Immunohistology is valuable in distinguishing between Paget's disease, Bowen's disease and superficial spreading malignant melanoma.

Thirty-nine lesions, originally diagnosed as Paget's disease (19), superficial spreading melanoma (13) or Bowen's disease (7), were reviewed. Supplementary immunohistochemistry on routine processed tissue, using antibodies to cytokeratins (PKK1 and M717) and to S-100 protein, was carried out. Two of the lesions, originally classified as Bowen's disease and superficial spreading type malignant melanoma respectively, were reclassified as Paget's disease based on the immunohistochemical findings. Both lesions contained pagetoid cells positive with PKK1. The results indicate that immunohistochemistry may sometimes be valuable in establishing the correct diagnosis in such lesions.

Epithelial cells from human fallopian tube in culture.

The epithelial cells lining the inner surface of the Fallopian tube influence the reproductive process by both their ciliary and secretory activities. The aim of the present work was to establish a method to culture these cells as a model for more specific studies of their properties. Minor slices of the mucosal ridges were cut and minced extensively using a fine scissor. The resulting pieces were washed once, resuspended in RPMI 1640 with 20% fetal calf serum and seeded in plastic dishes. After 2 days, the medium was replaced with RPMI 1640 containing human albumin, insulin and transferrin. Seven to 10 days later, the cell number had increased 5-8 times in 70% of the cultures. The identity of the cells was assessed after 1-3 weeks in culture. Of the cells, 98% stained positive for the antibody to epithelial cell-specific protein cytokeratin. Electron microscopic studies of the cultures showed epithelial characteristics including cilia, microvilli and intercellular junctions in the form of desmosomes. The cells could be kept in culture for 6-8 weeks. In conclusion, a method to culture epithelial cells from the human Fallopian tube is described. The cells have been identified and they can be kept in culture for 6-8 weeks in quantities sufficient for experimental use.

N-myc amplification in neuroblastomas: histopathological, DNA ploidy, and clinical variables.

The association between tumour N-myc amplification, DNA ploidy, and various prognostic factors (patient age, tumour stage at diagnosis, primary site and histopathological differentiation) was studied in 18 children who had neuroblastoma, ganglioneuroblastoma, or ganglioneuroma. Amplification of genomic N-myc was observed in six patients who had been treated with chemotherapy before surgery (one with stage III and five with stage IV). All these tumours were located in the adrenal or upper retroperitoneum; five were neuroblastomas and one was a ganglioneuroblastoma. Three of them were aneuploid and three diploid. The degree of N-myc patients with tumour N-amplification varied from 20 to 1500 copies without relation to ploidy. All patients with tumour N-myc amplification died of their tumour. Amplification was always associated with poor prognosis, independent of tumour cell ploidy. Four patients without such amplification also died: three had diploid tumours, the fourth was aneuploid. It is suggested that genomic N-myc amplification takes place mainly in adrenal and retroperitoneal neuroblastomas and can be a feature of tumours with and without histological signs of differentiation. The precise role of N-myc in the pathogenesis of neuroblastoma remains unclear.

Bone marrow examination in neuroblastoma patients: a morphologic, immunocytochemical, and immunohistochemical study.

Bone marrow examination was performed at the time of diagnosis, before initiation of therapy, and during follow-up of 14 consecutive patients with neuroblastoma who were treated at the National Hospital in Oslo. A total of 30 bone marrow specimens were examined by conventional histology, by immunohistochemistry with selected monoclonal antibodies to neuroblastoma cells (UJ 13A, UJ 167.11, PI 153/3, and A2B5) applied on trephines, and by morphologic evaluation of smears in addition to immunocytochemistry of aspirated bone marrow cells. The study confirmed the value of immunohistochemistry and immunocytochemistry for the detection of bone marrow involvement in neuroblastoma. Immunohistochemistry performed on bone marrow trephines was a slightly better adjunct than immunocytochemistry on aspirated bone marrow cells.

Feulgen DNA values in Wilms' tumour in relation to prognosis.

