Solid pseudopapillary neoplasm of pancreas: Two case reports

RATIONALE

About 8384 cases of solid pseudopapillary neoplasms (SPN) of pancreas have been published in English literature, from 1933 to 2018. This is a low-grade tumor that usually occurs in children but is rare in adults and, in exceptional cases, can show extrapancreatic localization. In this paper we present 2 unusual cases of SPNs, 1 with retroperitoneal location (case 1) and 1 that was firstly diagnosed as a G1 neuroendocrine tumor (NET) and showed hepatic metastases after 13 years (case 2).

PATIENT CONCERNS

No symptoms in first case. The tumor was incidentally diagnosed, during ultrasound examination. In the second case, the metastasis was observed during regular follow-up.

DIAGNOSES

The diagnosis was established based on the histological features and immunohistochemical profile that showed positivity for vimentin, nuclear β-catenin, cyclin D1, CD10, and SRY-related high-mobility group box 11 and negativity for maspin.

INTERVENTIONS

Surgical excision, in both cases.

OUTCOMES

No recurrences in first case, at 5 months after diagnosis. Hepatic metastases in the second case, at 13 years after diagnosis, with portal invasion after another 15 months.

LESSONS

Without a complex immunoprofile, SPN can be misdiagnosed as NET. SPN can be a low-grade tumor but long-time follow-up is mandatory to detect delayed metastases. A correct diagnosis is necessary for a proper therapeutic management.

Prognostic significance of thyroglobulin antibody epitopes in differentiated thyroid cancer

CONTEXT

Thyroglobulin antibodies (TgAbs) are surrogate markers of disease recurrence or persistence in differentiated thyroid cancer (DTC). However, the prognostic significance of TgAb heterogeneity in DTC has not been investigated.

OBJECTIVE

To evaluate the relationship between TgAb epitope specificities and clinical outcomes in DTC patients.

DESIGN

We studied 61 TgAb-positive patients with DTC, post-thyroidectomy and remnant ablation (7 males, 54 females; age-range 16-80 years, median follow-up duration 8.9 years). TgAb epitope reactivities were mapped using a panel of 10 thyroglobulin (Tg) monoclonal antibodies delineating six antigenic Tg clusters in competitive ELISA studies. Sera from 45 patients with Hashimoto's thyroiditis (HT) and 22 TgAb-positive healthy subjects served as autoimmune and healthy controls. Tg was measured by immunoradiometric assay (IRMA), electrochemiluminescence immunoassay (ECLIA), and RIA, while TgAbs was measured by ELISA and ECLIA methods.

RESULTS

Samples from 26 DTC patients showed TgAb epitope restriction similar to HT patients, while 35 patients exhibited nonspecific reactivity comparable to healthy controls. DTC patients with epitope restriction had higher rates of recurrent/persistent disease (81% vs 17%, P < .001), higher median TgAb concentration (887.0 vs 82.0 kIU/L; P < .001), and a higher prevalence of thyroid lymphocytic infiltration (71.4% vs 26.8%; P < .001) compared to patients with nonspecific reactivity. Samples with epitope restriction also had a lower median Tg-IRMA/RIA ratio (3.0% vs 36.0%; P < .001) denoting greater degrees of Tg assay interference.

CONCLUSIONS

TgAb epitope restriction is associated with a less favorable prognosis than nonspecific reactivity in DTC patients. TgAb epitope specificities may have prognostic value in DTC.

Raised Serum Chondroitin Sulfate Epitope Level in Ovarian Epithelial Cancer

OBJECTIVE

To determine the value of serum chondroitin sulfate epitope WF6 and hyaluronan (HA) levels as a biomarker for early detection of ovarian epithelial cancer and other gynecological disorders.

METHOD

Serum WF6 CS epitope and HA were measured in 91 patients with ovarian epithelial cancer, 39 patients with non-cancer gynecological disorders and 30 healthy women. Serum chondroitin sulfate (CS) WF6 epitope was determined by a competitive immunoassay with the monoclonal antibodies WF6, which specifically recognizes an epitope in native CS chains. In addition, serum HA concentration was measured by an ELISA-based assay with a biotinylated affinity HA-binding proteins.

RESULTS

The serum concentration of CS (WF6) epitope was highly increased in epithelial types of ovarian cancer and at all stages of development (p < 0.005). Serum HA in ovarian cancer patients was significantly higher than normal controls (p < 0.05).

CONCLUSION

These results reflect changes in ECM metabolism in progressive ovarian cancer, which cause an increase in serum CS epitopes and HA. Therefore, serum CS epitopes may provide useful biomarkers for cancers and other disorders of the ovary. Measurement of serum HA provided complementary information, which may be useful as a discriminator between benign ovarian disorders and malignant ovarian diseases.

Papillary adenocarcinoma of the renal pelvis and ureter producing carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125

We report a case of advanced renal pelvis and ureter adenocarcinoma producing carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125). A 72-year-old woman was diagnosed with right renal pelvic and ureter tumor with para-aortic lymph node swelling. Biopsy of the ureteral mass revealed papillary adenocarcinoma. Serum levels of CEA, CA19-9 and CA125 were extremely elevated. The patient was successfully treated with paclitaxel/carboplatin chemotherapy followed by surgery.

