[Prognostic markers in transitional carcinoma of the bladder]. / Marcadores pronósticos en el carcinoma transicional de vejiga.

Due to the diversity of the biologic behaviour of the low-grade and low-stage superficial bladder carcinomas, particularly those that present a high recurrence rate, most of the research has been oriented towards finding prognostic markers of recurrence and future invasion of the tumor. Among these markers there are two that have demonstrated their usefulness: the study of the contents of the cellular DNA by flow cytometry and the study of blood group antigens. The latter are carbohydrate structures that form a complex, genetically-regulated signal code which intervenes in the cellular growth and maturation processes. Recently published works describing genetic alterations in transitional bladder carcinomas, oncogenic mutations, loss of the 9q chromosome that regulates the formation of A and B antigens, support the hypothesis that in neoplastic transformation processes, genetic alterations cause enzymatic deficiencies and disorders, and these produce several antigenic changes of the cellular membrane and thus interfere in the biologic behaviour of the malignant cell.

Expression of type 1 blood group precursor in human gastric carcinoma.

The surface epithelium of normal gastric mucosa from patients with gastric adenocarcinoma expressed the type 1 blood group precursor only in Lewis (Le) non-secretor individuals, Le a+b- (se/se, Le/-) and Le a-b- (se/se, le/le). In secretors, the superficial mucosa was negative. Deep areas of the mucosa showed no type 1 precursor regardless of secretor status. Expression of type 1 precursor was anomalously found in neoplastic cells in 14 of 16 Le a-b+ (secretors) patients and in 4 of 5 Le a-b- (secretors) patients. The 1 Le a-b- non-secretor carcinoma expressed type 1 precursor strongly. 6 of 8 Le a+b- non-secretor carcinomas showed positivity for the monoclonal antibody K-21. Thus the type 1 precursor reacted with the non-neoplastic gastric surface of non-secretors but not with those of secretors, and also with most gastric adenocarcinoma regardless of secretor status and Lewis phenotype.

Lewis system alterations in gastric carcinogenesis.

Alterations in the expression of type 1 blood group-related antigens (Lewis a and b) were examined immunohistochemically in 371 consecutives gastric biopsy and 80 surgical specimens from patients of gastric carcinoma. The ABH and Lewis phenotype and secretor status of the patients were correlated with histologic findings. An anomalous expression of Lewis a antigen was found in 88 of 249 gastric biopsy specimens of Lewis (a-b+) phenotype patients. The prevalence of this anomaly increased with the evolution of the premalignant process, in agreement with the commonly accepted model of gastric carcinogenesis. Thus, anomalous Lewis a antigen appeared in 66.6% of gastric dysplasia cases, in 64.6% of intestinal metaplasia, in 15.4% of atrophic gastritis, and in 7.4% of superficial gastritis. No alterations were found in subjects with normal gastric mucosa. Forty-seven of the 49 Lewis (a-b+) phenotype gastric carcinoma patients showed antigenic alterations in tumor cells (anomalous Lewis a antigen in 36 and loss of Lewis antigens in 11). In 26 of these gastric specimens an anomalous Lewis a antigen was present in areas of intestinal metaplasia and/or dysplasia away from the area of neoplastic transformation. The expression of Lewis a antigen in Lewis (a-b+) phenotype patients is a frequent phenomenon in gastric neoplastic cells and could result from the blocked synthesis of Lewis b antigen with accumulation of its precursors. These findings suggest that, during gastric carcinogenesis, antigenic alterations may precede neoplastic transformation. An anomalous Lewis a antigen could constitute a significant index of severity of the histologic lesion and contribute to identifying high-risk individuals.

Immunohistological patterns of blood group ABO and type 1 chain (Lewis a Lewis b) and type 2 chain (H-2, Y) antigens in normal uterine cervix.

Ten monoclonal antibodies and one lectin were used to study the localization and distribution of Blood Group ABH, type 1 chain (Lewis a, Lewis b) and type 2 chain (H-2, Y) antigens in 22 cases of normal uterine cervix, with known ABO and Lewis phenotype and secretor status. The results showed that ABH isoantigen expression is clearly related to the secretor status. It is positive in the endo- and exocervical epithelium of secretor individuals and negative in non-secretors. Lewis antigen expression in both endocervical and exocervical epithelium is related to the patient's Lewis phenotype and is clearly controlled by the secretor gene. Indeed, the expression of the Lewis a antigen is limited to the tissue of people of Lewis (a + b-) phenotype (non-secretors), and the expression of Lewis b antigen is limited to the tissue of people of Lewis a-b+) phenotype (secretors). The Y antigen showed a focal expression in endocervical mucosa in all the cases, independently of secretor status or Lewis phenotype. The same pattern was observed for H-type 2 antigen, though only in secretor individuals.

Expression of type 1 and type 2 blood group-related antigens in normal and neoplastic gastric mucosa.

