[Usefulness of ultrasound endometrium thickness measurement in diagnosis of endometrium pathology in women with abnormal peri- and postmenopausal bleeding]

OBJECTIVE

Aim of the study was to assess the usefulness of ultrasound endometrial thickness measurement in the diagnosis of endometrial pathology in women with abnormal peri- and postmenopausal bleeding.

MATERIAL AND METHODS

Material included 182 patients whose endometrium sample was obtained for analysis. Patients were divided into six groups according to histological findings.

RESULTS

Correlation between thickness of endometrium and histological diagnostic was sought. Wide and partially covered range of endometrium thickness were found in the observed groups. In carcinoma group the highest were maximal and average values. The difference in average thickness of endometrium in carcinoma and hyperplasia groups when compared to the remaining groups proved to be statistically significant A value of cut down ultrasound measured endometrial thickness to exclude endometrial cancer was 9 mm.

CONCLUSION

Ultrasound measurement of endometrial thickness is not sufficient to increase effectiveness of endometrial pathology diagnosis in women with abnormal peri- and postmenopausal bleeding.

Induction of apoptosis or necrosis in human endometrial carcinoma cells by 2-methoxyestradiol

BACKGROUND

We investigated the effects of 2methoxyestradiol (2-ME), an endogenous estrogenic metabolite, on human endometrial cancer HEC-1-A and RL-95-2 cell lines.

MATERIALS AND METHODS

After exposure of HEC-1-A and RL-95-2 cells to 2-ME, the morphological changes were evaluated by acridine orange staining and transmission electron microscopy. Cell cycle progress, apoptosis and necrosis were assessed by flow cytometry, DNA fragmentation and Western blot.

RESULTS

2-ME inhibited cell growth by blocking the S- and G2/M-phase in both cell lines, by inducing apoptosis in HEC-1-A cells and by causing necrosis in RL-95-2 cells. Apoptosis, on HEC-1-A cells, was accompanied by an increased expression of iNOS and STAT1. This apoptotic effect was prevented by the iNOS inhibitor 1400W and eliminated by the caspase inhibitor Z-VAD-FMK. Necrosis, on RL-95-2 cells, was due to a severe disruption of the mitochondrial membrane potential. 2-ME had no significant effect on normal human endometrial cells.

CONCLUSION

The data suggest that 2-ME has an antitumor effect on human endometrial carcinoma cells (HEC-1-A and RL-95-2) and may contribute as a new therapeutic agent for endometrial cancer patients.

[Prognostic significance of AgNORs expression in endometrial cancer]

OBJECTIVES

The purpose of the study was assessing prognostic value of AgNORs expression in endometrial cancer.

MATERIALS AND METHODS

The study was performed in a group of 90 patients, diagnosed with endometrial cancer, treated in Clinic of Gynecological Oncology in Wrocław. Silver nucleolar organizer regions (AgNORs) were stained in paraffin-embedded samples, using Ploton method modified by Oefner.

RESULTS

The mean number of AgNORs was 2.76 +/- 0.46. To assess the possible influence of AgNORs expression, patients were divided into three groups, based on the mean number of AgNORs: I- <2.3; II- 2.3-3; III- >3. The differences in the outcome between these groups were not significantly different. The mean number of AgNORs in the group of patients with distant metastases and progression did not differ (2.72). The highest mean number of AgNORs (3.38) was observed in patients with local failure.

CONCLUSIONS

At this point in time, there is inadequate evidence to use AgNORs as predictive factors in patients with endometrial cancer further studies are warranted.

Ultrastructural study of benign, low-malignant potential (LMP), and malignant ovarian tumors

Ultrastructural characteristics of benign, low-malignant potential (LMP), and malignant ovarian tumors were investigated, considering the aspects of histologic subtypes and histologic grading. In addition, the histogenesis of ovarian cancer was histologically investigated in an attempt to elucidate whether malignant tumor was generated from benign or LMP tumor, or whether it was generated de novo from normal tissues. Although all the benign, LMP, and malignant tumors appeared to be derived from Mullerian duct in serous tumors, the origin of endometrioid or mucinous tumor could not be ultrastructurally clarified. However, there was ultrastructural similarity between benign and malignant tumors among serous, endometrioid, and mucinous tumors, and it was suggested that benign adenoma may be the developmental origin of malignant tumors regardless of the histologic subtype. In addition, the investigation of endometrioid tumors revealed that the differences of histologic grading in malignant tumors reflected the ultrastructural differences, and that G1 tumor had an ultrastructure that was more similar to that of benign and LMP tumors than to that of G2 tumor.

Retinoic acid signaling through PI 3-kinase induces differentiation of human endometrial adenocarcinoma cells

The specific signals required for actin polymerization in response to extracellular factors remain unknown. However, in many cell types, there is a correlation between actin polymerization, activation of phosphatidylinositol 3-kinase (PI 3-kinase), and the production of the second messenger phosphatidylinositol-3,4,5-triphosphate. Increased levels of PI 3-kinase have been detected during cell growth and transformation. However, PI 3-kinase is also activated during differentiation, suggesting that PI 3-kinase and its lipid products also play a role in the regulation of cellular differentiation. The newly characterized CAC-1 cell line established from a poorly differentiated human endometrial adenocarcinoma (Exp. Mol. Pathol. 69 (2000), 175) was used as a model to investigate the role of PI 3-kinase in differentiation induction. CAC-1 cells differentiated upon treatment with pharmacological doses of retinoids (1 micro M of 13-cis or all-trans), evidenced by actin filament reorganization, and cell enlargement. PI 3-kinase staining is primarily localized to perinuclear regions in untreated cells. However, retinoic acid treatment induced PI 3-kinase to relocalize throughout the cytoplasm. Subcellular fractionation and Western blotting confirmed that PI 3-kinase decreased in the particulate fraction, concurrent with retinoid-induced differentiation. Interestingly, pretreatment with the PI 3-kinase inhibitor wortmannin (100 nM) prior to retinoic acid treatment prevented retinoic acid-induced actin reorganization and cell enlargement. To distinuish whether retinoid regulation of PI 3-kinase is mediated through traditional nuclear retinoic acid receptors, the levels of retinoic acid receptor-beta (RAR-beta) protein were evaluated. Retinoid treatment did not alter RAR-beta protein levels compared to controls. These data suggest that PI 3-kinase activity and cytoplasmic relocalization are required for retinoid-induced differentiation of poorly differentiated human endometrial adenocarcinoma cells.

Microscopic morphometry--a modern approach

OBJECTIVES

The aim of this paper is to give a brief presentation of the recent trends in histologic and histopathologic computerized morphometry, based on the personal experience in exploiting modern software environments and illustrated by a relevant case study. Through its goal, overall conception and direct involvement in diagnosis, the work belongs to the currently emerging researches on analytical and quantitative histology.

MATERIAL AND METHODS

The proposed methodology for the automatic extraction of quantitative features is applied to an endometrial adenocarcinoma and is implemented as a procedure, called ADK, running on ZeissKS400 platform. The description of the ADK procedure, as a detailed flowchart, is preceded by an overview of the KS400 resources for biomedical domain, compared to the main characteristics of other three well-known software packages for digital image processing.

RESULTS AND DISCUSSIONS

The results are formulated in terms of the numerical information provided by the exploitation of ADK procedure, referring to the 2-D and 3-D (stereological) evaluation of tumorous versus stromal areas and volumes, respectively. Procedure ADK also performed measurements for the nuclei corresponding to the stromal and tumorous zones, respectively, in order to calculate the percentage of nuclei inside these zones. The discussions focus on the interpretation of the measurement results, as factors for the prognostic assessment.

