Intraperitoneal free cancer cells in non-gynaecological adenocarcinomas: a reproducibility study.

OBJECTIVE: In recent years, therapeutic approaches including cytoreductive surgery followed by intraperitoneal chemotherapy have proven effective in peritoneal carcinomatosis of colorectal origin. If cytology is to be used to include patients in aggressive treatment regimens, it is necessary to evaluate its performance, particularly in terms of specificity. The aim of this study was to assess interobserver agreement for the detection of intraperitoneal free cancer cells (IFCCs) in patients with non-gynaecological adenocarcinomas. METHODS: Over a 5-year period, 1223 patients were recruited in 19 French surgery departments. Peritoneal samples were examined in 14 dispersed pathology laboratories. Giemsa-stained slides were sent to a control reader blind to the previous diagnosis. Discordant cases, concordant positive results and a random selection of negative concordant cases were reviewed by a panel of seven cytopathologists. The 'final diagnosis' was that of the consensus meetings but took into account locally-processed slides. RESULTS: Gathering dubious cases with negative results, a 95.6% concordance was achieved between local readers and the control reader. IFCCs were ascertained by the panel in 85 cases (7.0%). Eight of 873 colorectal cancers cases viewed locally were falsely positive (0.9%). Radiotherapy and neoadjuvant therapy had no impact on the false-positive rate as assessed by final validation by the panel (P > 0.05). Samples initially considered as dubious were reclassified as negative by the panel in 24 of 25 cases (96.0%). CONCLUSIONS: The panel consensus allowed reclassification of most dubious/equivocal peritoneal cytology cases, whereas clearcut distinction between benign and malignant cases was correctly achieved in almost all cases.

A pilot study in two French medical schools for teaching histology using virtual microscopy.

PURPOSE: Glass slides and standard microscopes associated to a brief review of the lectures with projection slides were used during practical training in histology and histopathology for many years. Today it is necessary to develop new tools to improve teaching, and to face a lower number of teachers, as well the increase of the microscope maintenance costs. The goal of this study was to evaluate the feasibility of virtual slide implantation in several medical schools, the feedback from students, and to develop the interest in microscopic histology. METHODS: We used virtual slides generated by the Samba 2050 system produced by Samba technologies. A collection of all organs for histology training was realized and overviewed by three MD, PhD. A questionnaire was distributed in middle of the year to evaluate the feedback. RESULTS: The feedback of the students is highly positive. Students works faster, on better resources, interactivity between students is increased, and the fact that this is a new modality of teaching raises the students' interest. CONCLUSION: Today the teaching program in two French medical schools (Lyon and Grenoble) include virtual slides alone or in addition to microscopic glass slide examination to teach histology or pathology.

[Bronchial obstruction and the ideopathic hyper-eosinophilic syndrome]. / Obstruction bronchique et syndrome hyperéosinophilique idiopathique.

The idiopathic hyper-eosinophilic syndrome is defined as a peripheral blood eosinophilia greater than 1.5 x 10(9)/litre present for at least 6 months and associated with visceral involvement. It may only be accepted after carefully excluding the other common or rare causes of hyper-eosinophilia and should remain a diagnosis of exclusion. The associated visceral lesions are multiple and non-specific. Among these neurological, digestive, dermatological and cardiac manifestations are the most frequently described. Whereas pleuro-pulmonary involvement is also common, asthma is rarely reported. We report a case of ideopathic hyper-eosinophilic syndrome presenting as asthma. This was secondary to eosinophilic infiltration of the bronchial mucosa as demonstrated by cytological examination of induced sputum.

Dag-1 carcinoma cell in studying the mechanisms of progression and therapeutic resistance in bladder cancer.

