CEA Levels in Gastric Juice in Precancerous Conditions and Cancer

First described in 1965 as a specific antigen for cancer of the colon, CEA is now considered to be an antigen associated with many types of malignant neoplasia, although the CEA-Test's role in clinical routine has yet to be clearly defined.

In the present study CEA levels in gastric juice were measured in subjects with gastric carcinoma (n = 25) and with benign gastric lesions (n = 171). CEA was significantly (p < 0.05) higher in patients with gastric carcinoma (GC) than in subjects with benign gastric lesions, other than chronic atrophic gastritis (CAG) associated with intestinal metaplasia (IM). In this latter condition CEA levels were similar to those in patients with GC.

These results suggest that the assay of CEA in gastric juice could be included in the diagnostic program for gastric cancer and its precursors with the aim of assessing its utility as risk indicator in the management of precancerous conditions and lesion.

Liver Glutathione Contents in Patients with Gastric Adenocarinomas

Many antineoplastic agents alter the reduced glutathione (GSH) status of liver and tumor tissue by inhibiting cellular GSH-linked enzymes. Thus, intracellular GSH plays an important role in a wide variety of antineoplastic interventions regarding therapeutic efficacy and toxicity. Mean GSH values were 0.791 ± 0.072 mg/m wet weight (ww) and 0.719 ± 0.047 mg/g ww in gastric cancer tissue and nontumorous glandular mucosa, respectively. Whereas, the average GSH level of normal gastric mucosa was 1.709 ± 0.135 mg/g, the mean GSH level of normal liver biopsies was 2.378 ± 0.260 mg/g. The GSH values of normal liver tissue were higher than the hepatocellular GSH concentrations of patients with gastric adenocarcinoma and of another group of tumor-bearing patients who had received chemotherapy preoperatively. These results suggest that the GSH levels of tumor and liver may influence the efficacy and/or toxicity of chemotherapeutic agents.

Immunohistochemical Detection of Carcinoembryonic Antigen (CEA) in Non-Cancerous and Cancerous Gastric Mucosa

Carcinoembryonic antigen (CEA) was stained by the PAP immunoperoxidase method in cancerous and non-cancerous gastric mucosa of 40 patients (25 non-cancerous dyspeptic patients and 15 patients with gastric carcinoma). The pattern of CEA localization was apical or membranous-cytoplasmic and immuno-reactivity was mild (+), moderate (++) or intensive (+++). No CEA immunoreactivity was detected in normal gastric mucosa whereas it was marked in gastric mucosa of non-cancerous dyspeptic patients with chronic atrophic gastritis and dysplasia (intense). In patients with superficial gastritis and epithelial hyperplasia it was mild or absent. The CEA localization pattern was also apical in non-cancerous dyspeptic patients with microscopic changes, e.g. superficial or chronic atrophic gastritis, epithelial hyperplasia and dysplasia, and in non-cancerous mucosa and cancerous tissue of patients with well (G1) and moderately (G2) differentiated adenocarcinoma.

Distribution of beta-human chorionic gonadotropin-positive cells in noncancerous gastric mucosa and in malignant gastric tumors

The authors examined the localization and behavior of beta-human chorionic gonadotropin (HCG)-positive cells in human gastric noncancerous mucosa and in gastric malignant tumors, using immunohistochemistry and the anti-beta-HCG antibody. The beta-HCG-positive cells were located mainly in the antral mucosa and were generally restricted to the neck portion of the pyloric glands, although a few were present in fundic glands of the gastric body. The beta-HCG-immunoreactive cells were found in gastric carcinomas in 53% of the 92 cases examined. These cells were observed more often in advanced carcinomas that were histologically poorly differentiated than in early carcinomas or in well-differentiated tumors, but this prevalence had no statistical significance. The presence of the beta-HCG-positive cells in the gastric carcinomas suggested no appreciable prognostic significance, even quantitatively. In the syncytiotrophoblast-like tumor cells seen in four gastric tumor samples with histologic features of a choriocarcinoma, immunoreactivity to the beta-HCG was striking. There was, however, no recognizable dominance in the number of beta-HCG-reactive cells in the noncancerous mucosa around the tumor.

[An autopsy case of extramural malignant leiomyoblastoma of the stomach with ovarian cancer: an immunohistochemical study]

The subject was an 85-year-old woman, who had been diagnosed as having an ovarian cancer and carcinomatous peritonitis and had been treated conservatively. She subsequently died from respiratory and renal insufficiency, and the autopsy that followed revealed that her pelvic cavity had been filled by a tumorous mass that size of a child's head. Histologically, the tumor was a serous cystadenocarcinoma of the ovary. Moreover another tumor, also the approximate size of a child's head, was found sited extramurally, beneath the posterior wall mucosa of the stomach body. Histological inspection of this tumor revealed a proliferation of round oval, and spindle-shaped tumor cells. A vacuolation of the cytoplasms and karyomitosis to the extent of 10/50 HPF also were observed. Based on the findings of being positive for Vimentin and a negative EMA, this tumor was diagnosed as being a malignant leiomyoblastoma of the stomach smooth muscle. The leioblastoma is a relatively uncommon neoplasm, and recent advances in immunohistochemical staining have indicated that some of these tumors are not only of smooth muscle derivation but also of nerve origin. Therefore, this tumor, given its morphological characteristics, had been generalized in this case as a gastric stromal tumor, and with negative findings for Desmin and S-100 protein, as well as positive for Vimentin.

