Triple negative phenomenon in endometrial cancer: recognition criteria and impact on survival

OBJECTIVES

Endometrial cancer is the most common malignant cancer of female reproductive organs. The number of diagnosed cases of endometrial cancer is increasing from year to year. Endometrial cancer is a neoplasm with a good survival rate. However, there are also cases with a fast, aggressive course. In recent years, the triple negative phenomenon (TNP) has been identified as one of the factors determining shorter survival in patients with endometrial cancer.

MATERIAL AND METHODS

The study covered 265 patients with histopathologically confirmed endometrial cancer. Patients were divided into two groups: 1) patients with endometrial cancer with TNP; 2) patients with endometrial cancer without TNP. Tissue microarrays (TMA) were examined with immunohistochemistry to evaluate the expression of estrogen, progesterone and HER2 receptors. In several cases FISH method was used to assess HER2. The expression was evaluated by computer image analysis using the Nuclear Image Analysis virtual microscopy system. The evaluation of HER2 expression was performed manually. The criterion for TNC diagnosis was H-Score < 50 or < 75 and Allred score < 4.

RESULTS

Depending on the scoring system used, TNP was found in from 10.19% to 15.09% of cases. Regardless of the criteria employed in endometrial cancer, the presence of TNP was neither a factor increasing the risk of death nor it affected the patients' survival.

CONCLUSIONS

The proportion of TNP diagnosed in endometrial cancer depends on the examined population and the diagnostic criteria. The incidence of TNP did not affect the survival of patients.

Nucleolin and nucleophosmin expression patterns in pulmonary adenocarcinoma invading the pleura and in pleural malignant mesothelioma

BACKGROUND

Visceral pleural invasion (VPI) in adenocarcinoma of the lung is considered a poor prognostic factor. The purpose of this study was to analyze nucleolin and nucleophosmin expression in pulmonary adenocarcinoma (PA) with VPI and in pleural malignant mesothelioma.

METHODS

The study was conducted on the basis of 19 pathologically-confirmed cases of adenocarcinoma of the lung and 29 cases of epithelioid malignant mesothelioma. The nucleolin and nucleophosmin expression was assessed immunohistochemically and analyzed with image analysis software.

RESULTS

Nucleolin expression was lower while nucleophosmin was higher in pleural invasion of pulmonary adenocarcinoma than in the central part of the tumor. Differences in subpopulations of cells with different expression of proteins studied were also found. Malignant mesothelioma showed lower nucleolin expression than adenocarcinoma of the lung but no differences in nucleophosmin expression were found.

CONCLUSIONS

The results of our study suggested that lower nucleolin and higher nucleophosmin expression may be related to higher invasiveness of adenocarcinoma of the lung. Differences in nucleolin expression between pulmonary adenocarcinoma and malignant mesothelioma indicate another aspect of biology of these pleura-invading cancers that requires further study.

KEY POINTS

SIGNIFICANT FINDINGS OF THE STUDY: Differences in nucleolin and nucleophosmin expression in pleura invading pulmonary adenocarcinoma indicate the involvement of these proteins in its locoregional spread while differences in nucleolin expression between pulmonary adenocarcinoma and malignant mesothelioma suggest another aspect of biology of these cancers.

WHAT THIS STUDY ADDS

This is the first study on nucleolin and nucleophosmin expression in pleural malignant mesothelioma and pleura-invading pulmonary adenocarcinoma. Our findings may assist in understanding the mechanisms of locoregional spread of adenocarcinoma and differences between these two pleura-invading cancers.

Nucleolin and Nucleophosmin Expression in Gleason 3 and Gleason 4 Prostate Cancer With Seminal Vesicles Invasion (pT3b)

BACKGROUND/AIM

The aim of this study was to analyze the expression of nucleolin (NCL) and nucleophosmin (NPM) in prostate adenocarcinoma and in its loco-regional spread in the form of seminal vesicle invasion (SVI).

