Measuring S100 protein and neurone specific enolase in melanocytic tumours using video image analysis

Digital image analysis for the evaluation of the inflammatory infiltrate in psoriasis

Traditionally the evaluation of the cellular infiltrate and protein expression in skin tissue sections is done by manual quantification. However, for reliable evaluation of histology in the development of new anti-psoriatic treatments there is a need for a more time-efficient and reproducible method. To test the use of digital image analysis (DIA) in this situation we compared the assessment of immunohistochemically stained skin sections with the more traditional manual quantification (MQ) and semi-quantitative analysis (SQA). The number of CD3+ T cells and the expression of E-selectin were evaluated in stained paired skin biopsies from 11 patients with chronic plaque psoriasis before and after initiation of anti-psoriasis therapy. We observed significant correlations between MQ and DIA for the number of T cells (epidermis: r=0.88, P< or =0.01, dermis r=0.87, P< or =0.01). Both DIA and MQ were equally effective in detecting reductions of T-cell numbers in active-treated patients. MQ took 20 h, compared to 6 h for DIA. We also observed significant correlations between SQA and DIA for the expression of E-selectin (r=0.88, P< or =0.01), although DIA was more sensitive than SQA to detect (early) changes. SQA took 10 h, compared to 4 h for DIA. In conclusion, the quantification of the inflammatory infiltrate in psoriatic lesional skin by DIA generated similar results as MQ and SQA in a reliable, reproducible and higher time efficient fashion.

Human liver cancer cells and endothelial cells incorporate iodised oil

Iodised oil (lipiodol) administered via the hepatic artery localises selectively in primary liver cell cancers (hepatocellular carcinomas or HCCs) for prolonged periods and has been used as a vehicle for cytotoxic agents. Despite clinical use, the mechanism of lipiodol retention by tumours has remained unclear, embolisation of oil droplets in the tumour vasculature being the prevailing hypothesis. We have investigated the role of tumour and endothelial cells in lipiodol retention. Human liver tumour (Hep G2) cells and human umbilical vein endothelial cells in culture were exposed to lipiodol. Light microscopy using selective silver impregnation stains and transmission electron microscopy revealed lipiodol incorporation by both cell types, probably by pinocytosis. This was not associated with cellular injury in terms of cell lysis, cell replication or radio-labelled leucine uptake. Histological analysis of 24 HCCs either surgically resected or discovered incidentally at liver transplantation (with prior arterial injection of lipiodol) revealed vesicles of lipiodol in the cytoplasm of tumour cells and endothelial cells lining tumour vessels. Thus, lipiodol is likely to deliver cytotoxic agents directly into tumour cells and endothelial cells, both in vitro and in vivo. This may also apply to other lipids and to other human tumours. These findings have significant therapeutic implications.

Image analysis in dermatopathology

BACKGROUND/AIMS

Image analysis in dermatopathology has been used for DNA ploidy analysis, morphometry, stereology, and quantitative immunohistochemistry. The object is to review image analysis in dermatopathology and evaluate these modalities and their application in pigmented lesion pathology, for elucidation of tumor behaviour and architecture and as an aid in tumor identification and prognostication.

CONCLUSION

Image analysis in dermapathology has a huge potential. The techniques are difficult and at present mainly used in specialized centres.

Approach to diagnostic image analysis of melanocytic tumors

Numerous attempts have been made to apply image analysis in dermatopathology. The technics used comprise measurement of nuclear size, shape, chromatin content, and texture, evaluation of immunohistological slides, assessment of proliferation, pattern analysis, and tumor volume estimation. For commonly accepted routine use, however, image analysis research has to be extended to large numbers of cases, using straightforward and reproducible measuring procedures, and to the development of ready-to-use equipment for specific tasks. In this way, image analysis in dermatopathology might supply useful diagnostic tools in addition to conventional microscopy, and may increase our understanding of morphology as a whole.