Sialylpentaosylceramide detected with anti-GM2 monoclonal antibody. Structural characterization and complementary expression with GM2 in gastric cancer and normal gastric mucosa

The ganglioside fraction of human gastric mucosa was analyzed with a newly established anti-GM2 monoclonal antibody KM531. Using this antibody, accumulation of GM2 was observed in all of four cases of gastric carcinoma. In all ganglioside fractions extracted from normal gastric mucosa obtained from eight cases of peptic ulcer GM2 itself was not detected, but three kinds of glycolipid showing slower mobility than GM2 on thin-layer plates were detected by immunostaining with KM531. These glycolipids were assigned as NGM-1, -2, and -3. They were completely lost in all carcinoma tissues and in non-cancerous gastric mucosa from two cases of gastric cancer, and they were also not detected in the ganglioside fraction of small or large intestine. Of these glycolipids, the major one, NGM-1, was isolated from the pooled ganglioside fraction of normal gastric mucosa obtained from cases of peptic ulcer. The structure was determined by proton nuclear magnetic resonance, negative ion fast atom bombardment-mass spectrometry, gas chromatography-mass spectrometry, and treatment with exoglycosidases and mild acid hydrolysis. The structure was GalNAc beta 1----4(NeuAc alpha 2----3) Gal beta 1----4GlcNAc beta 1----3 Gal beta 1----4Glc beta 1----1Cer, which has the same terminal sequence as GM2 but has internal neolacto series structure. This epitope was previously identified as Cad blood group antigen. The decrease of this glycolipid and the increase of GM2 was considered to be a cancer-associated change in gastric mucosa.

Immunoelectron microscopic localization of human type III collagen in human gastrointestinal carcinomas

Ultrastructural immunolocalization of human type III collagen/procollagen was investigated in 28 cases of human gastrointestinal carcinoma by the pre-embedding method using a monoclonal antibody. In addition to immunoreactivity on collagen fibers, amorphous or finely fibrillar immunoreactive substances were observed in the extracellular matrix adjacent to the plasma membrane and in the cisternae of rough endoplasmic reticulum (rER). These substances were considered to represent type III procollagen and/or collagen before fiber formation. Cytoplasmic recesses containing immunoreactive fibers were also observed. These findings related to collagen production were detected in stromal fibroblasts in 16 of 28 cases and in carcinoma cells in six of 28 cases. The positivity rate of these findings was lower in diffuse-type gastric carcinoma. The present study thus clarified further details of collagen production and secretion, and revealed that carcinoma cells may also be involved in the production of stromal collagen in some cases as well as stromal fibroblasts.

Sarcomatoid carcinoma of the stomach. A report of three cases with immunohistochemical and ultrastructural observations

The authors report three cases of sarcomatoid carcinoma arising in the stomach. This uncommon tumor is characterized by a mixture of malignant epithelial and spindle cell elements. All three tumors were large (average diameter, 5 cm) and infiltrated deep into the stomach wall. Two of the tumors had a polypoid configuration; the third was ulcerated and endophytic. Intestinal metaplasia was present adjacent to the tumor in all cases, with dysplasia in two. Immunohistochemical studies showed positivity for cytokeratin, carcinoembryonic antigen, and epithelial membrane antigen in the epithelial component of all tumors, and Leu-M1 was positive in the epithelial component of one. The spindle cell components contained vimentin, and in tumor 2, the spindle cell component was also positive for desmin. Two tumors showed focal positivity for cytokeratin in the spindle cells immediately adjacent to the epithelial component. Ultrastructurally, the spindle cell component of two tumors was composed of undifferentiated cells without specific epithelial or mesenchymal features. The third tumor contained occasional cells with features of myofibroblasts.

[Gastrinoma and carcinoma-carcinoid tumor causing Zollinger-Ellison syndrome]

7 gastrinomes and 1 gastrin-producer complex carcinoma-carcinoid tumor were examined by light and electron microscopical-method and by immunohistochemical method. In six cases, the tumor was in the pancreas or in the wall of duodenum; in two cases its localisation was of extra-gastroenteropancreatic (liver, lymph node). All patients developed Zollinger-Ellison syndrome, three patients bled and one had diarrhea. One patient had other tumors, besides gastrinome, which were characteristic of MEN-I syndrome. By immunohistochemical methods all tumors proved to be gastrin and neuron-specific-enolase positive. In four cases somatostatin positivity, in some cases glucagon, pancreatic polypeptide, S-100 protein, keratin and carcinoembryonal antigen positivity were detected. Relation could not be detected between other polypeptide hormones, produced besides gastrin, and biological behaviour of tumor and clinical symptoms.

[The significance of determination of urinary trypsin inhibitor related antigen in patients with cancer of the digestive organs]

A highly sensitive enzyme immunoassay was developed for the determination of urinary trypsin inhibitor related antigen (UTIRA) in plasma, urine and cancer tissues, and we investigated its significance as a tumor marker in patients with cancer of the digestive organs. Variations in UTIRA in plasma and urine were not associated with the age of the volunteers, but in urine, high average was observed in male volunteers. UTIRA levels in the urine of the patients with esophageal, stomach and colorectal cancer increased as the stage progressed, except in the patients with liver cancer. And those levels in the urine significantly decreased after a curative operation, but did not decrease after a non-curative operation. UTIRA levels in stomach cancer tissues were significantly higher than those in adjacent healthy mucosa, but UTIRA levels were not high in tissues of esophageal, colorectal and primary liver cancers. Therefore, we speculate that the high levels of UTIRA in urine and plasma in patients with cancer of the digestive organs may not be caused by UTIRA released from cancer tissues. The determination of UTIRA may be significant in a broad sense as an index of the cancer stage or recurrence of cancer, particularly of the stomach.

