CD71 (transferrin receptor): an effective marker for erythroid precursors in bone marrow biopsy specimens.

Accurate analysis of the erythroid lineage is essential in evaluating bone marrow biopsy specimens and can be particularly challenging in the setting of dyserythropoiesis. Transferrin receptor (CD71) mediates the uptake of transferrin-iron complexes and is highly expressed on the surface of cells of the erythroid lineage. Although CD71 has been used for flow cytometric analysis, its usefulness in paraffin-embedded bone marrow biopsy specimens has not been examined. This study defined the immunohistochemical profile of CD71, as compared with glycophorin A (CD235a) and hemoglobin, in 65 bone marrow biopsy specimens, including normal marrow specimens and cases of myelodysplastic syndrome, acute myeloid leukemia, acute lymphoblastic leukemia, plasma cell neoplasm, and metastatic carcinoma. Immunoreactivity for CD71 was restricted to erythroid precursors in normal and dyspoietic marrow samples and exhibited a membranous and cytoplasmic staining pattern. The vast majority of mature erythrocytes lack expression of CD71, greatly facilitating interpretation. CD71 is a highly effective marker for the detection of cells of erythroid lineage in bone marrow biopsy specimens.

Single tube, six-color flow cytometric analysis is a sensitive and cost-effective technique for assaying clonal plasma cells.

Bone marrow flow cytometric analysis is a powerful and rapid tool for evaluating plasma cell myeloma. By using a noncontrolled patient population in various stages of diagnosis and treatment, we compared 6-color (single-tube) and 4-color (multiple-tube) flow cytometric immunophenotyping protocols. Prospective comparison in 52 cases demonstrated improved ability to detect clonal plasma cells or identical diagnoses in 100% of the cases using 6-color, single-tube analysis. In cases in which 6-color flow cytometric analysis improved detection of a clonal population, concurrent biopsy showed less than 5% involvement by plasma cell myeloma, suggesting that 6-color flow cytometry has an advantage in patients with a low disease burden. In addition, the simplification of the procedure resulted in substantial savings in technologist time and reagent costs. Taken together, this study demonstrates that 6-color flow cytometry is an excellent, cost-effective means to assay for clonal plasma cells in a noncontrolled patient population.

Podoplanin (D2-40) is a highly effective marker of follicular dendritic cells.

The monoclonal antibody D2-40 recognizes the membrane protein podoplanin, which is an established marker for germ cell tumors, mesotheliomas, and other tumor types and is also expressed in a variety of normal cells including follicular dendritic cells (FDCs). To determine whether podoplanin represents an effective FDC marker for pathologic lymph nodes, we compared immunohistochemical studies (sensitivity, staining patterns, and intensity of staining) for podoplanin (D2-40) with those of the traditional FDC markers CD21, CD35, and clusterin. Paraffin sections of 26 lymph nodes were analyzed, including 4 cases of nodular lymphocyte-predominant Hodgkin lymphoma, 4 angioimmunoblastic T-cell lymphoma, 8 follicular lymphoma (including 3 cases with a component of diffuse large B-cell lymphoma), 5 hyaline-vascular Castleman disease, and 5 reactive lymph nodes with follicular hyperplasia. In all cases, qualitatively and quantitatively podoplanin represented a highly effective marker for detection of FDCs, with staining intensity equal to or greater than that observed for other FDC markers. This study demonstrates that podoplanin is an excellent marker for FDCs and adds to its growing list of diagnostic applications.

Aluminum granuloma after administration of the quadrivalent human papillomavirus vaccine. Report of a case.

We report the case of a young woman who developed a subcutaneous granulomatous response after administration of the quadrivalent human papillomavirus vaccine. The inciting agent was most likely an aluminum adjuvant, which previously has been reported to be associated with a granulomatous response after administration of other vaccines. Histologically, the lesion consisted of a necrotic/necrobiotic center surrounded by palisading epithelioid histiocytes closely resembling deep granuloma annulare or rheumatoid nodule. The histiocytes contained abundant intracytoplasmic violaceous/gray granular material. An ammonium aurintricarboxylate (Aluminon) stain demonstrated the presence of aluminum in the granular material. Aluminum granulomas should be included in the differential diagnosis of deep granulomatous reaction in young women, due to the high frequency of vaccination in this population.

Suppurative inflammation with microabscess and pseudocyst formation is a characteristic histologic manifestation of cutaneous infections with rapid-growing Mycobacterium species.

Mycobacterial infections of the skin classically cause a granulomatous tissue reaction. We have observed a suppurative pattern of inflammation associated with infections by rapid-growing Mycobacterium species in immunocompromised patients. We report 6 cases in skin and soft tissue with an unusual but consistent lack of a predominance of granulomatous inflammation. Of the 6 cases, 4 had predominantly (approximately 75%) suppurative inflammation, 1 case predominantly demonstrated (approximately 75%) a mix of acute and chronic inflammation, and 1 case showed an approximately equal contribution of suppurative and granulomatous inflammation. All 6 cases showed abscess formation and numerous acid-fast bacilli (AFB) on AFB stain and were confirmed by tissue culture. Of these 6 cases, 2 had microabscesses with central pseudocysts harboring microorganisms. Five patients were taking oral prednisone, and 1 had an uncharacterized immunodeficiency. These cases highlight the need for awareness of this unusual manifestation of infection with rapid-growing Mycobacterium species, particularly in immunocompromised patients.

Trigeminal trophic syndrome with features of oral CMV disease.

