Julio Torrado

Lewis system alterations in gastric carcinogenesis

Alterations in the expression of type 1 blood group‐related antigens (Lewis a and b) were examined immunohistochemically in 371 consecutives gastric biopsy and 80 surgical specimens from patients of gastric carcinoma. The ABH and Lewis phenotype and secretor status of the patients were correlated with histologic findings. An anomalous expression of Lewis a antigen was found in 88 of 249 gastric biopsy specimens of Lewis (a–b+) phenotype patients. The prevalence of this anomaly increased with the evolution of the premalignant process, in agreement with the commonly accepted model of gastric carcinogenesis. Thus, anomalous Lewis a antigen appeared in 66.6% of gastric dysplasia cases, in 64.6% of intestinal metaplasia, in 15.4% of atrophic gastritis, and in 7.4% of superficial gastritis. No alterations were found in subjects with normal gastric mucosa. Forty‐seven of the 49 Lewis (a–b+) phenotype gastric carcinoma patients showed antigenic alterations in tumor cells (anomalous Lewis a antigen in 36 and loss of Lewis antigens in 11). In 26 of these gastric specimens an anomalous Lewis a antigen was present in areas of intestinal metaplasia and/or dysplasia away from the area of neoplastic transformation. The expression of Lewis a antigen in Lewis (a–b+) phenotype patients is a frequent phenomenon in gastric neoplastic cells and could result from the blocked synthesis of Lewis b antigen with accumulation of its precursors. These findings suggest that, during gastric carcinogenesis, antigenic alterations may precede neoplastic transformation. An anomalous Lewis a antigen could constitute a significant index of severity of the histologic lesion and contribute to identifying high‐risk individuals.

T-antigen. A prognostic indicator of high recurrence index in transitional carcinoma of the bladder

Forty biopsies from 36 patients with bladder tumors were tested for T‐antigen (TAg) expression on tumor cells on sections untreated or treated with neuraminidase; a 37.5% of tumors showed abnormal expression of TAg either as an aberrant expression, or absence of this antigen after removing sialic acid. These changes were not well correlated with histologic signs of anaplasia or infiltration, nor with other biologic properties of tumor cells such as the expression of blood group antigens (ABH). However, a practical utility of TAg in the study of bladder tumors, is suggested by the analysis of those biopsies with low‐grade low‐stage tumors, on which the abnormal expression of TAg was more discriminatory than the ABH changes in defining those patients suffering tumors with a particular aggressiveness. Circulating antibody titer was also investigated in 20 patients but all of them displayed titers in the normal range, with independence of the results observed in their corresponding bladder biopsies.

Blood-group phenotypes, sulfomucins, and Helicobacter pylori in Barrett's esophagus.

Barretts esophagus, morphologically analogous to gastric intestinal metaplasia, often precedes the development of esophageal adenocarcinoma. In the stomach, expression of sulfomucins and aberrant Lewis(a) (Le[a]) antigen is an excellent predictor of premalignant progression, and Helicobacter pylori infection is a crucial determinant for the development of atrophy, metaplasia, and adenocarcinoma. In the esophagus, the significance of sulfomucin expression is controversial, the aberrant expression of Le(a) has not been explored, and the role of H pylori in the evolution of preneoplastic conditions is unknown. We investigated in 155 patients referred for endoscopy the association of Barretts esophagus with expression of sulfomucins, Lewis, secretor, and ABO phenotypes, and H pylori infection. We report a subtype of intestinal metaplasia, present in all patients with esophageal adenocarcinoma, similar to gastric intestinal metaplasia of colonic type (type III or incomplete), that expresses sulfomucins and aberrant Le(a) in goblet and columnar cells. Lewis(a+b-), nonsecretor and blood group A phenotypes, were all positively associated with esophageal adenocarcinoma, suggesting a genetic susceptibility. H pylori infection was detected in 75% of patients with esophageal adenocarcinoma.

Blood group isoantigens ABO (H) in transitional carcinoma of the bladder: a clinicopathological study.

Blood group A, B and H antigens were investigated in 183 paraffin embedded biopsies from 58 patients with transitional cell carcinoma of the urinary bladder, by a modified specific red cell adherence test, direct immunofluorescence with Ulex Europeus lectin and indirect immunoperoxidase method with monoclonal antibodies against blood group antigens. The results were correlated with pathological grade and stage and with the clinical course of patients evaluating the recurrence index and clinical state. Histological findings were roughly correlated with the expression of red cell tissue antigens but not with the presence of precursor H substance in biopsies from patients of blood group A or B, in which a higher proportion of H positive results was appreciated. The clinical course was also related to the presence or absence of blood group antigens in referential biopsies: 90 per cent of negative biopsies corresponded to patients who had high recurrence index whereas 75 per cent of positive biopsies corresponded to patients who had low recurrence index or did not have recurrence for five years; 25 per cent of recurrences observed in patients with referential positive biopsy were invasive whereas the proportion of invasive tumor in recurrence from negative biopsies rises to 73 per cent. In addition, all the final biopsies from patients who died of bladder tumor were negative for blood group antigens. The diagnostic and prognostic significance of these tissue antigens in transitional cell carcinoma of the urinary bladder is discussed, and we conclude that the analysis of blood group antigens in bladder biopsies by established techniques is a useful tool in clinical pathology for the screening and followup of bladder tumors, as previously suggested.

Manifestaciones infrecuentes de la enfermedad de Whipple. Estudio de cuatro casos

Resumen La enfermedad de Whipple (EW) cursa habitualmente con afeccion intestinal y con frecuencia el diagnostico se basa en la existencia de malabsorcion y sindrome toxico. Se presentan cuatro pacientes con EW que tuvieron manifestaciones poco comunes: tos seca persistente, dolor abdominal y estrenimiento, suboclusion intestinal y sintomas neuropsiquiatricos. Se analizan estas manifestaciones clinicas y se compara su frecuencia entre las series mas numerosas de la literatura descritas hasta la actualidad.

Carcinoma papilar seroso peritoneal

Resumen Introduccion - El carcinoma papilar quistico de peritoneo es una neoplasia de elevada agresividad y no bien conocida Material y metodos Se presentan dos casos de carcinoma papilar quistico de peritoneo tratados mediante quimioterapia – carboplatino& taxol – Conclusiones El carcinoma papilar quistico de peritoneo debe ser considerado en el diagnostico diferencial de procesos neoplasicos peritoneales de otra naturaleza con el fin de establecer el tratamiento correcto.