Lymphocytic infiltration in pediatric thyroid carcinomas

Lymphocytic thyroiditis has been associated with an increase in the incidence of thyroid papillary carcinoma in some reports, mostly series of both adults and children. Relatively little is written about thyroiditis and follicular carcinomas. We have seen several cases of pediatric follicular thyroid carcinomas, that had an associated lymphocytic infiltrate, which led us to examine all primary malignant thyroid neoplasms in our surgical files from 1984 through 2000 to examine this relationship. We also investigated the nature of the lymphocytic infiltrate with routine immunohistochemistry. Ten patients (five male, five female, ages 4.5-21 years of age) had a thyroid carcinoma resection, six (three males and three females) with papillary carcinoma and four patients (two males and two females) with low-grade follicular carcinoma. Seven samples (one male had two cases with tumor) from patients who had a papillary carcinoma resection with tissue blocks available were identified (one patient had slides but no blocks), as were all four patients with a follicular carcinoma. The thyroid of all patients with a follicular carcinoma contained a lymphocytic infiltrate; only four of the seven papillary carcinoma samples had an associated lymphoid infiltrate. In all cases with a lymphoid infiltrate, the infiltrate was present in both lobes (both adjacent and separate from the tumor). B lymphocytes were present in the lymphoid infiltrate of three of four patients with follicular carcinomas and in 1 of 3 cases of papillary carcinomas. T cells were dispersed throughout all the tumors with lymphoid infiltrates. We conclude that pediatric follicular carcinomas have an associated lymphocytic infiltrate in the tumor and/or adjacent thyroid, more commonly than papillary carcinomas.

[The role of Fas/FasL system in the regulation of tumor-immune system interactions in papillary thyroid carcinoma in children and adolescents]

Fas(APO-1/CD95) is a transmembrane protein that induces apoptosis in susceptible normal and neoplastic cells upon cross-linking by its ligand (FasL). Changes in the Fas and FasL expression were suggested to be a potential mechanism of tumor immune evasion. Thyroid cancer in children and young adults of the Republic of Belarus is the consequence of the Chernobyl accident. Papillary thyroid cancer (PTC) is the most common variant of thyroid carcinoma. This study was performed on the formalin-fixed and paraffin-embedded tissues obtained after surgery from 43 patients with PTC. The presence of Fas and FasL in thyroid tissue specimens was examined immunohistochemically. Positive staining for FasL was observed on neoplastic thyrocytes, whereas staining of normal thyroid cells was weak or absent. The pattern of staining was membranous and cytoplasmic. Staining of lymphocytes both in tumor tissue and in lymph nodes for FasL was weak or absent. Fas expression was found on normal thyroid cells, cancer cells and lymphocytes both in tumor and in lymph nodes with metastases. In lymph node metastases, in lymphocytes adjacent to FasL cancer cells morphological signs of apoptosis were observed.

The feasibility and safety of immunotherapy with dendritic cells loaded with CEA mRNA following neoadjuvant chemoradiotherapy and resection of pancreatic cancer

BACKGROUND

Resected pancreatic cancer has a high risk of recurrence and mortality despite the the use of chemoradiotherapy. Because pancreatic cancers express tumor antigens such as carcinoembryonic antigen (CEA), it may be possible to immunize patients to induce tumor antigen-specific immune responses. We hypothesize that high-frequency tumor antigen-specific immune responses will reduce recurrence and increase survival. Autologous dendritic cells (DCs) loaded with tumor antigens are particularly potent at inducing tumor antigen-specific immune responses.

METHODS

Three patients with resected pancreatic adenocarcinoma following neoadjuvant chemoradiotherapy received autologous, monocyte-derived DCs loaded with the mRNA encoding CEA monthly for 6 mo.

RESULTS

It was feasible to generate an adequate number of DC from these patients and to cryopreserve them for repeated use. The DC demonstrated the typical immature phenotype. The immunizations were well-tolerated without evidence of adverse events. All three developed injection site reactivity. All three are alive without evidence of disease at more than 2 1/2 yr from the original diagnosis.

CONCLUSION

The postoperative period following neoadjuvant chemoradiotherapy and pancreaticoduodenectomy for pancreatic cancer is an ideal environment to test novel immune-based therapies. DC-based immunotherapy in this setting is safe and feasible and may lead to prolonged survival.

[Histological and molecular-biological markers of malignancy in different variants of thyroid papillary carcinoma]

Material for this study from 61 patients (thyroid papillary carcinoma) is shown to represent a heterogenic group of tumors differing from each other morphologically, molecular-biologically and histogenetically. The most malignant were long-cell and B-cell variants and the least malignant--a follicular variant. 81% of the tumors had neuro-endocrine differentiation and their malignant potential was higher compared to tumors without this differentiation.

P53 autoantibodies in sera from Danish ovarian cancer patients and their correlation with clinical data and prognosis

The p53 gene, a tumour suppressor gene located on the short arm of chromosome 17 (17p13), is frequently mutated in various human tumours. Accumulation of p53 protein in neoplastic cells and its release following tumour necrosis can lead to development of circulating autoantibodies (AAb) against p53. Earlier studies of ovarian cancer (OC) patients reported different frequencies of p53 AAb and conclusions regarding the clinical and prognostic value of these AAb have not been in agreement. We therefore analysed for the presence of p53 AAb in a total of 227 preoperative serum samples from 193 OC patients and 34 patients with ovarian borderline tumours, and, in addition, serum samples from 86 healthy controls. An enzyme-linked immunosorbent assay (ELISA) was used to measure serum IgG antibodies against p53. The p53 protein used in the assay was produced as a hexahistidine-tagged fusion protein by baculovirus-infected Spodoptera frugiperda cells. Cut-off values for p53 AAb were evaluated, and correlations of p53 AAb with clinical-, biochemical data and survival were examined. We found a low sensitivity for p53 AAb alone, and no major additional effect of the detection rate of CA125 was found. No significant associations were found between p53 AAb and clinical stage, age, histological subtype and radicality after primary surgery. In contrast, we found significantly elevated CA125 levels in p53 AAb-positive patients compared to lower CA125 levels in p53 AAb-negative patients (p=0.003). No significant differences were found between p53 AAb-positive and p53 AAb-negative patients in the univariate and multivariate survival analyses. In conclusion, in a screening study for OC serum p53 AAb levels are of no diagnostic value, even if combined with the tumour marker CA125. The presence of increased serum p53 AAb in patients with diagnosed OC could not be correlated with any clinical data and preoperative serum p53 AAb status had no evident value.