Sex hormone receptors in gastric cancer

Gastric adenocarcinoma that originates from mucosal tissue invades submucosa, muscle, and serosa in different stages. The level of progesterone receptors (PgR), estrogen receptors (ER), and androgen receptors (AdR) in the superficial part of gastric cancer tissues (CAs) from 16 patients was determined and compared with that of the corresponding normal gastric mucosal tissues (NLm). There were PgR in all CAs (100%) with values that ranged from 20.5 to 548.4 fmol/mg protein. Eight CAs (50%) had ER values that ranged from 6.8 to 325.1 fmol/mg protein. AdR was found in two CAs with values of 14.7 and 16.4 fmol/mg protein. In NLm, 15 (93.8%) had PgR values that ranged from 7.3 to 473.2 fmol/mg protein and ten (62.5%) had ER values that ranged from 0.9 to 87.9 fmol/mg protein. AdR were present in two NLm with values of 1.5 and 73.5 fmol/mg protein. There was no statistical difference in levels of PgR and ER between CAs and NLm. There were PgR in all gastric cancers and in 93.8% of NLm. The results suggest that gastric mucosa may be the target tissues for progesterone action. Furthermore, the lack of correlation between the levels of ER and PgR in gastric cancer tissue suggests that the PgR in gastric cancers are probably estrogen independent.

Cytophotometrically determined DNA content, mitotic activity, and lymph node metastasis in clinical gastric cancer

Analyses of cytophotometrically determined DNA content and mitotic rate were carried out in 37 cases of gastric carcinoma to identify biologic significance of DNA abnormalities. Lymph node metastasis was also evaluated by DNA content and mitotic rate. According to the linear regression analysis, there were statistically significant correlations of mitotic rate with DNA variants such as the peak value, the mean value, and the frequency of cells with values exceeding tetraploid or hexaploid chromosome complement. There were significantly higher values for these DNA parameters in patients with lymph node metastasis compared with those without metastasis. Similarly, higher mitotic rates were observed in tumors with metastatic disease. Thus abnormal DNA fractions appear to be indicative of tumors with a high mitotic activity. The quantitative detection of the DNA abnormalities will provide pertinent biologic information required to predict the occurrence of metastasis in patients with gastric cancer.

[An analysis of the cellular DNA contents in lung-metastasized stomach cancers]

A study has been conducted of the cellular DNA contents in the primary and metastatic lesions of 30 cases of lung-metastasized stomach cancers, in which each DNA Index (DI) was calculated and analysed comparatively. As a consequence, the rate of the diploid type in the nodular lung metastases was found to be higher than the rate of the others. Further, the DI's of 22 out of 30 (73%) metastatic lymph nodes corresponded with those of the primary lesions. Four lung metastatic lesions out of five differed from their primary lesions, but all five lesions simulated their metastatic lymph nodes. Thus understanding of the properties of the metastatic lymph nodes, rather than their primary lesions, would seen to be helpful in planning the therapy to combat recurrent cancers.

Immunohistochemical demonstration of epidermal growth factor in human gastric cancer xenografts of nude mice

Thirty-two surgical specimens and three cell lines of human gastric cancers were used for subcutaneous transplantation into nude mice, resulting in the establishment of eight (25%) xenografts from the surgical specimens and two (67%) from the cell lines. The localization of epidermal growth factor (EGF) in the surgical specimens and cell lines of the gastric cancers and their xenografts in nude mice was then investigated immunohistochemically. Epidermal growth factor was stained in the cytoplasm of the cancer cells, being detected in 16 (50%) of the 32 surgical specimens and in all of the cell lines. Seven (44%) of the sixteen EGF-positive surgical specimens and one (6%) of the 16 EGF-negative ones were tumorigenic in nude mice. All of the xenografts in nude mice were positive for EGF. The tumorigenicity of human gastric cancer xenografts in nude mice may, therefore, be correlated with the presence of EGF in cancer cells.

Advanced gastric carcinoma simulating early gastric carcinoma

Eighty-six cases of advanced gastric carcinoma simulating early gastric carcinoma were studied clinicopathologically. Cytophotometric DNA analysis was also performed in 33 cases. Most of these particular carcinomas were of the depressed type on gross inspection. Histologically, the tumors were of diffuse type in 60%. The rate of the carcinomas restricted to within the muscularis propria was 48% and high in comparison with those in conventional advanced gastric carcinomas. There were four main growth patterns: small invasion type (Type A, 43 cases), ulcer-connected type (Type B, 19 cases), vessel permeation type (Type C, six cases), and diffusely infiltrative type (Type D, 13 cases). There was a relationship between growth patterns, lymph node metastasis, and prognosis: Types A and B had a small percentage of lymph node metastasis and a good prognosis, whereas Types C and D a high percentage and a poor prognosis. DNA analysis revealed that two thirds of the examined cases showed a low ploidy pattern. The DNA ploidy patterns were concerned with the tumor growth pattern: high-ploidy cases were rarely seen in Types A and B yet were frequent in Types C and D. The 5-year survival rate was 73%, but results were poor in cases of tumors with blood vessel permeation, in those with lymph node metastasis, in those with the Type D or C growth patterns, and in those with high DNA ploidy pattern. Since these carcinomas can be understaged endoscopically and by gross examination, a precise study of the surgically excised tissues will aid in making an accurate prognosis.

