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PubMed2004

An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms.

Invasive pancreatic ductal adenocarcinoma is an almost uniformly fatal disease. Several distinct noninvasive precursor lesions can give rise to invasive adenocarcinoma of the pancreas, and the prevention, detection, and treatment of these noninvasive lesions offers the potential to cure early pancreatic cancers. Noninvasive precursors of invasive ductal adenocarcinoma of the pancreas include pancreatic intraepithelial neoplasias (PanINs), intraductal papillary mucinous neoplasms (IPMNs), and mucinous cystic neoplasms. Diagnostic criteria, including a distinct ovarian-type stroma, and a consistent nomenclature are well established for mucinous cystic neoplasms. By contrast, consistent nomenclatures and diagnostic criteria have been more difficult to establish for PanINs and IPMNs. Because both PanINs and IPMNs consist of intraductal neoplastic proliferations of columnar, mucin-containing cells with a variable degree of papilla formation, the distinction between these two classes of precursor lesions remains problematic. Thus, considerable ambiguities still exist in the classification of noninvasive neoplasms in the pancreatic ducts. A meeting of international experts on precursor lesions of pancreatic cancer was held at The Johns Hopkins Hospital from August 18 to 19, 2003. The purpose of this meeting was to define an international acceptable set of diagnostic criteria for PanINs and IPMNs and to address a number of ambiguities that exist in the previously reported classification systems for these neoplasms. We present a consensus classification of the precursor lesions in the pancreatic ducts, PanINs and IPMNs.

Carcinoma in Situ↗
PubMed1991

Paneth-like cells in an adenoma and adenocarcinoma in the ampulla of Vater.

A case of adenocarcinoma with significant Paneth cell differentiation arising in a villoglandular polyp at the ampulla of Vater is presented. Paneth-like cells, containing distinct fuchsinophilic granules, were a prominent component of the nonglandular invasive adenocarcinoma and were also seen in the associated adenomatous polyp. Lysozyme, trichrome, and periodic acid-Schiff digest stains, and electron microscopy confirmed that the granules were lysosomal in nature. This case confirms that cells with Paneth-like features can be a significant component in invasive neoplasms and can occur at unusual sites such as the ampulla of Vater.

Adenocarcinoma↗
PubMed1981

Nuclear DNA study of vulvar intraepithelial and invasive squamous neoplasms.

In this study, 59 vulvar intraepithelial squamous neoplasms (8 atypia and 51 carcinoma in situ) and 33 invasive squamous carcinomas were analyzed for their nuclear DNA content using Feulgen microspectrophotometry. Four cases of atypia had a polyploid DNA distribution. The remaining 4 cases of atypia and all cases of carcinoma in situ had an aneuploid pattern, and nearly two thirds of these had high ploidy stem cells (greater than 3N). This is in contrast to the low ploidy stem cells (less than 3N) seen in 70% of the invasive carcinomas and in 82% of the intraepithelial neoplasms in the vicinity of invasive carcinomas. This observation suggests that not all vulvar intraepithelial neoplasms have the same propensity to become invasive. Invasive carcinomas of comparable size and depth of invasion with low ploidy stem cells had a higher frequency of lymph node metastasis than those having high ploidy stem cells. The significance of nuclear DNA findings related to gynecologic neoplasms is discussed.

Aneuploidy↗
PubMed2003

Classification and grading of the non-invasive urothelial neoplasms: recent advances and controversies.

The classification and grading of the non-invasive, intraepithelial neoplasms of the urothelium are based on the morphological pattern of growth-that is, papillary or flat (and endophytic)-and on their degree of architectural and cytological abnormalities. Recent advances in the morphological, molecular, and quantitative evaluation of these lesions have contributed to the refinement of the current classification and grading schemes. However, some controversies on the precise criteria and terminology, especially when the papillary lesions are concerned, are still present.

Carcinoma in Situ↗
PubMed1996

Evaluation of chromosome aneuploidy in tissue sections of preinvasive breast carcinomas using interphase cytogenetics.