Adenocarcinoma of the ileum producing carbohydrate antigen 19-9: report of a case

We report herein the case of an 81-year-old woman found to have small intestinal carcinoma producing carbohydrate antigen (CA)19-9, in whom recurrence on the abdominal wall was strongly suspected 4 months after resection. She presented to our hospital with acute abdominal pain with severe anemia. Marked serum elevation of CA19-9 to 164.8 U/ml suggested a progression to malignancy. A fluorography using an ileus tube revealed an abnormal mucosal pattern. An exploratory laparotomy showed an incomplete annular constrictive Borrmann type 2 tumor, located approximately 190 cm from Treitz's ligament, without any signs of peritoneal or hepatic metastases. Histological examination confirmed a diagnosis of papillotubular adenocarcinoma without metastases of the regional lymph nodes. CA19-9 antigenicity was detected in the cytoplasm and on the surface of the cancer cells, using the monoclonal CA19-9 antibody, NS19-9. In this report, we demonstrate the CA19-9 productivity and distribution of the cancer tissues in relation to their prognosis.

Potential allogeneic graft-versus-tumor effect in a patient with ovarian cancer

A 33-year-old woman developed progressive ovarian cancer resistant to classical chemotherapy agents. We performed a bone marrow allograft after a myeloablative regimen. During hematological recovery, she developed acute graft-versus-host disease (GVHD). From this time her tumor diminished progressively. One year post transplant she has limited chronic liver GVHD and is still free of disease. The complete remission of advanced ovarian cancer was probably related to the GVHD which might therefore provide a new treatment option for this disease.

Humoral immune responses to cathepsin D and glucose-regulated protein 78 in ovarian cancer patients

Many cancer patients develop tumor-reactive immune responses against antigens that are either expressed on the surface of tumor cells or released from them into the peripheral circulation. In this study, tumor-reactive immunoglobulins, present in the sera of ovarian cancer patients, were used to identify commonly recognized tumor-associated antigens on ovarian tumor cells. Western immunoblot analysis of cellular proteins, obtained from UL-1 ovarian tumor cell line, demonstrated several commonly recognized immunoreactive proteins. Two of these proteins (Mr 32,000 and 71,000) were selected for further investigation. Cellular proteins isolated from normal human ovarian epithelia, in a similar fashion, failed to exhibit corresponding immunoreactivity to these proteins. As an additional control, sera from normal (nontumor-bearing) individuals failed to identify these proteins on Western immunoblots. Furthermore, the absorption of the ovarian cancer patients' sera with normal ovarian epithelial tissue did not remove the reactivity of these two proteins. The Mr 32,000 and 71,000 proteins were subsequently purified by reverse-phase high-performance liquid chromatography, separated by SDS-PAGE, transferred to the polyvinylidene difluoride membrane, and digested with trypsin. These resulting tryptic fragments were separated by microbore reverse-phase high-performance liquid chromatography, and selected fragments were sequenced by mass spectrometry. This sequence analysis identified the Mr 32,000 protein as cathepsin D and the Mr 71,000 as glucose-regulated protein 78 (member of the heat shock protein family). The identities of cathepsin D and glucose-regulated protein 78 were confirmed by Western blot analysis. Additionally, the presence of cathepsin D was demonstrated in association with immune complexes in vivo. Currently, the common antigenic epitopes of these proteins are being defined.

Development and characterization of an interleukin-2-transduced human ovarian carcinoma tumor vaccine not expressing major histocompatibility complex molecules

OBJECTIVE

We initiated studies to develop cytokine-secreting human ovarian carcinoma cells for the purpose of using these cells as vaccines for the treatment of advanced epithelial ovarian cancer.

STUDY DESIGN

A human ovarian carcinoma cell line (UCI-107) was genetically engineered to secrete the cytokine interleukin-2 by retroviral-mediated gene transduction.

RESULTS

One clone, termed UCI-107A IL-2 AS, constitutively secreted high levels of interleukin-2 (i.e., 2000 to 2300 pg/ml/10(5) cells per 48 hours) for > 55 passages and 8 months of study. Unlike parental- and vector-transduced cells, UCI-107A IL-2 AS cells were aneuploid and failed to express major histocompatibility complex class I and HER2/neu surface antigens. UCI-107A IL-2 AS cells were highly resistant to killing by gamma irradiation and continued to produce high levels of interleukin-2 even after irradiation with 10,000 cGy. Balb/C nude mice injected intraperitoneally with UCI 107-A IL-2 AS cells survived significantly longer than control animals, with 25% of the animals totally rejecting their tumors. UCI-107A IL-2 AS was totally resistant to killing by fresh allogeneic peripheral blood lymphocytes in four hour chromium 51 release assays but induced high levels of killing in 72-hour long-term cytotoxic assays.