Significance of gastric endocrine tumor and age-related gut peptide alterations in Mastomys

The Mastomys (Praomys natalensis) species are a unique natural model in which the bioactivity of gastric carcinoids may be studied. Several investigators have previously demonstrated that these tumors contain large amounts of histamine. In this study we investigated the presence of peptides associated with the neoplasm. The levels and location of gastrin, gastric inhibitory peptide (GIP), neurotensin, peptide YY (PYY), pancreatic polypeptide (PP), glucagon, bombesin, vasoactive intestinal peptide (VIP) and somatostatin (SRIF) were investigated by radioimmunoassay and immunocytochemistry. In addition the distribution of these peptides were evaluated in the gastrointestinal tract of young and old animals to investigate possible age-related changes. PYY and enteroglucagon (EG) were significantly (P less than 0.001) elevated in both tumor tissue (676 +/- 152, 551 +/- 164 pmol/g) and plasma (620 +/- 160, 500 +/- 147 pmol/l) of tumor-bearing animals. Immunocytochemistry revealed PYY- and EG-like immunoreactivity in 20-30% of tumor cells. A significant decrease (P less than 0.05) in bombesin was noted in older animals, but no changes in gastric tissue content of PYY or EG could be detected between young and old animals. Gastrin was not detected in tumors and there were no significant changes in tissue or plasma levels with age. Small bowel concentrations of VIP and PYY were higher in the older mastomys (P less than 0.05). In contrast, colonic levels of bombesin, VIP, somatostatin and PYY were significantly lower (P less than 0.05) in older mastomys compared with young. The age-related changes in several peptides may reflect an adaptive response to acid hypersecretion. The multi-hormonal character of these neoplasms suggests that these tumors develop from a pluripotential stem cell.

Correlation of DNA ploidy and clinical outcome in early gastric carcinomas

The nuclear DNA content was measured in 120 early gastric carcinomas and the results correlated with histologic findings and S-phase fractions measured by in vivo bromodeoxyuridine (BrdU) labeling. Forty-six cases (38%) were diploid and 74 cases were aneuploid. In aneuploid tumors, incidence of submucosal invasion, vascular invasion, and lymph node involvement were significantly higher than that in diploid tumors. In addition, the S-phase fractions in aneuploid tumors were significantly higher than those in diploid tumors. There was no recurrence in diploid tumors; whereas 21% of cases with aneuploid tumors recurred. These results indicate that DNA content may be a prognostic factor in early gastric carcinoma.

[A clinicopathological study of signet-ring cell carcinomas of the stomach]

Surgically resected signet-ring cell carcinomas of the stomach have been clinicopathologically investigated. Although this type of carcinoma was found to be widely spread in the propria mucosa, a deeper invasion beyond the submucosa appeared more slowly than in other types of carcinomas. For example, the larger the early carcinoma in which the invasion was restricted to within the submucosa, the greater the incidence of a signet-ring cell carcinoma increase, especially in cases involving the mucosa. The incidence of a nodal metastasis was found to be lower than in cases of a moderately and poorly-differentiated adenocarcinoma in the early stage. However, when the signet-ring cell carcinomas invaded beyond the submucosa, the tumor cells spread rapidly and widely in the wall with a subsequent abdominal implantation, causing ascites and peritonitis carcinomatosa. It seemed likely that this deep invasion was accelerated by cellular change, such as the enlargement of nucleus, cellular atypy, and a decreased mucin production. As signet-ring cell carcinoma arise from the neck of glands and infiltrate the propria mucosae under the superficial epithelium, diagnosis by the barium enema and an endoscopic examination is very difficult in the case of small-size lesions. In lesions greater than 1 cm in diameter, these carcinomas usually showed an erosive and/or ulcerated appearance.

Regional ploidy variations in signet ring cell carcinomas of the stomach

Regional ploidy variations within individual tumors were analyzed by in-situ cytofluorometry of metaphase cells in Feulgen-stained paraffin sections, using 45 resected stomachs with early and advanced signet ring cell carcinomas. Aneuploid cells were found in one of 30 early cancers and in eight of 15 advanced cancers, and were almost always accompanied by diploid cancer cells in the mucosal part of the cancers. The diploid and the aneuploid cells were generally found to be distributed in different territories in the mucosa, and aneuploid foci were often included in the diploid area. These findings suggest the diploid origin of signet ring cell carcinomas and the occurrence of aneuploidy during the tumor development. Moreover, the aneuploid cells appeared to infiltrate beyond the mucosa more readily than the diploid cells; most of the aneuploid populations already invaded the extramucosal tissue, and the cancer cells infiltrating in the extramucosal tissue were predominantly aneuploid in six of the nine cancers with aneuploidy. Thus, it appears that the occurrence of aneuploid clones may accelerate the progression of signet ring cell carcinomas from early to advanced stages.

DNA cytometry and morphometry by TV based image analysis system (TAS) in the diagnosis of gastric carcinoma

Cytological smears from gastric biopsies were studied by two types of TAS. Böcking's algorithm and a great number of form factors were used to separate the intact cells from the tumourous ones. The numerically expressed density features and morphometric parameters are able to indicate the possibility of malignant transformation even in dysplasia. These values become much higher in tumours and lead to unequivocal diagnosis. Both types of TAS render valuable help in assessing cases not reliably diagnosed by routine staining procedures.

Procoagulant activity of human stomach and colon cancers

Procoagulant activity in extracts from human stomach and colon cancers was examined, using chromogenic substrate S-2222. The activity of direct activator of factor X varied between 6 and 96% of total procoagulant activity of the tested extracts. The direct activator of factor X from stomach cancer was sensitive to heating and was inhibited by phenylmethylsulphonylfluoride and also by iodoacetic acid and HgCl2. Such results lead to the assumption that investigated activator is of enzymatic nature.

DNA analysis and prognosis of digestive tract cancers

Cytophotometric DNA analysis was performed on esophageal and gastric carcinomas. In 35 cases of mucosal and submucosal carcinoma of the esophagus, patients with types I and II (relatively regular in DNA distribution) had an uneventful postoperative course and no recurrence, whereas 3 of 15 (20%), and 5 of 9 (55.6%) with type III and type IV, respectively (widely scattered DNA distribution, died following a recurrence. Cytophotometric DNA analysis using biopsy specimens from 75 patients with esophageal cancer in various stages also showed a close relationship between the DNA distribution pattern and prognosis. However, the growth mode and the DNA ploidy of mucosal gastric cancer correlated well in the investigation of 66 cases. Thus, data of this method closely reflected the outcome in patients with digestive tract cancers. These results suggested the potential usefulness of cytophotometric DNA analysis for assessing the prognosis, even in the early stage of cancers.