CONCLUSIONS

The computer-aided morphometric investigations open perspectives for operating with more expressive criteria in pathology diagnosis, resulting from the possibility to quantify, at the pixel level, features of interest which in classical approaches are subject to rough approximations.

Loss of gamma-Catenin expression in squamous differentiation in endometrial carcinomas

Squamous differentiation occurs in 25 to 50% of endometrial endometrioid adenocarcinomas. In this study, we analyzed the immunohistochemical expression and localization of beta- and gamma-catenin, molecular changes in the beta-catenin gene, and the subcellular localization of the desmosomal component protein, desmoplakin, by laser scanning microscopy in 35 endometrial carcinomas with squamous differentiation. In the glandular component, beta-catenin showed nuclear localization in 10 of 35 (28.5%) samples, whereas in the squamous component, nuclear localization was found in 15 of 35 (42.9%). Of the 15 samples that showed nuclear localization of beta-catenin in the squamous component, seven samples (46.7%) did not express gamma-catenin. The phenomenon was not correlated with mutation in exon 3 region of beta-catenin gene. Furthermore, in these samples, there was diffuse cytoplasmic staining for desmoplakin. These observations have not been reported in other tumors. Our results suggest that unique molecular events, i.e., stimulation of beta-catenin and suppression of gamma-catenin expression, occur within endometrial carcinomas with squamous differentiation.

The influence of hormones on CD44 expression in endometrial and breast carcinomas

The expression of distinct variant isoforms of the cell surface glycoprotein CD44 (CD44v) has been found to be associated with metastatic potential of rodent adenocarcinoma cells and with an altered prognosis in several types of human cancer. In hormone-dependent gynecological cancers, different CD44v expression patterns have been observed. The influence of ovarian steroid hormones and their antagonists on CD44v expression is still unclear, since there are only retrospective correlation studies so far. Therefore, we examined the CD44 mRNA expression in a standardized stimulation experiment in a number of breast and endometrial carcinoma cell lines varying in estrogen receptor (ER) status. Higher CD44 overall expression was observed in ER positive endometrial and breast carcinoma cell lines when compared to corresponding ER negative cell lines. The number and composition of alternatively spliced isoforms showed no clear correlation to the ER expression status. Three CD44v isoforms were detected in all cell lines expressing CD44v, two of which have not been reported previously in normal endometrial cells. These isoforms may have specific functions in this type of carcinoma. In the second part of the study, the influence of (anti-) hormones on CD44 expression in endometrial carcinoma cell lines was examined. CD44 overall expression showed an increase when the cells were grown in medium containing fetal calf serum (FCS) as compared to cells maintained in medium-free of FCS. CD44 expression was transiently increased by estradiol (1 h). The CD44 splice pattern of endometrial cancer cell lines RL95-2 and Hec-1-A, after treatment with (anti-) hormones showed constant and high expression rates for distinct CD44v-isoforms such as CD44E (CD44v8-v10). Only certain weakly expressed isoforms changed their expression level during the experimental period, but no direct correlation to hormone treatment was observed. In conclusion, estradiol or FCS increase CD44 overall expression, but there seems to be no direct influence of ovarian steroid hormones on the CD44v splice machinery in endometrial carcinoma cell lines.

[Endometrial metastasis of a "balloon" cell melanoma mimicking a "xanthomatous endometritis"]

Xanthomatous changes are unusual lesions of the corpus endometrium that may mask endometrial carcinoma. The term "xanthomatous endometritis" refers to morphological changes frequently induced by estrogen stimulation. We report for the first time a case of uterine metastasis of balloon-cell melanoma mimicking xanthomatous endometritis. Light microscopic, immunohistological, and ultrastructural results are presented and discussed in connection with our ideas on the pathogenesis of this peculiar tumor. The findings favor the hypothesis of a regressive phenomenon in the balloon-cell transformation of melanoma cells. The melan-A immunohistology seems to be more important in the diagnosis of balloon cell melanoma than the classic melanoma antibody HMB 45.

Progression curves for endometrial lesions

OBJECTIVE

To derive a numeric measure for the progression of endometrial lesions as a baseline study for an eventual assessment of chemopreventive intervention efficacy.

STUDY DESIGN

Tissue sections from normal endometrium at the proliferative and secretory phase, simple hyperplasia, atypical hyperplasia from cases free of concomitant adenocarcinoma and adenocarcinoma of the endometrium were recorded at high spatial resolution. Six cases from each diagnostic category were chosen as "typical," and 60 epithelial nuclei were randomly selected for measurement for each case. Discriminant analyses were carried out to derive a direction of progressive change in feature space and to correct the progression curve for the presence of cells not expressing progressive change among the random sample of nuclei.

RESULTS

A well-conditioned progression curve was derived based on the mean discriminant function scores for each diagnostic category and the mean nuclear abnormality of the nuclei in each category, as expressed by their deviation in feature values from normal reference nuclei. The lesion signatures showed a clear trend toward extension into the range of higher nuclear abnormalities with increasing progression. There was an indication that abnormal endometrial lesions may comprise cases with distinctly different degrees of nuclear abnormality.

CONCLUSION

A numeric assessment of lesion progression for endometrial lesions, based on karyometric measurements, is possible. The data suggest that additional analysis may provide further characterizing information for individual lesions.

Standardized AgNOR analysis as a prognostic parameter in endometrial carcinoma, endometrioid type

OBJECTIVE

To evaluate interobserver reproducibility of histologic grade in endometrial adenocarcinomas of endometrioid type (EC), to assess the relationships between nuclear grade and the amount of argyrophilic nucleolar organizer region (AgNOR) proteins and to determine the prognostic value of AgNOR proteins and the main clinicopathologic parameters.

STUDY DESIGN

Architectural and nuclear grading were independently assessed by two pathologists in 64 formalin-fixed, paraffin-embedded surgical samples of EC obtained from an equal number of patients (age range, 38-84 years; mean, 63.5). Interobserver agreement was determined using the kappa statistic; discrepant cases were reviewed, and a consensus was reached. Standardized AgNOR analysis was performed according to the guidelines of the Committee on AgNOR Quantification, measuring the mean area of AgNORs per nucleus (NORA) by an image analysis system.

RESULTS

The kappa values for interobserver agreement were substantial for architectural grading and moderate for nuclear grading. When NORA values were compared to the nuclear grade assessed by different observers, the most significant linear correlation (r = .713, P < .001) was found for the nuclear assessment obtained by consensus of the two pathologists. Moreover, statistical analysis allowed discrimination of architectural grade 1 from grade 2 and 3 EC. By the Kaplan-Meier method, the prognosis was worse for patients with higher NORA values (> 4.212 micron 2), while, by Cox multivariate analysis, AgNOR quantity emerged as an independent prognostic variable.

CONCLUSION

Use of standardized AgNOR analysis may be an additional and objective tool in the assessment of histologic grade as well as a reliable method of determining prognosis in EC.

