goblet cells, as well as on the microvilli of the cells. In two well-differentiated colon cancers, the normal preferential surface expression of CEA on the microvilli was maintained, but in six poorly differentiated cancers, CEA was distributed equally over the entire cell surface. We conclude that CEA is a product of goblet cells in the small intestine, columnar and goblet cells in the colon, and colonic cancer cells. CEA on the surfaces of the normal epithelial cells is expressed in a polar manner. This polarity is lacking in undifferentiated neoplastic colon cells, which suggests that failure to establish or maintain the polar expression of normal cell-surface glycoproteins is a characteristic of the neoplastic cells.

Immunohistochemical detection of carcinoembryonic antigen (CEA) in parotid gland carcinomas. Analysis of 52 cases

The presence of CEA in parotid gland tumours was studied by immunohistochemical methods. 52 cases were analysed. 7 of 8 adenocarcinomas, 3 of 5 cystadenocarcinomas, 3 of 4 adenoid cystic carcinomas and all 3 salivary duct carcinomas were positive for CEA. 5 of 8 squamous cell carcinomas and 9 of 21 carcinomas in a pleomorphic adenoma were also positive for CEA. The anaplastic carcinomas were negative. The distribution pattern of the presence of CEA in the carcinomatous and the adjacent normal or inflamed tissue was analysed. The results are discussed with regard to their histogenetic and diagnostic implications.

Presence of a carcinoma-associated antigen(s) in the spent chemically defined medium of a human colon carcinoma cell line

The human colon carcinoma cell line HT-29 was adapted to grow in chemically defined medium (CDM). The spent CDM (S-CDM) was concentrated by Amicon filtration and the crude HT-29 S-CDM purified by 40% saturated (NH4)2 SO4 precipitation. The purified antigen was tested by a microcomplement fixation (MCF) assay against the sera of cancer patients of various histologic types and against the sera of normal donors. Fifteen of 20 (75%) colon cancer, 16/20 (80%) breast cancer sera, 14/19 (74%) lung cancer sera, and 13/20 (65%) miscellaneous carcinoma sera were positive in the MCF. By contrast, 2/21 (10%) melanoma sera, 7/20 (35%) sarcoma sera, and 2/19 (11%) normal sera were positive. These data suggest the presence of a carcinoma-associated antigen in the spent CDM of the HT-29 colon carcinoma cell line adapted to grow in CDM.

Carcinoembryonic antigen in fetal tissues and in material serum

The occurrence of CEA was extensively adsorbed to eliminate cross-reactions with CEA-related antigens. After the first trimester of pregnancy CEA was found throughout the gastrointestinal tract by both techniques, whereas the other fetal tissues and fetal serum did not contain detectable amounts of CEA. The CEA-level of all 69 sera of pregnant women was below 2.5 ng/ml. The excretory nature of CEA was suggested by the localization of CEA in the luminal border of the alimentary tract and by the finding that the CEA concentration in the content of fetal gastrointestinal canal was higher than in the surrounding tissue. Gel filtration on Sepharose 4B showed that molecular weight of CEA immunoreactive material of the fetal gut was similar to that of CEA purified from colon cancer, but a minor component with a higher molecular weight was eluted in the void volume. When tested in radioimmunoassay, the CEA immunoreactive material in both peaks gave an inhibition curve parallel to that of purified CEA.

Carcinoembryonic antigen in endoscopic brush specimens from benign and malignant gastric lesions

The measurement of carcinoembryonic antigen (CEA) in serum and endoscopic brush specimens was evaluated for the differential diagnosis of malignant and nonmalignant gastric disease. Brush specimens were studied from 33 patients with gastric cancer and 36 patients with benign gastric lesions or apparently normal gastric mucosa. Demonstrable CEA immunoreactivity was found by radioimmunoassay in brush specimens from 24/33 cancer patients (73%) and from 23/36 patients with benign lesions (64%). Patients with CEA+ tissue in the immunoperoxidase test had somewhat higher CEA concentrations in the brush specimens than cases with CEA- biopsy tissue, although overlap was considerable. Thirty-five per cent of cancer patients had both a positive tissue CEA reaction and a CEA/DNA ratio greater than 10 ng/micrograms, whilst patients with benign lesions had only 15% of positives by these criteria (0.01 greater than P greater than 0.001). The serum CEA concentration was above the upper normal level of 5 ng/ml in 2/39 patients, both of whom had gastric cancer. The CEA immunoreactive material from benign and malignant lesions eluted in gel filtration on Sephadex G-200 in the same volume as CEA purified from liver metastases of cancer of the colon, showing that a glycoprotein sharing immunological and physicochemical properties with CEA is present both in malignant and nonmalignant lesions of the gastric mucosa, and that there is considerable overlapping in the amount of CEA. The estimation of CEA in gastric-brush specimens is therefore of limited value in the differential diagnosis of benign and malignant gastric lesions.

Purification of human intestinal goblet cell antigen (GOA), its immunohistological demonstration in the intestine and in mucus producing gastrointestinal adenocarcinomas

Goblet cell antigen (GOA) was purified from gastric signet ring cell carcinoma. It was immunogenic and was used to produced antisera which stained goblet cells of the small and large intestine and of intestinalized gastric mucosa by indirect immunological methods. Various types of gastric and colonic cancer contained GOA. These findings demonstrate a histiogenic relationship between intestinal goblet cells, various gastrointestinal cancers and associated premalignant conditions.

Correlation of carcinoembryonic antigen in tissue sections with spread of mammary carcinoma

An immunoperoxidase technique for the histological demonstration of Carcinoembryonic Antigen (CEA) was applied to paraffin sections from 74 breast carcinomas and 43 benign breast lesions. Sixty-six per cent of the carcinomas and the only case of granular cell myoblastoma examined were CEA positive. Two examples of mammary dysplasia (7%) showed foci of CEA positive acini. All tumour tissue found in lymphatics and in metastases in lymph nodes was CEA positive, including two cases where the primary tumour was CEA negative, and all the metastases examined from CEA positive tumours. A significant relationship was found between CEA positivity of the primary tumour and the presence of lymph node metastases.

Immunohistochemistry of carcinoembryonic antigen in the small intestine

Carcinoembryonic antigen (CEA) was demonstrated in formalin-fixed paraffin embedded sections of normal small intestine using an immunoperoxidase method. In all the sections studied the antigen was present over the surface of the villi, within goblet cells and lining the crypt lumens. At the electron microscopic level CEA was identified in mucin granules of goblet cells and in the glycocalyx but not intracytoplasmically. During the study cross-reactivity of antiCEA with Paneth cell granules, red blood cells and endothelium was observed. The shared antigenic determinants responsible for these immunological cross-reactions between CEA and other tissue glycoproteins were found to be carbohydrate in nature. Even when well controlled, misleading immunohistochemical results may be caused by immunological cross-reactions.

Immunohistochemistry of carcinoembryonic antigen: characterisation of cross-reactions with other glycoproteins

In the course of demonstrating carcinoembryonic antigen (CEA) in normal human small intestine cross-reactivity of specific antiserum against red blood cells, vascular endothelium, and Paneth cell granules was noted. Pretreatment of sections with periodic acid eliminated these cross-reactions without affecting the staining of CEA, indicating that the antigenic determinants shared between CEA and other glycoproteins are in the carbohydrate portion of the molecules. These findings emphasise the caution with which immunohistochemical results should be regarded even when they are apparently well controlled.