Small bowel intussusception caused by multiple intestinal metastases from a giant cell carcinoma of the lung: a case report

Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.

Value of uroplakin III in distinguishing variants of primary bladder urothelial carcinoma from malignancy metastatic to the urinary bladder

BACKGROUND

Urothelial carcinoma (UC) variants can be difficult to differentiate from carcinoma metastatic to the bladder.

MATERIALS AND METHODS

We examined immunostaining for uroplakin III in 43 cases of primary bladder UC variants including micropapillary UC (n=19), nested variant of UC (n=2), pleomorphic giant-cell carcinoma (n=8), plasmacytoid UC (n=4), lymphoepithelioma-like carcinoma (n=2), large cell undifferentiated carcinoma (n=2), UC with abundant myxoid stroma (n=3) and lipid cell variant (n=3) and in 11 tumors from other organs metastatic to the bladder. These tumors included invasive ductal carcinoma of the breast (n=2), colorectal adenocarcinoma (n=4), endometrioid adenocarcinoma (n=1) and serous papillary carcinoma of the uterus (n=1) melanoma (n=1), embryonal carcinoma of the testis (n=1), and renal clear cell carcinoma (n=1).

RESULTS

Out of the 43 UC variants, 35 (81%) were positive for uroplakin III, including micropapillary, lipid cell variant and UC with abundant myxoid stroma. Pleomorphic giant cell carcinoma, plasmacytoid UC and nested variant of UC were less commonly positive. Of the 11 metastatic tumors, six were found to be positive for uropIakin III: metastatic colorectal adenocarcinoma, clear cell carcinoma of the kidney and embryonal carcinoma of testis.

CONCLUSION

UP III Positivity for uroplakin III is not found only in primary bladder UC variants, but in some tumors that have metastatized to the bladder. Staining for uroplakin III alone should not be taken as evidence of UC.

Esophageal pleomorphic giant cell carcinoma combined with small cell carcinoma

Herein is presented the case of an esophageal pleomorphic giant cell carcinoma combined with small cell carcinoma (SCC). The patient, a 77-year-old man, initially presented with dysphagia and hoarseness, and endoscopy indicated a large esophageal tumor. Despite chemoradiation therapy, the patient died from widespread local extension of the tumor and distant metastases approximately 8 months after onset of the symptoms. Histologically, the primary tumor was composed of pleomorphic tumor components, SCC components, and a tiny focus of squamous cell carcinoma. The pleomorphic tumor cells, consisting of solid sheets of poorly cohesive epithelioid cells and numerous multinucleated giant cells with abundant eosinophilic cytoplasm, were immunohistochemically positive for vimentin and desmin, with scattered positivity for epithelial membrane antigen (EMA) and neuron-specific enolase (NSE), but negative for myoglobin. These findings were histopathologically compatible with pleomorphic giant cell carcinoma occurring at other sites such as the lung. SCC cells, morphologically similar to their pulmonary counterpart, were positive for EMA and some neuroendocrine markers such as chromogranin A and NSE, and occasionally positive for vimentin and desmin. Esophageal pleomorphic giant cell carcinoma can occur in close association with SCC, and should be included in the differential diagnosis of esophageal tumors showing pleomorphism.

Giant cell carcinoma of the hypopharynx: pathologic diagnosis and natural history

A 48-year-old man was initially seen with a giant cell carcinoma arising in the right piriform fossa. Following debulking, the tumour was treated with chemoradiation. The patient subsequently underwent laryngopharyngectomy. Distant metastases developed 10 months following treatment, despite the absence of locoregional recurrence. To our knowledge, this is the first reported case of giant cell carcinoma of the hypopharynx and first giant cell carcinoma of the laryngopharynx treated with chemoradiation. Based on our experience, surgery should remain the primary intervention to achieve locoregional control.