BACKGROUND: Little is known about cellular level genetic alterations in preinvasive breast lesions, particularly lobular carcinoma in situ. METHODS: We employed fluorescence in situ hybridization (FISH) using pericentromeric (alpha satellite) probes to assess numerical alterations of chromosomes 1, 7, 8, 16, 17, and X in deparaffinized archival tissue sections of 9 lobular carcinomas in situ (LCIS), 10 ductal carcinomas in situ (DCIS), and a spectrum of proliferative lesions (including 3 ductal hyperplasias, 1 adenosis, 1 radial scar, and 2 atypical hyperplasias). Three of the LCIS lesions and five of the DCIS lesions were from patients who had a concurrent invasive neoplasm as a component of the tumor. RESULTS: None of the proliferative lesions exhibited detectable chromosome gains, and only 1 showed evidence of signal loss consistent with monosomy (chromosome 7 in the adenosis lesion). Six LCIS patients (67%) displayed evidence of monosomy, with involvement of chromosome 17 in 6 of 6 patients, chromosome 8 in 2 of 6 patients, and chromosome 7 in 2 of 6 patients. Two LCIS patients, each of whom had a concurrent invasive neoplasm, exhibited signal gains consistent with trisomy for chromosomes 1 and 8 (1 patient each). Chromosome aneuploidies were observed in 7 of 10 (70%) DCIS patients, including 2 of 5 patients (40%) without concurrent invasive neoplasm and 5 of 5 patients (100%) with concurrent invasive neoplasm. The pattern of numerical chromosome alteration in DCIS included two patients with losses only, 2 patients with gains only, and 3 patients with both gains and losses (i.e., involving different chromosomes). Chromosome 17 aneuploidy was observed in all DCIS and all LCIS patients who exhibited abnormalities; however, DCIS patients showed more frequent aneuploidies for chromosomes X and 16 (0 LCIS patients vs. 4 DCIS patients with each). CONCLUSIONS: Distinctive pathologic subsets of preinvasive breast neoplasia have divergent patterns of genetic instability. Foci of residual in situ neoplasia that accompany invasive disease may have a greater degree of genetic instability than neoplasms that lack progression to invasive phenotype.

Aneuploidy↗
PubMed2005

[Prognostic significance of depth and mode of invasion of the neoplasm in the presence of micrometastases in laryngeal carcinoma--cytokeratin antigens expression in lymph nodes].

According to the recent reports analyses of characteristic of neoplasm's invasion is one of the most reliable methods of estimation the progress of the changes of tumor and prediction the outcome in patients with laryngeal cancer. Depth and mode of invasion are features which are able to assess the dynamics of the tumor growth quite precisely. In this study it was presented direct relation between morphological features of tumor front as a depth and mode of carcinoma's growth and the probability of micrometastases. The authors have analysed 22 cases of patients who were operated on the laryngeal squamous cell carcinoma in ENT Department Medical University of Lodz in the period of 1998-1999. Features of the TFG and its dependence on lymph node micrometastases, considered in immunohistochemistry with using of panel of cytokeratins (CKs) were analysed. Our study showed that feature such as depth and mode of invasion is very useful in prediction of micrometastases in patients with laryngeal squamous cell carcinoma.

Aged↗
PubMed1997

p53-independent expression of p21waf1/cip1 in preinvasive and invasive squamous neoplasms of the uterine cervix.

Although mutations of the p53 gene are the most common genetic alteration in human tumors, they are relatively rare in cervical carcinomas, possibly because human papillomaviruses of the oncogenic type encode for an oncoprotein that leads to the ubiquitin-mediated destruction of p53. An important mediator of p53-induced cell-cycle arrest is p21waf1/cip1, and although several studies evaluated invasive and preinvasive cervical lesions for p53 expression, none has studied expression of this important downstream effector. We examined normal cervical squamous epithelium, squamous cell carcinomas, and a range of preinvasive cervical lesions for expression of p53, p21waf1/cip1, and the proliferation-associated antigen, Ki-67, by immunohistochemical analysis. p53 expression was absent in normal squamous epithelium and all dysplasias regardless of severity, consistent with the presence of predominantly wild-type p53. Invasive carcinomas were mostly negative but contained occasional small nests of cells immunoreactive for p53. p21waf1/cip1, on the other hand, was expressed in all normal squamous epithelium and all preinvasive and invasive lesions. In normal squamous epithelium, the basal and immediate parabasal layers were negative, with the early differentiating layers positive. Expression was increased in dysplasias compared with normal squamous epithelium, both in number of immunoreactive nuclei and intensity of staining. The highest expression was seen in high-grade dysplasias and invasive carcinomas. Ki-67 expression also increased with increasing severity of the lesion, but p21waf1/cip1 and Ki-67 seemed to be expressed in different cells, a fact that was confirmed by double immunohistochemical staining for these two proteins on the same sections. This paradoxical increase in p21waf1/cip1 expression and mutually exclusive expression might be related to the role of p21waf1/cip1 in differentiation.

