Prognostic value of carcinoembryonic antigen distribution in tumor tissue of colorectal carcinoma / Valor prognóstico da distribuição do antígeno carcinoembriônico (CEA) no tecido neoplásico do carcinoma colorretal

CONTEXT: Carcinoembryonic antigen (CEA) can be detected in colorectal tumor tissue but its role in the survival of patients remains controversial. OBJECTIVE: To characterize the expression of tissue CEA using immunohistochemical staining in colorectal tumors and to analyze the relationship between this finding and preoperative plasmatic level of CEA, morphologic features and survival of patients operated with curative intent for colorectal carcinoma. METHOD: Forty-seven patients were included in the study: 18 (38.3 percent) males and 29 (61.7 percent) females, with a mean age of 67.8 ± 9.7 years (37 to 84 years). Immediately before laparotomy, pre-operative serum levels of CEA were obtained where normal levels were considered <2.5 ng/mL for non-smokers, and <5.0 ng/mL for smokers. CEA immunohistochemical studies were carried out using anti-human CEA monoclonal mouse antibody. The expression of immunostaining for each neoplasia was classified according to the pattern of CEA tissular distribution into apical or cytoplasmic. The variables considered for the statistical analysis were plasmatic preoperative CEA level, location of the lesion within the large intestine, lesion diameter, lymph node involvement, Duke's classification, vein invasion, grade of cellular differentiation, survival and pattern of CEA tissular distribution. The statistical models utilized were Spearman's correlation and the Mann-Whitney, Kruskal-Wallis and Student t tests. Patients' survival was analyzed using the Kaplan-Meier method. RESULTS: The mean preoperative CEA value was 15.4 ± 5.5 ng/mL (0.2 to 92.1 ng/mL). The neoplasm was located in the colon in 29 (61.7 percent) and in the rectum in 18 (38.3 percent) patients. Eight (17.0 percent) patients were classified as Duke's stage A, 22 (46.8 percent) as stage B and 17 (36.2 percent) as stage C. On immunohistochemical studies, the pattern of CEA tissular distribution was apical in 33 (70.2 percent) patients and cytoplasmic...

CONTEXTO: O antígeno carcinoembrionário (CEA) pode ser detectado no tecido do carcinoma colorretal, mas seu papel na sobrevivência dos doentes permanece controverso. OBJETIVO: Caracterizar a expressão do CEA tecidual com coloração imunoistoquímica na neoplasia colorretal e analisar a relação entre esse achado e os níveis plasmáticos pré-operatórios do CEA, aspectos morfológicos e a sobrevivência dos doentes operados com intenção curativa de carcinoma colorretal. MÉTODO: Quarenta e sete doentes foram incluídos neste estudo: 18 (38,3 por cento) homens e 29 (61,7 por cento) mulheres, com média de idade de 67,8 ± 9,7 anos (37 to 84 anos). Imediatamente antes da laparotomia, foram obtidos os níveis plasmáticos pré-operatórios do CEA. Níveis séricos pré-operatórios normais de CEA foram considerados < 2,5 ng/mL para não-fumantes e <5,0 ng/mL para fumantes. O estudo imunoistoquímico do CEA foi realizado utilizando anticorpo monoclonal de rato anti-CEA humano. A expressão da imunocoloração de cada neoplasia foi classificada de acordo com o padrão de distribuição tecidual do CEA em apical ou citoplasmática. As variáveis consideradas para a análise estatística foram os níveis plasmáticos pré-operatórios do CEA, localização da lesão no intestino grosso, diâmetro da lesão, comprometimento dos linfonodos, classificação de Dukes, invasão venosa, grau de diferenciação celular, sobrevivência e padrão da distribuição tecidual do CEA. Os modelos estatísticos utilizados foram correlação de Spearman, teste de Mann-Whitney, teste de Kruskal-Wallis e teste t de Student. A sobrevivência dos doentes foi analisada utilizando-se o método de Kaplan-Meier. RESULTADOS: O valor médio de CEA pré-operatório foi de 15,4 ± 5,5 ng/mL (0,2 a 92,1 ng/mL). A neoplasia estava localizada no colo em 29 (61,7 por cento) e no reto em 18 (38,3 por cento) doentes. Oito (17,0 por cento) doentes foram classificados como estádio A de Dukes, 22 (46,8 por cento) como estádio B e 17...