The distribution of the blood group-related antigens type 1 (Lewis(a) [Le(a)], Lewis(b) [Le(b)]) and type 2 (H type 2, Y) has been examined in histologically normal and malignant mucosa of 40 surgical specimens of patients with adenocarcinoma of the stomach, with the use of a panel of monoclonal antibodies. Patients' Lewis phenotype and secretor status are correlated to the authors' findings. The surface epithelium of normal pyloric and fundic mucosa expressed the Lewis isoantigen (Le(a) in Le[a+b-] phenotype and Le(b) in Le[a-b+] phenotype), whereas the deep areas of this mucosa no showed the Le(a), Le(b) antigens and expressed the Y and H type 2 antigens whatever the secretor status of patients. Nineteen of 24 patients with Le(a-b+) phenotype showed anomalous expression of Lea antigen in neoplastic cells. In three of them, this alteration was found in tumor adjacent mucosa. No expression of Le(a) or Le(b) antigens was found in tumors or normal mucosa from Le(a-b-) phenotype patients.

Expression of Lewis antigenic determinants in colorectal adenocarcinomas.

Expression of type 1 and type 2 chain Lewis antigens was studied in 32 rectal adenocarcinoma specimens; the results were correlated with the patients' Lewis phenotype and secretor status. In addition, the pattern of expression of these antigens was analyzed in adjacent and distant normal mucosa. We used an indirect immunofluorescence technique with p-phenylenediamine counterstaining (Oriol technique) and a panel of monoclonal antibodies directed against the different antigenic specificities. Normal distal colonic mucosa only expresses monofucosylated structures (Lea and X) arising from activity of the alpha 1-3,4-fucosyltransferase coded by the Le gene. Rectal adenocarcinomas also show Lea and X, but also reexpress blood group antigens ABH and exhibit difucosylated determinants (Leb and Y). The accumulation of mono- and difucosylated type 2 chain in neoplastic processes, independently of the Le and Se genes, could be due to the enzymes coded by reactivation of the H and X genes. Blood group antigens form a complex signal code, genetically regulated, which intervenes in differentiation, growth and cellular recognition processes, and which may undergo important modifications during malignant transformation. These alterations could be useful in the diagnosis and prognosis of some types of carcinoma.

T-antigen. A prognostic indicator of high recurrence index in transitional carcinoma of the bladder.

Forty biopsies from 36 patients with bladder tumors were tested for T-antigen (TAg) expression on tumor cells on sections untreated or treated with neuraminidase; a 37.5% of tumors showed abnormal expression of TAg either as an aberrant expression, or absence of this antigen after removing sialic acid. These changes were not well correlated with histologic signs of anaplasia or infiltration, nor with other biologic properties of tumor cells such as the expression of blood group antigens (ABH). However, a practical utility of TAg in the study of bladder tumors, is suggested by the analysis of those biopsies with low-grade low-stage tumors, on which the abnormal expression of TAg was more discriminatory than the ABH changes in defining those patients suffering tumors with a particular aggressiveness. Circulating antibody titer was also investigated in 20 patients but all of them displayed titers in the normal range, with independence of the results observed in their corresponding bladder biopsies.

[Pancreatic resection in the treatment of infantile hypoglycaemia]. / La pancreatectomía en el tratamiento de la hipoglucemia.

Authors report four patients with hyperinsulinemic unremitting hypoglycaemia due to pancreatic nesidioblastosis. Onset was neonatal in three of them and at the end of the first year in the remaining one. After variable periods of only partially successful medical therapy, the four patients were operated and subtotal pancreatectomy was carried out. This alone was sufficient in one case, and in another one diazoxide made control possible. The other two children had a total pancreatectomy, and one of them has needed insulin ever since. Hypoglycaemia is under control in all children and only one has mental impairment. Diagnostic work-up and surgical techniques are described, and the need for a prompt operation when medical control is incomplete is stressed. Although apparently a blind and major undertaking, surgery is still the only way of preserving neuronal function in some selected cases.

Cryptorchidism and persistence of Müllerian remnants in a normal male.

A four-year-old boy was explored for bilateral cryptorchidism. Operation led to the discovery of two intraabdominal testes with their corresponding vasa, two Fallopian tubes and a small uterus. No urological anomalies were found except for a vesico-ureteral reflux. Cystourethroscopy revealed a normal male tract. Sexual chromatine was negative and karyotype was 46, XY. A normal rise in testosterone serum level was recorded after stimulation with CGH. At operation both gonads could be placed extra-abdominally and the female internal structures were biopsied and left in place. This very unusual condition is derived from the absence of regression of Müllerian structures during fetal life due to a deficit in testicular secretion of anti-Müllerian hormone. The current knowledge on this topic is updated.

[Mesenteric cystic lymphangiomas (report of three cases) (author's transl)]. / Linfangiomas quísticos del mesenterio. Estudio de tres casos.

Three cases of mesenteric cystic lymphangiomas in children are reported. All of them were found during laparotomies for acute abdomen, and their pathology was rather similar, except for the contents which was chylous in the two cases located in the jejunum and serous in the remaining ileal case. One of these tumours contained calcified material, a fact which makes diagnostic suspicion possible. The literature on this topic is up-dated.