A newly characterized human endometrial adenocarcinoma cell line (CAC-1) differentiates in response to retinoic acid treatment

A new cell line of poorly differentiated human endometrial adenocarcinoma cells termed "CAC-1" cells has been established. These cells are epithelial, as indicated by positive cytokeratin and negative vimentin staining. They are rounded and possess a high nuclear-to-cytoplasmic ratio, desmosomes, surface microvilli, intercelular lumens, and pleomorphic nuclei containing multiple nucleoli. These cells have been in long-term culture for 2 years. Our previous studies demonstrated that moderately differentiated (RL95-2) cells differentiated in response to retinoic acid treatment, illustrated by their reorganization of actin filaments and cell enlargement (Carter et al., 1996; Anticancer Res. 16, 17-24). CAC-1 cells exhibited a similar response because they also organized actin filaments and enlarged in response to retinoic acid treatment. Concurrently, retinoic acid treatment caused a 40% decrease in cell detachment in an in vitro detachment assay compared to controls. A slight lag in cell growth was observed when CAC-1 cells were treated with 1 microM 13-cis or all-trans retinoic acid during a 12-day growth curve. In addition, we examined the effects of retinoic acid on protein kinase C-alpha (PKC-alpha) and myristoylated alanine-rich C-kinase substrate (MARCKS). Treatment with retinoic acid caused cytoplasmic PKC-alpha to increase concomitant with a decrease in PKC-alpha in the membrane. In contrast, MARCKS increased in the membrane in response to retinoic acid treatment. These data indicate that retinoid treatment causes inactivation of PKC-alpha, allowing MARCKS to relocalize to the membrane, where it can cross-link actin filaments. CAC-1 cells represent an ideal model for investigating the effects of retinoids on differentiation induction concomitant with actin reorganization.

Nucleolar organizer regions in differentiated preneoplastic and neoplastic endometrial lesions

The aim of the study was the quantitative assessment of nucleolar organizer regions (NORs) in the cells of preneoplastic and neoplastic endometrial lesions. Retrospective analysis included tissue material obtained from 87 patients with simple and complex hyperplasia with or without atypia and well-differentiated stage-I endometrial adenocarcinoma. Sections were made from routine paraffin blocks and stained with AgNO3. The mean number of AgNORs per cell was determined. The results obtained indicate that the evaluation of proliferative activity of cells expressed by AgNOR count can help in the distinction between atypical hyperplasia and well-differentiated adenocarcinoma, and thus can serve as a useful pathological criterion.

[Nucleolar organizers and mitotic conditions in endometrial hyperplasia and carcinomaĭ]

The study deals with the levels of nucleolar organizers (NO) and mitotic conditions in 85 samples of the endometrium (proliferative stage of menstrual cycle--5; glandular hyperplasia--10; adenomatosis--15; atypical hyperplasia--25 and adenocarcinoma--25). These findings point to a significant increase in NO number in atypical hyperplasia and especially in adenocarcinoma. The latter showed an inverse correlation between the index under study and cell differentiation stage. Endometrial mitosis displayed a higher mitotic index, a larger fraction of pathological mitoses and cells passing through metaphase as well as a variety of pathological forms of karyokinesis. A high correlation between NO number and mitotic index was observed for different conditions of the endometrium.

Low-grade endometrial stromal sarcoma with intracardiac extension. Evolution of extensive smooth muscle differentiation and usefulness of immunohistochemistry for its recognition and distinction from intravenous leiomyomatosis

This case, a rare example of low-grade endometrial stroma sarcoma with extensive smooth muscle differentiation which extended to the inferior vena cava and cardiac chambers closely resembling intravenous leiomyomatosis grossly and microscopically, illustrates the importance of extensive sectioning and the usefulness of immunohistochemistry. Although spindle cell components arranged in interlacing bundles consistent with smooth muscle differentiation were recognizable in the primary tumor (on retrospective review), extensive smooth muscle differentiation in the recurrent tumors masked prototypical morphologic features of stromal sarcoma and only small neoplastic stromal components were preserved in limited areas, leading to initial failure to distinguish the lesion from intravenous leiomyomatosis. The immunophenotyping disclosed two distinct cell populations in the tumor: i.e. vimentin-positive and smooth muscle marker negative stromal cells, and vimentin-negative spindle-shaped desmin-positive smooth muscle cells. Our observation suggests that the predominance of a smooth muscle component in such a tumor can be misleading and does not always warrant a diagnosis of intravenous leiomyomatosis, nor does it predict a benign clinical course. This case also provides an insight into the relationship of the endometrial stroma and myometrium, and their cell of origin and the histogenesis of endometrial stromal sarcoma.

Evidence for characteristic vascular patterns in solid tumours: quantitative studies using corrosion casts

The vascular architecture of four different tumour cell lines (CaX, CaNT, SaS, HEC-1B) transplanted subcutaneously in mice was examined by means of microvascular corrosion casting in order to determine whether there is a characteristic vascular pattern for different tumour types and whether it differs significantly from two normal tissues, muscle and gut. Three-dimensional reconstructed scanning electron microscope images were used for quantitative measurements. Vessel diameters, intervessel and interbranch distances showed large differences between tumour types, whereas the branching angles were similar. In all tumours, the variability of the vessel diameters was significantly higher than in normal tissue. The quantitative data provide strong evidence for a characteristic vascular network determined by the tumour cells themselves.

Ultrastructural interactions in the microvasculature of human endometrial adenocarcinoma

OBJECTIVES

Our purpose was to study the ultrastructural morphology of the microvasculature of human endometrial adenocarcinoma and to determine the effect of this malignancy on cell-to-cell communication between the components of the microvasculature and with the other tissue compartments of human endometrium. Methods. Multiple cases of human endometrial adenocarcinoma were studied and graded by light microscopy. Six cases of Grade I and six cases of Grade II were selected. Two blocks per case were studied ultrastructurally.

RESULTS

In contrast to our expectation that the ultrastructure of tumor vessels would suggest a great deal of proliferation and new vessel formation, we found that tumor vessels displayed a high degree of cellular differentiation, in the form of numerous and varied cell-to-cell contacts, and large amounts of protein production.

CONCLUSIONS

The morphology of the microvasculature of endometrial adenocarcinoma suggests an active rather than passive role in tumor vessels.

Digital image analysis of silver-stained nucleolar organizer region--associated proteins in endometrial cytologic samples

OBJECTIVE

Digital image analysis was applied to determine the number, area and size of silver-stained nucleolar organizer regions (AgNORs) in cytologic samples from curettage in normal, hyperplastic and malignant endometrium.

STUDY DESIGN

Thirty-two archival cytologic smears from curettage (previously stained by the Papanicolaou method) with the histologic diagnosis (4 inactive endometrium, 5 secretion, 5 proliferation, 5 simple hyperplasia, 5 complex hyperplasia, 3 atypical hyperplasia, 5 adenocarcinoma, grade 1) were analyzed with the AgNOR technique. Count, area and size of AgNORs were analyzed in 50 cells per sample using a magnification of 1,000x. Quantitative analysis was performed on an SFORM digital imaging system. Data were analyzed with the SPSS/PC+ program. Mann-Whitney and chi 2 tests were performed.

RESULTS

The average value of AgNOR count increased from normal to hyperplastic endometrium and well-differentiated adenocarcinoma. Differences were significant except between atypical hyperplasia and adenocarcinoma. Four, five and more AgNORs in 40% or more of the nuclei were found in complex and atypical hyperplasia and adenocarcinoma. Proliferation, and simple and atypical hyperplasia had similar mean values of AgNOR area. The mean total AgNOR area value increased from normal to hyperplastic had similar mean values of AgNOR area. The mean total AgNOR area value increased from normal to hyperplastic and well-differentiated adenocarcinoma. Differences were statistically significant. AgNOR size in well-differentiated adenocarcinoma was significantly different from that in normal endometrium and different grades of hyperplasia.

CONCLUSION

Digital image analysis of AgNOR count, area and size enabled a distinction to be made between normal, hyperplastic and malignant endometrium.