CONCLUSION

The potential use of these interleukin-2-secreting ovarian carcinoma cells as vaccines for women with advance ovarian cancer will be discussed.

[Two cases of CA19-9 producing pulmonary papillary adenocarcinoma]

Two cases of CA 19-9 producing pulmonary papillary adenocarcinoma were reported. Pathological examination showed a well differentiated papillary adenocarcinoma with partially bronchiolo-alveolar cell type. Immunohistochemical study showed a positive straining for CA 19-9 on tumor cells. The level of CA 19-9 decreased after lobectomy and anti-cancer chemotherapy using CDDP and VDS. The series of CA 19-9 level is very useful to evaluate the effect of surgery and chemotherapy. Also it is useful to find out the recurrence of carcinoma.

[A case of lung scar cancer with special pathohistological feature and high CA 19-9 level]

A 58-year-old woman complained of cough and fever. CX-P and chest CT revealed pneumonic shadow and serum CA 19-9 level was high. Since the malignant cells were found in the bronchial lavage fluid, the lower lobectomy of the left lung was done. Both macroscopically and microscopically, adenocarcinoma only existed in 2-3 mm width at the peripheral site of the scar lesion. The postoperative CA 19-9 values continued to be high, suggesting the recurrence of the cancer. After 23 months from the first operation, the upper lobe of the left lung was resected on the base of the similar findings in CX-P and chest CT. The histological finding of the specimen was compatible with the scar cancer described above. After the second operation, the serum CA 19-9 value decreased to normal. We reported a case of the lung scar cancer with special pathohistological feature.

[The expressions of proliferating cell nuclear antigen (PCNA) in primary gallbladder carcinoma and its significance]

Anti-PCNA monoclonal antibody and ABC staining were used to study the expressions of proliferating cell nuclear antigen/cyclin in patients with primary gallbladder carcinoma (31 cases), adenoma and tumor-like lesions of gallbladder (10 cases), and chronic cholecystitis (7 cases). The PCNA indices were 373.48 +/- 219.83, 94.9 +/- 93, and 56 +/- 28.63, respectively. This index was significantly higher in malignant lesions than in benign diseases (P < 0.01). There was a tendency that the higher the PCNA index, the lower differential degree of the gallbladder carcinoma (P < 0.01). But there were no significant correlations between the PCNA indices and the pathohistological types, the nevin classifications and the TNM classifications of the gallbladder carcinoma (P > 0.05).

Swainsonine augments the cytotoxicity of human lymphokine-activated killer cells against autologous thyroid cancer cells

OBJECTIVE

Swainsonine (SW), an inhibitor of mammalian Golgi alpha-mannosidase II, blocks the processing of high mannose to complex type oligosaccharides. In this study, the effect of SW on the cytotoxicity of lymphokine-activated killer (LAK) cells against autologous thyroid cancer was investigated.

DESIGN

Peripheral blood lymphocytes from patients with thyroid cancer were incubated with recombinant interleukin 2 (100 U/mL) and 0.5 mg/L of SW for 7 days, and thyroid cancer cells obtained from surgical specimens were pretreated with SW (0.5 mg/L) for 18 hours. The cytotoxicity of SW-treated LAK cells against tumor cells tested in a standard 4-hour radioactive chromium Cr 51 release assay.

RESULTS

The cytotoxicity of SW-treated LAK cells against autologous thyroid cancer cells was found to be significantly greater than that of standard LAK cells incubated with interleukin 2 alone. The N-alpha-benzyloxycarbonyl-L-lysine thiobenzyl ester esterase activity of LAK cells, this activity being a cytotoxic factor that is necessary for the lethal hit stage, was also increased by SW treatment. Further, thyroid cancer cells incubated with SW, as compared with nontreated tumor cells, showed much higher susceptibility to LAK killing.

CONCLUSIONS

Our results suggest that SW might have potential immunomodulatory properties in the treatment of thyroid cancer.

Expression of carbohydrate antigens in human pulmonary adenocarcinoma

BACKGROUND

The altered and anomalous expression of carbohydrate antigens (CA) occur in patients with lung carcinomas.

METHODS

To investigate the relationship between prognosis and immunohistochemical findings of CA in serum and pulmonary adenocarcinomas (PA), PA specimens surgically resected from 102 patients were studied with the use of A, B, H, Lewis(Le)a, Le(b), Le(x), Le(y), sialyl Le(a) (FH-7), sialyl Le(x-i) (SLX) (FH-6), sialosyl Tn (TKH-2), and CA 19-9. The Lewis blood group types were determined by the dot blotting method on patients' serum using monoclonal anti-Le(a), Le(b), Le(x), and Le(y). Formalin-fixed paraffin-embedded PA sections were stained using the avidin-biotin-peroxidase complex methods.

RESULTS

There was no correlation between the patients' postoperative survival and tissue expression of CA, although survival correlated with the clinical stages, histologic differentiation of PA, and serum SLX in Stage 4. The higher the positive rate of both Le(b) and Le(y), the better their differentiation in PA specimens. Regardless of blood group type, PA showed high positive reactions for FH-6 (88%) and Le(y) (87%). The serum concentration of CA 19-9 correlated with immunohistochemical reactions of tumors (Spearman correlation coefficient = 0.33, P = 0.02). The expression of Le(a) in Lewis (a-b+) phenotype patients and Type 2 CA, such as Le(y) and FH-6, is characteristic in PA.

CONCLUSIONS

The findings suggest that CA tissue expression may not reflect postoperative survival length of patients with PA, but biological aberrant fucosylation or sialylation as well as morphologic alteration may occur in neoplastic cells.