Pleomorphic Giant Cell Carcinoma of the Prostate

We report the clinical and pathologic features of 2 cases of pleomorphic giant cell carcinoma of the prostate. One case was found at autopsy in a 77-year-old man and was composed of high-grade prostatic adenocarcinoma with prominent anaplastic giant cells. The patient presented with metastases to multiple retroperitoneal lymph nodes, liver, and lumbar vertebrae. The second case occurred in a 45-year-old man who underwent transurethral resection of the prostate and was found to have high-grade prostatic adenocarcinoma with an extensive anaplastic giant cell component. The patient presented with distant metastases and died within 9 months. Both regular adenocarcinoma and anaplastic giant tumor cells displayed cytoplasmic immunoreactivity for prostate-specific antigen, prostatic acid phosphatase, and keratin AE1/AE3; in one case, scattered cells were also positive for chromogranin and epithelial membrane antigen. Pleomorphic giant cell carcinoma is a rare variant of prostatic adenocarcinoma with a poor prognosis that should be considered in the differential diagnosis of prostatic pleomorphic tumors.

[Differentially expressed genes in human giant-cell lung cancer lines with different metastatic potentials]

OBJECTIVE

To screen genes differentially expressed in two human giant-cell lung cancer lines of same origin but with different metastasis potentials.

METHODS

Suppression subtractive hybridization (SSH) was done twice on two giant-cell lung cancer lines, PLA-801C and PLA-801D (hereafter abbreviated as C and D), of same origin but with low (C) and high (D) metastatic potentials. In the first round, SSH C was used as tester and D as driver, while in the second round, the tester and driver were interchanged. The sequences acquired from both rounds of SSH were spotted on glass slides respectively and screened by hybridizing with two-color fluorescence probes. Clones that had different expression levels on chips were also confirmed by RNA dot blot or Northern blot.

RESULTS

There were 16 sequences with high expression in C as compared to those in D, and 79 sequences with high expression in D compared to those in C. After sequencing, most of them were found to be highly homologous to those encoding the following proteins: (1) cytokines and their receptors; (2) kinases and related proteins; (3) other proteins including enzymes, heat shock proteins, receptors, proteins of cell skeleton and mitochondria, products of oncogenes, etc; (4) some proteins deduced from gene sequences with yet unknown functions.

CONCLUSION

The alterations in expression of some known genes, including HSP70, AXL receptor tyrosine kinase and 14-3-3zeta, might have impact on metastasis of giant-cell lung cancer. Whether some differentially expressed genes newly revealed are metastasis-related needs further study.

[Function of IL-18 in promoting metastasis of lung cancer]

OBJECTIVE

To study the function of IL-18 in promoting metastasis of lung cancer.

METHODS

The differential expression of IL-18 protein or mRNA level between highly and poorly metastatic sublines of human lung giant cell carcinoma metastatic model was detected by Western blot, semi-quantitative RT-PCR and northern blot analysis. The poorly metastatic PLA801C subline or highly metastatic PLA801D subline was transfected with constructed IL-18 sense or IL-18 antisense expressed plasmid by lipofectamine stable transfection technique. The metastasis-related effect mediated by IL-18, the metastatic phenotype differences, cell motility and cell invasion potential in vitro determined by MICS system and the expression level of metastasis-associated biomarkers detected by Western blot analysis, were compared between IL-18 stably transfectants and mock control, i.e. between PLA801C/IL-18(S) and PLA801C/pcDNA3.1, or between PLA801D/IL-18(As) and PLA801D/pcDNA3.

RESULTS

IL-18 was only present in highly metastatic PLA801D subline at either protein or mRNA level, which implied that IL-18 might play a role in promoting metastasis of lung cancer. After IL-18 sense expressed plasmid was transfected into poorly metastatic PLA801C subline, IL-18 fused protein with myc tag detected by Western blot analysis using either IL-18 or myc tag monoclonal antibody. In addition, cell motility ability in vitro was significantly increased about 3 times and E-cadherin protein was significantly down-regulated at about 50% in PLA801C/IL-18(S) transfectants compared with mock control. While IL-18 expressed plasmid was transfected into highly metastatic PLA801D subline, IL-18 protein and mRNA were simultaneously decreased by 30%. In addition, cell invasion ability in vitro was significantly decreased at about 75% and E-cadherin protein was significantly up-regulated in PLA801D/IL-18(As) transfectants compared with mock control.