Oncocytic metaplasia and carcinoma of the endometrium: an immunohistochemical and ultrastructural study

Endometrial oncocytic carcinoma is an unusual neoplasm, with few cases reported. Endometrial curettage specimens coded as prominent oxyphilic metaplasia (N = 5) and oxyphilic or oncocytic carcinoma (N = 4) were reviewed, and hysterectomy slides from the four carcinomas were also examined. Immunohistochemical and ultrastructural analyses were performed in three of five metaplasias and in all four carcinomas. Most patients (89%) with oncocytic metaplasia and carcinoma had vaginal bleeding. Oncocytic metaplasia was characterized by a single layer of cells with abundant eosinophilic, granular cytoplasm, minimal pleomorphism, and rare mitotic activity. Carcinoma was diagnosed on the basis of an altered stroma (n = 2) and/or a confluent growth pattern (n = 4) and had a papillary (n = 4), glandular (n = 2), or solid (n = 1) morphology. Carcinomas showed a similar population of oncocytic cells as metaplasias, but with occasional nuclear stratification and greater pleomorphism and mitotic activity. Tumors were International Federation of Gynecology and Obstetrics (FIGO) grade 1 (n = 2) or 2 (n = 2) and FIGO stage Ib, Ic, IIb, and IIIc. Omental metastases developed in the patient with the stage III tumor at 13 months; the two patients with stage I tumors were alive with no evidence of disease at a mean of 29 months. All carcinomas expressed p53 and 75% and 100% were estrogen receptor (ER)- and progesterone receptor (PR)-negative, respectively, whereas all metaplasias were p53 negative- and ER- and PR-positive. Ki-67 labeling index was 1 to 3% in metaplasias and 14 to 33% in carcinomas. Oncocytic metaplasias and carcinomas contained abundant mitochondria and free ribosomes, accounting for the oncocytic appearance. Because oncocytic carcinomas frequently show deep myometrial invasion and require surgical staging, it is important to distinguish oncocytic metaplasia from carcinoma on biopsy material. Ki-67, p53, and ER and PR immunostains may assist in this potentially difficult differential.

Electron microscopic examination of cytologic samples

OBJECTIVE

To review the results of observations of cytologic samples performed in our laboratory by light microscopy (LM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM) performed in succession (LM-SEM-TEM examination) using the same cytologic sample and to assess the diagnostic value of this method of successive examination.

STUDY DESIGN

Using a previously reported method of LM-SEM-TEM sample preparation and observation, we analyzed 201 cytologic specimens over a seven-year period (1986-1993) and investigated whether the histologic origin and malignancy can be estimated from SEM and TEM findings on the cells.

RESULTS

Observations of many cytologic samples over a seven-year period (by LM, SEM and TEM) showed that several basic interpretations of cellular ultrastructure are possible. In cases where cell identification was difficult by LM, electron microscopic findings were sometimes useful for determining the biologic characteristics of cells and for estimating their tissue origin. Electron microscopic findings also provided important information for cytodiagnosis.

CONCLUSION

SEM and/or TEM findings are useful for determining the morphologic (including biologic) characteristics of cells in cases where they cannot be determined by LM. With the accumulation of data on electron microscopic examination of cytologic samples, it is expected that in the future, electron microscopy will continue to provide new information that can be used to improve the accuracy of cytodiagnosis by LM.

Characterization of a newly established endometrial stromal sarcoma cell line

We describe a newly established human sarcoma cell line derived from an endometrial stromal sarcoma (ESS). The cell line has been maintained in long-term cell culture for more than 2 years. It has been repeatedly analyzed in terms of morphology, immunocytochemical features, ultrastructure and karyotypic characteristics. In contrast to uniform endometrial stromal differentiation in vivo, the tumor cells were shown to display distinct phenotypical heterogeneity in vitro. In addition to the predominant cell type, which retained sarcomatous differentiation, foci of epithelial-like cells were observed in the cell culture. Immunocytochemical and ultrastructural analysis demonstrated a mainly mesenchymal phenotype with signs of epithelial characteristics, such as expression of cytokeratins, and the presence of desmosomes and kinetocilia, respectively. Cytogenetic analyses in early and late passages revealed unbalanced translocations between chromosomes 3 and 6 and an additional i(19)(q10), as common karyotypic changes in all tumor cells, indicating a monoclonal origin. Our new cell line can be used as an in vitro model to study the mechanisms of heterogeneous differentiation patterns in ESS.

The effect of fixation on the size, shape and summed optical density of endometrial cancer nuclei

OBJECTIVE

Nuclear morphometric features have been shown to be of prognostic importance in several malignancies including recently, endometrial cancer. The authors attempted to see whether the type of fixation affected nuclear size (NUSZ), shape (NUSH), and summed optical density (NUSD).

METHODS

Fifty specimens, half air dried and half alcohol fixed, were obtained from 25 consecutive patients with endometrial cancer. Results were compared with the paired samples t-test. Differences among the nuclear morphometric features and histologic grade, stage, and depth of myometrial invasion were studied by one-way analysis of variance. Logistic regression was used to determine if any were independent prognostic features. Image analysis was used to determine NUSZ, NUSH, and NUSD.

RESULTS

Mean NUSZ was shown to be significantly larger in air dried specimens (89.13 microm2) as compared to alcohol fixed specimens (80.34 microm2) P=0.047. Mean NUSH was significantly closer to round in air dried specimens (15.21) as compared to alcohol fixed specimens (15.65) P=0.025. There was no significant difference in mean NUSD between air dried (128.61) and alcohol fixed specimens (126.22) P=0.76. Stage, as well as air dried NUSZ, NUSH, and NUSD were all independent predictors of recurrence. In this study none of the nuclear parameters from the alcohol fixed tissues were predictive of recurrence.

CONCLUSION

The type of fixation significantly affects the nuclear morphometric parameters of size and shape. While NUSZ, NUSH, and NUSD from air dried specimens were predictive of recurrence, the same parameters from alcohol fixed specimens were not. A larger prospective trial is currently underway to validate these findings.

Establishment of a cell line from a neuroendocrine carcinoma of the endometrium and an invasion model

A new cell line (YKK) was established from a primary tumor of neuroendocrine carcinoma of the endometrium. Cultured YKK cells are polygonal in shape. The modal chromosome number is 46 XX. The doubling time of the cells, after the 19th passage, is 38 hours and this cell line has been propagated continuously by serial passage over 50 passages for the past 2 years. YKK displays characteristics resembling the original tumor cell from the donor patient: it contains the neuron-specific enolase and chromogranin antibody, produces neuron-specific enolase, and is sensitive to cisplatin, carboplatin, and etoposide. When YKK cells are transplanted subcutaneously together with Matrigel into nude mice they form a very large tumor invading the subcutaneous muscular tissue. This experimental model is useful for studying the mechanism(s) regulating the invasion of this tumor into muscular tissue, and for the establishment of new anti-cancer treatments for neuroendocrine carcinoma.

Random nuclear p53 overexpression pattern in tamoxifen-mediated endometrial carcinoma

In a previous paper, we suggested that tamoxifen (TAM)-mediated endometrial carcinogenesis may not involve estrogenic pathways because of random estrogen receptor positivity among endometrial carcinomas with and without TAM treatment for breast cancer. DNA adduct formation (reported in rat liver and human endometrium) was considered to be a more plausible mechanism for TAM-mediated carcinogenesis. To examine the reported correlation between DNA adduct formation and p53, the present study examined p53 expression in the endometrial carcinomas reported in the previous study. Seven endometrial adenocarcinomas associated with long-term TAM treatment for breast carcinoma and 4 carcinomas without TAM treatment but with history of breast carcinoma were immunohistochemically investigated for nuclear p53 expression. The bcl-2 product was also examined. Diffuse and intense nuclear reactivity for p53 protein was present in only one TAM-related case. Essentially, no differences were observed in the bcl-2 staining patterns of TAM-treated and -untreated patients with cancer. Thus, p53 overexpression in endometrial carcinomas occurring in patients with breast cancer seems to be not specific for TAM-treated patients, and, if DNA adduct formation has any role in this type of endometrial carcinogenesis, it may not be related preferentially to p53 gene alteration. Further studies are needed to understand the precise mechanism(s) of the endometrial carcinogenesis.