[The relationship between carcinoembryonic antigen (CEA) expression and histogenesis of gastric cancer (application of immunohistochemical and mucin histochemical techniques)]

The distribution of CEA and mucin in gastric specimens of 134 cases was examined by immunohistochemical and mucin histochemical techniques. The results showed that in 85.58% of the gastric cancers CEA was positive, including all mucinous adenocarcinomas, signet-ring cell carcinomas and papillary adenocarcinomas. In tubular adenocarcinoma, there was a tendency of increased expression of CEA with the degree of cell differentiation. The positive rate of CEA in intestinal type of gastric cancer was higher than that in gastric type and stem cell type. Intestinal metaplasia with colonic type sulphomucin had a higher positive rate than that without sulphomucin. The positive rate of CEA in cancers secreting sulfomucin was higher than that in cancers without sulfomucin. It suggested that gastric cancers expressing CEA was histogenetically related to colonic type intestinal metaplasia and cancers without CEA expression might be evolved from gastric proper epithelium.

Serum levels and thyroid tissue expression of CA50 and CA 19-9 in patients with thyroid tumor

A 77-year-old man was admitted to the hospital with a thyroid nodule. The levels of serum tumor-associated carbohydrate antigens (CA 50, CA 19-9) and thyroglobulin (HTG) were markedly increased. We performed total thyroidectomy and right neck lymph node dissection. After treatment, the serum CA 50, CA 19-9 and HTG levels were markedly decreased. Histological examination of the thyroid tumor showed papillary adenocarcinoma and the dissected neck lymph nodes contained metastatic adenocarcinoma. The expression of CA 50 and CA 19-9 (defined by the monoclonal antibodies) was studied by immunoperoxidase staining from the normal and carcinomatous thyroid tissues and the dissected neck lymph node. CA 50 was expressed more strongly by the carcinoma cells than CA 19-9. The positive rates for serum CA 50 and CA 19-9 levels in other patients with papillary adenocarcinoma were not significantly higher compared with patients with benign nodules and normal subjects. But a significant positive correlation was found between the diameter of the carcinoma and the serum levels of CA 50 and CA 19-9. These results suggest that the serum levels of CA 50 and CA 19-9 might not become useful markers for diagnosing carcinoma of the thyroid, but might be useful markers for monitoring the growth or recurrence of papillary adenocarcinoma of the thyroid in patients with high serum levels of CA 50 and CA 19-9.

Killer cells induced by stimulation with allogeneic tumor cells and subsequent culture with recombinant interleukin-2

Peripheral blood lymphocytes were cultured for 5 days with allogeneic tumor cells (allogeneic mixed lymphocyte/tumor cell culture), and subsequently cultured with recombinant interleukin-2 for 12 days. These cultured cells were found to be cytotoxic to autologous tumor cells. Results of two-color analysis using monoclonal antibodies to cell markers showed that more than 80% of their cultured cells were CD3+ cells, and CD4+ cells showed a higher distribution than CD8+ cells. However, CD8+ cells had a much higher killing activity with autologous tumor than did CD4+ cells, when estimated by an elimination study using monoclonal antibodies to T cell phenotypes and complement. The "cold-target" inhibition test showed that the cytotoxicity of these cells for autologous tumor cells was inhibited by unlabeled autologous tumor cells but not by unlabeled stimulator cells. Furthermore, about 40% of the cytotoxicity was suppressed by blocking of HLA class I antigen with a monoclonal antibody on autologous tumor cells. Thus, cytotoxic activity of lymphocytes to autologous tumor restricted by target cell HLA class I antigen is possibly induced by allogeneic tumor-stimulation.

Autologous antibodies eluted from membrane fragments in human ovarian epithelial neoplastic effusions. III. Cytotoxic potential in vitro and characterization of antigen(s)

Cyst and ascites fluids from patients with ovarian epithelial neoplasms contain immunoglobulins with antitumor activity. Autologous antibodies bound to the cellular membrane fragments obtained from human ovarian neoplastic effusions react with cell-surface antigens on different human ovarian cell lines, surgical specimens of human ovarian adenocarcinoma, and human ovarian tumors grown in athymic Balb/c mice. The antibodies do not react with tissue preparations from normal human ovaries, other nonovarian normal or neoplastic tissues, and nonovarian human cell lines. These studies indicate that these antibodies are capable of complement-mediated lysis of human ovarian tumor cell lines in vitro. Preliminary characterization of the autologous ovarian tumor-associated antigen(s) indicates that it may be composed of three large-molecular-weight proteins of 182,000, 164,000, and 122,000 d.

[A clinicopathological study of early mucinous adenocarcinoma of the stomach]

From 1963 to 1986, 1126 cases (1300 lesions) of early gastric carcinoma were treated at Fukui Prefectural Hospital. Mucinous adenocarcinomas comprised 16 lesions in this series. These cases of mucinous adenocarcinoma were younger than all the other early carcinomas of the stomach and they often were locted in the lower third of the stomach. Macroscopically, most were types "Iia + IIc". Dividing them into 3 grouping: papillary, tubular, and signet ring cell types, depending on the microscopic appearance of the intramucosal carcinoma, the signet ring cell group differed from the other two as to age, macroscopic appearance, and region it occupied. An immunochemical study showed that CA19-9 stained positively in a mucous lake, much like a carcinoma cell, but that CEA stained little.