OBJECTIVE: We describe a new human bladder carcinoma cell line (DAG-1) established from a resected bladder cancer fragment and maintained in culture for more than 5 years and over 300 passages. METHODS AND RESULTS: Immunological, biochemical and molecular analysis showed that the DAG-1 cells (62 chromosomes) express the cytokeratines 8, 13, 18 and 20 that confirm their epithelial origin as well as numerous cytokine and cytokine receptor mRNAs. They secrete tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA), plasminogen activator inhibitors (PAI-1 and PAI-2), and express u-PA receptors (u-PAR/CD87) at their surface. DAG-1 cells are resistant to TNFalpha- and IFNgamma-induced apoptosis, two cytokines secreted in the urine of Calmette-Guérin bacillus-treated patients and involved in the tumor regression. CONCLUSION: The DAG-1 cell line is a useful tool, both in vitro and in vivo, to study the progression of bladder tumors and their mechanisms of resistance to immunotherapy in relation with PAI-2 and antioxidant enzymes.

Nucleus labeling or membrane labeling for studying the proliferation of drug treated cells?

Proliferation and multidrug resistance status are key predictors of therapeutic outcome in acute myeloid leukemia (AML). This study compared cell cycle analysis (nuclear labeling) with cell division analysis (membrane labeling, PKH67) for studying the proliferation of cells cultured with daunorubicin (DNR) and/or Cytarabine (Ara-C), drugs commonly used in AML treatment. PKHs are a family of lipophilic, fluorescent membrane intercalating dyes. When labeled cells divide, the resulting daughter cells receive half the label, reducing fluorescence intensity to one-half that of the parent cells. DNR has the disadvantage of overlapping the spectrum of propidium iodide (PI), which is the most commonly used marker of membrane integrity. In this study, necrosis was evaluated using TOTO-3, a marker of nucleic acids emitting fluorescence above 645 nm and which incorporates cells with disrupted membranes. Comparison of cell cycle analysis with cell division for studying proliferation revealed that PKH67 was a marker of choice for analyzing the mitotic process in cells cultured with drugs.

[Breast, cervical and colo-rectal simultaneous mass screening program for women 50 to 69 years old in Isere]. / Programme de dépistage simultané du cancer du sein, du col utérin et du côlon-rectum destiné aux femmes de 50 à 69 ans en Isère.

A cervical screening campaign is implemented in the Isere department since 1990 for women aged 50 to 69, together with breast cancer and colo-rectal cancer screening. The attendance rate is about 30% but a survey performed among this population shows that 68.6% of these women did presented for screening during the year following their invitation. One and a half per cent of all smears were abnormal or ASCUS smears. Cancer detection rate for invasive cancer and CIN III was 1.3/1000. General practitioners and gynaecologists took the same part in the programme. During a postal survey conducted among them, they declared that they felt concerned with cancer screening, even if they met some difficulties. This results suggest that nominative invitations and a good cooperation of GPs may improve the coverage of eligible women. For the future success of the National Programme, which is to be implemented in France, organisational arrangements have to be set up. The review of positive points and difficulties met by Isere's local programme may help to discuss it.

Expression of E-, P-, n-cadherins and catenins in human bladder carcinoma cell lines.

PURPOSE: Cadherins are cell surface glycoproteins that mediate Ca2+-dependent, homophilic cell-cell adhesion. The classical cadherins, E-, P- and N-cadherins, are known to self-associate from their extracellular domain, while their cytoplasmic domain interacts with either beta-catenin or plakoglobin (gamma-catenin), which in turn is bound to alpha-catenin that links the complex to the actin cytoskeleton. The aim of the present study was to analyze the expression of E-, P- and N-cadherins and catenins in human bladder carcinoma cells. MATERIALS AND METHODS: Five human bladder carcinoma cell lines, representing a variety of differentiation states, were grown in cell culture. We performed a cell aggregation assay, specific for biological cadherin activity. The expression of cadherins and catenins was analyzed by immunocytochemistry, Western blotting and RT-PCR. The interactions between cadherins and catenins were assessed by immunoprecipitation. RESULTS: We observed a reduced E-cadherin expression in the poorly differentiated and invasive-tumor derived cells. Interestingly, immunofluorescence study reveals the persistent localization of catenins at intercellular contacts in two E-cadherin deficient cell lines (T24 and TCCSUP) which yet exhibit an epithelial-like morphology and a calcium-dependent adhesive capacity. This suggests that other cadherin(s) are expressed in these both cell lines. P-cadherin, another epithelial cadherin, is expressed only in E-cadherin positive cells. On the other hand, N-cadherin is present at cell-cell borders in the very anaplastic cell lines, T24 and TCCSUP, and is able to link beta-catenin or plakoglobin. CONCLUSION: These results indicate that N-cadherin may participate in intercellular adhesion, while facilitating bladder tumorigenesis.