A difference in nuclear morphometry when frozen rather than fresh tissue is studied

OBJECTIVE

Since the value of nuclear morphometry as a prognostic indicator in gynecologic malignancies is beginning to be explored, the authors attempted to see whether there was a difference in the nuclear morphometric features of size, shape and summed optical density in endometrial cancer when touch preparations were made from fresh versus frozen tissue.

METHODS

Fifty specimens were obtained from twenty-five consecutive patients with endometrial cancer. Each patient had an air dried touch preparation made from fresh and frozen tissue. Values were compared using paired samples T-test. Logistic regression was used as a type of multivariate analysis. Nuclear size (NUSZ), shape (NUSH), and summed optical density (NUSD) were calculated by image analysis.

RESULTS

Mean NUSZ was shown to be significantly larger in fresh specimens (117.3 microns2) when compared to the frozen specimens (89.3 microns2) p < 0.001. Mean NUSH was significantly closed to round in frozen specimens (15.21) when compared to the fresh specimens (15.55) p = 0.038. Mean NSUD was shown to be significantly larger in frozen specimens (128.6) as compared to fresh specimens (120.2) p = 0.045. Stage, NUSZ was NUSD from fresh tissue were shown to be independent predictors of recurrent disease.

CONCLUSION

The type of tissue (fresh versus frozen) from which touch preparations are made is important. Significant differences in NUSZ, NUSH, and NUSD were seen between fresh and frozen specimens. While NUSZ and NUSD from fresh specimens were predictive of recurrence, the same parameters from frozen specimens were not. A larger prospective trial is underway to determine the validity of these preliminary conclusions.

Estrogen and progesterone receptor expression in postmenopausal tamoxifen-exposed endometrial pathologies

Assessment of receptor levels in tamoxifen-exposed endometrial pathologies may indicate endometrial cells potential for interaction with tamoxifen. To assess this assumption, we analyzed estrogen receptor (ER) and progesterone receptor (PR) expression by an immunohistochemical technique in endometrial specimens with benign hyperplasia, benign polyps, and carcinoma obtained from postmenopausal breast cancer patients treated with tamoxifen (study group) and from age-matched healthy postmenopausal women treated with estrogen replacement therapy (control group I) and not treated with estrogen replacement therapy (control group II). Overall gland and stromal ER expression of benign endometrial hyperplasia and of benign endometrial polyps was significantly higher in control groups I and II than that obtained from the study group (endometrial hyperplasia: P = 0.0274 and 0.00093, respectively, and P = 0.00003 and 0.00001, respectively; benign endometrial polyps: P = 0.02889 and 0.00596, respectively; and P = 0.00228 and 0.00005, respectively), while there were no differences between the two control groups. Overall gland and stromal PR expression was nearly similar in all the three groups (P = NS). There was no correlation between the length of tamoxifen treatment and the presence of ER and PR in various endometrial pathologies in the tamoxifen-treated patients. The significantly lower ER expression in most benign endometrial pathologies obtained from postmenopausal tamoxifen treated patients may further support the weak estrogen-like effect of tamoxifen on the endometrium in the menopause.

Histogenesis of hollow cell ball structure of ovarian and endometrial adenocarcinoma cells in vivo and in vitro

Hollow cell ball structure is often found in the ascites of adenocarcinoma patients. How to form a hollow cell ball structure was studied in vivo and in vitro, using the human cell lines derived from ovarian and endometrial adenocarcinomas. The hollow cell ball structure was formed by horizontal rotation culture of 1 x 10(7) single-suspended cells for 24 hours or by transplanting 1 x 10(6) single-suspended cells into the peritoneal cavity of nude mouse for 24 hours. At one month after transplantation hemi-cyst and hollow cell ball structure were formed in the outermost layer of the grafted tumor on the intraperitoneal serous membrane in the nude mouse. And also great number of floating hollow cell ball structure in the ascites were observed. These results suggest that mechanisms of formation of hollow cell ball structure found in the ascites; one by cell aggregate of single cells, sometimes inner cells of cell aggregate fall into necrosis or secretes mucus inside and make a hollow cell ball structure and another by the removed as the hollow cell ball structure grown from hemi-cyst on the surface of intraperitoneal grafted tumor.

mRNA expression of ligands of the epidermal-growth-factor-receptor in the uterus

Six different ligands of the epidermal-growth-factor receptor (EGFR) have been identified in the past. In some cervical squamous-cell carcinomas, an increased amount of proteins binding to the EGFR has been reported. In order to identify the mRNA of EGFR ligands (EGFRL), which might be overexpressed in cervical and endometrial cancers, we performed semi-quantitative reverse-transcription/polymerase chain reactions (RT-PCR) for all 6 EGFRL in RNA extracts of normal and malignant tissue samples of the human uterus. PCR products from RNA extracts of 83 patients were quantitated relative to the housekeeping gene and internal standard pyruvate dehydrogenase by analyzing the PCR kinetics of product synthesis. In extracts of normal cervix, the level of mRNA expression of the EGFRL was significantly higher than in endometrium. No significant difference was detected between normal cervix and cervical carcinomas. However, both in cervical and in endometrial cancers, mRNA expression was non-parametrically distributed and in some cervical cancers overexpression of transforming growth factor alpha (TGF-alpha), amphiregulin or EGF was observed. In endometrial cancers, mRNA levels of all EGFRL were higher than in normal endometrium. This increase was significant (p < 0.005) for TGF-alpha and amphiregulin. Thus, TGF-alpha mRNA is overexpressed in approximately 10% of cervical cancers and in the majority of endometrial cancers. Since TGF-alpha anti-sense therapy might represent a future strategy in such cancers, we also determined the absolute level of TGF-alpha mRNA expression by quantitative PCR using a cloned standard.

[The mechanisms of progesterone treatment on endometrial carcinoma]

OBJECTIVE

To study the mechanisms of the exogenic progestrerone treatment on endometrial carcinoma.

METHODS

We observed the morphologic changes of the endometrial cancer cells treated by exogenic progesterone with light and electronic microscopy.

RESULTS

The main changes of the tumor cell treated were well differentiation, increase in secretory activity and apoptosis of tumor cells.

CONCLUSIONS

Progesterone may directly affect tumor cells, inhibit the growth of tumor cells and lead to well differentiation. Clinically with preoperative and postoperative progesterone therapy, it can decrease the peritoneum implantation and metastasis, and also decrease the recurrence after operation.

Tumor growth in a defined microcirculation

The fate of human tumor cells deposited in rat uteri was investigated by light microscopy of histological sections, immunohistochemistry, and scanning electron microscopy of microvascular corrosion casts. The human colonic tumor cell line LS 174 T was used as graft since it can be detected by CEA immunohistochemistry, and spayed nude rats (PVG rnu/rnu) were used as hosts, subjected to different hormonal regimens (no exogenous hormones, medroxyprogesterone acetate, 17-beta-estradiol, or the last two regimens in combination). Intrauterine deposition of a suspension of 2 x 10(6) tumor cells resulted in tumor take in 72% (21/29) of the nude rats. Endometrial growth was verified in only three animals (14%, 3/21). Extraendometrial growth, however, was found in all animals with tumor take. These observations suggest that the endometrium is comparatively resistant to growth of xenografted human colonic tumor cells. The tumor microcirculation consisted of new vessels, giving morphological evidence that tumor growth is dependent on angiogenesis and not on invasion of preexisting vessels.