CONCLUSION

IL-18 might play a role in enhancing tumor metastasis of lung cancer by down-regulating E-cadherin protein expression.

Solitary muscle metastasis from lung carcinoma

Recurrence after resection of non-small cell lung carcinoma is generally associated with a poor outcome. Limb muscle metastasis from lung cancer is extremely rare. We present a case of a 71-year-old man who presented with a solitary metastasis to his right lower limb two months after right upper lobectomy for lung cancer (stage: T2N0M0). Twenty-four months after surgical excision and chemotherapy he is alive without signs of neoplastic disease. We believe that a more aggressive approach might be considered for selected patients with solitary extracranial and extra-adrenal metastasis from lung cancer.

[The suppressing effect of TIMP-3 gene transfection on the invasion and metastasis of human lung carcinoma cells line]

OBJECTIVE

The purpose of this study is to determine if increasing levels of tissue inhibitor of metalloproteinase 3 (TIMP-3) expression could suppress the malignant phenotype of human cancer cells.

METHODS

The recombinant expression vector, which contains full length cDNA of human TIMP-3, was constructed and transfected into BE1 cell line by lipofectin technique. The invasive and spontaneous metastatic potential was examined.

RESULTS

TIMP-3 mRNA expression in TIMP-3 gene transfected BE1 cells was upregulated as detected by Northern blot. The invasion of TIMP-3 gene-transfected cells across matrigel-coated filters was significantly decreased when compared with controls. Following subcutaneous injection into nude mice, the TIMP-3 transfected cells suppressed primary tumor growth, as characterized by reduced tumor incidence (9/12 vs 6/6), longer latency and reduced metastatic potential to the lungs (1/12 vs 5/6) and lymph nodes (5/12 vs 6/6).

CONCLUSION

The results suggest that upregulation of TIMP-3 expression in BE1 cells resulted in suppression of the invasive potential of BE1 cells in vitro as well as tumorigenic and metastatic potential in nude mice.

Study on the metastatic mechanisms of human giant-cell lung carcinoma comparison between the strains C and D

The biologic characteristics of the two human giant-cell lung carcinoma strains with high (strain D) and low metastatic potential (strain C) were studied, including karyotype of chromosome, intracellular free calcium ([Ca2+]i), morphologic changes of cell surface and the expression of nm23-H1, p53, ras, c-myc, c-erbB2, bcl-2 genes and PCNA. The correlation between different biologic features and the metastatic potential of the two strains was analyzed. We found: 1) Both strains had the karyotypic abnormality of -13, -14, -15, +20, +21 with seven same marker chromosomes. Only strain D had the karyotypic abnormality of +7, -17, -18, +X, 7p+; 2) [Ca2+]i of the strain C (984.7 +/- 573.8) and D (517.6 +/- 216.6) was significantly different (p < 0.05). The amplitude of intracellular calcium oscillations of strain C was lower than the one of strain D; 3) strain C had more villous-like protrusions on the cell surface, whereas strain D had more bubble-like protrusions; 4) The expression of nm23-H1 and p53 protein of strain C was all higher than that of strain D. The expression of PCNA of strain C was lower than strain D; 5) nm23-H1 mRNA levels of strain C was lower than that of strain D. We consider that the karyotype of chromosomes, intracellular free calcium, the structure of cell membrane and the expression of nm23-H1 gene, p53 gene, PCNA could be closely related to the metastatic potential of human giant-cell lung carcinoma. They could be used as the sign for judging whether the tumor will metastasize in clinical practice as well as in judging the prognoses of patients.

[Zymographic analysis of MMPs in human carcinoma cell lines with different metastasis potential]

OBJECTIVE

To investigate the correlation between matrix metalloproteinases (MMPs) activities and metastatic potential of several groups of human carcinoma cells with different metastatic potential.

