Keizo Hiramatsu

The clinical value of tissue polypeptide antigen in patients with gynecologic tumors

Tissue polypeptide antigen (TPA) was measured by radioimmunoassay in sera from patients with various gynecologic tumors: 64 uterine myomas, 129 cervical cancers, 31 endometrial cancers, and 173 ovarian tumors (89 benign, 18 low‐grade malignant (LGM) and 66 malignant tumors). Among the cervical cancer patients, the incidence of elevated TPA levels increased with stage of disease from 12% in the preinvasive stage to 67% in the advanced stage. Similarly, the TPA values were elevated in 35% of the endometrial cancer patients. Among the patients with ovarian malignancies, serum TPA was elevated in the following order: LGM cases (33%), Stage I (44%), and advanced (88%). Serum TPA values varied directly with the stage and malignancy of disease, and also correlated with the effect of treatment. However, serum TPA was elevated in 22% of the patients with uterine myoma and in 12% of those with ovarian benign tumors. The current observations demonstrate that the lack of tumor specificity of TPA limits its diagnostic value in gynecologic malignancies, but that serial measurements of this antigen appear to be useful for the evaluation of therapy and monitoring of patients.

Immunohistochemical Demonstration of Tumor Antigen Ta-4 in Gynecologic Tumors

Tumor antigen TA-4, raised against human cervical squamous cell carcinoma, was studied by an immunoperoxidase method in various gynecologic tumors. TA-4 was detected invariably in normal differentiated cervical squamous cells. It was also found infrequently in normal glandular cells of the cervix, but not in the endometrium. In squamous cell carcinomas of the cervix, TA-4 was positive in the differentiated cells regardless of invasiveness or histological type. It was demonstrated in some adenocarcinomas of the cervix, and less frequently in those of the endometrium. In ovarian tumors, TA-4 was localized occasionally in a variable number of glandular tumor cells of serous, mucinous, endometrioid, and clear cell carcinomas. Only a few transitional cells contained TA-4 in a Brenner tumor. Squamous components of ovarian tumors, both benign and malignant, were frequently positive for TA-4.

Strumal carcinoid of the ovary: histological, ultrastructural, and immunohistological studies with anti-human thyroglobulin.

Abstract A strumal carcinoid arising in a benign cystic teratoma of the right ovary was reported in a 40-year-old woman. The solid tumor was histologically a trabecular carcinoid tumor associated intimately with thyroid follicle-like structures. By electron microscopy, spherical dense core secretory granules were found in the cytoplasm of tumor cells. Final diagnosis of strumal carcinoid, however, was established in the present tumor by the immunohistological confirmation of thyroid tissue with anti-human thyroglobulin.

Immunohistochemical demonstration of peptide hormones in endometrial carcinomas.

Sixty‐eight endometrial carcinomas were examined histochemically and immunohistochemically for the presence of amine‐containing or neurohormonal peptide‐containing cells, particularly in relation to argyrophil cells. Argyrophil cells, detected in 43 of the 68 endometrial carcinomas by the Grimelius method, were subgrouped into two types according to the distribution of argyrophil granules and the shape of the tumor cells. Type I was found in 7 tumors and type II in 39; 3 tumors contained both cell types. The argyrophilia of type II cells was diminished in varying degrees in some tumors by diastase digestion, although it was unchanged in type I argyrophil cells. Indoleamine was detected by the formaldehyde‐induced fluorescence method in type I argyrophil cells of four carcinomas. Immunohistochemically, somatostatin‐reactive cells were found in two well‐differentiated adenocarcinomas with argyrophilia; many of these cells corresponded to some of the type I argyrophil cells, although some were nonargyrophilic. Two adenosquamous cell carcinomas with type II argyrophil cells also contained cells that were immunoreactive with antisera against gastrin; however, they were nonargyrophilic.

Endometrial Argyrophil Cell Adenocarcinoma with Indole- or Catecholamine Precursor Uptake and Decarboxylation

The capacity for indole- or catecholamine precursor uptake and decarboxylation of the argyrophil cell adenocarcinoma of the endometrium was examined by fluorescence microscopy, microspectrofluorometry, and biochemical analyses. Both argyrophil and nonargyrophil cell adenocarcinomas of the human endometrium have been grown serially in nude mice. With the use of the formaldehyde-induced wet-histofluorescence method, yellowish green fluorescence was demonstrated in the cytoplasm of some cells of the argyrophil cell adenocarcinomas after exposure in vitro and in vivo to L-dopa. When 5-hydroxytrytophan was administered in vitro and in vivo to these tumors, an intense yellow fluorescence was also obtained in the cytoplasm. These fluorescent products were located in the argyrophil cells and corresponded to argyrophil granules. Microspectrofluorometrical and biochemical analyses strongly suggested that the yellowish green fluorescent products were dopamine and the yellow ones were serotonin, produced by decarboxylation of each amine precursor.