Autocrine regulation of TPA-induced apoptosis in monoblastic cell-line U-937: role for TNF-alpha, MnSOD and IL-6.

The present studies were undertaken to analyse the factors regulating TPA-induced apoptosis. Treatment of the monoblastic U-937 cells with the phorbol ester, TPA, was found to induce apoptosis in two distinct phases. In phase I (from 0 to 72 hours following TPA induction), apoptotic cells appeared, despite the expression of high levels of the anti-apoptotic Bcl-2 protein. After 96 h. of TPA treatment (phase II), the percentage of apoptotic cells increased as did the cell differentiation stage. The first phase apoptotic response could be significantly reduced (70%) by treatment with anti-tumor necrosis factor-alpha (TNF-alpha) antibody. TNF-alpha protein required de novo RNA and protein synthesis and was found to be mediated by protein kinase and protein tyrosine kinases. Manganese superoxide dismutase (MnSOD) inhibited, whereas IL-6 increased TPA-induced apoptosis. These findings suggest that both TPA, via TNF-alpha synthesis, exerts its protective function intracellularly by inducing MnSOD production and IL-6 may be an effective adjunct to TNF-alpha in the clinic, increasing the antitumor potency of this cytokine.

Identification of amylase crystalloids in cystic lesions of the parotid gland.

OBJECTIVE: To identify alpha-amylase crystalloid formations in parotid specimens obtained by fine needle aspiration. STUDY DESIGN: The study concerned three cases of sialadenitis with crystalloid formation observed between 1993 and 1998. In one of these cases, transmission electron microscopy, mass spectrometry and measurement of amylase activity were used to characterize the nature of the crystalloids. RESULTS: Light microscopy revealed the same crystalloid structure in all three cases. In one case, where the material was saved, a biochemical method made it possible to reveal high amylase activity, while protein electrophoresis and mass spectrometry were used to identify salivary alpha-amylase. CONCLUSION: Crystalloids of salivary alpha-amylase can be identified by May-Grünwald-Giemsa and Papanicolaou stain and can be rapidly confirmed through determination of amylase activity.

Response of chemosensitive and chemoresistant leukemic cell lines to drug therapy: simultaneous assessment of proliferation, apoptosis, and necrosis.

BACKGROUND: The balance between cell proliferation and drug-induced cell death by apoptosis or necrosis plays a major role in determining response to chemotherapy. Commonly-used DNA analysis methods cannot study both parameters simultaneously. A new approach described here combines a green fluorescent membrane-intercalating dye (PKH67) with Hoechst 33342 or annexin V and propidium iodide, to allow simultaneous assessment of cell division, cell cycle status, apoptosis, and necrosis, respectively. METHODS: To test this approach, we used cultured K562 leukemic cell lines which are drug-sensitive (K562S) or drug-resistant (K562R) by virtue of whether they lack or exhibit expression, respectively, of the gp-170 (PGP) glycoprotein pump involved in multidrug resistance. RESULTS: We found that: 1) PKH67 fluorescence intensity decreases proportionately to number of cell divisions, 2) labeling with PKH67 does not alter either cell cycle distribution, as assessed by vital DNA staining with Hoechst 33342, or cell growth, and 3) using a simple threshold analysis method suitable for real-time sorting decisions, subpopulations of proliferating cells present at initial levels of >/= 10% can readily be detected after two cell division times, based on decreased PKH67 intensity. Finally, we demonstrated that after treatment of an admixture of K562S and K562R with vincristine, triple-labeling with PKH67, annexin V, and propidium iodide can be used to identify and sort those cells which remain not only viable (nonnecrotic, nonapoptotic) but actively dividing (decreased PKH67 intensity) in the presence of drug. CONCLUSIONS: Although the studies described here were carried out in a model system using cells having known drug resistance phenotypes, we expect that the methods described will be useful in ex vivo studies of clinical leukemic specimens designed to identify the role played by specific chemoresistance proteins and mechanisms in therapeutic outcomes for individual patients.

