poorly differentiated squamous carcinoma of the bronchus: a light and electron microscopic study

2
32 remaining 8 patients expressed far higher levels of basal PCA than control cells (25.1 + or - 5.9 units as compared to 3.9 + or 1.0 units/5 x 104 cells). These cells retained their ability to respond to en- dotoxin in vitro with a 3-fold increase in PCA. In all instances, alveolar macrophage PCA had the characteristics of tissue fac- tor. These data suggest t_hat the presence of primary lung cancer may modulate the expres- sion of PCA in alveolar macrophages close to the tumor site. PCA might be useful to bet- ter characterize the functional state of macrophages near the tumor. Role of Tumor-associated Macrophages in Lung Cancer. Takeo, S., Yasumoto, K., Nagashima, A. et al. Second Department of Surgery, Faculty of Medicine, Kyushu University, Higashi-ku, Fukuoka 812, Japan. Cancer Res. 46: 3179- 3182, 1986. The percentage of tumor-associated mac- rophages recovered (RAMR) and antitumoral activity of tumor-associated macrophages (TAM) were examined in 77 patients with resectable primary lung cancer. TAM was ob- tained by plastic adherence following tryp- sinization. TAMR increased from stage I to stage II and decreased in stage III. It also increased in N I as compared with N O and N 2 but was unrelated to tumor size. However, the cytostatic activity of TAM declined with advance in stage of the disease and an in- crease of tumor size, but it was relatively unaffected by the presence of metastasis to regional lymph nodes. There was no correla- tion between TAMR and the recurrence rate; however, cytostatic activity of TAM was correlated significantly with the prognosis of totally resected cases. TAMR and cytos- tatic activity of TAM tended to be lower in palliatively resected cases. These results suggest that the assessment of the antitumor activity of TAM, but not merely TAMR, may give prognostic information for lung cancer patients. 4. PATHOLOGY. Secular Trends in Histologic Types of Lung Cancer. Wu, A.H., Henderson, B.E., Thomas, D.C., Mack, T.M. Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles, CA 90033, U.S.A. J. Natl. Cancer Inst. 77: 53-56, 1986. The histology pattern of lung cancer is Los Angeles County was reviewed for a lO- year period, 1972-81. In men, the total lung cancer incidence has been fairly constant, but there has been a shift in the histology pattern with an increase in adenocarcinoma and a decrease in 'other' cell type (i.e., carcinoma not otherwise specified, large- cell and undifferentiated tumors). This changing histology pattern may be partly due to changes in diagnostic standards and prac- tices. With the assumption that these changes are comparable in men and women, the 'true' annual rate of change was estimated for each lung cancer cell type in women. All lung cancer types have increased in women; of the cell types squamous cell carcinoma, small-cell carcinoma, and adenocarcinoma, small-cell carcinoma showed the largest rate of annual increase and adenocarcinoma, the smallest. Cellular Heterogeneity in Lung Cancer. Dunnill, M.S., Gatter, K.C. Nuffield Depart- ment of Pathology, John Radcliffe Hospital, Oxford OX3 9DU, U.K. Histopathology i0: 461- 475, 1986. Sixty-six lung carcinomas have been ex- amined by light and electron microscopy, as well as by immunocytochemical techniques using a panel of monoclonal antibodies. There was considerable heterogeneity with regard to cell type and in only 18 cases was it possible to classify the tumour as a solely small cell, squamous or adenocar- cinoma. In the remaining cases there was evidence of two or three cell types. These findings support the thesis that all lung cancers are derived form a pluripotential basal or reserve cell in the bronchial mucosa which may proliferate along one or more lines of differentiation. This view of the histogenesis of lung cancer would ac- count for the heterogeneous appearance of many tumours and the difficulty experienced in placing them in one of the standard classifications. Poorly Differentiated Squamous Carcinoma of the Bronchus: A Light and Electron Micro- scopic Study. Carlile, A., Edwards, C. Department of His- topathology, East Birmingham Hospital, Bir- mingham B9 5ST, U.K.J. Clin. Pathol. 39: 284-292, 1986. As there is little published informa- tion on the ultrastructure of poorly dif-

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32

remaining 8 patients expressed far higher

levels of basal PCA than control cells (25.1

+ or - 5.9 units as compared to 3.9 + or

1.0 units/5 x 104 cells). These cells

retained their ability to respond to en-

dotoxin in vitro with a 3-fold increase in

PCA. In all instances, alveolar macrophage

PCA had the characteristics of tissue fac-

tor. These data suggest t_hat the presence of

primary lung cancer may modulate the expres-

sion of PCA in alveolar macrophages close to

the tumor site. PCA might be useful to bet-

ter characterize the functional state of

macrophages near the tumor.