Content of glucocorticoid receptor and arginase in gastric cancer and normal gastric mucosal tissues

The content of glucocorticoid receptor (GR) and arginase in human gastric cancer and the corresponding normal gastric mucosal tissues was determined. Among the 25 patients studied, the GR content in gastric cancer tissues was 33.2 +/- 10.2 fmol/mg protein versus 7.6 +/- 3.4 fmol/mg protein in gastric mucosal tissues. This difference is statistically significant (P less than 0.005). Of the 25 paired samples, 19 cancer tissues contained GR, whereas only seven of the normal mucosal tissues had GR. The level of arginase in gastric cancer tissues in 19 patients was assayed, it was 26.6 +/- 4.2 ng/mg protein which is also significantly higher than that in normal gastric mucosal tissues (13.5 +/- 1.8 ng/mg protein) (P less than 0.005). Since glucocorticoids and arginase are potent immune suppressive agents, the increased level of GR and arginase in gastric cancer tissue suggest that these glucocorticoid-related factors in gastric cancer tissue may play a partial role in regulating cellular immunity.

[Relationship between the effectiveness of CDDP therapy and the nuclear DNA content in advanced-recurrent gastric cancer cases]

A microspectrophotometric analysis of the DNA content has been performed on 9 advanced recurrent gastric cancer patients with measurable lesions, who has either been treated by CDDP alone or with other chemotherapeutics during a three-year period since, 1984. Histograms of the DNA content were classified into four ploidy patterns. All of the 4 responder cases (CR, PR, MR) showed type, IV, although only one of 5 non-responder cases revealed the same typing. In one of the two CR cases the DNA ploidy pattern, which was examined before and after the therapy, changed from type IV to type II. Thus it appears that an analysis of the DNA content may be useful in evaluating the effectiveness of different chemotherapies.

[Evaluation of DNA content in gastric dysplasia and carcinoma by image cytometry]

In 30 cases of gastric dysplasia and 10 cases of gastric carcinoma, DNA content was studied by IBAS image analysis system. The mean DNA level increased steadily with the advance of histologic gradation, and the highest DNA content was observed in gastric carcinoma. No case of aneuploidy was found in mild dysplasia. In moderate dysplasia, aneuploid cells were occasionally encountered. Severe dysplasia had a lower percentage (4.48%), and gastric carcinoma was characterized by a high percentage of aneuploid cells (14.54%).

[Effect of UFT on nuclear DNA distribution of gastric and colorectal carcinomas]

To evaluate the effect of UFT on nuclear DNA distribution of carcinoma, we measured the DNA content of biopsy specimens and resected specimens obtained from 18 patients by microfluorometry. The tumors consisted of 7 gastric and 11 colorectal carcinomas. Five patients who received administration of 400mg of UFT (400mg of tegafur) were classified as the chemotherapy group and another 13 patients were classified as the control group. 1) DNA indices of biopsy specimens and resected specimens of the same patients showed almost the same values both in the control group (r = 0.81) and in the chemotherapy group (r = 0.89) (p less than 0.05). 2) S and S + G2M fractions of resected specimens showed almost the same values as compared with those of corresponding biopsy specimen in the control group. However, in the chemotherapy group S and S + G2M fractions of resected specimens showed a tendency to be higher than those of corresponding biopsy specimen (0.05 less than p less than 0.1). This study indicates that the biopsy specimens are sufficient for DNA analysis and that UFT-induced DNA change may be increase of S and S + G2M fraction.

Solubilization and immunopurification of a somatostatin receptor from the human gastric tumoral cell line HGT-1

The human gastric tumoral cell line HGT-1 was previously shown to contain a membrane somatostatin receptor negatively coupled to adenylate cyclase through a pertussis toxin-sensitive inhibitory GTP-binding regulatory protein (Gi) (Reyl-Desmars, F., Laboisse, C., and Lewin, M. J. M. (1986) Regul. Pept. 16, 207-215). In this study, we have solubilized this receptor in a free unoccupied form using Triton X-100 as detergent and [125I-Tyr11]somatostatin-14 to monitor specific binding. Furthermore, we have prepared a monoclonal antibody against a chromatographically enriched soluble receptor fraction and used this antibody (30F3) to immunopurify the receptor in conjunction with Sepharose-somatostatin-14 immunopurification and steric exclusion high pressure liquid chromatography (HPLC). The purified fraction showed 18,600-fold enrichment in terms of specific binding (i.e. from 0.6 +/- 0.05 to 11,300 +/- 830 pmol/mg of protein) and a single dissociation constant (kappa D) of 76 +/- 8 nM. On HPLC, it migrated as a single and symmetric 90-kDa peak. Moreover, after 125I-protein labeling, it gave a single 90-kDa band on sodium dodecyl sulfate-polyacrylamide gel electrophoresis autoradiography. On the other hand, the 30F3 monoclonal antibody immunoblotted with a single 90-kDa band contained in the HGT-1 cell membrane. We therefore suggest that this antibody is specific to the HGT-1 membrane somatostatin receptor, that this receptor has a molecular mass of 90 kDa, and that we have obtained a homogeneous preparation of nondenatured receptor suitable for further cloning studies.