METHODS

Several groups of human carcinoma cell lines (human lung carcinoma, human prostatic carcinoma and melanoma) with different metastatic potential were selected. By using cell culture, collection and concentration of conditioned media and zymographic analysis method the difference of MMPs production and activity among those cell lines were detected.

RESULTS

The MMPs production capabilities of carcinoma cells rose following the increase of their invasive and metastatic potentials: that of PG is much higher than PAa's, and BE1 is higher also than CL3 and LH7. Advanced stage melanoma cell WM983a and WM451 product MMP-9, but primary stage cells don't. There are MMP-9 in the conditioned medium of prostatic carcinoma cell PC-3M, the metastatic clone of PC-3 which don't express MMP-9.

CONCLUSION

The expression of MMPs especially MMP-9 of carcinoma cells is closely correlated to the metastatic and invasive potential.

[A study on the correlation between the activity of 72,000 type IV collagenase and the metastatic potential of cancer cells]

OBJECTIVE

To evaluate the enzyme activity of 72,000 type IV collagenase and its relationship with the metastatic potential of cancer cells.

METHODS

The levels of secreted 72,000 type IV collagenase in the conditioned media of five human cancer cell lines with different metastatic potential and a normal lung fibroblast strain treated with cancer cell culture media were examined by gelatin zymography and densitometric analysis.

RESULTS

The levels of 72,000 type IV collagenase secreted by cancer cells with high metastatic potential (PG, WM451 and WM983a) were higher than those secreted by cancer cells with low metastatic potential (PAa and WM35). In the conditioned media of fibroblasts which were treated with the culture media of PG and WM451, enhanced levels of activation were observed.

CONCLUSION

The secretion of 72,000 type IV collagenase is closely correlated to the metastatic potential of cancer cells. The cancer cells with high metastatic potential may possibly through certain soluble mediators stimulate normal fibroblasts to activate 72,000 type IV procollagenase.

[Histogenesis of the giant cells of the osteoclast type in anaplastic thyroid carcinoma]

One case is reported of amphicrin thyroid carcinoma with signs of A- and C-cell differentiation. This tumor at its early stage had a follicular structure with massive deposits of amyloid in the stroma. In the course of progression the tumor transformed into C-cell anaplastic carcinoma with stromal amyloid deposits in the form of thin fibrils and production of polypeptide hormones and their precursors by tumor cells. The distinctive feature of the tumor metastases was the presence of many giant cells which, as was shown, were amyloid-clasts.

[Effects of TIMP-2 gene transfection on biological behaviors of a metastatic human lung carcinoma cell line]

OBJECTIVES

To explore the suppressive effects of tissue inhibitor of metalloproteinase 2 (TIMP-2) on malignant phenotype of human carcinoma cells and to evaluate its potential application in cancer gene therapy.

METHODS

A man malian expression vector containing TIMP-2 cDNA was constructed and transfected into a metastatic human lung carcinoma cell line PG. In vitro and in vivo tests such as Northern blotting, immunohistochemistry as well as x enografting in nude mice experiment were used to analyse expression levels of TIMPs and MMPs, in vitro and in vivo behaviors of the tumor cells before and after the gene transfection.

RESULTS

After transfection, the TIMP-2 mRNA expression was upregulated significantly. Changes, in some malignant phenotypes of the transfectants were seen. For instance, the abilities of in vitro invasion through Matrigel, colony formation on soft agar, tumorigenecity as well as spontaneous metastasis in nude mice were remarkably decreased. Immunohistochemical staining and in situ hybrydization showed that MMP2, MMP9, TIMP-1 and TIMP-2 were expressed by both tumor cells and stromal cells, with stronger staining at the site of tumor invasion.

CONCLUSION

Up-regulation of TIMP-2 in tumor cells could suppress their expression of malignant phenotype and could be used for cancer therapy.