Optimized fluorescent probe combinations for evaluation of proliferation and necrosis in anthracycline-treated leukaemic cell lines.

Proliferation and multidrug resistance status are key predictors of therapeutic outcome in acute myeloid leukaemia (AML). Anthracyclines such as daunorubicin (DNR) are typically used to treat AML and can induce drug resistance. The goal of the studies described here was to select a combination of fluorescent probes that could be used in combination with flow cytometry to monitor cell proliferation vs. cell death/necrosis as a function of anthracycline uptake. Propidium iodide (PI), the most commonly used marker of membrane integrity, cannot be used to evaluate necrosis in DNR-containing cells because of spectral overlap. A membrane integrity probe compatible with the use of a dye dilution method using PKH67 to study cell proliferation was also selected. The results show that DAPI and Cascade Blue (CB), like PI, were able to detect necrotic cells when no DNR was present, although CB gave less resolution between viable and necrotic cells than PI or DAPI. In the presence of DNR, DAPI cannot be used owing to the fluorescence quenching by DNR. However, it was found that a combination of DNR, CB, and PKH67 allows simultaneous identification of chemoresistant cells, based on reduced DNR accumulation, necrotic cells based on CB incorporation, and proliferating cells based on partitioning of PKH67 fluorescence between daughter cells. It was also found that unless a marker of necrosis is used in combination with the dye dilution assay, a moderate decrease of fluorescence as a result of necrosis may be incorrectly interpreted as proliferation.

CK20 gene expression: technical limits for the detection of circulating tumor cells.

The suitability of CK20 mRNA expression as a marker for the detection of minimum residual disease in patients with cancer of epithelial origin was evaluated. A sensitive nested RT-PCR assay with multiple replicates was optimised to detect a minimum number of circulating tumor cells expressing cytokeratin 20 (CK20) mRNA. Using this optimal procedure, we examined CK20 mRNA expression in ten epithelial and seven leukemic cell lines, in eight bladder tumors, in peripheral blood samples from 18 tumor patients and from 29 healthy controls and in 8 bone marrow samples from healthy donors. CK20 mRNA was found in 13 of 18 (72%) blood samples from patients with cancer of epithelial origin and in all the epithelial tumor cells tested. However, CK20 mRNA was also detected in 21 of 29 (72%) bloods, in 8 of 8 bone marrow samples from healthy donors and in 4 of 7 leukemic cell lines. These results highlight a requirement for either determination of threshold levels of CK20 normal expression or the development of quantitative techniques to distinguish between a tumor-specific CK20 gene expression and a low level background transcription of this marker. These results would also advise caution in using CK20 as a tumor specific marker in clinical investigations.

Chromosome 11 aneuploidy detected by fluorescent in situ hybridization (FISH) in breast cancer: relation with progesterone receptor expression.

Progesterone receptor (PR) expression is known to be impaired in breast cancer. As the PR gene is located on chromosome 11 which is also often affected, we studied their relationship in 15 patients with breast carcinoma. Tumoural imprints were used for PR immunocytochemistry and for FISH with chromosome 11 centromeric probes. Distribution profiles of chromosome 11 number in PR+ and PR- cell populations were examined. No difference in the number of chromosome 11 was found between PR+ and PR- breast tumours. Thus, loss of PR expression in breast cancer cannot be explained only by loss of chromosome 11; other genetic or non-genetic mechanisms should be advanced.

[Cytology of fluids of articular puncture]. / Cytologie des liquides de ponction articulaire.

