- Email: [email protected]
NEPHROBLASTOMA: INDEX CANCER
1391
parallel tissue analyses for 7 other ele(Ca, Cd, Cr, Cu, Ni, Pb, Zn). We shall also present a comparison between accident victims and persons who have died of heart-disease that, where magnesium is
give
the results of
ments
concerned,
neoplastic tumours of the kidney which have tinguished from nephroblastoma. Royal Army Medical College, Millbank, London SW1P 4RJ.
appears to be in broad agreement with the
to
be dis-
J. B. STEWART R. L. WARKEL.
earlier reports cited. This work is of Ontario.
supported by
grant
no.
PR21 from the Province
NEPHROBLASTOMA: INDEX CANCER
Department of Epidemiology and Biometrics,
T. W. ANDERSON D. HEWITT.
School of Hygiene, University of Toronto. Department of Epidemiology and Community Medicine, University of Ottawa, and Bureau of Epidemiology, L.C.D.C.,
L. C. NERI.
Health and Welfare Canada. Bureau of
Epidemiology, L.C.D.C.,
G. SCHREIBER.
Health and Welfare Canada.
Department of Chemical
Engineering, University of Ottawa.
F. TALBOT.
FIBROUS HAMARTOMA OF INFANCY p.
SIR,-We were interested to read your editorial (Sept. 22, 651) on the concept of using Wilms’ nephroblastoma as a
possible index of human
cancer incidence in different countries and continents of the world. Since accurate diagnostic coding of nephroblastoma would be essential we feel that a brief comment is necessary on your inclusion of fibrous hamartoma of infancy in the differential diagnosis. This term was proposed by Enzinger1 for a rare benign subcutaneous fibrous proliferation of childhood, characterised by a poorly cifcumscribed, organoid arrangement of fibrocollagenous bundles, whorls of immature-appearing stellate or spindle cells, mature fat, and foci of inflammatory cells. This histological appearance is distinctive and readily recognised by any pathologist familiar with the entity. It usually occurs in the subcutaneous tissue of the shoulder or axilla, but may be found in the buttock and thigh. The lesion has sometimes been reported at birth. The hamartoma described by Jones2 in a newborn infant’s lung is probably unrelated, and we are unaware of any examples occurring in the kidney or other visceral
organ.
Most of the confusion is due to terminology. Congenital which involves internal organs, is also sometimes referred to as " fibromatous hamartomatosis ",3 and another important condition which must be separated from nephroblastoma, fetal leiomyomatous hamartoma,4 is also known as fibromyomatous hamartoma of the kidney ".5 This latter lesion lacks any malignant epithelial or mesenchymal components, is composed of interweaving bundles of smooth muscle and fibroblastic tissue, embedded within which are relatively normal renal glomeruli, pursues a benign biological course, and is cured
generalised fibromatosis,
"
by nephrectomy. It is not our intention to review the differential diagnosis of nephroblastoma; many lesions may have to be considered clinically and histologically. We believe, however, that fibrous hamartoma of infancy is such a distinctive lesion
of the soft tissues that this term should not be allowed to creep into the already confused group of dysgenetic and 1.
Enzinger, F. M. Cancer, 1965, 18, 24. Jones, C. J. Archs Path. 1949, 48, 150. 3. Shuman, R. in Pathology (edited by W. A. D. Anderson); vol. I, p. 565. St. Louis, 1971. 4. Bogdan, R., Taylor, D. E. M., Mostofi, F. K. Cancer, 1973, 31, 462. 5. Nelson, W. E., Vaughan III, V. C., McKay, R. J. Textbook of 2.
Pediatrics;
p. 1454.
Philadelphia,
1969.
SIR,-Your editorial (Sept. 22, p. 651) points out that the worldwide constancy of nephroblastoma incidence is attributed to its virtually unique origin in early embryonic life. This alone, however, would not account for it. In addition, only if nephroblastomas and the other common childhood cancers are expressions of alleles at a particular " cancer " locus in the genome of Homo sapiens would conditions for worldwide constancy of incidence and relative frequency be satisfied. Fuller explanations are given elsewhere.1-3 Department of Pathology, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland, Australia.
