Transrectal Ultrasonography Compared to Histopathological Assessment for Local Staging of Prostatic Carcinoma

Transrectal ultrasonography (US) was used to predict tumor stage prior to radical prostatectomy in 59 patients with clinically localized carcinoma of the prostate. In 35 cases, US-guided biopsy was done. Histopathological examination of whole tissue mounts was compared with US findings in 49 cases. The remaining 10 had US-guided biopsies proving extracapsular extension of the tumor. Tumor size, as measured by US, was inadequate to distinguish between organ-confined disease and locally advanced tumor. Strategically taken US-guided biopsies of the periprostatic tissue or seminal vesicles were necessary. In the first 30 (group I) in this series of 59 cases, 18 of 22 tumors with extraprostatic spread (pT3) were understaged. In the last 29 cases (group II) only 6 of 19 pT3 tumors were understaged. After an initial training period, transrectal US, in combination with US-guided biopsy, can prove valuable for the pretherapeutic assessment of local spread of prostatic cancer, and can thus aid in the choice of appropriate treatment.

Cutaneous malignant melanoma in Swedish children and teenagers 1973-1992: a clinico-pathological study of 130 cases

To assess whether there has been a change in histological features and prognostic factors of primary cutaneous malignant melanoma (CMM) in young individuals in Sweden, an unselected, population-based study was undertaken; 177 cases of primary CMM in persons below 20 years of age were reported to the Swedish National Cancer Registry between 1973 and 1992. In 87% of the cases, original tumor tissue was available for histo-pathological review. The original diagnosis was verified in 88% (n = 126) of these cases. All tumors had histological features similar to adult CMM; 17% had an associated precursor lesion. Superficial spreading melanoma (SSM) was the most common sub-type, constituting 20/36 cases in the first decade and 59/90 in the second. Corresponding figures for nodular melanoma (NM) were 11/36 and 23/90. Only 5 melanomas in situ were diagnosed. In girls, the mean thickness of SSM decreased from 1.5 to 0.6 mm (p < 0.001). Overall mortality was 10%, 22% in the group with CMM diagnosed 0-15 years of age and 8% in individuals 15-19 years. Fatal CMM cases diagnosed below 15 years of age (n = 4) were NM > 1.6 mm thick and in subjects 15-19 years (n = 9) 44% of fatal tumors were NM with a mean thickness of 2.2 mm. Breslow index was the single most important prognostic factor. However, when known prognostic factors were adjusted for in a Cox regression analysis, young age remained an independent risk factor, with a relative death rate of 0.21 for individuals aged 15-19 compared with children < 15 years of age.

Increasing incidence of cutaneous malignant melanoma in children and adolescents 12-19 years of age in Sweden 1973-92

One-hundred-and-seventy-seven cases of cutaneous malignant melanoma were reported to the Swedish National Cancer Registry in subjects below the age of 20 during the period 1973-92. One-hundred-and-fifty-four (87%) were re-examined histologically, and the original diagnosis of primary cutaneous malignant melanoma was verified in 88%. The age-specific mean annual incidence rate increased to 0.5/100,000 in 1983-92 from 0.2/100,000 in 1973-82. Cutaneous malignant melanoma remained extremely rare in children below the age of 12, where only two cases were found. In subjects aged 12-19, the incidence doubled to 93 cases in the second 10-year period compared to 41 in the first. In boys, most of the melanomas occurred on the trunk, and, in girls, on the legs. Sixty-three percent of the melanomas were of the superficial spreading type, which also was the most rapidly increasing type of melanoma. These results emphasize the importance of surveillance and intensified preventive measures in protecting children and adolescents from the harmful effects of excessive exposure to the sun.

Ovarian endometrioid carcinomas simulating sex cord-stromal tumors: a study using inhibin and cytokeratin 7

We have investigated the use of inhibin and cytokeratin-7 (CK-7) in distinguishing endometrioid ovarian carcinomas (both typical and sex cord-like) form granulosa cell and Sertoli cell-containing ovarian tumors. Immunohistochemical staining with inhibin, CK-7, and epithelial membrane antigen (EMA) was performed on 6 endometrioid carcinomas simulating sex cord-stromal tumors, 5 typical endometrioid carcinomas, 14 adult granulosa cell tumors (AGCTs), 3 Sertoli-Leydig cell tumors (SCLTs), and 1 sex cord tumor with annular tubules (SCTAT). All AGCTs and SLCTs as well as the SCTAT were inhibin-positive. In contrast, all of the endometrioid carcinomas (both typical and those mimicking sex cord-stromal tumors) were inhibin-negative. CK-7 expression was not observed in the granulosa cell tumors and it was noted only in retiform areas in SLCTs. All 5 typical endometrioid carcinomas and 5 of the 6 sex cord-like endometrioid carcinomas were CK-7 positive. EMA was positive in all carcinomas but negative in the SCTAT, AGCTs, and SLCTs. Inhibin can distinguish between sex cord-stromal tumors (whether granulosa or Sertoli-Leydig type) and endometrioid carcinomas. CK-7 is also helpful in differentiating between AGCTs and most endometrioid carcinomas, and may also aid in separating SLCTs from sertoliform carcinomas. The addition of inhibin to an antibody panel is important because it provides a positively-staining marker for sex cord-derived cells.