Trigeminal trophic syndrome (TTS) is an exceedingly rare complication following injury to the trigeminal ganglion, characterized by painless ulcerations, which has only rarely been reported with intraoral features. We present a patient with multiple intraoral ulcerations of the right buccal and alveolar mucosa that had previously been treated with nerve ablation therapy for trigeminal neuralgia. Positive immunohistochemistry staining of a biopsy specimen for cytomegalovirus suggested a viral etiology; however, lesions persisted despite antiviral therapy, and immunohistochemistry was negative on follow-up biopsy. Diagnosis of TTS is one of exclusion as it can mimic many other conditions, and should be considered in patients with unilateral painless ulcerations with a history of trigeminal nerve damage.

Variable expression of coxsackie-adenovirus receptor in thyroid tumors: implications for adenoviral gene therapy.

Adenoviral gene therapy represents a novel approach for the treatment of aggressive thyroid carcinomas. Both coxsackie-adenovirus receptor (CAR) and integrins have been shown to be the major determinants for adenoviral infectivity in many types of cancer cells, yet conflicting results have been reported. In this report we examine these factors mediating adenoviral infection in thyroid cells and to evaluate CAR expression in various types of thyroid cancer. We found that neither expression levels of CAR nor integrins are solely predictive of adenoviral infectivity in thyroid cells. However, the absence of CAR was associated with poor adenoviral infectivity in immortalized rat FRTL-5 cells. Moreover, preincubation with alpha-CAR antibody decreased infectivity in FTC 238 cells, a human thyroid tumor line. These results indicate that CAR does play a role in adenoviral infection of thyroid cells. Immunohistochemical analysis revealed that CAR is expressed at the cell surface in the majority of malignant thyroid tumors. We further show that adenoviral infectivity in some thyroid cancer cells can be improved by poly-L-lysine. Our study warrants a functional method to evaluate adenoviral infectivity should be developed and instituted prior to clinical trials of adenoviral gene therapy in patients with advanced thyroid cancer.

Forskolin, 8-Br-3',5'-cyclic adenosine 5'-monophosphate, and catalytic protein kinase A expression in the nucleus increase radioiodide uptake and sodium/iodide symporter protein levels in RET/PTC1-expressing cells.

RET/PTC1, a thyroid-specific oncogene, has been reported to down-regulate sodium/iodide symporter (NIS) expression and function in vitro and in vivo. Recently, RET/PTC1 has been shown to interfere with TSH signaling at multiple levels in thyroid cells. The objective of this study was to investigate whether RET/PTC1-mediated NIS reduction can be rescued by activating cAMP-protein kinase A (PKA) pathways. We showed that both forskolin and 8-Br-cAMP increase radioiodide uptake and NIS protein in RET/PTC1-expressing cells to the same extent as the parental PC Cl 3 cells. We found that RET/PTC1 decreases nuclear localization of catalytic PKA, and forskolin treatment was able to counteract this RET/PTC1 effect. Furthermore, transient expression of catalytic PKA in the nucleus increased radioiodide uptake and NIS protein in RET/PTC1-expressing cells. Taken together, these studies suggest that RET/PTC1 down-regulates NIS expression by interrupting TSH/cAMP signaling, and this RET/PTC1 effect can be reversed by activating cAMP-PKA pathways.

Inhibition of heat shock protein 90, a novel RET/PTC1-associated protein, increases radioiodide accumulation in thyroid cells.

RET/PTC1 is a rearranged form of the RET tyrosine kinase commonly seen in papillary thyroid carcinomas. It has been shown that RET/PTC1 decreases expression of the sodium/iodide symporter (NIS), the molecule that mediates radioiodide therapy for thyroid cancer. Using proteomic analysis, we identify hsp90 and its co-chaperone p50cdc37 as novel proteins associated with RET/PTC1. Inhibition of hsp90 function with 17-allylamino-17-demothoxygeldanamycin (17-AAG) reduces RET/PTC1 protein levels. Furthermore, 17-AAG increases radioiodide accumulation in thyroid cells, mediated in part through a protein kinase A-independent mechanism. We show that 17-AAG does not increase the total amount of NIS protein or cell surface NIS localization. Instead, 17-AAG increases radioiodide accumulation by decreasing iodide efflux. Finally, the ability of 17-AAG to increase radioiodide accumulation is not restricted to thyroid cells expressing RET/PTC1. These findings suggest that 17-AAG may be useful as a chemotherapeutic agent, not only to inhibit proliferation but also to increase the efficacy of radioiodide therapy in patients with thyroid cancer.

Imaging of metastatic pulmonary tumors following NIS gene transfer using single photon emission computed tomography.

The Na+/I- symporter (NIS) is a membrane glycoprotein that facilitates the uptake of iodine into thyroid follicular cells. Recently, we and others have demonstrated the feasibility of imaging subcutaneous xenografts expressing exogenous NIS, suggesting that NIS may serve as an imaging reporter gene to monitor vector delivery and therapeutic gene expression. In this study, we established NIS-expressing pulmonary tumors in nude mice to investigate the minimal tumor size required for in vivo detection of pulmonary tumors by single photon emission computed tomography (SPECT) with pinhole collimation. In order to define the anatomic location of NIS-expressing tumor nodules detectable by SPECT, we performed simultaneous, dual-isotope imaging. We injected 1 mCi 99mTc-MAA via tail vein to image pulmonary perfusion and injected 1 mCi Na125I intraperitoneally to image NIS-expressing tumors. Fused images showed that 99mTc-MAA perfusion defects correlated with NIS-mediated 125I uptake. Post-mortem analysis revealed that tumors 3 mm in diameter could be detected by SPECT with pinhole collimation. These studies demonstrate the feasibility of SPECT to detect pulmonary tumors expressing exogenous NIS in mice.