Cytologic examination of synovial fluid has been shown to be useful in the diagnosis of various joint diseases. Few pathologists are proficient in the interpretation of the occasional synovial fluids that most cytology laboratories receive. The majority of the aspirated synovial fluids are sent only for bacterial culture and valuable information from the cytologic examination is missed. We describe how pathologists should perform analysis of these fluids and what kind of information they can provide to the physician.

Coexpression of multidrug resistance involve proteins: a flow cytometric analysis.

Cross resistance to multiple natural cytotoxic products represents a major obstacle in myeloblastic acute leukaemia (AML). Multidrug resistance (MDR) often involves overexpression of plasma membrane drug transporter P-glycoprotein (PGP) or the resistance associated protein (MRP). Recently, a protein overexpressed in a non-PGP MDR lung cancer cell line and termed lung resistance related protein (LRP) was identified. These proteins are known to be associated with a bad prognosis in AML. We have developed a triple indirect labelling analysed by flow cytometry to detect the coexpression of these proteins. Since no cell line expressing all three antigens is known, we mixed K562 cells (resistant to Adriblastine, PGP+, MRP-, LRP-) with GLC4 cells (resistant to Adriblastine, PGP-, MRP+, LRP+) to create a model system to test the method. The antibodies used were UIC2 for PGP, MRPm6 for MRP and LRP56 for LRP. They were revealed by Fab'2 coupled with Fluoresceine-isothiocyanate, Phycoerythrin or Tricolor with isotype specificity. Cells were fixed and permeabilized after PGP labelling because MRPm6 and LRP56 recognize intracellular epitopes. PGP and LRP were easily detected. MRP is expressed at relatively low levels and was more difficult to detect because in the triple labelling the non specific staining was higher than in a single labelling. Despite the increased background in the triple labelling we were able to detect coexpression of PGP, MRP, LRP by flow cytometry. This method appears to be very useful to detect coexpression of markers in AML. Such coexpression could modify the therapeutic approach with revertants.

Usefulness of PKHs for studying cell proliferation.

Classical methods for proliferative assessment (such as tritiated thymidine or bromodeoxyuridine (BrdUrd) incorporation) need sample fixation. As an alternative, we have evaluated the use of a dye dilution method using PKH26 to determine the rate and extent of proliferation in cell lines. Flow cytometric analysis associated with modelling software makes it possible to estimate the number of cells having undergone different numbers of cell divisions by sampling the cell population at varying times post-labelling. Two major questions were addressed in these studies. (i) Does PKH26 give a stable and reproducible labelling? (ii) Does labelling with PKH26 alter cellular proliferation characteristics? We conclude that the methods developed here provide a simpler, more complete means for assessment of cell proliferation in patients with hematological malignancies.

PKH26 probe in the study of the proliferation of chemoresistant leukemic sublines.

Proliferative status and multidrug resistance status are key predictors of therapeutic outcome in acute myeloid leukemia. Although classical methods for proliferative assessment such as tritiated thymidine or BrdUrd incorporation, are correlated with treatment outcome, they are time consuming and difficult to standardize. As an alternative, we have evaluated the use of a dye dilution method using PKH26 to determine rate and extent proliferation in drug sensitive and resistant cell lines. When cells labelled with this fluorescent membrane intercalating dye divide, each resulting daughter cell receives half of the dye. Using flow cytometric analysis, it is possible to estimate the number of cells having undergone different numbers of cell divisions. Four different questions were addressed in these studies: a) does PKH26 give stable and reproducible labelling? b) does labelling with PKH26 alter cellular proliferation characteristics? c) is PKH26 a substrate for PGP and MRP? d) does PKH26 labelling alter PGP expression and/or PGP activity? We found that PKH26 labelling is stable, reproducible and has no effect on cell proliferation. It does not modify PGP activity or expression, nor does it appear to be a substrate for PGP or MRP, since the rate of decrease in fluorescence intensity is similar for sensitive and resistant cells which are proliferating at the same rate. Using the dye dilution method, it is possible to simultaneously assess PGP, proliferative status, and level of PGP expression. We conclude that the methods developed here provide a simpler, more complete means for assessment of the effects of the drug therapy on sensitive and resistant cell populations in patients with hematologic malignancies.