Argyrophil cell adenocarcinoma of the endometrium

Abstract Out of 11 endometrial adenocarcinomas examined with Grimelius staining, an argyrophil cell adenocarcinoma was found in a 64-year-old gravida 3, para 1 woman. Her chief complaint was irregular genital bleeding. Numerous polypoid tumor masses occupying the uterine cavity were revealed by surgery. The tumor was diagnosed at first as a well-differentiated endometrial adenocarcinoma with mucin production, by conventional pathology. Most of the tumor cells, however, were found to contain the argyrophil granules, especially in the apical portion of cytoplasm. This appears to be the first reported case of argyrophil cell adenocarcinoma of the endometrium.

Malignant fibrous histiocytoma arising in a benign cystic teratoma of the ovary

Abstract A rare case of malignant fibrous histiocytoma arising in a benign cystic teratoma of the right ovary is reported in a 42-year-old nulliparous married woman. Two-thirds of the tumor was occupied by a benign cystic teratoma, from which the remaining solid tumor was arising. The solid tumor was composed of both fibrous and histiocytic elements, showing diverse histologic findings: a storiform pattern of the fibrous elements, admixture of histiocytes and multinucleated giant cells, clumps of foam cells, and a patchy infiltrate of lymphocytes. The malignancy of the present tumor was established by assessing the bizarre neoplastic giant cells in the sarcomatous areas and also by the metastatic recurrence. This appears to be the first reported case of a malignant fibrous histiocytoma arising in a benign cystic teratoma.

Argyrophil cells in the endometrioid carcinoma of the ovary

Of 42 endometrioid carcinomas of the ovary examined with Grimelius staining, 19 tumors were found to have argyrophil cells. Argyrophil cells were subgrouped into two types according to the distribution of the argyrophil granules. Type I cells contained argyrophil granules in the basal part of the cytoplasm, and were found in four tumors. Type II cells contained argyrophil granules mainly in the apical portion or throughout the whole cytoplasm, and were found in 14 tumors. Both type I and II cells were found in different areas of one tumor. In type II cells, the distribution of argyrophil granules was similar to that of mucins, and the apical argyrophilia was diminished in varying degrees in some tumors after diastase digestion. The distribution of argyrophil granules paralleled that of secretory granules identified by electron microscopy in the representative tumors of each type. In the immunohistochemical study, somatostatin was found in a tumor with both types of argyrophil cells. Somatostatin‐containing cells generally corresponded to type I cells, but were less numerous than argyrophil cells.

Immunohistochemical demonstration of peptide hormones in cervical adenocarcinomas with argyrophil cells

SummaryThirty patients with cervical adenocarcinoma were analyzed clinicopathologically with special reference to argyrophil cells. In contrast to argyrophil small cell carcinoma of the cervix, four adenocarcinomas with argyrophil cells were not more aggressive than the remaining 26 usual ones. One or two peptide hormones were demonstrated in three out of four tumors with argyrophil cells which were examined by immunohistochemistry. Somatostatin- and gastrin-containing cells were found in one tumor, but were located differently from each other. Either gastrin- or adrenocorticotropic hormone (ACTH)-containing cells were detected in two other tumors. They all corresponded to argyrophil cells, but were less numerous.

Immunohistological Study of Mucous Antigens in Gynecologic Tumors with Special Reference to Argyrophil Cells

Mucinous tumors of the ovary and adenocarcinomas of the female genital tract with or without argyrophil cells were studied by immunohistology for mucous antigens. These were isolated from intestinal mucosa and ovarian mucinous cyst fluid. Mucous antigen, M1 which is primarily associated with ovarian mucinous cystadenoma, was found in all mucinous tumors of the ovary, adenocarcinoma of the cervix, and endometrium. Intestinal mucous antigen (IMA), which is specific for goblet cells of the normal intestinal mucosa, was detected only in a few mucinous tumors of the ovary, with or without argyrophil cells. It was concluded that, while M1, was common to glandular gynecologic neoplasms, no special relationship existed between IMA and argyrophil cells in tumors of the ovary, endometrium, and endocervix.