Quantitative computerized image analysis of immunostained lymphocytes. A methodological approach

A methodological approach by computerized image analysis to quantify immunostained objects in histological sections is described. We have investigated antibodies against CD4, CD8, CD20, CD23 and CD25 in frozen sections of human nasal mucosa; however, the methodology of standardization is of general validity. The study was designed particularly to investigate the following points: 1) light intensity, 2) the grey level for counter staining intensity, 3) the grey level threshold value for positive objects, 4) the minimal acceptable size of a positive object, 5) the influence of the brightness of the light on both the number and the area of objects. Furthermore, random sampling and determination of 6) the area per section, and 7) the number of histological sections to be measured per biopsy. Finally, a study of reproducibility of immunostaining intensity was performed. The influence of the different parameters mentioned above was studied and the values (eg. threshold value) for our particular setting of microscope, image analysis equipment, computer software etc, were defined. The method was then tested for intra- and interindividual variation which was found to be less than 5%. Correlation analysis of the reproducibility gave coefficients of correlation of 0.99, both concerning number of immunopositive objects and immunopositive area. We emphasize the importance of a highly standardized methodology if the numeric data obtained from computer assisted image analysis are to be more accurate than semiquantitative assessments by experienced observers. With a thorough standardization as described in this method it is possible to obtain numeric values, and data with low deviations, which are two obvious and important advantages.

Analytic morphology in clinical and experimental dermatology

During the past several years, quantitative morphology has gained increasing attention in diagnostic pathology and in certain research applications. In the field of dermatopathology, quantitative morphology has been applied to numerous problems, ranging from the interactive measurement of nuclear contours to fully automated, high-resolution image analysis of ultrastructural micrographs. Dermatologic applications are reviewed, and potential developments in the future are briefly outlined.

Neuron-specific enolase as a prognostic factor in metastatic malignant melanoma

Serum neuron-specific enolase (NSE) was measured in 63 patients with metastatic malignant melanoma. 20 patients (32%) had elevated serum NSE (> 10 micrograms/l) before the start of treatment. Another 13 patients (21%) developed pathological NSE values during the course of the disease. In many patients, elevated NSE was related to a large tumour burden, and a gradual rise in serum NSE indicated disease progression. Patients with elevated pretreatment NSE had a median survival time of 3 months compared with 12 months for those with normal pretreatment NSE values. NSE thus proved to be a useful prognostic factor in metastatic malignant melanoma.

Immunohistochemical evaluation of uveal melanocytic tumors. Expression of HMB-45, S-100 protein, and neuron-specific enolase

The authors compared the immunohistochemical reactivity of 13 uveal nevi and 20 uveal melanomas for HMB-45, S-100 protein, and neuron-specific enolase (NSE) in formalin-fixed, paraffin-embedded sections. All 33 of the lesions were positive for HMB-45. The false-negative rates for S-100 protein and NSE were 21% and 18%, respectively. If only strongly positive reactions were considered, more than 50% of the tumors would be interpreted as negative for S-100 protein and NSE. Nevi stained with less intensity than melanomas using all three antibodies. The expression of HMB-45 appeared to be greater in active nevi than in inactive nevi. There was a weak association between S-100 protein reactivity and the ability of the uveal melanomas to metastasize (P = 0.1); however, the standard deviation of nucleolar area was a much better predictor (P = 0.02). These results indicate that pathologists will find HMB-45 to be a useful tool in differentiating uveal melanoma from nonmelanocytic tumors.

Neuron specific enolase (NSE) in serum of patients with malignant melanoma

Serial measurements of serum NSE were performed in 63 patients with metastatic melanoma. NSE was measured by a sensitive immunoradiometric assay based upon monoclonal anti-bodies with monodisperse magnetizable particles as the solid phase. Increased NSE values were found in 30 patients (48%) during the course of the disease. In 10 patients serum NSE normalized during systemic therapy. In 11 patients with initial normal serum NSE, the marker values became elevated as the tumor progressed.