MATERIALS AND METHODS

The study was performed on tissue microarrays of 40 cases of Gleason 3+4 pT3b prostate cancers including tissue samples from SVI. The expression of NCL and NPM was detected immunohistochemically and analyzed with image analysis software.

RESULTS

The expression of NCL and NPM were higher in cancer cells within a prostate gland than in SVI. Gleason 4 pattern showed higher expression of NPM than Gleason 3 pattern cells.

CONCLUSION

Differences in nuclear NCL and NPM expression in cancer cells between the prostate gland and SVI may indicate involvement of these proteins in loco-regional spread of adenocarcinoma of the prostate. Differences in NPM expression in Gleason 3 and Gleason 4 pattern suggest involvement of this protein in the differentiation of prostate cancer.

Nucleolin and nucleophosmin expression in seminomas and non-seminomatous testicular tumors

INTRODUCTION

Testicular tumors are heterogeneous group of neoplasms divided mainly into two types: seminomas and non-seminomas. Nucleolin (NCL) and nucleophosmin (NPM) are abundant nucleolar proteins involved in many physiologic and pathologic processes including cancer. Their overexpression was found in many tumors but it was not studied in testicular cancer.

MATERIAL AND METHODS

The study was performed on tissue microarrays of 19 seminomas, 21 embryonal carcinomas and 11 yolk sac tumors. The expression of NCL and NPM was detected with monoclonal antibodies and visualized with EnVision FLEX/HRP technique. Immunohistochemical reactions were measured with Aperio ImageScope Software and analyzed as means of percentages of all immunopositive cells in three groups of reaction intensity, i.e. 3+, 2+, and 1+ as well as of H-score.

RESULTS

Seminomas showed higher expression of nucleolin indicated by higher H-score and higher percentage of positive cells than non-seminomas. The differences in subpopulations of NCL-positive cells were also found. Embryonal carcinomas and yolk sac tumors showed lower expression of NCL than seminomas indicated by H-score. The percentage of NCL-positive cells did not differ between embryonal carcinomas and seminomas while there were significant differences in subpopulations of cells. The percentage of NCL-positive cells in yolk sac tumors was lower than in seminomas. The results show different heterogeneity of subpopulations of NCL-positive cells in embryonal carcinomas and yolk sac tumors compared to seminomas. The analysis of nucleolin expression in embryonal carcinomas and yolk sac tumors showed no differences between these two tumor types. No differences in nucleophosmin expression between seminomas and non-seminomas were found.

CONCLUSIONS

The differences in the expression of nucleolin between two groups of germ cell testicular tumors found in the current study indicate a new aspect of biology of these neoplasms and require further studies on the role of nucleolin in germ cell tumorigenesis.

Cell and region specificity of Aryl hydrocarbon Receptor (AhR) system in the testis and the epididymis

Aryl hydrocarbon receptor (AhR) plays multiple important functions in adaptive responses. Exposure to AhR ligands may produce an altered metabolic activity controlled by the AhR pathways, and consequently affect drug/toxin responses, hormonal status and cellular homeostasis. This research revealed species-, cell- and region-specific pattern of the AhR system expression in the rat and human testis and epididymis, complementing the existing knowledge, especially within the epididymal segments. The study showed that AhR level in the rat and human epididymis is higher than in the testis. The downregulation of AhR expression after TCDD treatment was revealed in the spermatogenic cells at different stages and the epididymal epithelial cells, but not in the Sertoli and Leydig cells. Hence, this basic research provides information about the AhR function in the testis and epididymis, which may provide an insight into deleterious effects of drugs, hormones and environmental pollutants on male fertility.

The role of aryl hydrocarbon receptor (AhR) in the pathology of pleomorphic adenoma in parotid gland

OBJECTIVES

Pleomorphic adenoma (benign mixed tumor) is one of the most common salivary gland tumors. However, molecular mechanisms implicated in its development are not entirely defined. Therefore, the study aimed at definition of aryl hydrocarbon receptor (AhR) involvement in pleomorphic adenoma pathology, as the AhR controlled gene system was documented to play a role in development of various human tumors.