[Differential expression and response of growth factors in metastatic variants of human pulmonary giant cell carcinoma cell line]

OBJECTIVE

To study the difference in expression and response of certain growth factors between the two metastatic variants PGbE1 and PGLH7 of human pulmonary giant cell carcinoma, and the action of these growth factors on the metastasis of tumor cells.

METHODS

RT-PCT was conducted to detect the expression of TGF alpha, TGF beta 1, IL-6, IL-8, bFGF and ANG, and the expression of receptors EGFR, IL-6R and IL-8R; 3H-TdR incorporation assay was used to determine the effects of recombinant TGF alpha, TGF beta 1 and IL-6 on the proliferation of the two cells.

RESULTS

TGF alpha, EGFR, IL-6 and IL-6R were expressed at a higher level in PGbE1 cells than in PGLH7 cells. No significant differences were found in the expression of TGF beta 1, bFGF, IL-8, IL-8R and ANG between the two cells. Recombinant TGF alpha and IL-6 stimulated the proliferation of both cells, while TGF beta 1 had dual effects.

CONCLUSION

TGF alpha, TGF beta 1, bFGF, IL-6, IL-8 and ANG may be involved in the autocrine regulation of the growth and proliferation of pulmonary giant cell carcinoma, TGF alpha and IL-6 may play an important role in the metastasis of the tumor cells.

[Regulatory effects of cAMP analogs on growth and differentiation of metastatic human lung cancer cells]

OBJECTIVE

To study the effects of two cAMP analogs with different site-selectivity on growth and differentiation of metastatic human lung cancer cells.

METHODS

The methods used include cell culture, in vitro invasion assay, soft agar colony formation assay, immunocytochemistry and electron microscopy. A metastatic human lung cancer cell line gwas treated with dibutyryl cAMP (db-cAMP, non-site-selective) or 8-chloro-cAMP (8-Cl-cAMP, site-selective for type II PKA).

RESULTS

Treatment of PG cells with 1 mmol/L of db-cAMP for 7 days resulted in 48% growth inhibition, while treatment with 20 mumol/L of 8-Cl-cAMP gave 70% growth inhibition. The growth inhibitory effect of db-cAMP was shown to be reversible, while that of 8-Cl-cAMP was not. The ability of PG cells to penetrate matrigel-coated membrane and to form colonies in soft agar was also significantly inhibited by treatment with these two drugs. Microscopic observation showed that cells formed elongated cytoplasmic processes and increased expression of neuron-specific enolase as well as chromogranin after treatment.

CONCLUSION

The objective to inhibit malignancy could be reached by activation of specific PKA with site-selective cAMP analogs.

[Are lung choriocarcinoma and giant cell carcinoma producing chorionic gonadotropins just variants of the same neoplasm?]

An article presents two cases of choriocarcinoma lung metastases. One case revealed the primary mediastinal choriocarcinoma and the second one had unknown primary localisation of the tumor, which could be suggestive of a spontaneously regressed primary gonadal choriocarcinoma. Authors discuss the clinico-pathological aspects of extragonadal choriocarcinomas, theories of their histogenesis and the morphological similarities to anaplastic giant cell lung carcinoma.

[The expression of 67-KD laminin receptor (LN-R) gene in PG tumor cells with high metastatic potential]

The expression level of 67-KD LN-R mRNA was observed in high-metastatic PG tumor cells and low-metastatic PAa tumor cells based on the cDNA fragments of 67-KD LN-R amplified by PCR technique and the specific cDNA probe prepared by random primer labeling method. Results showed that the transcripts were homologous in size, about 1.7kb, in PG and PAa tumor cells. The 67-KD LN-R mRNA level was higher in PG than that in PAa tumor cells, and gene amplification was also more marked in PG tumor cells. After treated with 67-KD LN-R monoclonioal antibody (50, 100 and 400 micrograms/ml) for 48 hours, LN-R mRNA of PG tumor cells decreased significantly. It is suggested that 67-KD LN-R may play important roles in metastatic processes of PG tumor cells.