A novel antinuclear antibody associated with a lupus-like paraneoplastic syndrome

The association of malignancy with lupus-like syndromes is rare, and the relation between these two processes is uncertain. A 71-year-old woman who presented with serositis, Raynaud phenomenon, and positive results on an antinuclear antibody test was initially thought to have systemic lupus erythematosus but was found to have ovarian adenocarcinoma. A unique sparsely speckled antinuclear antibody pattern was seen. The patient's sera reacted to novel antigens with six bands of 100, 80-78, 48, and 17 kD on Western blots not typical of reactivity for sera from patients with systemic lupus erythematosus.

[The immunohistochemical localization of CA 15-3 in human breasts and their tumors]

The tissue distribution of CA 15-3, a breast carcinoma associated antigenic determinant, has been investigated by an avidin-biotin immunoperoxidase technique in the human breasts and in their tumors. In cases of scirrhous carcinoma, positive stainings for CA 15-3 were observed in almost all carcinoma cells. In cases of solid-tubular carcinomas and papillotubular carcinomas, the reaction was various and there was no correlation between the distribution of CA 15-3 and the clinical stage. Apical staining was recognized in both solid-tubular and papillotubular carcinomas, in benign breast tumors, and in normal breast tissues. CA 15-3 appears to be related to the degree of differentiation of the breast tissue.

In vivo localization of radiolabeled monoclonal antibody to carcinoembryonic antigen (CEA) in a CEA-producing tumor--comparison with polyclonal antibody

To compare accumulation of the 125I-labeled antibodies (anti-carcinoembryonic antigen (CEA) monoclonal antibody and polyclonal antibody) to a CEA-producing tumor (SC-2-JCK), an in vivo localization study was performed in nude mice. The tumor-to-blood ratio at 120 hours after injection rose to 4.6 for the monoclonal antibody, but remained at 1.3 for the polyclonal antibody. However, no differences were noted between the antibodies up to 72 hours after injection. In autoradiograms, selective accumulation of the tracer was noted in the tumor for both antibodies. However, no superiority or inferiority of imaging for either of the antibodies could be definitely determined.

Immunotherapy in a spontaneously developed murine mammary carcinoma with syngeneic monoclonal antibody

A new spontaneously arisen murine breast tumor, designated JC, has been established in immunocompetent BALB/c mice. Upon reestablishment of tumor in vitro and in vivo, the epithelial murine tumor cells retained their original papillary adenocarcinoma morphology. Various immunotherapy protocols have been performed in previously implanted and progressively growing JC tumor in syngeneic hosts with a murine monoclonal antibody (McAb), F36/22 (IgG3). Affinity of McAb binding to JC tumor cells was determined to be 6.1 x 10(7) L/M. Quantitatively 1.2 x 10(5) molecules of McAb bound to a JC tumor cell. Immunotherapeutic effectiveness in vivo on a tumor mass after its establishment is a major feature of this experimental tumor model. When four sequential administration of McAb, i.p., at a dose of 400 micrograms 4 days apart were used, McAb-treated animals showed statistically significant tumor regression and longer survival than those of control animals treated with an irrelevant McAb of the same isotype. Two temporal phases of tumoricidal activity were observed as measured by tumor volume reduction. The first phase of tumoricidal response (tumor regression) was detected within days upon the first administration of McAb. A distinct second phase followed within 3-5 weeks after the last McAb administration, which resulted in tumor necrosis even in large tumors. Histological examinations revealed heavy infiltration of inflammatory cells at the beginning of the second phase. Similar tumor regression was also obtained from animals treated with a single dose (400 micrograms) of McAb followed by injections of McAb with complete and incomplete adjuvant, respectively. These results demonstrate that this syngeneic murine mammary tumor can serve as a potential preclinical model for investigation of parameters and mechanisms associated with McAb immunotherapy.

Macroamylasemia associated with thyroid cancer, elevated serum thyroxine-binding globulin (TBG), chronic pancreatitis and gastrointestinal polyposis

A case of macroamylasemia in a 78 year-old female, associated with papillary adenocarcinoma of the thyroid and elevated serum thyroxine-binding globulin was described. Serum amylase of the patient was very high despite a normal level of serum lipase. Her serum amylase was characterized as macroamylase on the basis of electrophoresis and elution profile of gel chromatography. Serum precipitation response using chain-specific rabbit anti-human IgG, IgA and IgM antisera disclosed that her macroamylase was mainly composed of immune complexes between amylase and IgA class anti-amylase antibodies. Both the pathogenesis and clinical significance of the association of these disorders in this patient were discussed.

[Prognostic significance of immunoreactivity of regional lymph nodes in colorectal cancer--an analysis of 2,502 cases. National Cooperative Group on Pathology and Prognosis of Colorectal Cancer]

This paper presents an analysis of the relation between immunoreactivity of the regional lymph node and survival rate. 2,502 cases of colorectal cancer collected from 13 areas in China were studied. The immunomorphology of the regional lymph node in this study was shown by sinus histiocytosis (SH), paracortical hyperplasia (PH) and germinal hyperplasia (GH). Each of these reactions was divided into 4 grades (-, +, ++, +++). The results show: A significant correlation exists between the extent of immunoreaction and prognosis. The 5 year survival rates of patients with SH (++, +++), PH (++, +++), GH (++, +++) are 59.0%, 58.1% and 62.1% respectively, much higher than those in the negative groups (P less than 0.001). The effect of these three immunoreactive features on prognosis is diverse. The 5 year survival rate of cases with simple GH (++, +++) is 62.9%, statistically higher than those of cases with simple PH (++, +++) or SH (++, +++). It seems that the B-cell may play a very important role in the host defence mechanism. It was found that SH (++, +++), PH (++, +++) and GH (++, +++) occurred more frequently in Dukes' A stage than those in Dukes' C stage. The same phenomenon is also identified in comparing the well-differentiated with the poorly-differentiated cases.