DESIGN

The study was carried out in pleomorphic adenoma and control parotid gland tissues where gene expression of AHR, AhR nuclear translocator (ARNT), AhR repressor (AHRR), as well as AhR controlled genes: CYP1A1 and CYP1B1, at mRNA and protein (immunohistochemistry) levels were studied. Functional evaluation of AhR system was evaluated in HSY cells (human parotid gland adenocarcinoma cells) using 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) as AhR specific inducer.

RESULTS

Pleomorphic adenoma specimens showed cytoplasmic and nuclear AhR expression in epithelial cells as well as in mesenchymal cells. In parotid gland AhR was expressed in cytoplasm of duct cells. Quantitative expression at mRNA level showed significantly higher expression of AHR, ARNT and CYP1B1, and comparable levels of CYP1A1 in pleomorphic adenoma tissue in comparison to healthy parotid gland. The HSY cell study revealed significantly higher expression level of AHRR in HSY as compared with MCF-7 cells (human breast adenocarcinoma cell line used as reference). Upon TCDD stimulation a drop in AHRR level in HSY cells and an increase in MCF-7 cells were observed. The HSY and MCF-7 cell proliferation rate (measured by WST-1 test) was not affected by TCDD.

CONCLUSIONS

Summarizing both in vitro and in vivo observations it can be stated that AhR system may play a role in the pathology of pleomorphic adenoma.

Angiogenesis within the duodenum of patients with cirrhosis is modulated by mechanosensitive Kruppel-like factor 2 and microRNA-126

BACKGROUND

The mechanism involved in neovascularization in splanchnic circulation and the main trigger that induces angiogenesis in patients with cirrhosis are not fully recognized.

AIMS

To explore the involvement of flow sensitive lung Kruppel-like factor (KLF2), microRNA-126 (miR-126), angiopoietin-2 (Ang-2) and heme oxygenase-1 (HO-1) in modulation of vascular endothelial growth factor (VEGF) signalling that have a critical effect on growth of new blood vessels.

METHODS

Duodenal biopsies from 22 patients with cirrhosis and 10 controls were obtained during routine endoscopy. The process of angiogenesis was evaluated by a measurement of CD31 concentration, immunodetection of CD34 protein and estimation of capillary densities. Messenger RNA (mRNA) and protein expressions were analysed by real-time PCR, Western blot or ELISA respectively.

RESULTS

Markers of angiogenesis (both, CD31 and CD34) were significantly enhanced in cirrhotic patients. In comparison to healthy controls, levels of Ang-2 and KLF-2 mRNAs as well as Ang-2, KLF-2, HO-1, VEGF protein expressions were considerably increased. Levels of sCD163, a surrogate marker of portal hypertension, correlated with levels of Ang-2, (P = 0.021) and VEGF (P = 0.009). The expression of miR-126, a KLF2-mediated regulator of the VEGF signalling was enhanced in cirrhotic patients.

CONCLUSIONS

Our results demonstrate, for the first time in humans, that neovascularization is induced in duodenal tissue of patients with cirrhosis and proangiogenic factors such as KLF-2, Ang-2, miR-126 and VEGF can contribute to the angiogenesis induced by hemodynamic forces. Thus, cirrhosis-induced blood flow and pressure within splanchnic vessels may be important hemodynamic triggers that initiate the angiogenic signalling cascade.