Mucinous tumors of the vermiform appendix and ovary, and pseudomyxoma peritonei: histogenetic implications of cytokeratin 7 expression

Cytokeratin 7 (CK-7) has been shown to be uncommonly expressed in colonic epithelial tumors, as opposed to ovarian epithelial tumors, which are always CK-7 positive. The authors investigated the expression of CK-7 in 17 appendiceal cystadenomas and carcinomas, 20 mucinous borderline tumors of the ovary, 10 cases of simultaneous mucinous tumors of the appendix and ovary, three so-called high-stage mucinous borderline tumors of the ovary, and three cases of pseudomyxoma peritonei (PP) of unknown origin. Nine appendiceal cystadenomas were CK-7 negative; two of these were associated with PP, and the peritoneal lesions were negative as well. Three cystadenomas were CK-7 positive. Three appendiceal carcinomas were CK-7 negative, and in one case the metastases were also negative. Two carcinomas were CK-7 positive. All 20 ovarian borderline tumors were CK-7 positive. Six cases of simultaneous mucinous tumors of the ovary and appendix were CK-7 negative, as were their peritoneal mucinous deposits. Four cases showed a positive reaction in both appendiceal and ovarian sites. Two of three so-called high-stage ovarian borderline tumors were CK-7 negative. All three cases of PP of unknown origin were CK-7 negative. In conclusion, appendiceal cystadenomas are often CK-7 negative, whereas ovarian mucinous borderline tumors are always CK-7 positive. The concordant staining pattern for CK-7 of simultaneous mucinous tumors involving the appendix and ovary (60% of which were CK-7 negative) supports an appendiceal origin for these tumors. Our results also support an appendiceal (or colonic) source for any CK-7-negative mucinous tumor involving the ovary or the peritoneum. Furthermore, our findings are in agreement with the assumption that mucinous borderline-like tumors in the ovary associated with PP are not ovarian in origin but are often, if not always, metastatic from an appendiceal (or other) mucinous tumor.

Infiltration of mononuclear inflammatory cells into primary colorectal carcinomas: an immunohistological analysis

Local immunoregulation mediated by mononuclear tumour-infiltrating cells is considered of importance for tumour progression of colorectal cancer, although the balance between immunosuppressor and cytotoxic activities is unclear. Colorectal cancers from 26 patients were investigated using a panel of monoclonal antibodies in order to identify subsets of mononuclear inflammatory cells and to study their pattern of distribution in relation to tumour stage and cytotoxic immune reactivity against the tumour. In all but five tumours, mononuclear cells, lymphocytes or monocytes were present in fairly large numbers, particularly in the stroma. The infiltration of CD4+ mononuclear cells predominated over the CD8+ subset. Infiltration near the tumour cells was found in four cancers only. Stromal infiltration of CD11c+ macrophages was found in all but eight tumours. Small regressive areas, in which the histological architecture of the tumours was broken down, were found in 17 tumours with intense or moderate infiltration by CD4+ lymphocytes or CD11c+ macrophages. Probably this destruction of tumour tissue was caused by cytotoxic activity of the tumour-infiltrating mononuclear cells. In Dukes' class A and B tumours, CD4+ lymphocytes predominated over CD4+ cells with macrophage morphology, but the latter were increasingly found in Dukes' class C and D disease. The occurrence of MHC II-positive macrophages and lymphocytes in different Dukes' classes was similar to that of CD4+ cells. In contrast to this, CD11c+ and CD11a+ cells were more frequent in Dukes' A and B class tumours compared with Dukes' C and D. Four out of nine tumours of the latter stages showed a poor inflammatory reaction. The interpretation of our results is that the subsets of tumour-infiltrating mononuclear cells change with advancing Dukes' class and that the local immune control is gradually broken down in progressive tumour growth, even if some cytotoxic activity is still present.

Occurrence and prognostic importance of micrometastases in regional lymph nodes in Dukes' B colorectal carcinoma: an immunohistochemical study

OBJECTIVE

To evaluate the incidence and prognostic importance of micrometastatic disease in regional lymph nodes from Dukes' B colorectal carcinomas.

DESIGN

Retrospective study.

SETTING

University hospital, Sweden.

SUBJECTS

100 patients operated on for primary colorectal carcinoma, classified as Dukes' B lesions.

INTERVENTIONS

The regional lymph nodes were re-examined immunohistochemically using monoclonal antibodies against cytokeratin.

OUTCOME MEASURES

Incidence and prognostic importance of micrometastases.

RESULTS

Micrometastases were found in 39% (39/100) of the patients. The number of positive cells in the lymph nodes examined varied from 1 to over 100. They appeared as single cells or small clusters of cells located within the capsule or in the peripheral sinus of the lymph node. At least three sections from each of three lymph nodes had to be examined to identify 95% of the patients with lymph node micrometastases. The outcome of the patients with micrometastases was not significantly different from that of patients with no epithelial cells in the lymph nodes.

CONCLUSION

Micrometastases in regional lymph nodes are a interesting phenomenon but clinically seem to be of only weak prognostic value.

Tumor necrosis factor-alpha expression in human primary malignant malanoma and it relationship to tumor infiltration by CD3+ cells

Optimal conditions for immunohistochemical staining of tumor necrosis factor-alpha (TNF-alpha) in paraffin-embedded tissue sections were established to investigate TNF-alpha expression in human primary malignant melanomas. Seventeen malignant melanomas of the nodular (NMM) and superficially spreading (SSM) subtypes were analyzed. Twelve of these were TNF-alpha+, while 5 did not stain for the cytokine. To evaluate how TNF-alpha expression affected the immune response to the tumors, infiltration by CD3+ and mac387+ cells was investigated in NMM. TNF-alpha expression seemed to selectively affect the capability of T cells to infiltrate the tumors since TNF-alpha+ tumors were found to have significantly lower levels of infiltrating CD3+ cells, while there was no difference in numbers of mac387+ cells. These results demonstrate that TNF-alpha is variably expressed in primary malignant melanoma in vivo and that the T-cell response to TNF-alpha-expression NMM is inhibited.