Adult↗
PubMed1999

Structural studies of initial lymphatics adjacent to gastric and colonic malignant neoplasms.

Invasion and metastases are the main causes of death from cancer, and prognosis is best correlated with invasion of malignant cells into initial lymphatics and dissemination to regional lymph nodes. Using both light and transmission electron microscopy, we examined human gastric and colonic cancers and their relation to initial lymphatics. Invasion of malignant tumor cells into the initial lymphatics was characterized by interdigitating and overlapping endothelium giving way to open junctions as lymphatic endothelial cells were apparently dissolved and destroyed. Cytoplasmic vesicles, mitochondria, and rough endoplasmic reticulum were qualitatively increased as demonstrated by image analysis.

Colonic Neoplasms↗
PubMed1998

Clinicopathologic analysis of microscopically invasive breast carcinoma.

Breast biopsy or mastectomy cases having diagnoses of carcinoma in situ with "microinvasion," "minimal invasion," "focal invasion," or "suggestive of invasion" were reviewed and all histologically identified foci of invasive disease from each case were measured using an ocular micrometer. Cases in which any single focus of invasion was greater than 5 mm or the added size of separate invasive foci exceeded 10 mm were excluded, resulting in a study group of 75 patients. Invasive neoplasm was present in the initial biopsy in 69 of 75 cases (92%); however, residual invasive neoplasm was found in the subsequent lumpectomy/mastectomy from 14 of these (20%). In 59% of cases, two or more histologically separate foci of invasion were identified. Invasive foci consisted of isolated cells or cell clusters, each less than 1 mm (microfocal invasion), in 33% of cases. In 12 cases, the sum of individual invasive foci was 5 to 10 mm. Axillary lymph nodes (LN) from 5 of 69 patients (7%) contained metastatic carcinoma (four cases, one LN positive; one case, two LN positive). The cumulative sizes of all invasive foci in the LN-positive group were microfocal invasion (one case), 0.6 mm (one case), 1.1 mm, 2.5 mm, and 5.8 mm. The difference in frequency of axillary node metastasis between tumors with microfocal and measurable invasion (4.3% v 8.6%) was not statistically significant. Follow-up data were available on 55 cases (mean interval, 66.1 months). One (node-negative) patient had duct carcinoma in situ recurrence in the same breast 4 years after initial treatment. Another (with unknown node status) developed an axillary lymph node metastasis 13 months after initial treatment (96% disease-free survival). We conclude that microscopic stromal invasion in breast carcinoma, at least in the setting of significant in situ component, is often initiated from multiple foci. Patients with microscopically invasive breast carcinoma have a small but significant risk of axillary metastases, although a highly favorable survival.

Aged↗
PubMed1991

Analysis of the physical state of different human papillomavirus DNAs in intraepithelial and invasive cervical neoplasm.

The integration of human papillomavirus (HPV) DNA into the human genome has been generally accepted as a characteristic of malignant lesions. To gain a better understanding of this phenomenon, genomic DNA from 181 cervical biopsy specimens was isolated and analyzed for HPV type and physical state of the HPV genome. These specimens represented the full spectrum of cervical disease, from condyloma to invasive carcinoma. Discrimination between integrated and episomal HPV DNA was accomplished by the detection of HPV-human DNA junction fragments on Southern blots. In most cases in which ambiguous Southern blot results were obtained, the specimens were reanalyzed by two-dimensional gel electrophoresis. Of the 100 biopsy specimens of cervical intraepithelial neoplasia analyzed, only 3 showed integrated HPV DNA, in contrast to 56 (81%) of 69 cervical carcinomas (P less than 0.001) showing integrated HPV DNA. Of the 40 carcinomas containing HPV 16 DNA, 29 (72%) had integrated HPV DNA, of which 8 (20%) also had episomal HPV DNA. In 11 (27%) cancers, only episomal HPV 16 DNA was detected. All 23 HPV 18-containing carcinomas had integrated HPV DNA, and 1 also had episomal HPV 18 DNA. The difference between HPV types 16 and 18 with respect to frequency of integration was statistically significant (P less than 0.01). The results of this study indicate that detectable integration of HPV DNA, regardless of type, occurs infrequently in cervical intraepithelial neoplasia. The absence of HPV 16 DNA integration in some carcinomas implies that integration is not always required for malignant progression. In contrast, the consistent integration of HPV 18 DNA in all cervical cancers examined may be related to its greater transforming efficiency in vitro and its reported clinical association with more aggressive cervical cancers.