Expression of p21WAF1 in Astler-Coller stage B2 colorectal cancer is associated with survival benefit from 5FU-based adjuvant chemotherapy

In several, but not all, previous studies, positive p21^WAF1 expression has been suggested as an indicator of a good prognosis in patients with stage III/IV colorectal cancer. However, it is not known whether the same is true for stage B2 patients. The purpose of this study is to assess the influence of p21^WAF1 expression in tumor cells on disease-free survival (DFS) and overall survival (OS) of Astler–Coller stage B2 and C patients with colorectal cancer who underwent 5-fluorouracil-based adjuvant chemotherapy. Nuclear p21^WAF1 was detected by immunohistochemistry in tissue microarrays from 275 colorectal cancers. The expression of p21^WAF1 was associated with DFS (p = 0.025) and OS (p = 0.008) in the subgroup of stage B2 patients that was treated with adjuvant chemotherapy. In multivariate analysis, it remained the only independent prognostic parameter in relation to DFS and OS (p = 0.035 and p = 0.02, respectively). In the subgroup of 72 stage B2 patients with positive p21^WAF1 expression but not in the subgroup of 61 stage B2 patients with negative p21^WAF1 expression, adjuvant chemotherapy was associated with better DFS (85% 5-year survival versus 65% without chemotherapy, p = 0.03) and OS (96% versus 82%, p = 0.014). In the combined stage B2 and C group of patients treated with adjuvant chemotherapy, positive p21^WAF1 expression was also associated with better DFS and OS (p = 0.03, p = 0.002, respectively). Expression of p21^WAF1 in colorectal tumor cells identifies a subgroup of Astler–Coller stage B2 patients who could benefit significantly from 5FU-based chemotherapy and may improve the selection of patients for adjuvant chemotherapy.

Elastin degradation within the abdominal aortic aneurysm wall--relationship between intramural pH and adjacent thrombus formation

BACKGROUND

The natural history of abdominal aortic aneurysm (AAA) is wall remodelling potentially leading to a final rupture. The pathogenesis of AAA appears to be multifactorial. The aim of this pilot prospective study was to assess the relationship between the thickness of the thrombus within the abdominal aortic aneurysm, intramural pH and local elastin degradation.

MATERIALS AND METHODS

The AAA size, intraluminal thrombus (ILT) morphology and location were evaluated in 206 consecutive patients. Thirty patients with large AAA (aortic diameter > or = 50 mm) and adjacent ILT with the thinnest part < or = 10 mm and thickest > or = 25 mm, measured in the region of the maximum diameter of AAA, were included for further study. During AAA surgery intramural pH measurements were performed and specimens taken from both thin thrombus-covered and thick thrombus-covered wall for computerized morphometric analysis.

RESULTS

Mean intramural pH value was 7.21 +/- 0.18 for the wall covered by thick ILT and 7.64 +/- 0.10 for the thin one (P < 0.001). Computerized morphometric analysis demonstrated that elastin fibres in the thin thrombus-covered wall were decreased in size (for width--P < 0.0001, for length--P < 0.13), irregularly orientated (P < 0.000001) and the amount of fibres was reduced when compared to the wall covered by thick ILT (P < 0.0004).

CONCLUSION

A strong relationship between intramural pH and elastin net destruction suggests that the local alkaline status within the thin thrombus-covered part of the aneurysm wall is contributing to the elastinolytic process.

Membranous glomerulonephritis may be associated with heavy marijuana abuse

It is well documented that drug abuse can cause renal diseases. Nephropathy and proteinuria among heroin addicts has been recognized since the early 1970s. The predominant lesions in heroin-associated nephropathy are segmental glomerulosclerosis in African-Americans and membranous glomerulonephritis (MGN) in the Caucasian population. Cocaine may induce kidney damage, predominantly acute renal failure in the course of rhabdomyolysis. However, there are no case reports of nephropathy associated with marijuana smoking. We report a case of a marijuana-addicted 27-year-old Caucasian man after cadaveric kidney transplantation who developed de novo posttransplant MGN. The long period and high level of narcotic intoxication suggested that de novo MGN may have been associated with heavy marijuana abuse.