Role of Tumor-associated Macrophages in Lung

Cancer.

Takeo, S., Yasumoto, K., Nagashima, A. et

al. Second Department of Surgery, Faculty of

Medicine, Kyushu University, Higashi-ku,

Fukuoka 812, Japan. Cancer Res. 46: 3179-

3182, 1986.

The percentage of tumor-associated mac-

rophages recovered (RAMR) and antitumoral

activity of tumor-associated macrophages

(TAM) were examined in 77 patients with

resectable primary lung cancer. TAM was ob-

tained by plastic adherence following tryp-

sinization. TAMR increased from stage I to

stage II and decreased in stage III. It also

increased in N I as compared with N O and N 2

but was unrelated to tumor size. However,

the cytostatic activity of TAM declined with

advance in stage of the disease and an in-

crease of tumor size, but it was relatively

unaffected by the presence of metastasis to

regional lymph nodes. There was no correla-

tion between TAMR and the recurrence rate;

however, cytostatic activity of TAM was

correlated significantly with the prognosis

of totally resected cases. TAMR and cytos-

tatic activity of TAM tended to be lower in

palliatively resected cases. These results

suggest that the assessment of the antitumor

activity of TAM, but not merely TAMR, may

give prognostic information for lung cancer

patients.

4. PATHOLOGY.

Secular Trends in Histologic Types of Lung

Cancer.

Wu, A.H., Henderson, B.E., Thomas, D.C.,

Mack, T.M. Department of Preventive

Medicine, University of Southern California

School of Medicine, Los Angeles, CA 90033,

U.S.A. J. Natl. Cancer Inst. 77: 53-56,

1986.

The histology pattern of lung cancer is

Los Angeles County was reviewed for a lO-

year period, 1972-81. In men, the total lung

cancer incidence has been fairly constant,

but there has been a shift in the histology

pattern with an increase in adenocarcinoma

and a decrease in 'other' cell type (i.e.,

carcinoma not otherwise specified, large-

cell and undifferentiated tumors). This

changing histology pattern may be partly due

to changes in diagnostic standards and prac-

tices. With the assumption that these

changes are comparable in men and women, the

'true' annual rate of change was estimated

for each lung cancer cell type in women. All

lung cancer types have increased in women;

of the cell types squamous cell carcinoma,

small-cell carcinoma, and adenocarcinoma,

small-cell carcinoma showed the largest rate

of annual increase and adenocarcinoma, the

smallest.

Cellular Heterogeneity in Lung Cancer.

Dunnill, M.S., Gatter, K.C. Nuffield Depart-

ment of Pathology, John Radcliffe Hospital,

Oxford OX3 9DU, U.K. Histopathology i0: 461-

475, 1986.

Sixty-six lung carcinomas have been ex-

amined by light and electron microscopy, as

well as by immunocytochemical techniques

using a panel of monoclonal antibodies.

There was considerable heterogeneity with

regard to cell type and in only 18 cases was

it possible to classify the tumour as a

solely small cell, squamous or adenocar-

cinoma. In the remaining cases there was

evidence of two or three cell types. These

findings support the thesis that all lung

cancers are derived form a pluripotential

basal or reserve cell in the bronchial

mucosa which may proliferate along one or

more lines of differentiation. This view of

the histogenesis of lung cancer would ac-

count for the heterogeneous appearance of

many tumours and the difficulty experienced

in placing them in one of the standard

classifications.

Poorly Differentiated Squamous Carcinoma of

the Bronchus: A Light and Electron Micro-

scopic Study.

Carlile, A., Edwards, C. Department of His-

topathology, East Birmingham Hospital, Bir-

mingham B9 5ST, U.K.J. Clin. Pathol. 39:

284-292, 1986.

