Hemorrhagic invasive ductal carcinoma with immunohistological expression of b-subunit HCG: A case report.

A hemorrhagic breast mass was excised from a 27-year-old female. Microscopically, the tumor showed typical areas of invasive ductal carcinoma with intraductal component admixed with some trophoblast-like tumor giant cells in the hemorrhagic area. These cells exhibited β-subunit HCG by immunohistochemistry. The modified radical mastectomy was done after exclusion of the coexisting choriocarcinoma in breast cancer. Postoperatively, the HCG serum level was within normal limit and the gynecological check up showed no positive findings. The modified radical mastectomy specimen revealed that the residual tumor showed the same findings as seen in the previously excised mass.

Significance of thyroglobulin in thyroid diseases detected by the immunoperoxidase method.

Thyroglobulin (TG) is a protein that synthesized from the thyroid follicular epithelium and can reflect the thyroid gland in origin together with the cellular activity. The aim of this study is to detect TG qualitatively and semiquantitatively by immunoperoxidase method in various thyroid lesions. The result shows that all of the nodular goitre (43 cases), primary diffuse hyperplasia (18 cases), adenoma 60 cases, papillary carcinoma (43 cases) and follicular carcinoma (22 cases) show cytoplasmic staining of TG in varying pattern and intensity, while only 3 out of the 7 anaplastic carcinoma show irregular cytoplasmic staining. These findings can be used in identifying the thyroid gland in origin in the metastatic lesion and the functional status of the lesion.

Determination of marrow involvement in non-hodgkin's lymphoma by immunocytochemical studies.

Bone marrow involvement in non-Hodgkin's lymphoma (NHL) alone can raise the clinical stage from I and II (localized disease) to IV (advanced disease). Multiparameter assessment is thus required to detect early marrow involvement (positive marrow) besides the conventional morphologic evaluation of bone marrow biopsy and marrow aspirates. Determination of lymphocyte subsets in the marrow is considered useful if the phenotype of NHL is known. To prove this possibility, we have performed immunocytochemical studies on marrow aspirate smears to determine CD3+ T-cells and CD19+ B-cells by using the alkaline phosphatase-labeled streptavidin-biotin method in 8 cases of NHL with positive marrow (4 B-cell, 4 T-cell NHL), 11 cases of NHL with negative marrow (8 B-cell, 3 T-cell NHL), and 11 cases of controls including Hodgkin's disease (2), acute leukemia (4), SLE (1), anemia (1), inflammatory bowel disease (1), polycythemia vera (1), and Wegener's granulomatosis (1). CD3+ T-cells and CD19+ B-cells were enumerated by counting 500 nucleated marrow cells. The results showed that the mean CD3/CD19 ratios in B-cell NHL and T-cell NHL with positive marrow were 1.8 and 20.5, while those in B-cell NHL and T-cell NHL with negative marrow and in controls were 3.3, 3.1, and 2.6, respectively. Moreover, cytologic difference between CD3+ T-cells and CD19+ B-cells was observed in 1 case of B-cell NHL and 3 cases of T-cell NHL with positive marrow, while such a difference was absent in NHL with negative marrow and in controls except in 1 case of T-cell NHL with negative marrow. Therefore, immunocytochemical studies are helpful to determine marrow involvement in NHL.

Expression of insulin-like growth factor I and II in various regionally important solid tumors.

Insulin-like growth factor I (IGF-I) may thwart a T cell response to several cancers, since suppression of IGF-I expression using an episome transcribing an antisense RNA into rat glioma and murine teratocarcinoma, which are known to actively express IGF-I, resulted in tumor regression and CD8+ T cell infiltration.1,2,3,4 This finding led to the gene therapy protocol for human glioblastoma multiforme, a known IGF-I over-expressing tumor, using the same strategy in 1993. The hypothesis that cancers which over-express IGF-I can be cured by this episome has led us to search for other cancers which actively produce IGF-I. Many cancers were reported to express IGF-I4, but most of the geographically important tumors in Thailand had not been studied for the expression of IGF-I. Our immediate goal was to survey the leading human cancers in the Tumor Registry of Siriraj Hospital (i.e., non-small cell lung cancer, cholangiocarcinoma, hepatocellular carcinoma, papillary thyroid carcinoma, nasopharyngeal carcinoma) including all stages of astrocytomas for the expression of IGF-I and IGF-II (a homologue of IGF-I). Tumor tissue collected from paraffin blocks deposited at the Department of Pathology, Siriraj Hospital was screened for the presence of the predominant form of IGF's (IGF-I or -II). Tumor tissues that express any specific form of IGF's more than adjacent wild-type cells are potential candidates for an antisense gene therapy against the expression of that specific form of IGF. Paraffin sections containing these cancer cells and adjacent wild-type cells were examined by immunohistochemical technique using mouse IgG-1 antihuman IGF-I, or antihuman IGF-II as primary antibodies. Normal liver tissue, known as the largest producer of both forms of IGF's, was used as a positive control. The staining pattern of both IGF-I and IGF-II in the liver was highest in the cytoplasm of normal hepatocytes. The majority of the tumors except for papillary thyroid carcinoma and nasopharyngeal carcinoma strongly expressed IGF-I. Only a few samples of the tissues studied expressed a low level of IGF-II, if any. This raises a further working proposal that the blockade of IGF-I synthesis in these tumors may help to delay the tumor progression so that an effective immune response can be established and destroy the tumor.

Mixed carcinoid – adenocarcinoma of vermifrom appendix: A case report.

Three histology types of appendiceal carcinoid are classified as: tubular carcinoid or classic carcinoid; goblet cell carcinoid or adenocarcinoid; and mixed carcinoid-adenocarcinoma. Each have a different prognosis and method of treatment. We report a 56-year-old Thai woman who presented with an intermittent abdominal pain in the right lower quadrant for nine months and was finally diagnosed as acute appendicitis. Appendicectomy was performed and the patients was unexpectedly found to have a mixed carcinoid-adenocarcinoma. Subsequently, hemicolectomy was carry out to provide appropriate treatment. Immunostains and ultratructural studies were performed to confirm the combination of endocrine and glandular differentiation.

Dedifferentiated leiomyosarcoma of the retroperitoneum, report of a case with immunohistochemical and ultrastructural study.

Dedifferentiated leiomyosarcoma is referred to well-differentiated leiomyosarcoma with presence of pleomorphic malignant fibrous histiocytome - like portion. A case of this tumour of the retoperitoneum was reported in a 75-year-old Thai woman who complained of 2 months of right sided abdominal pain. The 8 cm well-circumscribed mass adherent to the aorta and right ureter was found. Removal of the tumour with cauterization of the remaning fibrous tissue was performed. The patient died 3 months later with recurrence of the tumour and metastasis. Pathological examination revealed well-differentiated leiomosarcoma with abrupt change into malignant fibrous histiocytoma – like tumour. The pleomorphic multinucleated giant cells had immunoreactivities for vimentin, alpha-1-antitrypsin and alpha-1-antichymotrypsin. Very few cells stained with smooth muscle actin. Ultrastructural features were those of undifferentiated cells with rare poorly developed microfilaments with dense aggregate-like area. The findings were similar to one dedifferentiated leiomyosarcoma of the intestinal tract reported by Fakuda et al. The immunohistochemical and ultrastructural study of the dedifferentiated portion reflected malignant fibrous histiocytoma-like features (myofibroblastic) or differentiation toward smooth muscle.