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Alpha-amylase in resectable lung cancer
140
Abstracts/Lung
Cancer
Comparison of clinical aeumlogical function and CT response during cbemotberapy for initial brain metastasis from small cell lung cancer Sorensen PS, Kristjansen PEG, Wagner A, Hansen HH. Department of Neutvlogv. Rigshospitalet, DK-2100 Copenhagen. Acta Neural Stand 1994;89:312-I. We compared the clinical neurological and functional response with changes in CT during systemic combination chemothempy in 20 patients with initial brain metastases f?om small cell lung cancer (SCLC). Seven patients died within four weeks from start of chemotherapy, leaving 13 patients for evaluation of treatment response. Eight patients improved to or maintained a high neurological score, meaning no or insignificant neurological deficits or disability. Three patients had a stable neurological score, and 2 patients deteriorated. The median duration of tbe clinical response was 20 weeks. Based on changes in CT four patients had complete remission, six had partial remission, and two showed no change. One patient had a rapid deterioration of her clinical condition and died without CT control. Five patients with late CNS relapse were treated with second-line cranial irradiation inducing clinical improvement in three. Median survival was 11 weeks, and in assessable patients, excluding early deaths, 28 weeks. In conclusion initial brain metastases respond to systemic chemotherapy as readily as extracranial locations of SCLC, and in many patients prolonged neurological and CT remission can be achieved.
Fine needle aspiration diagnosis of benign metastasizing leiomyoma of tile lung: A case Ieporl I-k&z MA. Wang K-P, Be&man A. Department of Pathology Harbor Hospital Center; 3001 South Hanover Sheet, Baltimore, MD 21225. Acta Cytol 1994;38:398-402. Percutaneous fine needle aspiration biopsy was performed on a woman with multiple bilateral lung nodules. The cytology and histology showed a benign spindle cell tumor compatible with benign metastasizing leiomyoma. The patient had a history of hysterectomy 14 years earlier for a cellular leiomyoma with atypia. No significant mitosis was present in either the uterine tumor or lung metastasis. Benign and malignant salivary gland-type mixed tumors of tbe lmg: Cliaicopathologic and immuoobistocbemical study of eight cpses Moran CA, Suster S, Askin FB, Koss MN. Pulmonaty~ediastinai Pathol. Dept., Armed Forces Institute of Pathology, Washington, DC 20306-6000. Cancer 1994;73:2481-90. Backgtwund. Primary lung hllllors showing features of salivary glandtype neoplasms are extremely rare. Methoak Eight patients with primary lung neoplasms showing light microscopic and immunohistochemical features of salivary gland-type mixed tumors were studied. Results. The patients were six women and two men, ages 35-69 years (mean, 52.5 years). The tumors ranged from 2 to 16 cm in greatest diameter. In two patients the lesions presented as polypoid endobronchial lesions obstructing the lumen; in another two patients the lesions were found in close proximity or in continuity with a bronchus; in three patients, the lesions presented as peripheral parenchymatous nodules unrelated to a bronchus; and in one patient, the relationship to the bronchus could not bc determined. Histologically, the lesions were. biphasic, showing admixtures in varying proportions of epithelial elements containing a predominant myoepithelial cell population with a stromal component containing an abundant myxoid or focally chondroid matrix. Immunohistochemical studies showed strong positivity of the cells in the epithelial component with low molecular weight keratins (CAM 5.2). and to a lesser extent with broad speatum keratin, actin, and vimentin antibcdies. The cells also showed variable reactivity in the epithelial and nonepithelial elements with S-100 protein and glial
1.2 (1995)
113-160
fibrillary acidic protein. Six tumors were grossly and histologically benign; in two patients, the tumors were larger, locally invasive, and showed more atypical histologic features. All patients were treated with surgical excision. On follow-up, of the six patients with histologically benign-appearing tumors, one was alive and well 6 years after surgery; another died 4 years after surgery of a second unrelated malignancy; one died during the immediate postoperative period of myocardial infarction; and three have been lost to follow-up. In the two patients with bistologieaUy atypical lesions, the tumors recurred and metastasized after 2 and 3 years, respectively, with one of them leading to death caused by widespread metastases and superior vena cava syndrome. Conclusions. Review of the literature and the findings in the current series indicate that salivary gland-type mixed tumors of the lung may present with a spectmm of histologic features and clinical behavior, ranging from benign to frankly malignant, similar to that observed for their salivary gland counterparts. Size of the lesion at the time of presentation, extent of local infiltration, and degree of mitotic activity appear to be the most reliable prognostic features of these tumors.
