Immunocytochemical markers of benignancy and malignancy. Do they exist?
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Histocytochemistry↗
Biomedical subjects
M R Wick
Publications and source records attributed to M R Wick.
Transitional (cylindric) cell carcinoma with endodermal sinus tumor-like features of the nasopharynx and paranasal sinuses. Clinicopathologic and immunohistochemical study of two cases.
We report two cases of adult patients with primary tumors in the nasopharynx and paranasal sinuses, which were characterized histologically by areas of transitional cell (cylindric or "schneiderian") carcinoma and other foci virtually indistinguishable from endodermal sinus tumor (yolk sac carcinoma). Immunohistochemical studies supported the impression of yolk sac differentiation. Both patients were treated with irradiation and multidrug chemotherapy. One patient died of uncontrollable recurrence of tumor, whereas the other developed locally recurrent, transitional cell carcinoma in the absence of yolk sac tumor. The concurrence of these patterns of carcinoma, which has been undescribed previously to the best of our knowledge, seems to be associated with more aggressive biologic behavior than pure transitional cell carcinomas of this region.
Adult↗
Endovascular papillary angioendothelioma of childhood: a vascular lesion possibly characterized by "high" endothelial cell differentiation.
Two cases of endovascular papillary angioendothelioma (EPA) of the skin were studied immunohistochemically to assess the expression of endothelial, leukocytic, and epithelial determinants by these lesions. The tumor cells in both cases were labeled by antibodies to Factor VIII-related antigen, vimentin, and blood group isoantigens; they also bound Ulex europaeus I agglutinin. On the other hand, immunoreactivity for epithelial membrane antigen, Leu-M1, HLA-DR (Ia-like antigen), and leukocyte common antigen (LCA) was not observed. Stromal and intravascular lymphocytes were labeled intensely with antibodies to LCA and HLA-DR and were intimately associated with papillary configurations of proliferating intravascular tumor cells. These results confirm the endothelial nature of EPA and suggest that the cells of this lesion may differentiate toward "high" endothelial cells, which have been shown to interact functionally with circulating lymphocytes.
Cell Differentiation↗
Isolated cardiac amyloidosis associated with sudden death.
An unusual case of localized cardiac amyloidosis was associated with sudden death in the absence of prior symptoms of heart disease. Autopsy studies showed amyloid deposition in the ventricular myocardium and conduction system; there were no deposits in other viscera, and evidence of a plasma cell dyscrasia was lacking. Thus, it appears that isolated involvement of the heart by amyloidosis may cause death, even in patients who do not have a history of congestive heart failure or arrhythmia.
Aged↗
Adnexal carcinomas of the skin. I. Eccrine carcinomas.
The diagnostic identification of sweat gland carcinomas is hampered by their rarity and their histologic resemblance to various visceral tumors, leading to confusion with metastatic lesions. In this series, 14 cases of eccrine carcinoma in five male and nine female patients, ranging in age from 13 to 84 years, are described. Ten tumors strongly resembled infiltrating ductal adenocarcinomas of the breast, and were thus classified as ductal. Three had a prominent mucinous matrix, similarly explaining their categorization as mucinous carcinomas. Finally, one neoplasm was a classic eccrine porocarcinoma. Four patients with ductal eccrine carcinomas suffered metastasis, and a 50% mortality rate was observed among this group of ten cases. In contrast, only one of three mucinous carcinomas metastasized, although all of these lesions recurred locally, as did the single porocarcinoma. None of the latter four neoplasms proved fatal. The results of conventional special stains in these 14 cases are discussed, and histologic features that they shared, and which may be utilized in distinguishing eccrine carcinomas from benign sweat gland tumors, are presented.
Adenocarcinoma↗
Adnexal carcinomas of the skin. II. Extraocular sebaceous carcinomas.