S100 protein, neurone specific enolase, and nuclear DNA content in Spitz naevus

The differentiation between Spitz naevus and melanoma is at times difficult. The present study was undertaken to define means to positively identify such melanocytic tumours of doubtful malignancy. Immunohistochemical staining intensity for S100 protein and neurone specific enolase (NSE) was measured in sections of 35 Spitz naevi using a microcomputer image analysis system. The data were compared with results previously obtained from 19 cases of malignant melanoma and 16 benign compound naevi. Disaggregated cells from paraffin-embedded material were stained by the Feulgen technique for DNA estimation. The nuclear DNA content distributions were measured using the same image analysis system. Compared with the malignant cases, the Spitz naevi showed significantly lower staining intensity for both S100 protein (P less than 0.0001) and NSE (P less than 0.0001). When compared with the benign compound naevi, the staining intensity was significantly lower for S100 protein (P = 0.003). The nuclear DNA distribution in Spitz naevi proved to be a normal diploid pattern in 31 cases. Four cases showed a small proportion of hyperdiploid nuclei. The results show that Spitz naevi can be significantly distinguished from malignant melanoma by staining intensity for S100 protein and NSE. A normal diploid DNA content distribution appears to be typical for Spitz naevi. Spitz and benign compound naevi show dissimilar expression of S100 protein which may indicate different patterns of differentiation in these two types of lesion. The image analysis equipment used in this study is accurate, simple to use, produces results rapidly, and is economic. Therefore, it is clinically practicable.

Immunostaining of antral gastrin cells is quantitatively increased in Heliobacter pylori gastritis

The amount of gastrin-like immunostaining in gastrin (G) cells of the antral mucosa was quantified using a computer-assisted method of measuring immunoreaction product. Biopsies from 25 patients without Heliobacter-like organisms and 60 patients with varying degrees of infection were immunostained for gastrin. Twenty-five G cells from each patient were measured both subjectively and by image analysis. Gastrin-like immunoreactivity was found to be significantly increased in the presence of Heliobacter-like organisms.

Prognosis of conjunctival melanomas in relation to histopathological features

Twenty-six patients (age 29-85 years) with primary malignant melanoma of the conjunctiva were analysed for usefulness of various histopathological and immunohistochemical features of the primary, recurrent and metastatic tumours in evaluating their prognosis. The mean follow-up time was 5.5 years, ranging from 8 months to 17 years. Eight patients developed metastases and seven have died. The mean time from diagnosis to death due to metastasis was 3.8 years (range 1-6 years). The site of the primary tumour seemed to be most closely correlated to high metastatic risk. Only two of the sixteen limbal melanomas metastasised, whereas two of the four bulbar, all three tarsal and the only diffuse primary tumour caused metastatic disease. Two of the metastasising primary tumours were less than 1.5 mm thick, but all exceeded 0.8 mm in thickness. The mitotic rate, the amount of inflammatory infiltrate, the cell type or the presence of adjacent intraepithelial involvement did not obviously correlate to treatment outcome. Furthermore, the expression of S-100 protein and neuron-specific enolase (NSE), both suggested to be prognostic indicators in cutaneous melanoma, did not correlate to the tendency of the conjunctival melanomas to recur or metastasise.

S-100 protein: a prognostic indicator in cutaneous malignant melanoma?

A series of 215 cases of cutaneous malignant melanoma referred to a single department of clinical oncology between 1940 and 1969 was studied to assess the accuracy of the Breslow thickness and the role of S-100 protein in predicting the clinical prognosis. Histological examination of these tumours showed that although the Breslow thickness correlated well with prognosis, in a significant number of cases it did not reliably forecast clinical outcome. From this series, tissue from those patients who survived disease-free for more than 10 years and those who died within a year of diagnosis was stained immunohistochemically for S-100 protein. Contrary to the findings of earlier studies, strong staining for S-100 protein was associated with improved survival (P less than 0.001). A marked increase in the incidence of cutaneous malignant melanoma was noted during the period of the study.