The prognostic value of semiquantitative nuclear grading in endometrial carcinomas

The objective of this study was to evaluate the prognostic value of a convenient nuclear grading system based on only the proportion of nuclei measuring more than 10 microm in length at the shortest axis in endometrial carcinomas. Of the 235 cases reviewed, 9 serous and 5 clear cell adenocarcinomas and 2 small cell carcinomas were eliminated, resulting in a study population of 219 cases of endometrial adenocarcinoma. The architectural grade was determined by the FIGO system. The criteria for nuclear grade were as follows: grade 1, no nucleus measuring more than 10 microm in length at the shortest axis; grade 2, nuclei measuring more than 10 microm in length at the shortest axis seen in percentages ranging between 0 and 10% of tumor cells in active areas; and grade 3, more than 10% of tumor cells in active areas with nuclei measuring more than 10 microm in length at the shortest axis. The criteria for combined grades were as follows: the tumors were graded according to the architectural grade, but high-grade nuclear abnormalities increased the grade by one for architectural grade 1 and 2 tumors. The cumulative 10-year survival rates for architectural grades 1, 2, and 3 were 92.4, 82.6, and 65.2%, respectively (chi2 = 17.9, P = 0.001). The survival rates for nuclear grades 1, 2, and 3 were 96.2, 76.1, and 70.1%, respectively (chi2 = 21.6, P < 0.001), while for combined grades 1, 2, and 3 the survival rates were 98.3, 83.2, and 65.2%, respectively (chi2 = 26.9, P < 0.001). Even when the cases were limited to the 147 stage I endometrial carcinomas examined, the prognostic value of the combined grading system was still found to be superior to that of the architectural grading system. Our observations therefore supported the FIGO recommendation for nuclear grade not only in stage I endometrial carcinomas, but also in all stages of endometrial carcinomas.

p53lyn and p56lyn: a new signaling pathway in human endometrium and endometrial adenocarcinomas

OBJECTIVE

To identify specific tyrosine kinases that are involved in endometrial signaling and to study their in vivo expression in normal and abnormal endometrium. We hypothesized that proteins that are differentially expressed would be more likely to be important in regulated cellular events.

METHODS

Complementary DNA libraries, constructed from human secretory (n = 5) and proliferative (n = 5) endometrial specimens, were screened with a polyclonal anti-phosphotyrosine antibody. Positive clones were sequenced and screened for differential expression using immunoblotting and Northern analysis of samples from proliferative and secretory endometrium. The expression of one identified clone, lyn, a Src family member, was characterized further with Western and Northern blot analyses and immunolocalization.

RESULTS

One protein identified by the above method was lyn, a member of the src family of protein tyrosine kinases, never before described in the human endometrium. Western blot analysis revealed two forms of lyn protein, p53lyn and p56lyn, that were most abundant in the late secretory phase. Immunohistochemistry demonstrated uniform protein expression by all cells in normal glandular epithelium and suggested a correlation between lyn protein expression and cell differentiation for human endometrial adenocarcinomas, with markedly-elevated levels noted in poorly differentiated adenocarcinomas compared with well-differentiated tumors (n = 3). Northern hybridization confirmed the presence of the expected 3.5-kb lyn transcript in normal and abnormal endometrium.

CONCLUSIONS

Our data demonstrate that human cDNA libraries created from different phases of the menstrual cycle can be screened successfully using anti-phosphotyrosine antibodies to identify differentially expressed protein tyrosine kinases. Although p53lyn and p56lyn expression has been thought of as a predominantly lymphoid-specific tyrosine kinase, we show prominent expression of lyn protein and mRNA by normal and malignant epithelium of the human endometrium, suggesting a role in endometrial signaling and human reproduction.

Small-cell carcinoma of the endometrium: an immunohistochemical and ultrastructural analysis

Small-cell carcinoma of the endometrium is a rare neoplasm, and its aggressive behavior has been reported. We report a case of small-cell carcinoma occurring primarily in the endometrium of a 62-year-old woman with postmenopausal vaginal bleeding and lower abdominal pain. The excised uterus showed a necrotic polypoid mass and histologically displayed an endometrial small-cell carcinoma. Immuno-histochemically, the tumor cells were positive for cytokeratin, the epithelial membrane antigen, neuron-specific enolase, and chromogranin, but were negative for the leukocyte common antigen and Grimelius stain. Ultrastructural analysis revealed the presence of dense core granules in the cytoplasm of tumor cells. The patient died 2 months after surgery because of aggressive behavior of the tumor. We wish to distinguish small-cell carcinoma of the endometrium from conventional epithelial tumors of the endometrium, because of the former's distinctive histopathologic, immunohistochemical, and ultrastructural characteristics.

Cytoplasmic localization of endothelial constitutive nitric oxide synthase in endometrial carcinomas

BACKGROUND

Production of nitric oxide by nitric oxide synthase (NOS) has been implicated in numerous physiologic and pathophysiologic processes including mutagenesis. This study was designed to examine the expression of the endothelial constitutive isoform of NOS (ecNOS) in endometrial carcinomas.

METHODS

Fifty endometrial carcinomas (42 endometrioid, 4 serous papillary, 2 clear cell, and 2 adenosquamous carcinomas) and 21 normal endometrial gland tissue specimens (5 cases of proliferative, 5 early secretory, 5 mid-secretory, and 5 late secretory and 1 menstrual phase endometrium), previously formalin fixed and paraffin embedded, were immunostained using a commercially available anti-ecNOS monoclonal antibody. Localization of ecNOS staining to the plasma membrane, cytoplasm and nuclei was graded with respect to overall staining intensity (0-3+ scale) and frequency (percentage of immunoreactive cells).

RESULTS

Relatively little staining for ecNOS was localized to the plasma membrane in either normal or neoplastic tissues. Normal and hyperplastic endometrial glands demonstrated moderate cytoplasmic and weak nuclear staining in a small percentage of cells. While ecNOS expression was most prominent in epithelial cells, weak expression was also rarely noted in endometrial stroma, blood vessel walls, and endothelium. We found a broad range of ecNOS expression in endometrial carcinomas, predominantly localized to the cytoplasm and nuclei. No statistically significant difference in ecNOS staining frequency or intensity was found between different histologic subtypes of endometrial carcinomas. No apparent correlation was found between ecNOS expression and tumor stage, grade, extension to the lower uterine segment or cervix, nodal or distant metastases, recurrence, or final patient status among patients with endometrioid adenocarcinomas. Endometrioid tumors invading more than 1/2 of myometrial thickness (n = 18) had significantly higher cytoplasmic staining intensity than those tumors limited to the inner 1/2 of myometrium (n = 27; 2.0 vs. 1.3, p < 0.04). Furthermore, a trend toward shorter disease-free survival was noted with increased staining intensity and decreased staining frequency.

CONCLUSIONS

Cytoplasmic and nuclear expression of ecNOS, which is primarily limited to the glandular elements of normal endometrium, is also found to be expressed in endometrial carcinoma. Increased ecNOS staining intensity and decreased frequency tends to correlate with decreased disease-free survival. Lastly, increased cytoplasmic ecNOS staining intensity correlates with increased myometrial invasion.

[A cytofluorometric study of the stability of secondary DNA structure in the epithelial cells in endometrial hyperplasia and cancer]

Studies were performed on epithelial cells obtained from uterine cavity in 49 women. All cases were subdivided into four groups; unaltered endometrium-9, glandular endometrial hyperplasia-10, atypical hyperplasia-4 and endometrial adenocarcinoma-30. For fluorimetric evaluation of single- and double-strand DNA specimens were dyed with acridine orange, which is known to produce red fluorescence in combination with double-strand acids. Values of coefficients alpha for single and double-strand DNA after acid hydrolysis were much higher than those before acid treatment. This study provides a deeper insight into the relation between DNA lesions and malignancy.