Single-cell DNA measurements were performed on Feulgen-stained nuclei in 4 mu tumour sections from 30 patients with Wilms' tumour, all treated with initial nephrectomy. Fifteen patients died from their tumours within 2 years of nephrectomy. The remaining 15 had survived for at least 10 years without evidence of recurrence. Based on the histograms, the tumours were classified as being euploid (E type) or aneuploid (A type). Twenty tumours were euploid and 10 aneuploid. The euploid tumours predominated in the group of survivors. The group of 10 aneuploid tumours contained 7 tumour deaths. The tendency for aneuploid tumours to be associated with early tumour death, however, was not statistically significant.

Prognostic factors in neuroblastoma. Clinical, histopathologic, and immunohistochemical features and DNA ploidy in relation to prognosis.

Tumor samples from 58 patients diagnosed and treated for neuroblastoma or ganglioneuroblastoma in a single institution from 1967 to 1981 were included in a study of prognostic factors. Histopathology, certain immunohistochemical markers, and DNA ploidy were evaluated along with clinical variables such as tumor stage, primary site, and patient's age at diagnosis. Children under 1.5 years of age at diagnosis had a much better prognosis than did older ones, and this variable was the best prognostic indicator. Tumor Stages I to II and IVS, primary tumor site above the diaphragm, and tumor differentiation were also related to a better prognosis. The Shimada classification was of no additional prognostic value in our study. Neither was the immunohistochemical marker pattern, but it was sometimes helpful in establishing the tumor diagnosis. Tumor-cell ploidy, however, seemed to afford additional prognostic information because the 11 patients with aneuploid tumors under the age of 1.5 years at diagnosis all survived in contrast to only five of nine patients with diploid tumors in the same age group. It is possible that this was due to a better response to treatment in the aneuploid group. Our results suggest that patients with diploid neuroblastomas of undifferentiated histology and those over the age of 1.5 years at diagnosis might be selected for more intense treatment.

Carcinoma of the nasopharynx. Histopathological examination with supplementary immunohistochemistry.

One hundred and one nasopharyngeal malignancies, clinically accepted and treated as carcinomas, were histologically reviewed. Originally, all of them had been given the histopathological diagnosis of carcinoma or possible carcinoma. A wide variety of diagnostic formulations had been used, some of them inconclusive. The review was based on strict morphological WHO criteria, and a definite diagnosis was attained in most cases. Three of the neoplasms, however, did not fulfil the criteria of carcinoma, and were given the diagnosis of malignant tumour, probable lymphoma. Immunohistochemistry with routinely processed tissue was performed on 69 of the poorly differentiated non-keratinizing neoplasms, including the three possible non-Hodgkin's malignant lymphomas. The neoplasms were positive for cytokeratin PKK1 with four exceptions: the three possible lymphomas and a large cell tumour with epithelial growth and prominent nucleoli which was found to be positive only for neurone-specific enolase. Two of three possible lymphomas were verified as such by being positive for leucocyte common antigen. This study showed that the WHO classification is quite useful when strictly applied. The histopathological diagnosis of this category of neoplasms can easily be confirmed by immunohistochemistry on routinely processed material and this adjunct can usually resolve questionable cases.

Immunohistochemical performance testing of monoclonal antibodies to neuroblastoma cells on normal adrenals, spinal and sympathetic ganglia, and neural crest tumours.

Tissue specimens of neural crest-derived structures like normal spinal and sympathetic ganglia and adrenals of adults, infants and fetuses were used as immunohistochemical test substrates for a panel of 10 monoclonal antibodies to neuroblastoma cells raised by immunization with a variety of immunogens (fetal brain, neuroblastoma cell lineages, chick retinal cells or purified Thy-1 antigen). Antigen expression varied among normal structures such as ganglion cells, satellite cells, various nerve fibres, and different cells in the adrenal cortex. This variability in immunoreactivity shown by different cell types and structures was comparable to that seen when the same panel of monoclonal antibodies was applied to neuroblastomas and to ganglioneuroblastomas of different degrees of maturation and differentiation. The neoplasms thus seemed to reflect the normal maturation in the neuroectodermally-derived structures. Also, the studies give indications as to the cell of origin of the undifferentiated neuroblastomas.