Correlations of Ki-67 and PCNA to DNA ploidy, S-phase fraction and survival in uveal melanoma

In 79 patients with uveal melanoma, the tumours were investigated by DNA flow cytometry and immunohistochemical staining of PCNA and Ki-67. S-phase as a continuous variable was significantly correlated with Ki-67 (P = 0.033), but not with PCNA. DNA ploidy was not correlated with either of the two antigens. Ki-67 was significantly correlated with histopathological type (P < 0.001) and tumour size (P < 0.001). Large tumours and epithelioid cell type were associated with a high frequency of Ki-67 positive cells. A high level of Ki-67 positivity (> or = 6.5%) was also associated with a shorter survival (P = 0.0037), and when adjusted for DNA ploidy, histopathological type and tumour size, Ki-67 in the multivariate analysis remained an important prognostic factor (P = 0.017).

Correlation of DNA ploidy and S-phase fraction with chemotherapeutic response and survival in a randomized study of disseminated malignant melanoma

DNA ploidy and S-phase fraction were measured by flow cytometry in the tumour tissue of 87 patients with disseminated malignant melanoma, who had been classified either as responders or with progressive disease in a study of the effects of 2 chemotherapeutic regimens. The patients had been randomized to receive treatment with dacarbazine (DTIC) and vindesine (Eldesine) with or without addition of cisplatin (Platinol). Tumour tissue was obtained from both the primary tumours and the last histologically verified metastases, but in some cases only the primary tumours or the last metastases could be evaluated. There was a significantly higher mean S-phase value in melanoma metastases from patients with complete or partial responses compared with patients with progressive disease. Neither the S-phase fraction of the primary tumour, nor the DNA ploidy of the primary tumour or of the last histologically verified metastases taken before inclusion into the study were associated with therapeutic response. In the multivariate analysis, both the anatomical location of the metastases and the S-phase fraction measured on the last metastases remained significant prognostic factors of response. In the univariate survival analysis, there was an association between high S-phase fractions of the metastases and longer survival. In the multivariate survival analysis, the S-phase fraction, the number of involved metastatic sites and the treatment response were independent predictive factors. We conclude that, in disseminated melanoma treated with chemotherapy, a high S-phase fraction measured in the last histologically verified metastases is associated with a higher response rate and a longer survival. Our results clearly support the role of S-phase measurement as a potential tool for selecting patients for treatment.

Interrelations of clinicopathologic variables and their prognostic value in colorectal adenocarcinoma

We analyzed the interrelations of sex, age, tumor site, Dukes' stage, growth pattern and differentiation, and their prognostic value in 293 patients with primary colorectal adenocarcinoma. Simultaneously, growth pattern, differentiation, DNA and S-phase fraction (SPF) in paired primary tumors and lymph node metastases from 97 colorectal cancer patients were compared. The results revealed that poorly differentiated and mucinous tumors, as against well/moderately differentiated tumors, were frequently located in the proximal colon, and their frequencies were increased as Dukes' stage advanced (p=0.03). Tumor differentiation was usually identical in primaries and corresponding metastases (p=0.002), but this was not true of tumor growth pattern, DNA ploidy or SPF. In multivariate survival analyses, Dukes' stage provided strongly prognostic information (p<0.001) and mucinous tumors tended to predict worse survival (p=0.08).

Expression of cytokeratin 7 in simultaneous mucinous tumors of the ovary and appendix

Cytokeratin 7 (CK-7) is a simple epithelial keratin that may be used to investigate the site of origin of adenocarcinomas. In fact, CK-7 is present in ovarian epithelial neoplasms but is generally absent in colonic carcinomas. This pattern of CK-7 expression may aid in elucidating the genesis of mucinous tumors occurring simultaneously in the ovary and appendix, accompanied by psuedomyxoma peritonei. Five such cases were immunostained with anti-CK-7, and all showed a concordant staining pattern of the appendiceal, ovarian, and peritoneal lesions. Two cases showed a negative reaction for CK-7 and thus would appear to represent ovarian and peritoneal metastases from an appendiceal primary tumor. Three cases were CK-7 positive, and the nature of these mucinous lesions remains open to debate; they may either represent independent primary tumors or originate from the appendix. For comparison, five Stage I mucinous borderline tumors of the ovary and their normal appendices were also stained with anti-CK-7. These ovarian tumors were all CK-7 positive, whereas the appendices were negative. It is concluded that CK-7 is capable of distinguishing a group of tumors that can reliably be classified as primary appendiceal neoplasms metastatic to the ovaries and peritoneum.

Salivary duct carcinoma

Twelve cases of salivary duct carcinoma were examined clinically, pathologically and by flow cytometry to quantify their histological features as well as attempt to identify factors predictive of patient outcome. All of the tumours arose in the parotid gland. Eight of the twelve patients were male. Four patients died of disease (median survival 12.5 months); three are alive with disease; and five are alive with no evidence of disease (mean follow-up of 50 months). Two tumours arose in a pre-existing pleomorphic adenoma. Positive lymph nodes were present in eight of ten patients sampled; patients with two or more positive lymph nodes tended to die of their disease or be alive with metastases. Comedo necrosis, perineural invasion and vascular invasion were common findings by light microscopy. Ten of the twelve tumours were aneuploid. Neither clinical stage, tumour size, aneuploidy nor histological features correlated with patient outcome. This study confirms the aggressive nature of salivary duct carcinoma.

DNA ploidy and S-phase fraction as prognostic factors in patients with uveal melanomas

In 96 patients with uveal malignant melanomas the tumours were investigated by DNA flow cytometry. Thirty-eight per cent of the melanomas were aneuploid. By univariate analysis significant correlations with survival were found for histological type, tumour size, DNA ploidy, evidence of 'blind eye' and S-phase fraction. By multivariate analysis, significant prognostic variables were found to be histological type (P = 0.0008), tumour size (P < 0.0001) and DNA ploidy (P = 0.0038). Evidence of 'blind eye' was not significantly correlated with survival after adjustments for the other variables mentioned above. The S-phase fraction could be estimated in all 60 diploid tumours and in 12 of 36 aneuploid melanomas. By univariate analysis this variable was found to be a significant prognostic factor, but did not remain so after adjustment for ploidy, histological type and tumor size. We further conclude that patients with small DNA diploid uveal melanomas of spindle cell type have a rather favourable prognosis.

