Faculty Bibliography

A panel of monoclonal antibodies (MoAbs) against BGAg A, B, and H and Lewis a, b, X, and Y (Le a, Le b, X, Y) was used to characterize and evaluate the blood group antigens (BGAg) immunohistochemistry in Barrett's esophagus (BE) and associated adenocarcinomas (ACA). Thirteen cases of ACA arising in metaplastic columnar epithelium of the distal esophagus were reviewed (12 men; 1 woman; mean age: 59). Twelve cases had juxtaposed BE of different types with low-grade dysplasia in five and high-grade dysplasia in three. ACAs were classified as well differentiated (one case), moderately differentiated (three cases), and poorly differentiated (four cases). Five cases had mixed features. Loss of BGAg H was recorded in four ACA and in one adjacent BE. Loss of BGAg B was noted in three ACAs, but in only one case in the adjacent BE. Incompatible expression of BGAg A and B was present in one case each. Anomalous expression of Le a was seen in seven ACAs and adjacent BE. Loss of Le b was noted in six ACAs. Deletion of X was seen in four ACAs and in BE. Loss of Y was present in the only nonsecretor patient. We conclude that significant alterations of BGAg occur in BE and in associated ACAs. Recognition of these antigenic alterations warrants further investigation to define a role for BGAg immunohistochemistry in the surveillance of BE patients at risk of developing ACA.

This study investigates the prevalence and clinical relevance of nuclear overexpression of the p53 protein, as detected by antibody PAb1801, in 54 patients with pathologically confirmed Ta bladder carcinomas obtained by transurethral resection at Memorial Sloan-Kettering Cancer Center between 1972 and 1980. No patient received any prior adjuvant therapy. Clinical and histopathological prognostic variables such as age, sex and tumor grade were also analyzed. The median follow-up was 110 months. Patients were stratified into two groups according to the percent of tumor cells with nuclear overexpression of the p53 protein. Group A included carcinomas with less than 20% (n=42) and Group B with 20% or more (n=12) of tumor cells with positive nuclear immunoreactivity. Five patients of Group A (12%) developed tumor progression as did 7 (58%) patients of Group B (p=0.002). Three (7%) patients of Group A and 3 (25%) patients of Group B died of bladder cancer (p=0.12). This study demonstrates a relatively low prevalence of altered p53 expression in this early stage of bladder cancer (22%). Nuclear overexpression of the p53 protein in greater-than-or-equal-to 20% tumor cells,was highly associated with tumor grade (p=0.01), but the former was the only independent marker of tumor progression (p=0.0008) on the basis of the multivariate analysis performed. It was also the only independent variable . associated with death due to bladder cancer (p=0.04). We conclude that p53 nuclear overexpression is a prognostic indicator in this disease, and may be useful for selection of therapy for patients with non-invasive papillary superficial bladder carcinoma.

Kaposi's sarcoma (KS) encompasses a broad spectrum of lesions ranging from foci of muco-cutaneous angiomatosis to tumor masses of internal organs. Its strong association with immune deficiency and the marked differences in incidence between the various populations at risk are suggestive of an infectious etiology. The agent most often suspected of being implicated in the etiology of KS is cytomegalovirus (CMV); however, despite sustained research on this subject, its role remains controversial. The present work includes six cases of KS with a broad variety of lesions in which, with the use of light and electron microscopy, immunohistochemistry, and in situ hybridization, we investigated the presence of CMV and examined its relationship with KS. CMV was present in all six cases and showed a remarkable propensity for the KS lesions where both intranuclear and intracytoplasmic forms were not only next to but frequently within KS cells. Areas of angiomatosis, hemorrhage, and KS had usually an abundance of CMV. Herpes-like virus particles inside KS nuclei were documented by light and electron microscopy and identified as CMV by immunohistochemistry and in situ hybridization. The selective morphologic presence of this virus within the tumor cells, not previously demonstrated, indicates a strong association between CMV and KS, the significance of which remains to be established

A 47-year-old woman had a lesion of the uterine cervix that presented clinically as a protruding or aborted leiomyoma. Grossly the tumor occupied a substantial portion of the cervical and endocervical region. Histologically it showed a spindle cell neoplasm arranged in large fascicles that penetrated deeply into the fibromuscular wall of the cervix. The tumor cells had abundant pink cytoplasm that contained considerable brown melanin granules confirmed by Fontana's stain. Cytologically nuclear pleomorphism, hyperchromatism, and giant nuclear forms were observed. Mitoses were also seen. Localized nuclear palisading was present. Electron microscopic examination of paraffin-embedded material revealed numerous premelanosomes and opaque granules that were compatible with mature melanosomes, thus confirming melanogenesis in the tumor. Tumor cells exhibited focal projections, and the connective tissue showed abnormal spacing of collagen. Basal lamina material was noted focally on tumor cell surfaces. Immunocytochemistry showed a positive reaction to S-100 protein and HMB-45 in tumor cell cytoplasm