[Clinical study on tissue polypeptide antigen (TPA) in gastric cancer]

We evaluated whether assay of tissue polypeptide antigen (TPA) in the serum ia valuable for the determination of cancer stages compared to other tumor markers such as CEA, AFP, and ferritin. The study population consisted of 79 gastric cancer patients and 212 patients with benign gastroenteric disease. The percentage of positive cases for TPA (higher than 200u/l) was 41% in gastric cancer and 20% in active peptic ulcer. Serum TPA levels in well differentiated carcinoma and signet ring cell carcinoma were higher than that in other histological types. Serum TPA levels correlated well with the stage of the gastric cancer.

Prognosis of the pancreatic cancer in terms of the regional lymph node reaction

In order to elucidate the immunological defense mechanism in tumor bearing hosts against pancreatic cancer, tissue reactions of the regional lymph nodes were investigated in terms of extension and prognosis of pancreatic cancer. As the site for investigation of lymph nodes, the paracortical area, germinal center and sinus histiocyte systems were selected. In each case paracortical hyperplasia, germinal center hyperplasia and sinus histiocytosis were graded and the relationship between grade and prognosis of resected pancreatic cancer was studied with the following results. The grades of each tissue reaction in cases without lymph node metastasis were higher than that observed in cases with metastasis. There was a significant difference in sinus histiocytosis (p less than 0.01). Higher grade tissue reactions were observed in cases with primary lesion histologic type classified as papillary adenocarcinoma or as well-differentiated tubular adenocarcinoma as compared to those in cases of poorly differentiated histologic type. In pancreatic cancer the prognosis was better in cases with higher grade of tissue reactions of the regional lymph nodes. In cases with pancreatic cancer both cellular immunity and humoral immunity are involved in the host defense mechanism. It was considered that sinus histiocytosis is significant as an indicator for good prognosis and a factor to inhibit progression in pancreatic cancer.

Changes in polymorphonuclear leukocyte motility under agarose and luminol-dependent chemiluminescence response in patients with gastric cancer

This study was designed to assess polymorphonuclear neutrophil (PMN) functions such as motility and chemiluminescence (CL) in fifty gastric cancer patients, as well as to determine the correlation of PMN function with extent of disease and the degree of differentiation of the lesions. Furthermore, the effects of surgery and administration of Mitomycin C (MMC) on PMN functions were studied. In early gastric cancer and Stage I disease, the mean values of chemotaxis and CL were elevated in comparison to controls. As the disease progressed, the PMN function decreased and significant depression was noted in Stage IV cases. With respect to the relationship of PMN functions to the grade of differentiation of cancer, patients with papillary adenocarcinoma had significantly elevated mean chemotaxis in response to one of the chemoattractants, while patients with poorly differentiated and signet ring cell carcinomas had significantly lower chemotactic responses to chemoattractants compared to controls. There were no significant differences in CL according to the degree of differentiation of histologic type. Surgical removal of the tumor resulted in a tendency towards improvement of PMN chemotaxis while postoperative administration of MMC resulted in a decrease, but there were no statistically significant differences between responses before and after surgery. No improvement of the CL response was demonstrated approximately four weeks after surgery.

[The effect of anti-human AFP serum for AFP producing stomach cancer xenotransplanted nude mice]

The effect of anti-human alpha-fetoprotein (AFP) on growth, serum AFP levels and histological changes of two lines of AFP producing stomach cancer serially xenotransplanted in nude mice were examined. The efficacy of anti-human AFP antibody on tumor growth was observed specifically for the tumor producing AFP, but there was great difference on growth between two lines. The AFP levels of the serum disclosed a rapid decrease after administration of antibody and maintained as level of Ong/ml for a long period. On histopathologic examination, there were not observed any changes on the tumor cells and structure and necrotic change was not demonstrated. By the immunohistochemical examination (PAP method), anti-human AFP antibody was identified in tumor even 50 th days later after injection.

[Mucohistochemical studies of CEA producing and non-producing stomach cancers]

In this report, 141 patients with gastric cancer were studied histochemically. Tissue CEA was stained by the CEA-PAP method and the gastric cancer was classified into CEA-producing (96 cases, 68.1%) and CEA non-producing gastric cancer (45 cases, 31.9%). Histologically, CEA-producing gastric cancer was well differentiated adenocarcinoma and CEA non-producing gastric cancer was chiefly undifferentiated carcinoma. PAS, pH 2.5 Alcian-blue, High Iron Diamine, Alkaline-PAS, and Concanavalin A paradoxical stain were applied to specimens from each type of gastric carcinoma. Mucosubstances of CEA-producing gastric cancer were positive for A-B, HID, AL-PAS and CPS III-1; those of CEA non-producing gastric cancer were positive for PAS and CPS III-s, but negative for A-B, HID and A1-PAS. These results suggest that CEA-producing gastric cancer arises from intestinal metaplasia of gastric mucosa and that CEA non-producing gastric cancer arises from the gastric mucosa itself.