Elective lymph node dissection in stage I cutaneous malignant melanoma of the head and neck. A report from the Swedish Melanoma Study Group

The effect of elective lymph node dissection in patients with cutaneous malignant melanoma of the head and neck was investigated in a retrospective study. Of 517 patients in clinical stage I, 84 underwent elective dissection of the ipsilateral neck lymph nodes. In six of these patients, lymph node metastases were demonstrated at histopathological examination. There was a slight reduction in the incidence of recurrent disease in the regional lymph nodes in the group of patients who had undergone elective lymph node dissection, but this difference was not statistically significant. No significant differences were seen between the two groups regarding overall survival of disease-related survival.

Mucinous borderline and malignant tumors of the ovary. A clinicopathologic and DNA ploidy study of 92 cases

BACKGROUND

The morphologic spectrum of ovarian mucinous tumors is well known, but the features that predict aggressive behavior are still controversial.

METHODS

Ninety-two cases of primary ovarian mucinous tumors with atypical epithelial proliferation and/or stromal invasion were analyzed histologically and by DNA flow cytometry, and the results were correlated with clinical findings.

RESULTS

The authors reviewed 57 intestinal mucinous borderline tumors (IMBT), 3 endocervical-like mucinous borderline tumors (EMBT), 21 noninvasive mucinous carcinomas (NIMC), and 11 invasive mucinous carcinomas (IMC). The 5-year survival rate for Stage I tumors was: IMBT 100%, EMBT 100%, NIMC 94% and IMC 60%. The 5-year survival of Stage II-IV tumors was: IMBT 50%, NIMC 33% and IMC 0%. Forty-four IMBTs were diploid, and 4 were aneuploid. All six high stage IMBTs were diploid. Two EMBTs were diploid, and one was aneuploid. There were seven diploid, four polyploid, and six aneuploid NIMCs. Two of the three lethal NIMCs were aneuploid. Four IMCs were diploid, and four were aneuploid. Of these, only the diploid Stage I IMCs were nonlethal. All NIMCs that recurred or presented with metastases had been sampled inadequately. High stage tumors with pseudomyxoma peritonei (PP)-type lesions often were associated with pseudomyxoma ovarii of the cellular type.

CONCLUSIONS

Mucinous tumors with stromal invasion or presenting with PP had a definite malignant behavior. All other atypical mucinous tumors, when confined to the ovary and optimally sampled, had an excellent prognosis. DNA ploidy analysis may prove useful in determining the risk of progression, especially in Stage I IMCs.

DNA ploidy and S-phase fraction in primary melanomas and their regional metastases

Flow cytometric analysis of DNA ploidy and S-phase fraction was performed on the primary melanomas and the first metastases from 55 melanoma patients with regional lymph node metastases or in transit metastases. The frequency of aneuploidy was significantly higher in metastases than in the primary tumour (p = 0.009), suggesting a higher growth potential in melanoma metastases than in the primary tumours. In 18 patients with reliable S-phase determinations from both primary tumour and metastasis there was no significant difference in mean S-phase fraction between primary melanomas and metastases. Skin metastases localized in dermis and subcutis had a significantly (p = 0.012) higher mean S-phase fraction than lymph node metastases.

Some occupational exposures as risk factors for malignant lymphomas

BACKGROUND

Malignant lymphomas (Hodgkin disease [HD] and non-Hodgkin lymphoma [NHL]) have been subject to several epidemiologic studies and found to be associated with various environmental exposures, especially solvents, wood, and phenoxy herbicides.

METHODS

Various determinants for HD and NHL were evaluated in a case-referent study encompassing 31 cases of HD, 93 cases of NHL, and 204 referents, all alive. Information on these determinants, mainly occupational exposures, was obtained by mailed questionnaires.

RESULTS

Crude odds ratios were increased for various occupational exposures, i.e., exposures to solvents, pesticides, metal fumes, welding, and fresh wood, and nursing. Further analyses based on logistic regression indicated exposure to phenoxy herbicides and fresh wood among sawmill workers, lumberjacks, and paper pulp workers to be significant risk factors for HD. Welding, working as a lumberjack, nursing, and ex-smoking were associated with a significantly increased risk for NHL. Radiographic examinations were negatively associated with HD, as was office work for NHL.

CONCLUSIONS

The results were mainly in agreement with the findings of earlier studies, but diverging associations also appeared.

Cutaneous malignant melanoma of the head and neck. Analysis of treatment results and prognostic factors in 581 patients: a report from the Swedish Melanoma Study Group

BACKGROUND

Results of surgical treatment of cutaneous malignant melanoma (CMM) have been highly variable, probably because of patient selection. Therefore, a study of representative patients with this disease was performed.

METHODS

In a defined area of Sweden, 581 patients were analyzed. Clinical records and histopathologic findings were reviewed. The minimum follow-up time was 7 years. Prognostic factors were evaluated by the Cox proportional hazards model.

RESULTS

Evaluation of sex distribution, age, and anatomic site of the primary tumor showed that the patients were representative of all Swedish patients with CMM of the head and neck. The mean patient age at diagnosis was 64 years for both sexes. Fifty-three percent of the patients were women. Female patients had more tumors of the face than did male patients, whereas male patients were overrepresented among patients with tumors of the auricle-external ear canal and scalp-neck area. Localization to the face was observed in 68%, which is an overrepresentation of three to four times when skin surface is taken into consideration. Twenty-four percent of the patients had lentigo maligna melanoma. Only 33% of the patients had superficial spreading melanoma. In univariate analyses, sex, anatomic site of the primary tumor, histogenetic type, Clark level of invasion, and tumor thickness had prognostic power. In a multivariate analysis, tumor thickness, anatomic site of the primary tumor, and sex of the patient were independent prognostic factors.