Bcl-2 expression in rectal cancer

BACKGROUD: Proteins involved in apoptosis process seem to play an important role in colorectal carcinogenesis AIM: To determine the prevalence of bcl-2 protein immunohistochemical expression and its relation with clinical and histopathological variables of rectal adenocarcinoma. PATIENTS AND METHODS: One hundred and thirty-two patients operated at "Hospital de Clínicas de Porto Alegre", Porto Alegre, RS, Brazil, between 1988 and 1999 were studied through immunohistochemical reaction using a monoclonal antibody anti-bcl-2 on formalin-fixed, paraffin-embedded tissue samples RESULTS: The prevalence of bcl-2 protein was 29.5 percent. There was a significant increased number of positive bcl-2 cases among women as compared to men. There was no significant association between bcl-2 and age, tumour site, histological grade, mucin production, depth of invasion, lymphatic involvement, distant metastasis or stage, despite a trend showing decreased immunoreactivity to bcl-2 among poorly and moderately differentiated tumours, as well as disseminated disease CONCLUSIONS: Analysis of bcl-2 protein expression in tumour tissues, as well as other oncoproteins, may have a role in predict therapeutic response and prognosis of colorectal cancer. However, the potential use of bcl-2 protein assessment in the clinical set for management of rectal cancer remains to be determined.

RACIONAL: As proteínas envolvidas no processo de apoptose parecem desempenhar papel importante na carcinogênese colorretal. OBJETIVOS: Determinar a prevalência da expressão imunoistoquímica da proteína bcl-2 e sua relação com variáveis clínicas e histopatológicas do câncer de reto. PACIENTES E MÉTODOS: Cento e trinta e dois pacientes operados no Hospital de Clínicas de Porto Alegre, RS, entre 1988 e 1999 foram estudados através de reação imunoistoquímica, utilizando um anticorpo monoclonal anti-bcl-2 em amostras teciduais fixadas em formalina e parafinizadas. RESULTADOS: A prevalência da proteína bcl-2 foi de 29,5 por cento. Houve aumento significativo no número de casos bcl-2 positivo entre mulheres quando comparado aos homens. Não houve associação significativa entre bcl-2 e idade, sítio do tumor, grau histológico, produção de muco, profundidade de invasão, envolvimento linfático, metástases distantes ou estágio, apesar de uma tendência demonstrando imunorreatividade ao bcl-2 diminuída entre os tumores pouco e moderadamente diferenciados, bem como para doença disseminada. CONCLUSÕES: A análise da expressão da proteína bcl-2 em tecidos tumorais, bem como outras oncoproteínas, pode ter um papel em predizer a resposta terapêutica e o prognóstico do câncer colorretal. Entretanto, o uso potencial da avaliação da proteína bcl-2 na prática clínica no manejo do câncer de reto permanece a ser determinado.

Putrescine, DNA, RNA and protein contents in human uterine, breast and rectal cancer.

AIMS: To find out the status of DNA, RNA and protein in human uterine, ovarian, breast and rectal carcinoma. MATERIAL AND METHODS: In this prospective study, patients of age group between late thirties and late fifties suffering from uterine, ovarian, breast and rectal cancer were taken as subjects of the present study. The total number of cases studied for each cases was ten. Pieces of human carcinomatous tissues of above mentioned cases were taken along with surrounding normal tissues. From the tissue samples, putrescine is separated by the method of Herbst et al, DNA analysed by Diphenylamine method, RNA by Orcinol method and protein by Biuret method. RESULTS: Tissue content of putrescine rises simultaneously with that of DNA, RNA and protein in carcinomatous growths as above in comparison to their respective adjacent normal tissue, the differences being statistically highly significant. CONCLUSIONS: Increase in DNA, RNA and protein concentration may be a pre-requisite for increased synthesis of putrescine in carcinomatous tissue and thereby the concentration of other di- and poly-amines.

Morphological & immunohistochemical spectrum in anorectal malignancies.

The morphological features of 62 anorectal malignancies diagnosed on sigmoidoscopic biopsy were studied. On haemotoxylin and eosin staining the tumours were diagnosed as adenocarcinomas (43), squamous cell carcinoma (12), malignant melanoma (3), carcinoid (2), clear cell carcinoma (1) and poorly differentiated carcinoma (1). PAS Alcian blue, Grimelius silver stain, AgNOR and immunohistochemical stain for carcinoembryonic antigen (CEA) and human papilloma virus (HPV) were done to further categorise these tumours. The ages of the patients varied from 18 to 77 yr (mean 43.7 yr) and the male: female ratio was 2:1. PAS Alcian blue staining was helpful in differentiating mucinous from non-mucinous adenocarcinomas and reclassifying one poorly differentiated carcinoma as mucin secreting adenocarcinoma. Also, it clearly identified pagetoid spread in two cases of adenocarcinomas. Grimelius silver stain was strongly positive in melanomas and neuroendocrine tumours. Basal silver staining was visualised in metaplastic foci but was absent in dysplastic epithelium. AgNOR counts may be considered useful in differentiating melanomas (high counts) from spindle cell variant of squamous carcinomas (low counts). High AgNOR counts and strong Grimelius positivity in clear cell carcinoma suggested its melanotic origin. Immunostaining for CEA and HPV were of limited value. CEA was positive in the majority of the adenocarcinomas while HPV could only be demonstrated in two squamous cell carcinomas.