[Flow cytometric cell cycle analysis using a monoclonal antibody to bromodeoxyuridine on gastric cancers]

Flow cytometric cell cycle analysis using a monoclonal antibody to Bromodeoxyuridine was performed on 117 gastric cancers. Dissociated cells were stained with indirect immunostaining for BrdU (FITC-BrdU) and propidium iodide. Bivariate BrdU/DNA distribution were obtained using EPICS-C flow cytometry. Tumor ploidy was classified as follows, D1: diploidy, D2: diploidy + aneuploidy, A1: single aneuploidy, A2: multiple aneuploidies. The ploidies of noncancerous gastric mucosa were all diploidy and that of S-phase fraction(SPF) were ranged from 0.0% to 1.2%. In 117 gastric cancers, aneuploidy was observed in 80 cases, D2: 38, A1: 15, A2: 27. SPF was higher in aneuploidy (14.5 +/- 5.1%) than diploidy (6.1 +/- 5.1%). Significant differences were observed between that of D1 (6.1 +/- 2.5) and D2 (13.6 +/- 6.2), A1 (12.5 +/- 4.5), A2 (16.0 +/- 3.2), and A1 and A2 (p less than 0.01). The patients with aneuploid tumors had poor prognosis than diploid tumors (p less than 0.05). In concerned with DNA ploidy pattern, the patients with A2 had most poor prognosis than the other (p less than 0.05). Furthermore, the patients with SPF over 10% had poor prognosis than that of SPF below 10%. These results indicated that DNA ploidy pattern and SPF may possibly be useful prognostic markers for gastric cancers.

Promotion by bombesin of gastric carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine in Wistar rats

The effects of bombesin on the incidence, number, histological type, and depth of involvement of gastric cancers induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) were investigated in male Wistar rats. Rats received alternate-day s.c. administration of 20 or 40 micrograms/kg body weight of bombesin in depot form after p.o. treatment with the carcinogen for 25 weeks. Prolonged administration of bombesin at 40 micrograms/kg led to a significant increase in the incidence and number per rat of gastric cancers of the glandular stomach at Week 52. In rats that had received alternate-day injections of 20 micrograms/kg of bombesin, the number of gastric cancers per rat, but not the incidence of cancer, was significantly more than in untreated rats. However, bombesin at both dosages did not affect the histological appearance of the lesions or their depth of involvement. At Weeks 30 and 52, norepinephrine concentrations in the fundic and antral portion of the gastric walls and labeling indices in the antral and fundic mucosae were significantly higher in rats treated with bombesin at both dosages than in untreated rats. These findings indicate that bombesin enhances gastric carcinogenesis after administration of N-methyl-N'-nitro-N-nitrosoguanidine is stopped and that this effect may be related to its effects in increasing tissue norepinephrine concentrations in the stomach wall and increasing cell proliferation in the gastric mucosa.

Expression of ras oncogene p21 protein in early gastric carcinoma and adjacent gastric epithelia

The expression of the ras gene product p21 in normal gastric mucosa, early gastric carcinoma of diffuse (gastric) and intestinal types, and in adjacent mucosal abnormalities is reported. The analysis was performed on paraffin sections by an immunohistochemical assay using the mouse monoclonal antibody RAP-5 and the rat monoclonal antibody Y13-259. Expression of ras p21 was assessed by staining intensity and percentage of positively stained cells. In comparison to normal gastric mucosa of non-cancer patients, p21 was overexpressed in nearly all early carcinomas of both types and in the dysplastic and/or metaplastic mucosal alterations accompanying intestinal type of gastric cancer. Increased p21 expression was also observed in the normal-appearing mucosa adjacent to early carcinomas of diffuse type, but not in the morphologically normal gastric epithelium adjacent to the intestinal type. The results of this investigation suggest that ras p21 overexpression may be related to early events of human gastric carcinogenesis. The study supports the notion of different pathways in the development of diffuse (gastric) and intestinal types of gastric carcinomas.

c-erbB-2 oncogene product staining in gastric adenocarcinoma. An immunohistochemical study

The c-erbB-2 oncogene has been shown to be amplified in a variety of human adenocarcinomas. Antibodies to the protein product, p185, have been used for immunostaining of paraffin-embedded material, and have demonstrated that high levels of c-erbB-2 protein expression correlate with gene amplification under certain conditions. In studies by others, amplification has been demonstrated in 40 per cent of tubular type adenocarcinomas of the stomach, and an immunohistochemical study on frozen tissue has demonstrated staining in 3 out of 10 cases. Our study, using paraffin-embedded material, demonstrates staining in 19 per cent of 126 cases using a polyclonal antibody. Of the positive cases, 75 per cent were tubular or papillary type (P less than 0.025), and prominent staining was restricted to this group. Three cases showed well-defined positive areas in keeping with clonal expression of p185. No specific staining of normal or dysplastic epithelium adjacent to the carcinomas was found.

[A case of primary gastric choriocarcinoma]

A 66-year-old man with a primary gastric choriocarcinoma is presented. The pre-operative diagnosis of the gastric barium examination and an endoscopy was an unusual gastric carcinoma in the antrum. At laparotomy, an abscess in the lesser sac that had developed by a tumoral penetrance was found. Thus a total gastrectomy and a lymphadenectomy with a reconstruction was performed. The resected specimen was found to be a Borrmann 1 type tumor, and a histological examination showed it to be a choriocarcinoma with a syncytiotrophoblast, that was immunostained by human chorionic gonadotropin (HCG). The physical findings however, disclosed no tumor in the testis. The serum HCG was found to be 1,380 IU/l on the 7th postoperative day, then a pulmonary metastases appeared and progressed, and the patient died on the 22nd postoperative day.