CONCLUSIONS

In representative patients with CMM of the head and neck, tumor thickness, anatomic site of the primary tumor, and sex of the patients were independent prognostic factors.

A new aggressive treatment approach to high-grade endometrial cancer of possible benefit to patients with stage I uterine papillary cancer

Between January 1, 1988 and December 31, 1990, a new high-intensity treatment was delivered to 10 patients with clinical stage I uterine papillary serous carcinoma (UPSC) and 21 patients with clinical stage I, FIGO grade 3 endometrial adenocarcinoma. The treatment consisted of a radical hysterectomy and bilateral salpingo-oophorectomy with pelvic lymph node sampling, adjuvant external pelvic radiation, and four courses of cis-platinum/epirubicin. The clinical outcome was compared to that of a historical control group treated before 1988 with surgery and radiation. None of the high-intensity treated UPSC patients died or relapsed during a median observation time of 32 months. There was a significantly better survival in the high-intensity treated UPSC group compared to the controls. The UPSC patients diagnosed after January 1, 1988 showed a trend toward better survival compared to those diagnosed before this date, whether they had received high-intensity treatment or not. No significant difference in survival was observed in the non-UPSC group subjected or not to the high-intensity treatment.

DNA ploidy and S-phase in primary malignant melanoma as prognostic factors for stage III disease

In 82 patients with stage III malignant melanoma, the primary tumours were investigated by DNA flow cytometry. The tumours were classified as DNA diploid (n = 36), tetraploid (n = 11) and aneuploid (n = 35). By univariate analysis a significant correlation with post-recurrence survival was found for time to first metastasis, DNA-ploidy and S-phase fraction. By multivariate analysis, significant prognostic variables were found to be the time to first metastasis (P = 0.006), and ploidy (P = 0.011). Patients with diploid melanomas and a long recurrence-free interval had a median post-recurrence survival time of 45 months compared to 18 months in patients with DNA aneuploid tumours and an early recurrence. The S-phase could be estimated in 47 primary melanomas and was found to be a significant prognostic variable (P = 0.017). The median survival was 45 months for patients with melanomas with a S-phase fraction below 5%, and 19 months for melanomas with S-phase above 10%. The prognostic value of the S-phase remained significant even after adjustment for recurrence-free interval and DNA ploidy.

Association between permeability of the colonic wall and azoxymethane induced cancer of the colon in rats

OBJECTIVE

To investigate the association between colonic permeability and the development of azoxymethane induced colonic cancer in rats.

MATERIAL

Seventy-three male Fischer-Cooper hybrid rats.

INTERVENTIONS

Measurement of the concentrations of sodium fluorescein in plasma as an indication of its passage across the bowel wall in control rats, and six weeks and six months after injection of azoxymethane.

RESULTS

Forty-seven rats were given azoxymethane, and 26 acted as controls. Sodium fluorescein was instilled into segments of right (n = 46) and left (n = 27) colon and measured in peripheral blood; significantly higher concentrations were recorded after instillation into the left than into the right colon. No tumours developed in the 15 rats that were given azoxymethane and were examined after six weeks. At six months, however, 29 of the remaining 32 had developed 94 macroscopic tumours (range 1-12 tumours/rat), and 89 of these (95%) were in the left colon.

CONCLUSION

The greater permeability of the left colon in rats compared with the right may be associated with the higher incidence of carcinomas in the left compared with the right colon.

Nuclear morphometry: a strong prognostic factor for survival after secondary surgery in advanced ovarian cancer

Nuclear morphometry was performed on the diagnostic biopsy in 65 cases of non-mucinous ovarian carcinoma (FIGO stage IIB-IV) and its prognostic value regarding patient survival after the second-look operation was compared to that of morphology and clinical observations. In a univariate Cox survival analysis four morphometric factors were found to be significant predictors of survival (the standard deviations (SD) of the nuclear area, perimeter, largest perpendicular axis, and largest axis). Age, the size of residual tumor after the primary operation, and a combined variable describing the status at the second-look operation and also the result of tumor reduction were significant clinical variables. None of the morphologic variables proved to be significant. In the multivariate Cox analysis the SD of the largest perpendicular nuclear axis gave independent prognostic information together with either the size of residual tumor after the primary laparotomy (P = 0.00004) or the second-look variable (P < 0.00001). When the SD of the largest perpendicular nuclear axis and the second-look variables were included in the model the size of residual tumor after the primary operation added no further prognostic information. We conclude that nuclear morphometry is a simple, easily implemented and cheap quantitative method which gives objective and valuable prognostic information regarding survival in advanced ovarian cancer.

ras p21 expression in relation to DNA ploidy, S-phase fraction and prognosis in colorectal adenocarcinoma

ras p21 expression, as indicated by the monoclonal antibody ras 11, was estimated using immunohistochemistry on 69 primary colorectal adenocarcinomas. Also, DNA ploidy and S-phase fraction (SPF) were analysed with flow cytometry. Positive staining for ras 11 tended to be more common in DNA non-diploid tumours (P = 0.11), but was significantly correlated with high SPF (P = 0.038). Positive ras 11 staining, Dukes' stage, DNA ploidy and SPF were related to the recurrence-free interval of patients with Dukes' A-C tumours (P = 0.0014, P = 0.023, P = 0.035 and P = 0.040, respectively). ras 11 staining was a prognostic factor independent of both Dukes' stage and DNA ploidy (P = 0.011). The results indicate that pan ras p21 expression is associated with proliferative activity and has an independent prognostic value in colorectal adenocarcinoma.