[Immunohistochemical localization of carcinoembryonic antigen (CEA) in gastric cancer--a comparative study between tissue CEA and plasma CEA]

Plasma carcinoembryonic antigen (CEA) was examined in 122 cases of gastric cancer and immunohistochemical localization was also studied in 102 resected specimens. A comparative study between tissue CEA and plasma CEA was carried out. The results were as follows. Plasma CEA were positive (over 2.5 ng/ml) in 46 cases (37%). The positive rate was parallel with the size of cancer (p less than 0.05) and was higher in well-differentiated cancer. As to tissue CEA, 87 specimens (85%) showed the varying degree (+/- +) of positive reaction. CEA was localized in luminal border, cytoplasma and grandular lumen in well differentiated cancer, and only in cytoplasma in poorly differentiated cancer. The positive rate of plasma CEA was parallel with the degree of positive reaction in tissue. No significant histological difference was observed between strong positive reaction to tissue CEA and positive plasma CEA. In the cases with moderate positive reaction to tissue CEA, however, the positivity of plasma CEA was significantly higher in the cases with alpha or beta INF pattern and/or intermed stromal reaction. (p less than 0.05).

Induction of mammary tumors, estrous cycle abnormalities and endometrial hyperplasia in rats exposed to different doses of N-nitrosomethylurea

Groups of female Sprague--Dawley strain rats were given 3 i.v. injections of N-nitrosomethylurea in doses of 0.5, 1, 2, 3, 4 or 5 mg/100 g body weight at 4-week intervals. The first dose was given when they were 50 days old. By 23 weeks after the first injection, mammary tumors had developed in 0, 0, 33, 54, 72 and 100% of animals respectively. There was a direct relationship between the total dose of carcinogen administered and the degree of tumor anaplasia observed on histological examination. All of the tumors contained assayable amounts of estrogen and progesterone receptors, and the receptor concentrations were not related to the dose of carcinogen. Twenty-one rats, all exposed to the 4 highest doses of N-nitrosomethylurea, had arrest of the estrous cycle at the stage of estrus. In 15 of the 21 the walls of the uterine horns were thickened and grossly distended by fluid. Histological examination demonstrated the presence of endometrial hyperplasia. These uterine abnormalities were usually accompanied by polycystic disease of the ovaries. Both endometrial hyperplasia and abnormal estrous cycles without uterine changes were associated with elevated progesterone receptor to estrogen receptor ratios in the corresponding mammary carcinomas.

Identification of lymphocyte subpopulations in human breast cancer tissue and its significance: an immunoperoxidase study with anti-human T- and B-cell sera

Subpopulations of the infiltrating lymphocytes in breast cancer tissue from 31 patients were identified by indirect immunoperoxidase technique with antihuman T- and B-cell sera. In all noncancerous lesions examined (seven cases), B-cells were predominant and T-cells were scarcely found. In contrast, T-cells were predominant in breast cancer tissues (17 in 21 cases). T-cells tended to contact closely with cancer cells or cancer cell nests and accumulated around and in the walls of venules draining the cancer, while B-cells tended to cluster focally apart from cancer cell nests. T-cell infiltration was scanty in scirrhus carcinoma, whereas it was ample in infiltrating papillotubular carcinoma which had a better prognosis. There was a significant reverse correlation between the intensity of the T-cell infiltration and the clinical stages. The intensity of the T cell infiltration was significantly high in patients without lymph node metastasis. These facts suggest the possibility that the infiltrating T-cells in cancer tissue represent host resistance against cancer and that the intensity of the T cell infiltration correlates with the clinical prognosis of the breast cancer patients.

Identification of lymphocyte subpopulations in human breast cancer tissue and its significance: an immunoperoxidase study with anti-human T- and B-cell sera

Subpopulations of the infiltrating lymphocytes in breast cancer tissue from 31 patients were identified by indirect immunoperoxidase technique with antihuman T- and B-cell sera. In all noncancerous lesions examined (seven cases), B-cells were predominant and T-cells were scarcely found. In contrast, T-cells were predominant in breast cancer tissues (17 in 21 cases). T-cells tended to contact closely with cancer cells or cancer cell nests and accumulated around and in the walls of venules draining the cancer, while B-cells tended to cluster focally apart from cancer cell nests. T-cell infiltration was scanty in scirrhus carcinoma, whereas it was ample in infiltrating papillotubular carcinoma which had a better prognosis. There was a significant reverse correlation between the intensity of the T-cell infiltration and the clinical stages. The intensity of the T cell infiltration was significantly high in patients without lymph node metastasis. These facts suggest the possibility that the infiltrating T-cells in cancer tissue represent host resistance against cancer and that the intensity of the T cell infiltration correlates with the clinical prognosis of the breast cancer patients.

Quantitation of secretory component levels in cyst fluids, ascitic fluids, and sera from ovarian adenocarcinoma patients

A secretory component (SC) was detected by radioimmunoassay in the cyst fluids, ascitic fluids, and sera from patients with ovarian adenocarcinomas. Serous cyst fluids and ascitic fluids showed lower levels (expressed as means +/- SE) of SC (1.37 +/- 0.37 and 1.24 +/- 0.24 microgram/ml, respectively) than mucinous cyst fluids (181.50 +/- 50.40 microgram/ml). SC levels in the sera of all patients with ovarian adenocarcinoma were high (12.67 +/- 1.43 microgram/ml) when compared to SC levels in the sera of normal individuals (2.34 +/- 0.41 microgram/ml). Sera from patients with ovarian cancers diagnosed as serous, mucinous, papillary, and poorly differentiated adenocarcinomas showed SC levels of 9.93 +/- 1.68, 22.44 +/- 3.24, 7.35 +/- 1.13, and 10.10 +/- 1.58 microgram/ml, respectively.