Alpha-amylase in resectable lung cancer Lenler-Petersen P, Grove A, Brock A, Jelnes R. Topasdalen 8, DK8900 Randers. Eur Respir J 1994;7:941-5. Biochemical analysis and immunohistochemical techniques support the theory that hyperamylasaemia in lung cancer is due to amylase production in carcinoma cells. The vast majority of amylase-producing carcinomas are adenocarcinomas with amylase isoenzyme similar to the salivary type. This prospective study assesses 6-amylase expression in resectable lung cancer. Seventy four patients with resectable lung cancer were studied. Amylase activity in tumour tissue was analysed and isoamylase identification performed. Immunohistochemical analysis was performed using a polyclonal mbbit antibody against human salivary amylase. Hyperamylasaemia occurred in 13 out of 70 patients. Increased amylase activity in hnnour tissue was found in 10 out of 52 cases, of which only two were associated with hyperamylasaemia. With the exception of one large cell carcinoma and one squamous cell carcinoma, the hnnours were adenocarcinomas. Immunohistochemical analysis revealed amylase expression in seven adenocarcinomas and two adenosquamos carcinomas. In conclusion, immunohistochemical amylase expression was restricted to carcinomas with adenomatous differentiation. Biochemical analysis confirmed amylase production in 5 of 7 cases examined, the tissue amylase isoenzymes being of salivary type. However, hyperamylasaemia and a slightly increased amylase activity in tumour tissue may be caused by factors other than amylaseproducing carcino ma cells.
Prognostic value and clinicopathologic correlation of ~53 gene mutations and nuclear DNA content in human lung caocer: A prospective study Casson AG, McCuaig S, Craig I, Ayed A, Inculet R, Kerkvliet Net al. Mount Sinai Hospital, 600 Universi~ Ave., Totvnto, Ont. M5G IXS. J Surg Oncol 1994;56:13-20. The aim of this prospective study was to determine whether use of a combination of biomarkers, ~53 and nuclear DNA content, led to improved prognosis and clinicopathologic correlation in human nonsmall cell lung cancer. Nineteen patients undergoing curative resection of primary non-small cell lung cancer were evaluated. Resected tumors were studied by polymerase chain reaction/single strand conformation polymorphism analysis (p53 gene mutations), flow cytometry (nuclear DNA content and cell gcle analysis), and immunohistochemically (~53 oncoprotein). Histologically normal lung was used as an internal control for each patient. Minimum postoperative follow-up was 4 years ~53
Abstracts/Lung
Cancer
Comparison of clinical aeumlogical function and CT response during cbemotberapy for initial brain metastasis from small cell lung cancer Sorensen PS, Kristjansen PEG, Wagner A, Hansen HH. Department of Neutvlogv. Rigshospitalet, DK-2100 Copenhagen. Acta Neural Stand 1994;89:312-I. We compared the clinical neurological and functional response with changes in CT during systemic combination chemothempy in 20 patients with initial brain metastases f?om small cell lung cancer (SCLC). Seven patients died within four weeks from start of chemotherapy, leaving 13 patients for evaluation of treatment response. Eight patients improved to or maintained a high neurological score, meaning no or insignificant neurological deficits or disability. Three patients had a stable neurological score, and 2 patients deteriorated. The median duration of tbe clinical response was 20 weeks. Based on changes in CT four patients had complete remission, six had partial remission, and two showed no change. One patient had a rapid deterioration of her clinical condition and died without CT control. Five patients with late CNS relapse were treated with second-line cranial irradiation inducing clinical improvement in three. Median survival was 11 weeks, and in assessable patients, excluding early deaths, 28 weeks. In conclusion initial brain metastases respond to systemic chemotherapy as readily as extracranial locations of SCLC, and in many patients prolonged neurological and CT remission can be achieved.