Endometrial stromal sarcoma with sex cord-like areas and focal rhabdoid differentiation

An unusual uterine lesion is described in a patient with postmenopausal bleeding. Grossly, a yellow, polypoid mass projected into the uterine cavity. Histological examination showed a distinct biphasic pattern with areas of typical low-grade endometrial stromal sarcoma and areas where tumour cells were arranged in cords and trabeculae, resulting in a sex cord-like pattern. In these areas the cells assumed a rhabdoid morphology with eccentric vesicular nuclei, prominent nucleoli and eosinophilic hyaline cytoplasmic inclusions. Immunohistochemistry showed positive cytoplasmic staining of both components for vimentin, desmin and the cytokeratin marker CAM 5.2, but no staining for CEA and EMA. Electronmicroscopy revealed prominent paranuclear arrays of intermediate filaments. This is the second reported case of endometrial stromal sarcoma with rhabdoid differentiation and the first documented example of rhabdoid cells in sex cord-like areas. The report adds to the list of diverse neoplasms which may display a characteristic rhabdoid morphology and supports the hypothesis that extrarenal rhabdoid tumours are not a distinct clinicopathological entity. A diagnosis of malignant rhabdoid tumour of the uterus should be considered only when extensive sampling fails to disclose areas with an appearance typical of an endometrial stromal lesion.

The diagnostic value of endometrial thickness and volume measurements by three-dimensional ultrasound in patients with postmenopausal bleeding

We compared endometrial thickness and volume in patients with postmenopausal bleeding, and examined the value of each parameter in differentiating between benign and malignant endometrial pathology. A total of 103 patients with a history of postmenopausal bleeding were recruited into the study. Patients who were taking hormone replacements therapy or other hormonal preparations with a known effect on the endometrium were excluded. Each patient underwent three-dimensional ultrasonography for the measurement of endometrial thickness and volume. In 97 cases both of these measurements were obtained and the results were compared to the histological diagnosis after endometrial biopsy or dilatation and curettage. Endometrial cancer was diagnosed in 11 patients. The mean endometrial thickness was 29.5 mm (SD 12.59) and the mean volume was 39.0 ml (SD 34.16). In the remaining 86 patients there were eight cases with endometrial hyperplasia and seven with endometrial polyps. The endometrial thickness and volume in patients with benign pathology was 15.64 mm (SD 5.26) and 5.47 ml (SD 6.32), respectively. In 71 patients with atrophic or normal endometrium the mean thickness and volume was 5.29 mm (SD 3.97) and 0.91 ml (SD 1.71), respectively. Receiver operating characteristic curves showed endometrial volume to be superior to endometrial thickness for the diagnosis of endometrial cancer. The optimal cut-off value of endometrial thickness for the diagnosis of cancer was 15 mm, with the test sensitivity of 83.3% and positive predictive value of 54.5%. With the cut-off level of 13 ml for endometrial volume measurement the sensitivity was 100% and the positive predictive value 91.7%. Both the thickness and volume were higher in patients with advanced and less differentiated cancers. The measurements of endometrial volume was superior to that of endometrial thickness as a diagnostic test for the detection of endometrial cancer in symptomatic postmenopausal women.

Glucocorticoid and estrogen receptors have elevated activity in human endometrial and ovarian tumors as compared to the adjacent normal tissues and recognize sequence elements of the H-ras proto-oncogene

We examined the level of receptor binding in H-ras elements, using nuclear extracts derived from human endometrial and ovarian lesions and from adjacent normal tissue in gel retardation assays. We found increased binding of the glucocorticoid receptor (GR) to the H-ras GR element in more than 90% of endometrial tumors and in all ovarian tumors tested, as compared to the corresponding adjacent normal tissue. Additionally, we found elevated binding of the estrogen receptor (ER) in H-ras ER element in all pairs of ovarian tumor/normal tissue tested, whereas in ER-negative control breast tumor/normal tissue pairs, no differences in ER DNA-binding levels were observed. These results suggest that steroid hormone receptor binding could directly activate the H-ras oncogenic potency in human endometrial and ovarian lesions, providing additional evidence for the role of H-ras expression in hormonally responsive human cancers.

Interphase cytogenetic study of endometrial stromal sarcoma by chromosome in situ hybridization

Endometrial stromal neoplasms include a heterogenous group of tumors with different clinical behavior and response to treatment. Cytogenetic study of such tumors has been scanty. The aim of this study was to analyze and compare the chromosome composition in low-grade and high-grade endometrial stromal sarcoma using the technique of chromosome in situ hybridization. Eight cases of low-grade stromal sarcoma and three cases of high-grade stromal sarcoma were studied. Biotinylated DNA probes specific for the regions of chromosomes X, 11, 12, and 17 were used on formalin-fixed paraffin embedded material from these tumors. The in situ hybridization signals were visualized by immunoperoxidase technique. Four of the eight low-grade stromal sarcomas retained normal disomy of the chromosomes studied. The other four low-grade sarcomas showed a gain of from one to three chromosomes, whereas all of the three high-grade sarcomas showed polysomies in all of the four chromosomes being studied. No loss of chromosomes was detected. One case of high-grade sarcoma contained coexisting areas of low-grade sarcoma. Although aneusomy was found in the high-grade portion, disomy was noted in the low-grade areas. In the stromal sarcomas studied, there was no definite correlation between the presence of chromosome polysomies and the clinical progress of the tumors. This is the first interphase cytogenetic study of uterine stromal sarcoma, and the results support the concept that complex numerical chromosome abnormalities evolve during anaplastic transformation of endometrial stromal sarcoma.

Expression of component desmosomal proteins in uterine endometrial carcinoma and their relation to cellular differentiation

BACKGROUND

While the assessment of the malignancy of neoplasms is based on morphologic studies of cells and tissues, use of objective molecular markers is leading to a better understanding and more biologically meaningful classification of neoplasms. In recent years, changes in the expression of cell adhesion molecules, especially E-cadherin, catenin, and adenomatous polyposis coli (APC), in carcinomas have attracted the attention of researchers. However, little is known about desmosomes in the uterine endometrium or in endometrial carcinomas. In this study, we semiquantified the desmosomal components desmoplakin I and II and desmoglein, in tissue sections using confocal laser scanning microscopy (LSM), and examined their relationship to the pathological type, the occurrence of lymph node metastases, and the extent of myometrial invasion.

METHOD

Frozen sections of 31 specimens of normal endometrium, 5 specimens of atypical hyperplasia, and 41 specimens of endometrial carcinoma were stained by the immunofluorescence method using antidesmoplakin I and II and antidesmoglein, and these markers were then semiquantified in tissue sections by LSM.

RESULTS

The expression and location of desmoplakin I and II and desmoglein were similar, and their expression decreased with loss of differentiation. The expression was lower in cases of lymph node metastasis than in negative cases and was lower in the cases with > one-half myometrial invasion than in cases with < one-half myometrial invasion.

CONCLUSIONS

Reduction of desmoplakin I and II and desmoglein expression may play an important role in the invasiveness and metastatic activity of human endometrial carcinoma. They can therefore be used as differentiation markers for endometrial carcinoma.