Blotting, Southern↗
PubMed2005

Loss of cell-surface heparan sulfate expression in both cervical intraepithelial neoplasm and invasive cervical cancer.

OBJECTIVE: Syndecan-1 binds to various extracellular matrix components via its heparan sulfate glycosaminoglycans (HS-GAG) and most of its biological functions are considered to be associated with this process. The aims of this study are to investigate its expression in cervical neoplasms. METHODS: We investigated the expression of both the syndecan-1 core protein and cell-surface HS-GAG by immunohistochemistry in 53 cervical intraepithelial neoplasm (CIN), 19 microinvasive, 143 invasive cervical cancers, and 29 metastatic lymph node samples, and analyzed correlations with various clinicopathological features. RESULTS: The progression of CIN to early invasive cancer was found to associate with reduced levels of both syndecan-1 and HS-GAG expression. In squamous cell carcinomas, HS-GAG expression was significantly lower in cases with lymph-vascular space invasion. Additionally, the overall survival rates for patients exhibiting low HS-GAG expression was significantly lower than patients exhibiting high HS-GAG expression (P = 0.019). Low HS-GAG expression in positive nodes was determined to be a disease-free and overall survival prognostic factor (P = 0.028 and P = 0.018, respectively). CONCLUSION: The loss of syndecan-1 and HS-GAG expression is an early event in cervical carcinogenesis. The loss of HS-GAG expression particularly in positive nodes can serve as an indicator of aggressive disease potential and poor prognosis in patients with invasive cervical cancer.

Adult↗
PubMed1999

Analysis of chromosome aneuploidy in breast carcinoma progression by using fluorescence in situ hybridization.

Nonisotopic fluorescence in situ hybridization by using alpha satellite centromeric probes was performed on intact tissue sections of 12 breast carcinomas to compare the pattern of aneuploidy for chromosomes 7, 8, 16, and 17 between foci of residual in situ carcinoma (DCIS) and a representative area of coexisting invasive neoplasm. Most hybridization pairs (58%) showed a gain in chromosomal copy number between the in situ and corresponding invasive area, whereas 29% showed no apparent change and 13% showed loss in copy number. Hybridizations from areas of invasive carcinoma, thus, were more frequently characterized by tumor cells with trisomy/polysomy (78%) than neoplastic cells from residual DCIS (50%) and less frequently characterized by cells with monosomy (10% versus 16%, p = 0.01). Even when DCIS cells exhibited chromosome trisomy, 65% of hybridizations demonstrated a significantly greater proportion of trisomic cells in the corresponding invasive population. The hybridization pairs (n = 7) initially showing apparent loss in chromosome copy number from in situ to invasive growth were all from two cases that demonstrated morphologic heterogeneity. Enumeration of cells from histologically distinct areas of these cases revealed different patterns of aneusomy, in keeping with karyotypic diversity. However, comparison of histologically similar areas of DCIS and invasive neoplasm demonstrated a pattern of chromosome copy gain with invasive growth, similar to morphologically homogeneous tumors. We conclude that invading cells in breast carcinomas differ from residual in situ populations with respect to degree of chromosome aneuploidy and that tumor progression from preinvasive to an invasive phenotype in human breast carcinoma is characterized by a significant increase in the degree of genetic instability. The observed pattern of chromosome copy number gain, moreover, is consistent with a common cellular level genetic mechanism underlying early breast tumor progression.

Aneuploidy↗
PubMed2004

Non-invasive urothelial neoplasms: according to the most recent WHO classification.

The key points of the latest World Health Organization (WHO) classification of non-invasive urothelial tumors are: the description of the categories has been expanded in the current version to improve their recognition; one group (papillary urothelial neoplasm of low malignant potential) with particularly good prognosis does not carry the label of 'cancer'; it avoids use of ambiguous grading such as grade 1/2 or 2/3 (according to the WHO classification published in 1973, i.e., 1973 WHO classification); the group of non-invasive high grade carcinoma is large enough to contain virtually all those tumors that have biological properties (and a high level of genetic instability) similar to those seen in invasive urothelial carcinoma. This scheme is meant to replace the 1973 WHO classification. Changes in classification have their own inherent problems, tending to lead to confusion, at least for a period of time. From the practical point of view, the use of both the 1973 and the latest WHO classifications is recommended until the latter is sufficiently validated.

Adult↗