Extraocular sebaceous carcinomas are uncommonly seen neoplasms, and have been confused in the past with basal cell carcinomas showing sebaceous differentiation. In contrast to the latter tumors, however, sebaceous carcinomas have a distinct risk of aggressive behavior. This study presents clinicopathologic data on five cases of sebaceous carcinoma arising in cutaneous locations outside of the ocular adnexae. Four of five patients were men, and the average age at diagnosis was 63 years. Three tumors occurred on the face, one arose in the skin of the neck, and another occurred on the penis, an anatomic site that is extremely rare for sebaceous carcinoma. Three tumors metastasized, and two patients died of tumor or with residual tumor growth. In light of this behavior, the premise that extraocular sebaceous carcinomas rarely spread to distant sites may need reexamination.
Adenocarcinoma↗
Pancreatic islet cell carcinoma with gastrin and vasoactive intestinal polypeptide production.
The case history of a patient with an islet cell carcinoma, which produced both gastrin and vasoactive intestinal polypeptide (VIP), is presented. Although several examples have been observed of the combined production of these hormones by pancreatic endocrine tumors, few reports have related the clinical details of such cases. Resolution of diarrhea occurred in our patient after institution of nasogastric suction and cimetidine therapy, suggesting that gastric hypersecretion, rather than VIP activity, accounted for this problem. Chemotherapy with streptozotocin and 5-fluorouracil was highly effective in ameliorating clinical symptoms, diminishing serum levels of gastrin and VIP, and greatly reducing the bulk of metastatic disease in this case.
Adenoma, Islet Cell↗
Platelet transfusion therapy in acute leukemia: lack of effect of splenomegaly on transfusion requirements and risk of hemorrhage.
Platelet transfusions are an important supportive measure during treatment for acute nonlymphocytic leukemia (ANLL). The presence of splenomegaly may produce decreased posttransfusion platelet increments leading some to recommend an increased dose of platelets per transfusion in this situation. Forty-nine newly diagnosed patients with ANLL were evaluated during 1980 and 1981, and 24% had palpable splenomegaly. Although treated with usual doses of platelets per transfusion, there was no detectable statistical increase in transfusion requirement or incidence of hemorrhage in patients with splenomegaly. Experimental evidence indicates that the splenic platelet pool enlarges with splenomegaly, but the life span of circulating platelets is not significantly changed. Furthermore, the splenic platelet pool is in dynamic equilibrium with the circulating platelet pool thus allowing these platelets to participate in hemostasis. Although posttransfusion increment in platelet count may be less, it appears that platelet transfusion therapy need not be altered solely because of splenomegaly.
Acute Disease↗
A blood bank consultation service: principles and practice.
In the blood bank setting, a close relationship with both clinicians and patients is essential for good medical practice. In July 1982, the Mayo Clinic Blood Bank and Transfusion Services formally organized a consultation service with daily visits to patients of mutual interest to blood bank consultants and clinicians for practice and education. Detailed diaries of this activity were maintained for 12 months, during which time 802 impatient visits were recorded. The most frequent reasons for consultations were clarification or amplification of the clinical history (34.0%), evaluation of transfusion reactions (27.2%), and assessment of serologic problems (18.2%). These consultations resulted in diagnostic, management, and therapeutic recommendations for a wide variety of medical problems. Of the 802 consultations, 23% were conducted at the direct request of clinicians. We believe that a blood bank consultation service is feasible, is enlightening for the blood bank and clinicians, and contributes to patient care.
Blood Banks↗
S-100 protein immunostaining in the differential diagnosis of chondroblastoma.
In an effort to investigate the utility of immunostaining for S-100 protein in the differential diagnosis of chondroblastoma, the expression of S-100 protein in nine chondroblastomas was compared with that in six giant cell tumors, six aneurysmal bone cysts, four giant cell reparative granulomas, six cases of fibrous dysplasia, two cases of osteitis fibrosa cystica, two nonossifying fibromas, and one clear cell chondrosarcoma. Five enchondromas, three typical chondrosarcomas, and one mesenchymal chondrosarcoma were also included as control tumors. The proliferating stromal cells in seven of the nine chondroblastomas stained for S-100 protein, as did the lacunar chondrocytes in all of the enchondromas and chondrosarcomas and rare stromal cells in the clear cell chondrosarcoma. In contrast, none of the other tumefactive bone lesions included in this study demonstrated S-100 protein immunoreactivity. These results suggest that immunohistochemical assessment of S-100 protein may be a method for diagnostically separating chondroblastoma from pathologic entities that could be histologically confused with it in the presence of limited biopsy material. However, clear cell chondrosarcoma would appear to represent an exception to this general statement.