Fine needle aspiration diagnosis of benign metastasizing leiomyoma of tile lung: A case Ieporl I-k&z MA. Wang K-P, Be&man A. Department of Pathology Harbor Hospital Center; 3001 South Hanover Sheet, Baltimore, MD 21225. Acta Cytol 1994;38:398-402. Percutaneous fine needle aspiration biopsy was performed on a woman with multiple bilateral lung nodules. The cytology and histology showed a benign spindle cell tumor compatible with benign metastasizing leiomyoma. The patient had a history of hysterectomy 14 years earlier for a cellular leiomyoma with atypia. No significant mitosis was present in either the uterine tumor or lung metastasis. Benign and malignant salivary gland-type mixed tumors of tbe lmg: Cliaicopathologic and immuoobistocbemical study of eight cpses Moran CA, Suster S, Askin FB, Koss MN. Pulmonaty~ediastinai Pathol. Dept., Armed Forces Institute of Pathology, Washington, DC 20306-6000. Cancer 1994;73:2481-90. Backgtwund. Primary lung hllllors showing features of salivary glandtype neoplasms are extremely rare. Methoak Eight patients with primary lung neoplasms showing light microscopic and immunohistochemical features of salivary gland-type mixed tumors were studied. Results. The patients were six women and two men, ages 35-69 years (mean, 52.5 years). The tumors ranged from 2 to 16 cm in greatest diameter. In two patients the lesions presented as polypoid endobronchial lesions obstructing the lumen; in another two patients the lesions were found in close proximity or in continuity with a bronchus; in three patients, the lesions presented as peripheral parenchymatous nodules unrelated to a bronchus; and in one patient, the relationship to the bronchus could not bc determined. Histologically, the lesions were. biphasic, showing admixtures in varying proportions of epithelial elements containing a predominant myoepithelial cell population with a stromal component containing an abundant myxoid or focally chondroid matrix. Immunohistochemical studies showed strong positivity of the cells in the epithelial component with low molecular weight keratins (CAM 5.2). and to a lesser extent with broad speatum keratin, actin, and vimentin antibcdies. The cells also showed variable reactivity in the epithelial and nonepithelial elements with S-100 protein and glial
1.2 (1995)
113-160
fibrillary acidic protein. Six tumors were grossly and histologically benign; in two patients, the tumors were larger, locally invasive, and showed more atypical histologic features. All patients were treated with surgical excision. On follow-up, of the six patients with histologically benign-appearing tumors, one was alive and well 6 years after surgery; another died 4 years after surgery of a second unrelated malignancy; one died during the immediate postoperative period of myocardial infarction; and three have been lost to follow-up. In the two patients with bistologieaUy atypical lesions, the tumors recurred and metastasized after 2 and 3 years, respectively, with one of them leading to death caused by widespread metastases and superior vena cava syndrome. Conclusions. Review of the literature and the findings in the current series indicate that salivary gland-type mixed tumors of the lung may present with a spectmm of histologic features and clinical behavior, ranging from benign to frankly malignant, similar to that observed for their salivary gland counterparts. Size of the lesion at the time of presentation, extent of local infiltration, and degree of mitotic activity appear to be the most reliable prognostic features of these tumors.
Alpha-amylase in resectable lung cancer Lenler-Petersen P, Grove A, Brock A, Jelnes R. Topasdalen 8, DK8900 Randers. Eur Respir J 1994;7:941-5. Biochemical analysis and immunohistochemical techniques support the theory that hyperamylasaemia in lung cancer is due to amylase production in carcinoma cells. The vast majority of amylase-producing carcinomas are adenocarcinomas with amylase isoenzyme similar to the salivary type. This prospective study assesses 6-amylase expression in resectable lung cancer. Seventy four patients with resectable lung cancer were studied. Amylase activity in tumour tissue was analysed and isoamylase identification performed. Immunohistochemical analysis was performed using a polyclonal mbbit antibody against human salivary amylase. Hyperamylasaemia occurred in 13 out of 70 patients. Increased amylase activity in hnnour tissue was found in 10 out of 52 cases, of which only two were associated with hyperamylasaemia. With the exception of one large cell carcinoma and one squamous cell carcinoma, the hnnours were adenocarcinomas. Immunohistochemical analysis revealed amylase expression in seven adenocarcinomas and two adenosquamos carcinomas. In conclusion, immunohistochemical amylase expression was restricted to carcinomas with adenomatous differentiation. Biochemical analysis confirmed amylase production in 5 of 7 cases examined, the tissue amylase isoenzymes being of salivary type. However, hyperamylasaemia and a slightly increased amylase activity in tumour tissue may be caused by factors other than amylaseproducing carcino ma cells.
Prognostic value and clinicopathologic correlation of ~53 gene mutations and nuclear DNA content in human lung caocer: A prospective study Casson AG, McCuaig S, Craig I, Ayed A, Inculet R, Kerkvliet Net al. Mount Sinai Hospital, 600 Universi~ Ave., Totvnto, Ont. M5G IXS. J Surg Oncol 1994;56:13-20. The aim of this prospective study was to determine whether use of a combination of biomarkers, ~53 and nuclear DNA content, led to improved prognosis and clinicopathologic correlation in human nonsmall cell lung cancer. Nineteen patients undergoing curative resection of primary non-small cell lung cancer were evaluated. Resected tumors were studied by polymerase chain reaction/single strand conformation polymorphism analysis (p53 gene mutations), flow cytometry (nuclear DNA content and cell gcle analysis), and immunohistochemically (~53 oncoprotein). Histologically normal lung was used as an internal control for each patient. Minimum postoperative follow-up was 4 years ~53