Ras p21 expression in relation to histopathological variables and prognosis in colorectal adenocarcinoma

Ras gene protein products (p21) reacting with the monoclonal antibodies ras 11, DWP, R256 and E184 were studied with an immunohistochemical method which was applied to 17 normal and 79 colorectal adenocarcinoma specimens. Normal colorectal epithelium showed positive staining for ras 11 in 35% of the cases, but not for DWP, R256 and E184. The antibodies showed positive staining in colorectal adenocarcinomas in 76, 53, 29 and 35% of the cases respectively. The degree of staining for ras 11 was significantly related to the grade of differentiation and increased from Dukes stage A to C. Strong staining for ras 11 predicted a significantly shorter recurrence-free interval (p less than 0.001). In Cox's regression analysis, the degree of staining for ras 11 was a prognostic factor independent of the grade of differentiation and Dukes stage (p less than 0.01). The results indicate that the enhanced expression of pan ras p21 may provide an important biological marker for determining prognosis in colorectal adenocarcinomas.

Transrectal ultrasonography compared to histopathological assessment for local staging of prostatic carcinoma

Transrectal ultrasonography (US) was used to predict tumor stage prior to radical prostatectomy in 59 patients with clinically localized carcinoma of the prostate. In 35 cases, US-guided biopsy was done. Histopathological examination of whole tissue mounts was compared with US findings in 49 cases. The remaining 10 had US-guided biopsies proving extracapsular extension of the tumor. Tumor size, as measured by US, was inadequate to distinguish between organ-confined disease and locally advanced tumor. Strategically taken US-guided biopsies of the periprostatic tissue or seminal vesicles were necessary. In the first 30 (group I) in this series of 59 cases, 18 of 22 tumors with extraprostatic spread (pT3) were understaged. In the last 29 cases (group II) only 6 of 19 pT3 tumors were understaged. After an initial training period, transrectal US, in combination with US-guided biopsy, can prove valuable for the pretherapeutic assessment of local spread of prostatic cancer, and can thus aid in the choice of appropriate treatment.

Comparison of static and flow cytofluorometry for estimation of DNA index and S-phase fraction in fresh and paraffin-embedded breast carcinoma tissue

DNA index, S-phase and G2/M fractions were measured in breast carcinomas before and after paraffin-embedding. Unfixed tumors were analysed with flow cytometry, while cells prepared from fixed and paraffin-embedded tumors were analysed with both static cytometry and flow cytometry. Cells for static cytometry were prepared with pepsin and cells for flow cytometry were prepared with trypsin. In 44 of 51 paraffin-embedded tumors, analysed with flow cytometry, both DNA index and S-phase fraction could be estimated. There was a strong correlation between the three methods of obtaining DNA indices and S-phase fractions, but this was not true for G2/M fractions. Histograms from flow cytometry of archival material were corrected for background. We conclude that cells prepared from formalin-fixed and paraffin-embedded breast cancer tissue can yield reliable estimation of DNA index and S-phase fraction.

Effects of thyroid stimulating immunoglobulin on function and morphology of xenotransplanted toxic diffuse, toxic nodular and normal thyroid tissue

In order to examine the properties of human thyroid tissue, toxic diffuse goiter (TDG), toxic nodular goiter (TNG) and normal thyroid tissue were transplanted to nude mice. Starting 3 and 10 weeks after the transplantation the mice were given 14 daily injections of control serum or serum containing thyroid stimulating immunoglobulin (TSI). The uptake and release of 125I were repeatedly measured externally. The uptake and unstimulated release of 125I was lowest in TDG transplants, highest in TNG transplants, and intermediate in transplants of normal thyroid tissue. The findings were similar at both 3 and 10 weeks. Injections of TSI reduced the biological half-time of the tracer in TDG and normal transplants, but had no significant effect on TNG transplants. Light and electron microscopic studies showed that hyperplastic TDG tissue underwent involution after transplantation, whereas TNG and normal thyroid tissue remained unchanged. Injection of TSI reactivated TDG tissue; morphometry showed that the absolute and relative volumes of the follicle cells were more than doubled, with a corresponding decrease in the volume of the follicle lumen, and mitotic figures were common. Similar findings were seen in normal transplants, whereas the effect of TSI on TNG tissue was less pronounced. In summary, our observations show that serum from a patient with Graves' disease stimulated iodine release and induced follicle cell hyperplasia and probably also follicle cell multiplication in transplanted normal and TDG tissue, but had a lesser effect on TNG tissue.

Double-blind crossover study of ranitidine and placebo in gastro-oesophageal reflux disease

The effect of 150 mg ranitidine twice daily was compared with placebo by the double-blind crossover technique (8 weeks twice) in patients with gastro-oesophageal reflux (paired comparison in 38 patients). Ranitidine was superior to placebo with regard to effect on symptoms, improvement of oesophagitis as assessed by endoscopy and biopsy, and decrease of oesophageal acid hypersensitivity. The symptomatic response to ranitidine was, however, unsatisfactory in more than half of the cases. When symptomatic responders taking ranitidine (R) were compared with non-responders (NR), there was no difference with regard to the severity of oesophagitis or frequency of positive acid perfusion tests before or after the 8-week treatment. NR were younger and more often had endoscopic signs of incompetence of the cardia and gastric prolapse. Ranitidine is an efficient drug in patients with reflux disease. It cannot be expected that mechanical problems in the hiatal region will be influenced by ranitidine, which is probably why half the patients did not respond.

Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease

In a study comprising 100 patients referred to a surgical clinic with symptoms suggestive of gastro-oesophageal reflux disease the value of different diagnostic procedures was investigated. Positive acid perfusion and 24-h pH tests were the commonest findings. Forty-nine per cent showed a normal oesophageal mucosa or diffuse oesophagitis at endoscopy. The severity of heartburn and regurgitation did not differ between patients with normal oesophageal mucosa and oesophagitis of various severities. The severity of macroscopic oesophagitis was significantly correlated to the total reflux time, the presence of reflux or a hiatal hernia at radiology, an open cardia or reflux at endoscopy, pressure transmission or reflux and low lower oesophageal sphincter pressure at manometry. Gastric hypersecretion was found in 66% of the patients. Gastric acid secretion was not correlated to the severity of oesophagitis or to the findings at 24-h pH test. In patients with severe oesophagitis the sensitivity for radiologic, manometric, and endoscopic signs of incompetence of the gastro-oesophageal junction was 94%.

Oesophageal reflux tests, manometry, endoscopy, biopsy, and radiology in healthy subjects

The aim was to study the exposure time of acid during 24 h at two different oesophageal levels in 15 healthy subjects and its relation to other kinds of oesophageal findings. Five centimetres above the lower oesophageal sphincter the total reflux time was 0.2% (0-1.3%), and at the 15-cm level it was 0.1% (0-0.7%). A standardized compression test during manometry and radiologic examination showed that no subject had reflux. Hiatus hernia was provoked at the radiologic examination in four subjects, one of whom also had a widened hiatus. At endoscopy, one subject had a hiatus hernia and slightly granulated oesophageal mucosa. Biopsy specimens showed slight basal cell hyperplasia in one case. Bleeding in the dermal papillae or a few intraepithelial leukocytes were seen in eight cases, findings that might be due to endoscopic trauma. Without any history of gastrointestinal disorders, gastrooesophageal reflux was minimal under standardized conditions, although hiatus hernia and mild changes in biopsy specimens could be seen.

The incidence of spontaneous mammary carcinoma in C3H mice is influenced by dietary fat given from weaning and given to the mothers during gestation and lactation

The influence of dietary fat given to breeding C3H female mice during gestation and lactation on the incidence of spontaneous mammary carcinoma in the female offspring was studied. EWOS' commercial diet (E-diet) for mice and two test diets, one containing 2% soy oil (S-diet) and the other 2% soy oil and 0.1% methoxy-substituted glycerol ethers (MGE-diet), instead of the animal fat in the E-diet, were used. The breeding females were given the S- or MGE-diet during gestation and lactation and the progeny the S- or E-diet from weaning. The incidence of mammary carcinoma was studied in the force-bred progeny. The results disclosed significant correlations between the diets of the progeny and the number of litters and between the number of litters and the incidence of breast carcinoma. The results also indicated a strong influence of the mother's diet on the incidence of mammary carcinoma in the female progeny.

The fat composition of a mouse diet modifies the effects of levamisol on growth and spread of a murine tumor

The fat composition of the diet fed to C57BL/6J mice influenced the effect of Levamisol on the growth and spread of LLT. The timing of feeding of different diets as well as of the administration of Levamisol in relation to tumor transplantation was of importance. The tumor-suppressive effect of Levamisol given on day 9 was counteracted by a diet containing 2% soy oil instead of animal fat and given from day 1. Levamisol given on day 1 counteracted the facilitation of tumor growth and spread by the soy oil diet given from day 9. The soy oil diet was shown to suppress the immune response to SRBC. We conclude that standardization of the laboratory diets is necessary.

Ultrastructural morphology and evidence of iodide uptake and protein synthesis in normal human thyroid transplants in nude mice

Normal human thyroid tissue was xenotransplanted to athymic mice. Well preserved structural properties of the transplants were observed at both light and electron microscopical level. Analysis of the soluble proteins in the transplants by polyacrylamide gel electrophoresis showed that the major fractions were the 19S thyroglobulin, the 27S iodoprotein and a larger protein fraction. Protein synthesizing capacity of the transplants, as measured by in vivo 3H-leucine incorporation into the soluble transplants proteins was demonstrated. The observed 3H-leucine incorporation was in the same magnitude as that found in the original donor tissue at the time of transplantation. Four weeks after transplantation a significant 125I-iodide uptake (2.0%) was observed in the transplants. Corresponding value for the host thyroids was 6.6%. The biological half-time of the accumulated 125I-iodide in the transplants was reduced from 97 days to 38 days between 2 and 4 weeks after transplantation. The biological half-time in the host thyroid increased from 27 days to 32 days during the same period. This investigation shows that normal human thyroid tissue can be transplanted to nude mice with preserved tissue organisation and maintained cellular function.

The influence of disease at the margin of resection on the outcome of Crohn's disease

Sixty-seven patients with Crohn's disease undergoing 81 resections followed by a restorative procedure were reviewed to evaluate the influence of microscopic disease at the margin of resection on the recurrence rate. The average follow-up after resection was 5.6 +/- 2.8 years. The resectional margins were classified into three groups depending on the microscopic appearance of the most involved margin. Recurrent disease developed in 36 per cent of the resections without microscopic evidence of Crohn's disease, while 38 per cent of the resections with signs of Crohn's disease developed a clinical recurrence. The recurrence rate increased with the follow-up time, but was independent of microscopical disease at the resectional margins. Therefore we recommend restricted resection of macroscopically diseased bowel. Microscopical involvement does not seem to increase the recurrence rate.

The growth and spontaneous dissemination of melanoma B16 and Lewis lung tumour in two sub-strains of C57BL/6J mice treated with Corynebacterium parvum and/or levamisole

The effect of C. parvum and/or levamisole on tumour growth and spontaneous dissemination was tested in two tumour-host systems, melanoma B16 and LLT in C57BL/6J mice. C. parvum inhibited the growth of LLT and its dissemination to the lungs and the growth of B16 in females in one of the two sub-strains of mice used. Levamisole stimulated the growth of B16 in females in one sub-strain and in both sexes in the other sub-strain of mice. The growth of LLT was not influenced by levamisole but its dissemination to lymph nodes was facilitated. The growth-stimulating effect of levamisole was abrogated by C. parvum in the mice treated with both agents in combination. It is concluded that the effects of non-specific immunomodulators on tumour growth and spread can vary between sub-strains of the same inbred strain of mice bred at different laboratories.