Adolescent↗
Secondary neuroendocrine carcinomas of the skin. An immunohistochemical comparison with primary neuroendocrine carcinoma of the skin ("Merkel cell" carcinoma).
Since the initial clinical presentation of visceral neuroendocrine carcinoma is occasionally a cutaneous metastasis, diagnostic confusion with primary neuroendocrine carcinoma of the skin (Merkel cell carcinoma) may ensue. In this study, seven cases of secondary cutaneous neuroendocrine carcinoma were immunohistochemically compared with twenty-one Merkel cell carcinomas for ten antigenic moieties that have been associated with endocrine tumors. Six of seven secondary tumors stained for bombesin, leucine enkephalin, methionine enkephalin, or beta-endorphin, none of which was detected in the primary cutaneous neuroendocrine carcinomas. These data suggest that immunohistochemical study may be useful in separating primary from secondary neuroendocrine tumors of the skin and may assist in directing clinical attention to the most probable site of visceral neoplasia.
Adult↗
Passively acquired antibody directed at human erythrocytes seen during therapy with Minnesota antilymphoblast globulin.
6 renal transplant patients, seen at the Mayo Clinic between July 1982 and April 1983, received Minnesota antilymphoblast globulin (MALG) for treatment of allograft rejection and demonstrated warm-acting 'auto'-antibodies during such therapy. These antibodies represented xenogeneic reactivity in equine MALG, rather than the products of patient-derived immune responses, since they were not detected before or after the period of therapy with this immunosuppressive agent in any of the 6 cases. They interfered with crossmatch procedures for red cell transfusion, and were only variably removed by autoabsorption techniques. Heat treatment of sera containing MALG-related red cell antibodies was ineffective in abrogating their reactivity and also compromised the reactivity of some red cell alloantibodies which were tested as controls. Transfusion of 'least-incompatible' red blood cells had no adverse effects in 2 cases where it was necessitated by clinical circumstances, despite an inability to obtain suitable serological samples for crossmatching.
Adult↗
Vulvar sweat gland carcinomas.
Sweat gland carcinomas constitute less than 10% of all malignant tumors of the vulva, including those associated with extramammary Paget's disease (EPD). The histopathologic diagnosis of vulvar sweat gland carcinomas is difficult because of their rarity; their resemblance to metastatic carcinomas of the internal female genitalia, kidneys, and other sites; and their diversity of microscopic appearances. We report five examples of vulvar sweat gland carcinomas, two of which were associated with EPD. The other tumors included one example each of ductal eccrine adenocarcinoma, eccrine porocarcinoma, and clear cell hidradenocarcinoma. The clinical behavior of these neoplasms is correlated with their histologic types; we also discuss differential diagnosis and treatment recommendations.
Adenoma, Sweat Gland↗
Sarcomatoid transitional cell carcinomas of the renal pelvis. An ultrastructural and immunohistochemical study.
Transitional cell carcinomas of the urinary tract may occasionally assume a partial or complete spindle cell pattern of growth, leading to the erroneous classification of some true carcinomas as sarcomas. We have recently observed two such tumors of the renal pelvis. In these cases, ultrastructural study showed that the spindle cells retained features of epithelial differentiation; this conclusion was further supported by positive results of several immunohistochemical stains, using biotinylated peanut agglutinin and soybean agglutinin, and a rabbit antiserum directed against keratin proteins. In addition, both tumors manifested immunoreactivity for blood-group antigens, using primary murine monoclonal antibodies. The results of these studies suggest that immunocytochemistry is a helpful diagnostic adjunct in the proper classification of sarcomatoid urothelial neoplasms.
Aged↗
Thymic carcinoid. A histologic, immunohistochemical, and ultrastructural study of 12 cases.