M. D. INNIS.
CYTOGENETIC CONFIRMATION OF FAILURE OF POLAR-BODY EXTRUSION
SIR,-Dr de Kretzer and his colleagues (Sept. 28, p. 728) described the transfer of a human zygote. A possible complication of such a technique is the occurrence, in vitro, of chromosome abnormalities. Abnormalities of chromosome number or structure probably arise during meiosis or early mitosis. About 1 in every 200 liveborn infants and at least a third of all spontaneous abortions have demonstrable chromosome abnormality. Abnormal maturation of mammalian and human oocytes in vitro has been reported, but few chromosome preparations of abnormal meiotic divisions have been We report chromosome analysis of an demonstrated. oocyte that apparently failed to undergo extrusion of its first polar body. We
investigated the ovaries removed from a 51-year-old Her four pregnancies had resulted in three normal
woman.
children and one spontaneous abortion. In 1964 she underwent a radical mastectomy for carcinoma of the breast, at which time several lymph-nodes contained malignant tissue. She was apparently in good health until 1970, when several rib fractures were detected. Because metastatic cancer was suspected, a bilateral oophorectomy was performed. She had never received irradiation or chemotherapy, and had never taken oral contraceptives. She menstruated regularly, and her last menstrual period was 3 weeks before oophorectomy. After the ovaries were removed, several follicles were aspirated, and the aspirate was transferred to a petri dish for inspection. Three oocytes were recovered in follicular fluids, transferred to a second petri dish containing 2 ml. of Ham’s F-10 medium, and placed in an atmosphere of 10°o CO2 and 90% air. Two oocytes degenerated within 6 hours. The third oocyte, which showed no signs of degeneration, was observed periodically through phase microscopy for the next 68 hours. During this time no polar-body extrusion was seen. The oocyte was then placed in isotonic sodium chloride and its corona radiata mechanically dispersed. The oocyte was then suspended for 20 minutes in hypotonic solution (0-700 sodium citrate), fixed with acetic-acid!methanol, and stained with orcein. A single aggregate of chromosomes was seen (see figure), with a nuclear membrane a short distance away. This aggregate contained 92 distinct elements. Each element appeared to be one of the two chromatids of a dyad, presumably separating during metaphase of the second meiotic division. No chiasmata were seen. A karyotype revealed no apparent missing or additional chromosomes. 1. 2. 3.
Innis, M. D. Med. J. Aust. 1972, i, 18. Innis, M. D. Oncology, 1972, 26, 474. Innis, M. D. Med. J. Aust. 1972, ii, 322.
parallel tissue analyses for 7 other ele(Ca, Cd, Cr, Cu, Ni, Pb, Zn). We shall also present a comparison between accident victims and persons who have died of heart-disease that, where magnesium is
give
the results of
ments
concerned,
neoplastic tumours of the kidney which have tinguished from nephroblastoma. Royal Army Medical College, Millbank, London SW1P 4RJ.
appears to be in broad agreement with the
to
be dis-
J. B. STEWART R. L. WARKEL.
earlier reports cited. This work is of Ontario.
supported by
grant
no.
PR21 from the Province
NEPHROBLASTOMA: INDEX CANCER
Department of Epidemiology and Biometrics,
T. W. ANDERSON D. HEWITT.
School of Hygiene, University of Toronto. Department of Epidemiology and Community Medicine, University of Ottawa, and Bureau of Epidemiology, L.C.D.C.,
L. C. NERI.
Health and Welfare Canada. Bureau of
Epidemiology, L.C.D.C.,
G. SCHREIBER.
Health and Welfare Canada.
Department of Chemical
Engineering, University of Ottawa.
F. TALBOT.
FIBROUS HAMARTOMA OF INFANCY p.
SIR,-We were interested to read your editorial (Sept. 22, 651) on the concept of using Wilms’ nephroblastoma as a
possible index of human
cancer incidence in different countries and continents of the world. Since accurate diagnostic coding of nephroblastoma would be essential we feel that a brief comment is necessary on your inclusion of fibrous hamartoma of infancy in the differential diagnosis. This term was proposed by Enzinger1 for a rare benign subcutaneous fibrous proliferation of childhood, characterised by a poorly cifcumscribed, organoid arrangement of fibrocollagenous bundles, whorls of immature-appearing stellate or spindle cells, mature fat, and foci of inflammatory cells. This histological appearance is distinctive and readily recognised by any pathologist familiar with the entity. It usually occurs in the subcutaneous tissue of the shoulder or axilla, but may be found in the buttock and thigh. The lesion has sometimes been reported at birth. The hamartoma described by Jones2 in a newborn infant’s lung is probably unrelated, and we are unaware of any examples occurring in the kidney or other visceral
organ.
