Early immunologic diagnosis and prognosis of carcinoma

110

BRIEF Malignant TOPHERSON,

Mixed W.

Mullerian

M. Cancer

29:

COMMENTS

Tumors

of the

585-592(

1972).

Uterus.

WILLIAMSON,

E.

O.,

AND

CHRIS-

In all, 48 tumors occurred and follow-up was obtained on all the patients. Thirty-nine patients followed for 5 years had a survival rate of 20.5%, although one survivor had metastatic disease 15 years following primary treatment. The median length of survival was 7 months regardless of mitotic count or mode of therapy. Twenty patients had only homologous elements (carcinosarcoma), while 28 had heterologous elements (mixed mesodermal tumor). There was no statistically significant difference in survival between the two groups, and the clinicopathological features were similar, other than the presence of heterologous elements. In eight of the 16 cases with sufficient residual endometrium for adequate study, endometrial hyperplasia and/or endometrial adenocarcinema were found. Survival seems to depend more on the biologic nature of the tumor than on therapy, although total abdominal hysterectomy is generally advised. Comments. These rare tumors have been plagued over the years by an amazingly vague and nebulous glossology. McFarlane in 19352 collected over 125 different descriptive terms under which these tumors had been reported. Possibly it would be wiser to categorize the lesions as mixed mesodermal tumors rather than mixed mullerian tumors, since the latter should include only those lesions containing “mullerian or paramesonephric tissues.” Until it is possible to classify these lesions into more significant histologic categories depending on the individual cell anaplasia as is suggested in the grading of epithelial neoplasms, it will be also impossible to offer an adequate prognosis in the individual case and to propose appropriate adjunctive therapy. One of the major contributions that Christopherson and his group have made in the past 20 years or more has been to demonstrate the importance of a tumor registry. Until this idea is accepted more widely in the United States it will be very difficult to compare statistics as to incidence and results of therapy. Hopefully a lesson may be learned from such studies as to the importance of making cancer a reportable disease. - J. D. W. Early Levine

Immunologic Diagnosis Award Address). Amer.

and

Prognosis

of Carcinoma.

/. Clin. Pathol. 57: 715-730,

DAVIDSON,

ISRAEL

(Philip

1972.

The author discusses the specific red cell adherence test (SRCA) as a provocative new tool in diagnostic histopathology. The SRCA test is based on the fact that certain tissues normally contain A, B, and H antigens and that, in cancers derived horn these tissues, there is a loss of isoantigens -a form of immunologic dedifferentiation. The test utilizes a tissue section, a specific antiserum and indicator erythrocytes in a sandwich type of reaction. The results are read as positive (antigen in the tissue), negative (antigen absent in the tissue), or incomplete (antigen present in some areas and not in others). A positive correlation between the degree of anaplasia and the progressive loss of the isoantigens was noted utilizing four tissue systems including the cervix. In cervical in situ carcinomas the incomplete reaction was most commonly noted, whereas a negative result was found in an impressive number of metastatic carcinomas. Comments. There are a number of problems with the test at its present stage of development including: (1) the interpretation of the results are as much an art as the reading of the routine histological sections which it closely parallels and about which more is known; (2) the study is a retrospective one and, as the author points out, a prospective one is necessary to further evaluate the usefulness of the SRCA test; (3) many of the carcinomas studied were metastatic. Additional cases of invasive, but nonmetastatic carcinomas, should be studied and correlated with clinical course. (4) Some of the tissue isoantigens may be cross-reacting with the blood group substances, and until these tissue antigens are isolated and identified, the interpretation of results such as is presented in this address is problematical. Although the time may come when it will be possible to judge the biological potential of an individual lesion on the basis of its antigenic structure, a conservative attitude is probably warranted until the completion of well-defined, prospective studies using a better-defined antigen than is available at present.-RALPH M. RICHART, M.D. * MCFARLAND,

J. Dysontogenetic

Obstet. 61: 42(1935).

and mixed

tumors

of the urogenital

region.

Surg.

Gynecol.