A clinicopathologic analysis of 88 lung resections of suspected metastatic carcinomas with proven primaries.

Background: The lung is the most common site for metastatic carcinomas. Very few studies have comprehensively analyzed all pulmonary resections for metastatic carcinomas. Aims and Objectives: To analyze all lung resections for suspected metastatic carcinomas accrued over 10 years to evaluate: The most frequent primary site, The interval between primary tumor diagnosis and lung metastases, and The proportion of inadvertently resected benign lesions, clinicoradiologically mistakenfor metastatic deposits. Materials and Methods: Between 2002 and 2011, 88 pulmonary metastasectomies were done for suspected metastatic carcinomas, which form the basis of this study. Results: In 81 of 88 cases (92%) the diagnosis of metastatic carcinoma was histologically confirmed, whereas 7 cases (8%) were non-neoplastic. The mean interval between primary tumor and metastases was 2.5 years. The primary sites were colorectum (30; 37%), kidney and breast (14; 17.3% each), cervix (9; 10%), salivary gland carcinoma (3), thyroid carcinoma (2), squamous carcinoma (2, one each of mandible and larynx), papillary urothelial carcinoma (2), hepatocellular carcinoma (1), endometrioid adenocarcinoma (1), carcinosarcoma of endometrium (1), adrenocortical carcinoma (1), and neuroendocrine carcinoma (1). The 7 non-neoplastic lesions (8%) histologically revealed tuberculosis (4), bronchopneumonia (2), and aspergillosis (1). Conclusions: Almost three fourths (71.6%) of the metastatic pulmonary resections comprised primaries from colorectum, breast and kidney. The interval between primary tumor and metastases ranged from zero months to 10 years (mean 2.5 years). Tuberculosis was the most common histologic diagnosis among the 8% of the non-neoplastic lesions, which were mistaken for metastatic carcinoma on clinical evaluation.

A year of anaplastic large cell kinase testing for lung carcinoma: Pathological and technical perspectives.

BACKGROUND: An in‑frame fusion protein between echinoderm microtubule‑associated protein‑like 4 (EML4) and anaplastic large cell kinase (ALK) genes is seen in some non‑small cell lung cancer (NSCLC). EML4‑ALK demonstrates constitutive kinase activity. These ALK‑positive lung carcinomas have been shown to respond to ALK kinase inhibitors. ALK gene rearrangement is commonly detected using fluorescent in situ hybridization (FISH). AIMS: To study the pathological features of ALK positive and negative NSCLC and evaluate the causes of uninterpretable FISH results. MATERIALS AND METHODS: This is a retrospective, observational study. The molecular pathology records of patients on whom test for ALK had been performed in a period of 1 year (February 2012 to February 2013) were accessioned. A total 224 cases were identified. Histological features were reviewed. The in situ hybridization was performed using Vysis ALK Dual Color Break Apart Rearrangement Probe (Abbott Molecular Inc.). Signal interpretation under the fluorescent microscope was performed in accordance with College of American Pathologists guidelines. RESULTS: Five patients showed ALK gene rearrangement, 182 were negative and 37 cases were uninterpretable. Five patients with ALK gene rearrangement had a mean age of 48 years and the male to female ratio was 2:3. In the ALK negative cases, the mean age was 54 years and male to female ratio was 3.2:1. Histologically, amongst the rearranged cases, three showed solid pattern, one showed acinar and one showed acinar with signet ring cells on histology. CONCLUSION: The percentage of ALK gene rearrangement was 2.7% (excluding the uninterpretable cases). These ALK positive patients were relatively younger than ALK negative patients. Solid pattern on histology was associated with ALK positivity. In a quarter of the uninterpretable results, the material submitted was fixed and processed outside.

A clinico-morphological study of 95 cases of sarcomas with metastases to the lungs.

Background: Metastasis of soft tissue sarcoma most commonly occurs to the lungs. There are very few studies on histology of pulmonary metastatectomy and hardly any wherein the histology of the primary tumor has been compared with the metastasis. Aims and Objectives: To review histologically all metastatic sarcomas to lung and compare with the primary where available. Materials and Methods: Ninety-five patients with pulmonary metastases from sarcoma were analyzed histologically for type of sarcoma, chemotherapy-related changes, and changes in adjacent lung. Various clinical parameters like laterality, multiplicity, and interval between primary and metastasis were also studied. Results: Osteosarcoma constituted half of the metastatic sarcomas (48 cases, 50.5%) followed by synovial sarcoma (16 cases, 16.8%) and high grade spindle cell sarcoma-NOS (10 cases, 10.5%). The histology of primary and the metastases was similar in 60% of cases of osteosarcoma. Conclusions: Osteosarcoma is the commonest metastatic sarcoma to the lung. There is often a change to fibroblastic histology in patients of conventional osteosarcoma treated with chemotherapy.