Endoscopic total one-piece medial meniscectomy: its effect on the medial collateral ligament

Meniscus specimens from 10 patients subjected to endoscopic total medial meniscectomy were examined for remnants of the collateral ligament. Very small amounts were found in the postero-medial area of the specimens. None exceeded 2 mm in length or breadth and could be formed in only one of the sections. With our technique for endoscopic total meniscectomy the integrity of the medial collateral ligament is not violated and ligamentous instability can be avoided.

The nude mouse. A possible experimental model for investigation of human thyroid tissue

The effect of transplanting hyperfunctioning human thyroid tissue to athymic, nude mice was explored. The thyroid tissue was obtained from a patient with diffuse, thyrotoxic goiter preoperatively treated with a beta-adrenoreceptor blocker. One transplant was placed in each groin of 4 nude mice. Light microscopy after 4 weeks showed that transplants consisted mainly of typical follicles; capillaries were common at the periphery of the transplant but not in between the follicles. The ultrastructure of the follicle cells in the transplants was similar to that of follicle cells in general. All 8 transplants accumulated 125I as revealed by external counting; the uptake in each transplant 24 h after administration of radioiodine was 4-25% of that in the thyroid of the transplanted mouse. The release of radioiodine, measured during a period of 14 days, from the thyroid of a transplanted mouse was delayed as compared to a nontransplanted control; this indicates that the mouse thyroid activity was suppressed due to hormone production in the transplants. Electron microscopic autoradiography 24 h after injection of 125I showed that protein-bound label in transplants was located mainly in follicle lumens. The radioiodine was incorporated in thyroglobulin as demonstrated by separation of soluble proteins from transplants by sucrose density gradient centrifugation. The present study shows that human thyroid tissue can be transplanted to nude mice with maintained structural and functional properties. Transplantation of human thyroid tissue might be a useful model for studies of thyroid diseases.

Arthralgia and crystal deposits in Crohn's disease

Ten patients with Crohn's disease and recurrent pain in the knee joints were subjected to arthroscopy. Biopsies obtained from the synovial membrane were examined under polarizing light microscopy. The arthroscopy revealed crystalline deposits in 7 patients and the microscopic examination of the synovial membrane demonstrated positively birefringent crystals in 4 patients. The crystals with positive birefringence had the rod or rhomboid shape typical of pyrophosphate crystals. As arthroscopy crystals in 7 patients and polarizing microscopy revealed crystals in one further patient, crystal deposits were thus found in 8 patients altogether. All patients had normal serum uric acid values. The crystal deposits were interpreted as pyrophosphate and their possible connection with the recurrent arthralgia in Crohn's disease is discussed.

The influence of the lipid composition of the feed given to mice on the immunocompetence and tumour resistance of the progeny

In inbred CBA mice, the immunocompetence of adult progeny from breeding pairs fed three different diets was compared. Substitution of soy oil for animal fat in the feed of the mice during gestation or lactation significantly decreased the PFC response to SRBC in the adult offspring. Addition of 2-methoxy-substituted glycerol ethers to the feed of mothers deprived of animal fat during lactation partly restored the PFC response of the male offspring. In the adult mice fed differently pre- and perinatally the resistance to a transplanted syngeneic sarcoma was similar. The growth of offspring from mice fed the three diets was similar. In mice deprived of animal fat at weaning and for the following 21 days the immune reactivity to SRBC, tested about 3 months after stopping the diet, was not influenced. However, the resistance to a transplanted tumour in similarly fed mice was increased and this resistance was brought approximately to the control level by methoxy-substituted glycerol ethers.

Action on various experimental tumour-host systems of methyoxy-substituted glycerol ethers incorporated into the feed

The effect of the growth and spread of tumours by methoxy-substituted glycerol ethers incorporated into the feed has been tested on a broad spectrum of tumour-host systems. Inhibitory effects on tumour growth were noted mainly by 1-0-(2-methoxy-hexadecyl) glycerol and on Melanoma B 16, Lewis Lung Tumour, MCA-sarcoma MCG101 and the lymphomas LAA and P1534. Spontaneous metastasis formation from Melanoma B16 and two MCA-sarcomas was inhibited.

Serum cholic and chenodeoxycholic acid conjugates and standard liver function tests in various morphological stages of alcoholic liver disease

Fasting and postprandial serum concentrations of conjugates of cholic (CCA) and chenodeoxycholic (CCDA) acid measured by radioimmunoassay were compared with morphological changes in percutaneous liver biopsies from 49 patients with alcohol abuse. Sulfobromophthalein (BSP) and galactose elimination tests were also performed, and serum levels of aminotransferases (ASAT, ALAT), glutamyltransferase, alkaline phosphatase, and bilirubin were determined. Raised fasting serum concentrations of CCDA were found in 29 patients (59%), whereas elevated fasting serum levels of CCA were found in 19 patients (39%). The mean fasting and postprandial serum bile acid concentrations were significantly higher in patients with hepatofibrosis and cirrhosis than in those with only fatty changes. The extent of the postprandial rise, however, was variable and not significantly different among the various groups. The BSP elimination test was abnormal in 12 patients (25%) but gave normal results in 2 of the 3 patients with cirrhosis of the liver. The galactose elimination rates differed only between patients with normal liver biopsies and patients with cirrhosis of the liver. The serum enzyme levels were not significantly different between the various morphological groups. It is concluded that determinations of fasting serum bile acids, especially CCDA, give more reliable and sensitive information on the degree of liver damage in alcoholic liver disease than BSP and galactose elimination tests or serum enzyme assays.