Twelve cases of thymic carcinoid were studied by electron microscopy and immunohistochemistry. Clinically, all of them presented either as asymptomatic, radiographically detected mediastinal masses or as neoplasms producing symptoms of thoracic structural displacement or Cushing's syndrome. By light microscopic examination, the carcinoids manifested an organoid growth pattern, being composed of uniform polygonal cells with central, oval nuclei and finely dispersed chromatin. Immunohistochemical analysis disclosed the presence of cytoplasmic adrenocorticotropic hormone in four cases (three associated with Cushing's syndrome), of somatostatin in seven cases, and of serotonin in one case. Ultrastructurally, these tumors generally showed short, blunt, interdigitating cell processes; focal, scanty basement membrane material; infrequent but well-formed junctional complexes; moderate to large numbers of dense-core granules; and lipoautophagosomes. Six tumors contained small numbers of type I microfilaments, and three demonstrated perinuclear whorls of type II microfilaments. Rough and smooth endoplasmic reticulum was well developed in each tumor, the smooth form being prominent in cases with clinical Cushing's syndrome.
Adrenocorticotropic Hormone↗
The role of the Lewis antigen system in renal transplantation and allograft rejection.
The recent literature on the technologic and clinical progress being made in renal transplantation has not emphasized applicable advances in blood group serology. Accumulated data on the Lewis blood group system, however, seem to implicate Lewis incompatibilities between kidney donors and recipients as contributing factors in allograft rejection. Lewis antigens may be capable of inciting both cell-mediated and humoral immune responses of a cytotoxic nature, and such antigens are expressed on cell surfaces of the renal parenchyma in Lewis-positive persons. Hence, this serologically defined system could be the source of diminished allograft survival in recipients who are mismatched with their organ donors for Lewis antigens, despite compatibility within other histocompatibility antigen systems. This premise is still open to question, and future, controlled, clinical studies will be necessary to establish a definite role for the Lewis antigen system in renal transplant rejection.
ABO Blood-Group System↗
Immune thrombocytopenias: tests for platelet antibodies.
In a study of 49 consecutive patients for whom a test for platelet antibodies had been ordered, tests were performed for both cell-bound and serum platelet antibodies. In cases of autoimmune thrombocytopenia (ITP), the test result for cell-bound antibody was more likely to be positive than was the test result for serum antibody. In three patients with ITP who were taking systemic corticosteroids, however, the result of the CBPAT was negative. A similar phenomenon occurred in a patient with SLE. The result of the SPAT correlated best with the presence of alloantibodies formed during pregnancy or after blood transfusion.
Adrenal Cortex Hormones↗
Malignant histiocytosis: a clinical, histologic, and immunohistochemical study of 20 cases.
To better characterize the diagnostic criteria and clinical behavior of malignant histiocytosis, 20 patients treated at the Mayo Clinic during a 25-year period were studied. A wide spectrum of cytologic differentiation was observed, with cells ranging from bland to highly anaplastic; hemophagocytosis was prominent only in conjunction with a bland histologic appearance. In surgical specimens, the diagnosis of malignant histiocytosis necessitated the use of immunoperoxidase methods for lysozyme, immunoglobulin light chain, and alpha-antitrypsin content, as well as cytochemical stains for acid phosphatase and nonspecific esterase. All autopsies showed that organ involvement had varied somewhat from that reported earlier. The correct diagnosis of malignant histiocytosis was made prior to death in only ten of the 20 cases. The mean survival in the 17 fatal cases was 7.6 months; three of the seven patients treated by aggressive chemotherapy achieved complete remission. Relatively longer survival was correlated with initial confinement to the skin and the absence of cytopenia or liver function abnormalities. Three patients with pulmonary involvement from malignant histiocytosis had apparent inappropriate antidiuretic hormone secretion in the absence of central nervous system disease. The accelerated clinical progression of malignant histiocytosis and its response to current chemotherapeutic regimens make rapid diagnosis and familiarity with the pathologic variations seen in this disorder imperative. Routine utilization of special light-microscopic and immunohistochemical stains is mandatory.
Adult↗