Secondary carcinoma of testis--a clinicopathologic study of 10 cases.

Ten cases of metastatic carcinomas to the testis are recorded in the last 17 years from Tata Memorial Hospital (TMH). There were two from kidney and four each from prostate and gastrointestinal tract carcinomas. The age of the patients ranged from 40 to 82 years with a mean of 57 years. The disease was unilateral in eight cases and bilateral in two. The testicular mass preceded the symptomatology of the primary lesion in a single case. The disease was an incidental finding in three prostatic carcinomas, where bilateral orchidectomy was performed as a therapeutic procedure. Hydrocele was associated in three cases. Grossly the tumour deposits were nodular or diffuse. Microscopically involvement of the interstitial parenchyma, with sparing of the tubular structures of the testis, epididymis and retetestis and special stains for mucin were helpful in the diagnosis. Lymphatic emboli were present in six cases and vascular emboli in three. The spermatic cord was involved in two cases.

Mucin histochemistry of the lower gastrointestinal tract.

Variations in the mucin secretion pattern in the mucosal lining of the colon and rectum have been studied. Mucins have been differentiated histochemically as neutral mucins, sialomucins and sulphomucins, using alcian blue/PAS and HID/alcian blue techniques. In the normal colonic mucosa, the goblet cells secrete predominantly sulphomucins with small amounts of sialomucins. Twenty one cases with benign lesions showed varying patterns of mucin secretion. In the 35 cases with adenocarcinoma studied, the transitional mucosa adjacent to the lesion showed a reversal of mucin secretion pattern, with an increase in sialomucins and a marked decrease in sulphomucins, suggesting a reaction to neoplasia.

Mucin histochemistry of the upper gastrointestinal tract.

Histochemically differentiated mucins have been studied in the mucosal lining of the esophagus and the stomach. Acid mucin was differentiated from neutral mucin by the alcian blue/PAS technique and sulphomucin by the high iron diamine/alcian blue technique. Neutral mucin secreted normally by the stomach mucosa was replaced by acid mucin in 17 of the 19 mucin secreting adenocarcinomas involving the lower third of the esophagus, and in 24 of the 28 mucin secreting gastric adenocarcinomas studied. The intestinal metaplasia (IM) seen in the gastric mucosa associated with adenocarcinoma, chronic gastric ulcer and chronic gastritis was classified according to the type of mucin secreted by the goblet cells. IM secreting sulphomucins was seen to be associated with gastric adenocarcinoma.

Lectin binding in colorectal mucosa.

Lectin binding of goblet cell mucin in human colonic mucosa was studied in patients with irritable bowel syndrome, colorectal malignancy and ulcerative colitis using plant lectins, Dolichos biflorus agglutinin (DBA) and peanut agglutinin (PNA). Normal colonic mucosa demonstrated a strong binding with DBA (100%) but did not bind to PNA at all. Colonic carcinomas showed strong PNA binding (7 of 15 biopsies) while DBA binding was absent in 14 of 15 biopsies. The transitional mucosa showed reduced or absent DBA binding in 6 and positive PNA binding in 2 of 15 biopsies. During the active phase of ulcerative colitis, there was a loss of DBA binding in 10 of 15 biopsies, which was restored during remission in all. One biopsy with severe dysplasia showed PNA binding. It is concluded that normal colorectal mucosa binds DBA strongly but not PNA. Malignant tissue and transitional mucosa reveal PNA binding often, with decreased DBA binding. In ulcerative colitis DBA binding decreases during phases of activity.