Composite carcinoid-adenocarcinoma of the stomach associated with multiple gastric carcinoids and nonantral gastric atrophy

A case of multiple gastric carcinoids and nonantral atrophic gastritis in which the larger tumor was a composite carcinoid-adenocarcinoma is presented. The two components of the composite tumor immunohistochemically showed clear-cut diverging functional differentiations although the available evidence supported a common histogenesis from the metaplastic intestinal epithelium of the gastric mucosa. The carcinoid tissue of the composite tumor, which showed "atypical" features, also differed from the other, pure carcinoids, in which the histologic appearance was "typical." Total gastrectomy performed 1 month after the original gastric resection with antrectomy disclosed regressive changes in the endocrine cell proliferations of the gastric stump consistent with the withdrawal of a stimulating effect of the antral gastrin.

The effect of tamoxifen and estrogen receptor status on survival in gastric carcinoma

One hundred patients were entered in a randomized, controlled study of adjuvant tamoxifen therapy in gastric carcinoma. Estrogen receptor status was established by an immunohistologic method (ERD5) and 55.8% of the tumors were positive. Tamoxifen had no overall effect on survival, but there was a significant decrease in the survival time of the patients with ERD5-positive tumors. Estrogen receptor status (by the ERD5 method) is an independent prognostic factor in gastric cancer. Tamoxifen therapy does not prolong survival, and new therapeutic strategies require investigation.

Distributions of tegafur in tissues of gastric adenocarcinoma patients: tissue uptakes and concentrations in plasma after oral and rectal administrations

Fifty-one gastric adenocarcinoma patients were divided into two groups, according to the route of administration of the anticancer drug. One group was given FT-207 (tegafur, an enteric coated granule) orally and the other group, FT-207 in the form of a suppository. Blood and tissue concentrations of the drug were examined after a three-day administration of 750 mg at 09.00 and 21.00 hours. There were no significant differences between the two groups with respect to the concentrations of FT-207 and its metabolite 5-FU in the tissues. Levels of 5-FU in the excised tumor averaged 0.256 and 0.160 micrograms/g, in oral and rectal administrations, respectively, and levels in normal lymph nodes averaged 0.174 and 0.179 micrograms/g, respectively. The difference in 5-FU levels between normal and tumor tissues was statistically significant (P less than 0.05).

Localization of transforming growth factor alpha and its receptor in gastric mucosal cells. Implications for a regulatory role in acid secretion and mucosal renewal

Transforming growth factor alpha (TGF alpha) shares with epidermal growth factor (EGF) structural homology (35%), a common cell-surface membrane receptor (TGF alpha/EGF receptor), and a nearly identical spectrum of biological activity, including inhibition of gastric acid secretion. Herein, we report expression of TGF alpha mRNA in normal gastric mucosa of the adult guinea pig, rat, and dog. TGF alpha mRNA was also detected in matched surgically resected gastric mucosa and adjacent gastric carcinoma from 10 patients, and in gastric mucosa adjacent to a benign ulcer from an additional patient. TGF alpha protein was quantitated by radioimmunoassay and was present in tumor and adjacent mucosa. TGF alpha/EGF receptor mRNA was also detected in gastric mucosa from all species studied. Localization of TGF alpha and TGF alpha/EGF receptor mRNA expression was examined in samples of unfractionated guinea pig gastric mucosa and from chief cell-enriched and parietal cell-enriched fractions. All samples exhibited TGF alpha and TGF alpha/EGF receptor expression. The TGF alpha signal was greatest in the parietal cell fraction (5.8-fold increase), but was also enhanced in the chief cell fraction (1.9-fold increase) relative to the unfractionated gastric mucosa. Like TGF alpha expression, TGF alpha/EGF receptor mRNA expression was most intense in the parietal cell-enriched fraction (7.8-fold increase), but was also increased in the chief cell-enriched fraction (2.7-fold increase) relative to the unfractionated guinea pig gastric mucosa. We conclude that TGF alpha and TGF alpha/EGF receptor genes are expressed in normal adult mammalian gastric mucosa. These findings, when interpreted in light of described actions of TGF alpha and EGF, provide evidence that local production of TGF alpha could play an important role in the regulation of acid secretion and mucosal renewal in the stomach.

Papillary adenoma of the stomach. Pathologic and immunohistochemical study

A total of 13 gastric papillary adenomas composed of 8 papillary and 5 papillotubular adenomas were examined pathologically and immunohistochemically. They showed a dome-like or pedunculated appearance and were located at the antrum, except for one adenoma. Histologically, the adenoma cells showed atypia in varying degree and focal adenocarcinoma was noted in seven lesions. The number of goblet cells was apparently smaller in the papillary than in the tubular portion. Lysozyme was present at the supranuclear region in most papillary adenoma cells, whereas it was concentrated in Paneth's granules in tubular adenoma cells. No difference was found in the distribution and frequency of carcinoembryonic antigen, secretory component, and carbohydrate antigen CA 19-9 between papillary and tubular adenomas. Paucity of endocrine cells also characterized gastric papillary adenoma. Different phenotypic expressions might reflect the difference in histogenesis between papillary adenoma and tubular adenoma.

Comparison of serum assays for TAG-72, CA19-9 and CEA in gastrointestinal carcinoma patients

Tumor-associated glycoprotein (TAG-72) has been shown to be expressed in a wide variety of epithelial malignant tissues. We have investigated serum levels of TAG-72 antigen in patients with gastrointestinal cancer with a solid phase radioimmunometric assay (RIA), CA72-4, utilizing murine monoclonal antibodies CC49 and B72.3 which recognize the TAG-72 antigen. Elevated levels of serum TAG-72 antigen were found in 48% of 56 gastric carcinoma patients and 67% of 45 colorectal carcinoma patients. The serum concentrations of TAG-72 were compared to those of CA19-9 and CEA. The positive rates of CA19-9 in gastric carcinoma and colorectal carcinoma patients were 29% and 54%, and those of CEA were 52% and 60%, respectively. Elevated serum levels of TAG-72, CA19-9 and CEA were observed in 7%, 14% and 24%, respectively, of patients with benign disease, thus indicating a preferential expression of TAG-72, compared to CA19-9 and CEA, in gastrointestinal carcinoma patients versus in patients with benign disorder. A cocktail of CA72-4, CA19-9 and CEA RIAs increased positive rates to 68% in sera of gastric cancer patients and 84% in sera of colorectal cancer patients. Combination assays using CA72-4, CEA and CA19-9 RIAs for patients with benign gastrointestinal disorder, however, also increased the positive rate to 31%. These results indicate that CA72-4, CA19-9 and CEA RIAs may be complementary in detecting circulating tumor-associated antigens. It must be emphasized, however, that interpretation of the data provided by the combination serum assays requires careful consideration.