Erythrocyte depletion of human umbilical cord blood using dextran sedimentation.

We report on the results of a study using high molecular weight dextran for depletion of red blood cells (RBCs) from cord blood. Our technique achieved efficient RBC depletion by sedimentation without a significant loss in haemopoietic stem cells. Cord blood units were fractionated for erythrocyte depletion by unit gravity sedimentation in 3 per cent high molecular weight dextran. Dextran sedimentation enabled recovery of more than 80 per cent of the total nucleated cells present and 100 per cent mononuclear cell (MNC) recovery as compared to unfractionated cord blood. A four-fold increase in the colony forming unit-granulocyte macrophage (CFU-GM) number per 2 x 10(5) cells was observed after dextran treatment suggesting that this step also resulted in the enrichment of stem cells.

Umbilical cord blood as a source of CD34 positive haematopoietic stem cells.

In this paper we have used a monoclonal antibody to CD34 an antigen expressed solely on stem cells, and stem cell colony assays to show that umbilical cord blood has nearly the same number of functional stem cells as compared to normal bone-marrow. The number of CD34+ve cells in cord blood being 2 to 2.7 per cent, whereas bone-marrow had 3 to 3.5 per cent. The multi-potent colony forming cells (CFU-GEMM) were 60 +/- 18 in cord blood per 2 x 10(5) mononuclear cells (MNCs), whereas normal bone-marrow had 70 +/- 10 per 2 x 10(5) MNCs. Enrichment of these stem cells on Percoll gradients was successful for normal bone-marrow but not for cord blood.

Enhancement of haemopoietic stem cell adherence to bone-marrow derived stroma by phyto-haemagglutinin treated leucocyte conditioned medium (PHA-LCM).

Stem cell adhesion to bone-marrow derived stroma, plays a crucial role in haemopoiesis. However, there is very little information as to the nature of the adhesion molecule. In this paper we have shown that human bone-marrow derived stroma can be established in tissue culture. This stroma is able to adhere human bone-marrow mononuclear cells including the multipotent stem cell, viz. CFU-GEMM. Their adherence increases when the stroma is treated with lymphokines in the form of PHA-treated leucocyte conditioned medium (PHA-LCM). Triton X-100 extracts of the untreated and PHA-LCM treated stroma were analysed on single dimension PAGE. It was observed that PHA-LCM treated stromal extracts showed two extra bands and an increase in the density of a band of approximately 14 kDa. Whether these changes have anything to do with the increased adhesion of stem cell is not yet known.

Serum total sialic acid and regan isoenzyme levels in patients with lung cancer.

Serum total sialic acid (TSA), Regan isoenzyme (RI) (heat stable placenta like alkaline phosphatase) and TSA/Total protein (TP) ratio were estimated in 44 cases of Lung cancer using highly specific chemical methods to assess their efficacy as malignancy markers. Levels of the two markers were compared with 27 matched healthy controls. A significant increase (P less than 0.001) in both the bio-markers were compared with 27 matched healthy controls. A significant increase (P less than 0.001) in both the bio-markers was observed compared to controls. TSA/TP ratio was significantly higher (P less than 0.001) in lung cancer patients compared to controls. TSA levels were elevated in more cases of patients compared to elevations in RI. Mean values of TSA and RI were higher in epidermoid carcinoma than adeno carcinoma. The use of combination of these markers may be considered in the diagnosis of the disease in future trials.

Serum haptoglobin level in patients with malignant lymphoma and its clinical significance.

Serum haptoglobin level and its phenotypes were studied in 208 normal people and 176 malignant lymphoma patients consisting of 112 Non-Hodgkin's Lymphoma (NHL) and 64 Hodgkin's Disease (HD) at Tata Memorial Hospital, Bombay and were correlated with the clinical stages of the lymphomas. Haptoglobin (Hp) levels were also estimated in the patients at different intervals during their chemotherapy. Hp level was found significantly increased to 147.83 +/- 8.67 in NHL and 173.57 +/- 13.31 in HD as compared to 67.46 +/- 2.53 in the controls. The phenotypic and gene frequencies in the lymphoma patients did not differ significantly from those of the controls. All the clinical stages, except stage I, of NHL and HD revealed significant rise in Hp level when compared with the controls. When different clinical stages of NHL and HD were compared separately, HD showed significant rise in HP level over the NHL only in Stage IV (p less than 0.05). Significant reduction in Hp level was observed when the disease regressed due to chemotherapy but it again increased with the relapse of the disease. Thus, the study of serum haptoglobin levels at intervals in lymphoma patients would help to understand the regression or relapse of the disease and also the prognosis.