Intranuclear nucleolin distribution during cell cycle progression in human invasive ductal breast carcinomas in relation to estrogen receptor status

BACKGROUND

Nucleolin (NU) can be found in the nucleus in aggregates and in a diffused form. The expression and distribution of these two intranuclear pools of nucleolin was compared in estrogen receptor (ER)-positive and -negative invasive ductal breast carcinomas in relation to cell cycle phases.

MATERIALS AND METHODS

Using a laser scanning cytometer NU was measured within the whole nucleus, within nucleolin aggregates (NUA) and within the NUA-free karyoplasm. The G1-, S- and G2M-phase cell subpopulations were distinguished on DNA histograms.

RESULTS

The nuclei of ER-positive and ER-negative breast carcinomas in the G2M-phase differed in the expression of NU in the NUA and in the NUA-free karyoplasm, whereas in the S-phase they only differed in the NUA-free karyoplasm expression. In ER-positive carcinomas NU levels rose from G1 to G2M in both the NUA and the NUA-free karyoplasm, whereas in ER-negative carcinomas the NU levels increased only between G1/S in the NUA and between S/G2M in the NUA-free karyoplasm.

CONCLUSION

There are significant differences in nucleolin expression and localization during cell cycle progression depending on ER status.

Effect of trimetazidine on the nucleotide profile in rat kidney with ischemia-reperfusion injury

Ischemia-reperfusion injury is often responsible for delayed graft function after transplantation. Trimetazidine (TMZ) is an antioxidant agent used to protect grafts from ischemia-reperfusion injury. The aim of the study was to examine the effect of TMZ on nucleotide profile in rat kidney with ischemia-reperfusion injury. The study was carried out on Wistar rats divided into two groups: animals treated with TMZ and control group receiving placebo. TMZ 10mg/kg/day was administrated for 30 days. Concentrations of adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), adenosine (Ado), guanosine triphosphate (GTP), guanosine diphosphate (GDP), guanosine monophosphate (GMP), guanosine (Guo), inosine monophosphate (IMP), inosine (Ino), hypoxanthine (Hyp), xanthine (Xan), uric acid (UA), uridine (Urd), nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP) were determined in kidney tissues after ischemia-reperfusion using HPLC. The total adenine nucleotide concentration (TAN) and adenylate energy charge (AEC) were also determined. Moreover the kidneys were evaluated histologically. Tissue concentrations of ATP, ADP, AMP, TAN and AEC were significantly increased in kidneys from rats treated with TMZ in comparison with rats receiving placebo. Concentrations of products of nucleotide degradation: inosine (Ino), guanosine (Guo) and uridine (Urd), as well as oxypurines: Hyp and Xan, were significantly decreased in rats treated with trimetazidine. Moreover, significantly less pronounced acute tubular necrosis was observed in kidneys of rats treated with TMZ. These results suggest that trimetazidine protects against dephosphorylation of nucleotides and ischemic damage.

Simultaneous measurement of nucleolin and estrogen receptor in breast cancer cells by laser scanning cytometry

BACKGROUND

The purpose of the study was to test the feasibility of laser scanning cytometry (LSC) to simultaneously measure estrogen receptor (ER) and nucleolin (NU) expression in the nuclei of the same individual breast cancer cells.

MATERIALS AND METHODS

Cancer cells from 64 breast tumors were labeled with anti-NU and biotinylated anti-ER antibodies, then with secondary FITC-conjugated antibody and streptavidin-APC conjugate, respectively, and measured by LSC. The expression of NU in the nucleus and NU aggregates (NUA), number of NUA, nuclear and NUA areas and ER expression were assessed for aspiration each cell.

RESULTS

ER-bound APC fluorescence correlated with nuclear NU (r=0.65; p<0.001) and NUA-bound FITC fluorescence (r=0.59; p<0.001). Good correlation was found between percentages of ER-positive cells in LSC and by image analysis in paraffin-embedded sections (r=0.59, p<0.001).

CONCLUSION

ER and NU expression can be measured simultaneously in the same nuclei of breast cancer cells.