Most of the confusion is due to terminology. Congenital which involves internal organs, is also sometimes referred to as " fibromatous hamartomatosis ",3 and another important condition which must be separated from nephroblastoma, fetal leiomyomatous hamartoma,4 is also known as fibromyomatous hamartoma of the kidney ".5 This latter lesion lacks any malignant epithelial or mesenchymal components, is composed of interweaving bundles of smooth muscle and fibroblastic tissue, embedded within which are relatively normal renal glomeruli, pursues a benign biological course, and is cured
generalised fibromatosis,
"
by nephrectomy. It is not our intention to review the differential diagnosis of nephroblastoma; many lesions may have to be considered clinically and histologically. We believe, however, that fibrous hamartoma of infancy is such a distinctive lesion
of the soft tissues that this term should not be allowed to creep into the already confused group of dysgenetic and 1.
Enzinger, F. M. Cancer, 1965, 18, 24. Jones, C. J. Archs Path. 1949, 48, 150. 3. Shuman, R. in Pathology (edited by W. A. D. Anderson); vol. I, p. 565. St. Louis, 1971. 4. Bogdan, R., Taylor, D. E. M., Mostofi, F. K. Cancer, 1973, 31, 462. 5. Nelson, W. E., Vaughan III, V. C., McKay, R. J. Textbook of 2.
Pediatrics;
p. 1454.
Philadelphia,
1969.
SIR,-Your editorial (Sept. 22, p. 651) points out that the worldwide constancy of nephroblastoma incidence is attributed to its virtually unique origin in early embryonic life. This alone, however, would not account for it. In addition, only if nephroblastomas and the other common childhood cancers are expressions of alleles at a particular " cancer " locus in the genome of Homo sapiens would conditions for worldwide constancy of incidence and relative frequency be satisfied. Fuller explanations are given elsewhere.1-3 Department of Pathology, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland, Australia.
M. D. INNIS.
CYTOGENETIC CONFIRMATION OF FAILURE OF POLAR-BODY EXTRUSION
SIR,-Dr de Kretzer and his colleagues (Sept. 28, p. 728) described the transfer of a human zygote. A possible complication of such a technique is the occurrence, in vitro, of chromosome abnormalities. Abnormalities of chromosome number or structure probably arise during meiosis or early mitosis. About 1 in every 200 liveborn infants and at least a third of all spontaneous abortions have demonstrable chromosome abnormality. Abnormal maturation of mammalian and human oocytes in vitro has been reported, but few chromosome preparations of abnormal meiotic divisions have been We report chromosome analysis of an demonstrated. oocyte that apparently failed to undergo extrusion of its first polar body. We
investigated the ovaries removed from a 51-year-old Her four pregnancies had resulted in three normal
woman.
children and one spontaneous abortion. In 1964 she underwent a radical mastectomy for carcinoma of the breast, at which time several lymph-nodes contained malignant tissue. She was apparently in good health until 1970, when several rib fractures were detected. Because metastatic cancer was suspected, a bilateral oophorectomy was performed. She had never received irradiation or chemotherapy, and had never taken oral contraceptives. She menstruated regularly, and her last menstrual period was 3 weeks before oophorectomy. After the ovaries were removed, several follicles were aspirated, and the aspirate was transferred to a petri dish for inspection. Three oocytes were recovered in follicular fluids, transferred to a second petri dish containing 2 ml. of Ham’s F-10 medium, and placed in an atmosphere of 10°o CO2 and 90% air. Two oocytes degenerated within 6 hours. The third oocyte, which showed no signs of degeneration, was observed periodically through phase microscopy for the next 68 hours. During this time no polar-body extrusion was seen. The oocyte was then placed in isotonic sodium chloride and its corona radiata mechanically dispersed. The oocyte was then suspended for 20 minutes in hypotonic solution (0-700 sodium citrate), fixed with acetic-acid!methanol, and stained with orcein. A single aggregate of chromosomes was seen (see figure), with a nuclear membrane a short distance away. This aggregate contained 92 distinct elements. Each element appeared to be one of the two chromatids of a dyad, presumably separating during metaphase of the second meiotic division. No chiasmata were seen. A karyotype revealed no apparent missing or additional chromosomes. 1. 2. 3.
Innis, M. D. Med. J. Aust. 1972, i, 18. Innis, M. D. Oncology, 1972, 26, 474. Innis, M. D. Med. J. Aust. 1972, ii, 322.