Immunohistochemical differentiation of neuroblastomas from other small round cell neoplasms of childhood using a panel of mono- and polyclonal antibodies.

A panel of monoclonal antibodies to neuroblastoma cells, leucocyte common antigen, vimentin and MHC class II antigens (HLA-DR) and a polyclonal antibody to epidermal keratin were used for immunohistochemistry on sections of ethanol fixed and paraffin embedded specimens from 40 undifferentiated small cell tumours and 10 neural crest neoplasms. With the exception of central nervous system neoplasms and two embryonal rhabdomyosarcomas, immunohistochemical examination discriminated between the neural crest neoplasms and the other small cell tumours. Moreover, the staining pattern of neoplastic cells and structures in the neural crest neoplasms obtained with antibodies to neuroblastoma cells seemed, in part, to reflect the degree of tumour differentiation.

Erythrokeratodermia variabilis: immunohistochemical and ultrastructural studies of the epidermis.

Immunohistochemical and ultrastructural study of the epidermis was performed in a 53-year-old female with erythrokeratodermia variabilis (EKV) before and after treatment with the aromatic retinoid Etretinate (RO 10-9359). Aberrant expression of cytokeratin PKK2 (Labsystems, Helsinki, Finland) in lesional EKV stratum corneum was observed; this feature disappeared after Etretinate therapy. A normal distribution of DR-positive dendritic Langerhans' cells was seen in diseased, control and post-treatment skin specimens. The striking finding of this study was thus the shift to a basal cell-type keratin reactivity in stratum corneum in lesional skin, perhaps a reflection of cytoskeleton features related to cell adhesion. Increased adhesion between the cells in stratum corneum might account for the retention type of hyperkeratosis characteristic of EKV.

Diffuse pulmonary ossification and spontaneous pneumothorax in a pilot: a case report.

A 51-year-old pilot with spontaneous pneumothorax, emphysema, and multiple horny ossification in the lung is reported. The literature concerning diffuse pulmonary ossification is reviewed and aeromedical implications are discussed.

Ehlers-Danlos syndrome and diverticula of the bladder.

Cases of two boys, 6 and 4 years old respectively, with Ehlers-Danlos syndrome (EDS) and large bladder diverticula, are reported. Diverticulectomies were performed, but large diverticula reappeared in both patients. A connection between the increased extensibility of the connective tissue in EDS and the development of bladder diverticula is suggested.

Synovial sarcomas of the neck. A report of two cases.

Two cases of synovial sarcomas in the hypopharynx are reported, together with a review of similar neoplasms previously reported in this unusual region. The treatment of choice seems to be aggressive, with radical surgery followed by radiation therapy.

Radiographic diagnosis of non-palpable breast lesions. Correlation to pathology.

Eighty-seven mammary biopsies with radiographic signs of malignancy (microcalcifications or tissue condensation) without a corresponding clinical mass were examined by specimen radiography to determine the mammary lesion microscopically and find the exact location of the possibly malignant-associated microcalcifications. Fourteen malignant lesions (16.1%) were found, and atypical intraductal proliferations in an additional 14 biopsies. The calcifications were mostly located in the atypical epithelium. In 9 cases, however, the calcifications were located at a distance from the atypical epithelium. An open guided biopsy Is therefore considered to be mandatory in these cases.

Smear biopsies: a cause of negative follow-up biopsies in patients with premalignant conditions of the uterine cervix.

The cervical scrape technique used in diagnostic cytology may strip off epithelial sheets larger than 0.5 mm. We call them smear biopsies. We followed with cytological, histopathological and clinical examinations 28 nonpregnant women whose smear biopsies showed severe dysplasia or carcinoma in situ. All of them were followed for at least 4 years. In only two of them was atypical epithelium discovered. Our study shows that a cervical scraping may result in negative follow-up histology due to removal of all premalignant epithelium. The cytology findings in these cases should not be considered wrong by either the histopathologists or the clinicans, and the patient should be followed closely with cytological smears to detect recurrences or progression to carcinoma at an early stage.