Coexpression of platelet-derived growth factor (PDGF) A-chain and PDGF receptor genes in human gastric carcinomas

In this study we examined the expression of platelet-derived growth factor (PDGF) A-chain and PDGF receptor genes in seven human gastric carcinoma cell lines and 15 gastric carcinoma tissues. Expression of mRNA for PDGF A-chain was found in all gastric cell lines and all gastric carcinoma tissues. Two of the seven gastric carcinoma cell lines expressed PDGF receptor mRNA. Out of the 15 gastric carcinoma tissues, eight showed enhanced expression of PDGF receptor mRNA and all of them demonstrated prominent fibrous stroma. Moreover, the incidence of enhanced expression of PDGF receptor mRNA was higher in scirrhous carcinoma than in well differentiated adenocarcinoma. These results strongly suggest that PDGF produced by tumor cells acts as a paracrine growth factor for production of fibrous stroma in gastric carcinomas.

Correlation of DNA ploidy and clinical outcome in Borrmann type 4 gastric carcinoma

The correlation between DNA ploidy pattern and clinical outcome was studied in 76 patients with Borrmann type 4 gastric carcinomas. Twenty-six tumors were diploid, and 50 tumors were aneuploid. There was no correlation among DNA ploidy and histologic type, lymph-node status, wall invasion, or clinical stage. The incidence of vascular invasion in the aneuploid tumors was significantly higher than that in the diploid tumors. Five year survival was achieved in 28% of the patients with diploid tumors and 8% of those with aneuploid tumors, respectively. Among the patients undergoing curative resection, 5 year survival rate was 54% in the patients with diploid tumors compared to 28% with aneuploid tumors. There was a significant survival advantage in patients with diploid tumors. These results indicate that DNA ploidy might be an important prognostic factor in Borrmann type 4 gastric carcinomas.

[Nuclear DNA content of gastric cancer with biologically high malignancy]

Nuclear DNA content was microspectrophotometrically measured in 120 gastric cancer patients to assess the predominance of a particular DNA distribution pattern in gastric cancer with biologically high malignancy, such as the marked tendency for severe vessel invasion and remote metastasis, and for early recurrence after curative surgery. DNA distribution patterns were grouped into low and high ploidies, and the correlation between the DNA ploidy pattern and histopathologic, biologic findings was evaluated. The incidence of high DNA ploidy tended to be increased as the histological stage and level of infiltration progressed. On the other hand, the incidence of high DNA ploidy was higher in dead cases of early recurrence among cases of the same histological stage, or where vessel invasion and remote metastasis were severe among cases of the same depth of invasion. Therefore, we consider that the DNA distribution pattern well reflects the malignancy of gastric cancer.

Immunocytochemical detection of lactoferrin in human gastric carcinomas and adenomas

In gastric carcinomas, including 20 cases of intestinal type and 10 cases of diffuse type, in adenomas with mild to severe dysplasia (20 cases), and in hyperplastic polyps (10 cases), the presence of lactoferrin was investigated by immunohistochemistry. Incomplete or complete intestinal metaplasia or both and normal gastric mucosa were also tested. Preoperative hematocrit and serum iron levels (18 patients) were recorded. An evident reactivity for lactoferrin was encountered in intestinal type carcinomas, adenomas, and incomplete intestinal metaplasia, whereas diffuse-type carcinomas, hyperplastic polyps, and complete intestinal metaplasia were always unstained; mucous neck cells of the antrum and body were also positive for lactoferrin. The results are discussed in relation to the increased requirement of iron by neoplastic cells, although in gastric carcinomas serum iron levels appear to be unrelated to the immunohistochemical presence of lactoferrin.

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

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

[Immunohistochemical study on the relationship between cancer cell growth and stroma changes of gastric carcinoma]

To elucidate the stromal characteristics in gastric carcinoma, the localization of chondroitin sulfate proteoglycans (PGs), fibronectin (FN), and type IV collagen was observed by immunohistochemical methods in 46 surgically resected stomachs including 41 carcinomas, 2 adenomas, and 3 ulcers. Chondroitin 4-sulfate PG revealed by 9A2 antibody and FN were distributed abundantly in the stroma of gastric carcinoma. On the other hand chondroitin 6-sulfate PG revealed by 3B3 antibody and type IV collagen were located more broadly in the stroma of undifferentiated carcinoma, especially scirrhous carcinoma than differentiated carcinoma. Type IV collagen was ultrastructurally localized around smooth muscle cells, myofibroblasts, and capillaries. And Bromodeoxyuridine was labelled in the stromal cells including endothelial cells and smooth muscle cells whose proliferative activities were suggested. In addition to carcinoma, muscularis mucosae of adenoma and ulcer were stained by 3B3 antibody. In gastric carcinoma, extracellular matrix was more strikingly distributed compared with noncarcinomatous region and in particular, stromal changes may be promoted by cancer cells in scirrhous carcinoma. These results suggest that specific stromal changes in gastric carcinoma may be related with the histologic types and growth patterns.