Geoffrey Mendelsohn

The distribution of carcinoembryonic antigen in breast carcinoma diagnostic and prognostic implications

Carcinoembryonic antigen (CEA) has been shown to be a useful tumor marker in patients with breast carcinoma. The unlabeled antibody immunoperoxidase technique was used to localize CEA in 93 cases of primary breast carcinoma, 15 cases of atypical duct papillomatosis, and 4 cases of duct papilloma. Normal breast epithelium and breast epithelium in fibrocystic disease did not stain positively for CEA. Twenty‐four of 27 (88%) intraductal carcinomas, and 47 of 69 (68%) infiltrating duct carcinomas were CEA positive. In contrast, only 5 of 21 (23%) in situ lobular carcinomas and 8 of 24 (33%) infiltrating lobular carcinomas were positive for CEA. All 15 cases of atypical epithelial papillomatosis were negative, whereas 1 of the 4 cases of duct papilloma exhibited microscopic foci of weak CEA positivity. There was a trend for infiltrating duct carcinomas, 3 cm in diameter or smaller, staining strongly positive for CEA, to be associated with synchronous axillary lymph node metastases (P = 0.09). Tumor heterogeneity was a constant feature of CEA staining with positivity varying from region to region and even from cell to cell. Positive immunohistochemical staining for CEA may play an adjunctive role in discriminating intraductal carcinoma from atypical papillary ductal proliferations.

Pleomorphic Xanthoastrocytoma: Report of a Case with Light and Electron Microscopy

A case of pleomorphic xanthoastrocytoma is reported with light and electron microscopic findings. This unusual tumor arose in a 15-year-old male. The tumor consisted predominantly of nests of xanthomatous cells and plump spindle cells surrounded by a prominent reticulin network. There was considerable cellular pleomorphism with abundant bizarre giant cells and multinucleated cells. Occasional mitoses were present. Electron microscopy and immunoperoxidase localization of glial fibrillary acidic protein (GFAP) confirmed the glial nature of the tumor. Recognition of this tumor is important. Despite its m alignant appearance, the tumor characteristically has a relatively good prognosis and should not be confused with high-grade gliomas or meningeal sarcomas, which require aggressive therapy.

Squamous carcinoma of the foot arising in association with long‐standing verrucous hyperplasia in a patient with congenital lymphedema

A patient is reported with congenital lymphedema who developed a squamous cell carcinoma on his affected foot. Parallels are drawn between the development of a squamous cell carcinoma with condylomatous and spindle cell features arising in a setting of long‐standing verrucous hyperplasia, as seen in this patient, and the well‐recognized phenomenon of angiosarcoma occurring in areas of lymphangiomatous proliferation in patients with chronic lymphedema. The importance of a random genetic mutation occurring in hyperplastic tissue in an immunologically privileged site is discussed. Additional consideration is given, in the current case, to the possibility of viral oncogenesis and the role of ulceration as a promoter factor.

Endocrine Markers of Cancer

Specific “endocrine” markers (polypeptide hormones and biogenic amines) have for several decades now played a vital role in the clinical evaluation and management of patients with a wide range of endocrine tumors. Some of these hormones, such as ACTH, gastrin, insulin, vasoactive intestinal peptide (VIP), and serotonin are responsible for the production of specific and often dramatic clinical syndromes. Others, such as calcitonin, a highly sensitive marker for the spectrum of thyroid C-cell proliferative disorders, are not associated with any known clinical syndromes. Ectopic (inappropriate) endocrine syndromes in patients with non- endocrine tumors have likewise been recognized for several decades. The earliest appreciation of inappropriate endocrine activity by tumors dates back to the 1920s (Klemperer, 1923; Brown, 1928), and over the ensuing years, numerous examples of inappropriate endocrine syndromes have been noted in patients with non-endocrine tumors (Meador et al., 1962; Lipsett et al., 1964; Liddle et al., 1969; And erson, 1973; Ratcliff and Rees, 1974; Blackman et al., 1978; Trump and Baylin, 1979). In 1948, it was first appreciated that humoral factors might be involved in these endocrine syndromes (Albright and Reifenstein, 1948).

Hyperinsulin hypoglycemia in the neonate: Therapeutic choices*

Lack of elevated serum insulin in 3 patients with nesidioblastosis following 95% pancreatectomy leaves one with the theoretical possibility that the recurrent hypoglycemia is not due to excess insulin secretion, but rather an iatrogenic hypoglucagon state. If this explanation is correct, progression to a total pancreatectomy may not be the appropriate form of therapy. It seems to us that further evaluation of other hormones secreted by the endocrine portion of the pancreas must be clarified before continuing extensive or total pancreatic resections for nesidioblastosis in infancy.

Tumor cell origin of histaminase activity in ascites fluid from patients with ovarian carcinoma.

We have demonstrated by tissue assay and immunohistochemical techniques that tumor cells appear to be the source of the increased histaminase activity found in 60% of ascitic fluids from patients with ovarian carcinoma. The histaminase activity in 64% of tumor tissues studied was >100 U/g of tissue, a value higher than that for normal tissues other than kidney and intestine. The presence of elevated ascitic fluid histaminase activity (>3.5 U/ml) correlates with the presence of high histaminase activity in tumor tissue. Histaminase activity is higher in ascitic fluid from the patients than it is in their plasma, probably reflecting the direct entry of histaminase into the peritoneal cavity.