As there is little published informa-

tion on the ultrastructure of poorly dif-

ferentiated squamous caricnoma of the bron-

chus 18 examples of this tumour were

studied. On light microscopy i0 of the

tumours contained loci of keratinisation or

intercellular bridges and therefore ful-

filled the World Health Organisation's diag-

nostic criteria. In eight these features

were absent, but the overall appearance was

sufficiently squamoid to preclude their

placement in any other category. On electron

microscopy many cells showed the charac-

teristic desmosomes and tonofilaments of

s~mous carcinoma, but there were also

areas of adenodifferentiation. The

ultrastructure of both light microscopic

groups was identical. In conclusion, this

type of tumour is dimorphic with charac-

teristics of adenocarcinoma and squamous

carcinoma on electron microscopy.

Keratinisation and bridges are not essential

diagnostic criteria: the overall pattern and

cellular morphology are more important.

Subtypes of Small Cell Carcinoma of the

Lung: Morphometric, Ultrastructural, and Im-

munohistochemical Analyses.

Nomori, H., Shimosato, Y., Kodama, T. et al.

Pathology Division, National Cancer Center

Research Institute, Chuo-ku, Tokyo 104,

Japan. Hum. Pathol. 17: 604-613, 1986.

Fifty-three surgically resected small

cell carcinomas of the lung were studied

morphometrically, electron microscopically,

in~mlnohistochemically, and in terms of pos-

sible site of origin. Four subtypes of small

cell carcinomas were identified: oat cell

carcinoma (OAT), small cell carcinoma of the

intermediate cell type (INT), combined oat

cell carcinoma, and undifferentiated car-

cinoma of the small cell type (UCS). The

latter type is presumed to be nonneuroen-

docrine. Morphometric analysis showed con-

siderable overlap among OAT, INT, and UCS

with respect to nuclear area, cell area, and

nuclear/cytoplasmic ratio. Ultrastruc-

turally, significantly more carcinomas

categorized as OAT and INT contained

neurosecretory granules than did those in

the UCS category (P<O.01 and 0.05,

respectively). Cells with tonofibrils were

more frequent in UCSs than in OATs and INTs.

Inm~mohistochemically, fewer UCSs than OATs

contained cells with gastrin-releasing pep-

tide, neuron-specific enolase, and Leu-7 (P

= 0.5, P<0.05, P<0.05, respectively). UCSs

were located more frequently at the

periphery of the lung than were OATs

33

(P<O.OI)) and INTs (P = 0.06). These find-

ings suggest that UCS may be a pathologic

entity distinct from the typical

neuroendocrine-type small cell carcinoma and

that this subtype probably corresponds to

small cell carcinoma with a 'large cell com-

ponent,' and to very poorly differentiated

adenocarcinoma and sqlmmous cell carcinoma

of the small cell type.

Mixed Small Cell and Non-Small Cell Lung

Cancer.

Adelstein, D.J., Tomashefski, J.F. Jr.,

Snow, N.J. et al. Department of Medicine,

Cleveland Metropolitan General Hospital,

Cleveland, OH 44109, U.S.A. Chest 89: 699-

704, 1986.

Seventeen (i0 percent) of 176 patients

with small-cell carcinoma of the lung seen

at this hospital since 1976 proved to have

mixed small-cell and non-small-cell tumors.

The presence of a mixed lung cancer was es-

tablished prior to chemotherapy or irradia-

tion in nine patients. Eight were initially

diagnosed as pure small-ceil carcinoma but

proved to have a mixed tumor at either sur-

gery or autopsy. Of the 17 patients, eight

received chemotherapy, and four had a par-

tial response. Six of the 40 autopsies per-

formed on patients with small-cell lung can-

cer demonstrated intrathoracic tumor which

was histologically mixed. Extrathoracic

metastases in these patients were

heterogeneous and included pure small-cell,

pure non-small-ceil, and mixed histologic

type. We conclude that mixed small-cell and

non-small-cell lung cancers are relatively

frequent and carry important prognostic and

therapeutic implications. Clinical manage-

ment of patients with small-cell lung cancer

should therefore be flexible and tailored to

the potential for histologic diversity.

Mixed lung cancer in previously untreated

patients suggests a common endodermal origin

for small-cell and non-small-ceil pulmonary

tumors.

Scar Adenocarcinoma of the Lung: A Light and

Electron Microscopic Study.

Edwards, C., Carlile, A. Department of His-

topathology, East Birmingham Hospital, Bir-

mingham B9 5ST, U.K.J. Clin. Pathol. 39:

423-427, 1986.

Five well differentiated peripheral

adenocarcinomas of the lung were inves-

tigated, using light and electron micros-

copy. Each tumour contained a central nidus