Expression of the p53 homologue p63 in early cervical neoplasia

BACKGROUND

p63, a homologue of the tumor suppressor gene p53, is expressed in embryonic, adult murine, and human basal squamous epithelium and encodes both transactivating and dominant negative transcript isoforms. Mouse embryos functionally deficient in p63 fail to replenish basal squamous epithelial cells, resulting in multiple defects that include absent genital squamous epithelium. This study investigated the expression of p63 in the human cervical transformation zone and early cervical neoplasia.

METHODS

Tissue localization of p63 was determined by immunohistochemistry in a wide range of epithelia. A correlation was also made between p63 expression and squamous basal cell (keratin 14), endocervical columnar cell (mucicarmine), and cell-cycle specific (Ki-67) markers.

RESULTS

p63 expression by immunostaining delineated basal and parabasal cells of maturing ectocervical squamous mucosa, squamous metaplasia in the cervix, and basal and subcolumnar cells of the cervical transformation zone. In atrophic epithelia immunostaining for p63 was present in all cell strata. In early cervical neoplasia, p63 expression was inversely correlated with both squamous cell maturation and nonsquamous differentiation in CIN. This biomarker also identified basal cells in a subset of preinvasive cervical neoplasms with endocervical cell differentiation that were bcl-2 and keratin 14 negative.

CONCLUSIONS

In the lower female genital tract, p63 is preferentially expressed in immature cells of squamous lineage and is not linked to cell proliferation. The broader range of p63 expression relevant to keratin 14 and bcl-2 indicates that p63 may identify additional subsets of benign and neoplastic epithelial basal cells in the cervical transformation zone and may be useful in studying cell differentiation in the early stages of neoplastic change in this region.

Natural history of recurrent molar pregnancy

Seven patients with recurrent molar pregnancy were managed at the New England Trophoblastic Disease Center (NETDC) between July 1965 and December 1978. Recurrent molar pregnancy was associated with a worsening histology and an increased incidence of proliferative trophoblastic sequelae in the successive episodes of hydatidiform mole. While none of the initial 7 patients with molar pregnancy required any further treatment after evacuation, 5 of the 7 patients needed chemotherapy to achieve complete sustained remission of the recurrent episodes of hydatidiform mole. None of the patients with recurrent hydatidiform mole had normal viable pregnancies after 2 or more consecutive molar gestations. The literature regarding recurrent molar pregnancy is reviewed in the context of the authors' current observations.

Distinguishing lymph node metastases from benign glandular inclusions in low-grade ovarian carcinoma

In order to properly stage patients with ovarian carcinoma, we are routinely removing and microscopically examining sample aortic lymph nodes in these patients, since aortic lymph node metastases may affect long-term survival. Inasmuch as benign glandular inclusions can be found in pelvic and aortic lymph nodes, we have run into difficulty distinguishing such inclusions from genuine metastases in cases of low-grade or borderline serous ovarian carcinomas. Atypical epithelium in these tumors may closely resemble the lining of benign glandular lymph node inclusions. Moreover, like metastases benign glandular inclusions may grow in the peripheral sinusoid, show epithelial papillae and psammoma bodies, and may even proliferate as small sheets of cells. Just how crucial it is to recognize aortic lymph node metastases in these low-grade tumors will be clarified when the prognostic importance of aortic node metastases becomes understood.

A controlled trial of antiemetics in abortion by PGF2alpha and laminaria

Women undergoing abortion by intraamniotic prostaglandin F2alpha were randomized to receive either prochlorperazine edisylate 10mg, hydroxyzine hydrochloride 100mg, or a placebo every four hours by intramuscular injection in a double-blind fashion. Vomiting was significantly more frequent in the placebo-treated group [0.2 +/- 1.5 SD episodes per patient, n=21] than in the groups treated with prochlorperazine [1.2 +/- 0.5 episodes per patient, n=21] or hydroxyzine [0.3 +/- 0.8 episodes per patient, n=19]. The mean number of merperidine injections in the antiemetic-treated groups was lower than in the control group, but this effect was not statistically significant. There was no significant difference between the treated and the control groups in the interval from prostaglandin treatment to abortion.