Sonographic endometrial thickness: a useful test to predict atrophy in patients with postmenopausal bleeding. An Italian multicenter study

Eighteen centers took part in this prospective study into which 930 eligible patients were recruited. The selection criteria for admission were atypical bleeding after at least 6 months of postmenopausal amenorrhea, and absence of hormonal therapies for at least 6 months. The sonographic measurement of the maximum bi-endometrial thickness was made in a longitudinal plane. Sonographic measurements were always performed within 3 days prior to histological evaluation. In these patients the mean number of years from menopause (25-75th centile) was 6 (range 2-16). The prevalence of endometrial carcinoma was 11.5% and the prevalence of atrophy was 49.2%. The area under the receiver operator characteristic curves generated by sonographic thickness measurements reached the level of 85%, both for cancer and atrophy. The likelihood ratio for cancer, yielded by an endometrial thickness of < or = 4.0 mm, was 0.05, and for atrophy it was 7.1. This cut-off of > 4.0 mm yielded a sensitivity for the detection of cancer of 98% and a negative predictive value of 99%. The overall sensitivity and positive predictive value for atrophy achieved by this cut-off were 57.2% and 87.3%, respectively. A multivariate logistic model showed that age and body mass index were independent variables associated with a significantly higher risk of endometrial cancer. The post-test probabilities for cancer and atrophy were recalculated on the basis of the integration of age, body mass index and endometrial thickness. The estimated reduction of invasive procedures on the basis of this integration was 31%. Transvaginal sonographic measurement of endometrial thickness, integrated with individual risk factors, can help in the management of postmenopausal patients with atypical bleeding, with regard to either the need for histological evaluation in high risk cases, or the choice of possible expectant management. We have shown that an endometrial thickness of < or = 4.0 mm safely predicts endometrial atrophy and justifies expectant management when the patient understands the need for proper follow up. This could be achieved with a reduction in the use of invasive procedures without unwanted delay in cancer diagnosis.

[Experimental studies on the cell adhesion molecule E-cadherin and in vitro invasion of endometrial carcinoma cell lines]

The enhancement of the in vitro invasive ability and the morphological changes caused by anti-E-cadherin antibody HECD-1 were investigated by in vitro invasion assay and electron microscopy in three human endometrial carcinoma cell lines. The cell lines were NUE-1 (E-cadherin negative and high in vitro invasive ability), HEC-1BE and HEC-108 (E-cadherin positive and low in vitro invasive ability). In NUE-1 invasive ability was not enhanced by HECD-1, but in HEC-1BE and HEC-108 invasive ability was enhanced to 223 +/- 41.2% and 307 +/- 173% by 5 micrograms/ml HECD-1. Morphologically NUE-1 invaded the extracellular matrix (Matrigel) with a long micro villis. But in HEC-1BE and HEC-108 the villis did not invade the Matrigel, the whole cell invaded it. Together with HECD-1, HEC-1BE and HEC-108 were changed to become similar to the NUE-1 cell line with high invasive ability and the micro villis invaded the Matrigel.

Endometrial stromal sarcoma with focal smooth muscle differentiation: recurrence after 17 years: a follow-up report with discussion of the nomenclature

In 1977, a case report was published describing a 28-year-old women with an endometrial stromal tumor that showed foci of myogenic differentiation. The term "stromomyoma" was introduced to encompass both this type of neoplasm as well as "uterine neoplasms resembling ovarian sex-cord tumors" (UTROSCTs). More than 17 years later, the tumor recurred, involving the right ovary, sigmoid colon, small bowel, abdominal wall and omentum. The histologic and electron microscopic similarities between the recurrent tumor and the primary neoplasm were confirmed. Applying the recent classification and diagnostic criteria of endometrial mesenchymal neoplasms, we have concluded that this tumor was a low-grade endometrial stromal sarcoma (LGSS). The formerly proposed term "stromomyoma" implies a benign tumor, in contrast to the obviously malignant nature of this particular tumor. Focal myogenic differentiation of LGSS is not an uncommon finding and does not warrant a separate diagnostic or prognostic entity. UTROSCTs and endometrial stromal sarcomas are two separate diagnostic entities, and combining them under an inclusive terminology is not appropriate.

Estrogen activates migration potential of endometrial cancer cells through basement membrane

The migration potential through a basement membrane in an endometrial cancer cell line, such as Ishikawa, HEC-1-A or HHUA cell, in terms of strength, was enhanced by estradiol, but not modified by progesterone, medroxyprogesterone acetate (MPA), danazol or tamoxifen alone, by which estradiol-enhanced migration potential was inhibited. The order of the level of estrogen receptor was Ishikawa > HEC-1-A > HHUA cells. Therefore, it is suggested that the invasiveness of endometrial cancer cells might be activated by estradiol via estrogen receptors, but inactivated by progesterone, MPA, danazol or tamoxifen as an antiestrogen action, and that endometrial cancer cells could become invasive in the estrogen-predominant milieu, and the antiestrogenic agents could protect it.

Effects of interferon-beta on steroid receptors, prostaglandins and enzymatic activities in human endometrial cancer

Steroid receptors, prostaglandin output and enzymatic activities were determined in explants derived from human endometrium exposed to natural interferon-beta (IFN-beta). Receptors and cell metabolism were evaluated before culturing the tissue fragments and after a 3-day treatment with varying concentrations of IFN-beta. Total steroid receptor levels were unchanged when explants were set up, but there was a redistribution of both estrogen and progesterone receptors (ER and PR). A decrease in cytoplasmic receptors corresponded to an increase in receptor molecules within the nucleus. Treatment with low concentrations of IFN-beta caused a significant enhancement (p < 0.05) of ER and PR in neoplastic endometrium. In basal conditions the ratio between prostaglandin F2 alpha (Pgf2 alpha) and prostaglandin E2 (PgE2) was higher in normal than in neoplastic endometrium. The addition of low concentrations of IFN-beta to the culture medium determined a significant increase (p < 0.02) in PgF2 alpha and a parallel increase in the above ratio in neoplastic tissue, while no variation was found in normal endometrium. Analysis of the results concerning the variations in hormone-related enzymatic activities due to IFN-B revealed a significant increase (p < 0.05) in 17 beta-hydroxy-steroid-dehydrogenase (17 beta-HSD) activity. The data presented here indicate that treatment with IFN-beta modifies those biological characteristics of neoplastic cells which are involved in hormone-responsiveness.

Expression of nm23-H1 and nm23-H2 protein in endometrial carcinoma

nm23 gene expression has been shown to be inversely correlated with tumour metastatic potential in some cancers but not in others. Examination was made of the expression of nm23-H1 and nm23-H2 gene products by immunohistochemistry and immunoblotting in 28 endometrial carcinomas. Immunohistochemistry indicated the cytoplasm of cancer cells to be positive, and myometrium and endometrial stromal cells negative, for nm23-H1 and -H2 protein. The staining intensity for these proteins was significantly stronger in well-differentiated adenocarcinomas (G1) than in those moderately differentiated (G2) (P < 0.05). nm23-H1 and -H2 proteins were shown by immunoblotting to be present at significantly higher levels in G1 than in G2 tumours (P < 0.05). Two of eight cases expressed high nm23-H1 and -H2 protein in poorly differentiated adenocarcinomas (G3). In G3 tumours, nm23 expression may be diverse. In this study, the expression of nm23-H1 and -H2 was not correlated with stage, metastasis, tumour size, myometrial invasion, oestrogen receptor, progesterone receptor or menopause. It follows from the findings presented above that the high expression of nm23-H1 and -H2 is positively correlated with histological differentiation.

Mucinous adenocarcinoma of the endometrium with intestinal differentiation: a case report

Mucinous differentiation of endocervical type has been well documented in endometrial carcinoma. However, we describe an unusual case of adenocarcinoma of the endometrium showing diffuse histological, immunohistochemical, and ultrastructural evidence of intestinal differentiation. Although intestinal differentiation has been described in mesodermally derived tissues including endocervix, ovary, and urinary tract, it has not been reported in normal endometrium. One previous case has been reported showing this pattern in endometrial carcinoma. Possible histogenetic mechanisms of this pattern are discussed.