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Oncogenes are genes that make proteins (oncoproteins) that have the potential for causing cancer. An oncogene may come from a normal gene that has been damaged by X-rays, ultraviolet light, certain toxic chemicals, or other source of genetic mutation. Many different types of human tumors have been found to contain oncogenes and their associated oncoproteins. In some cases, prognosis has been related to the presence of oncoproteins in certain types of tumors. The oncogene called c-erbB-2 has been identified in some breast tumors, as well as other tumors, but has not been identified previously in endocrine tumors (tumors in the adrenal gland, pancreas, thyroid gland and lung). To determine if oncogenes are present in endocrine tumors, a special staining procedure using antibodies (immunoreactivity) was undertaken to screen tumors for several different types of oncoproteins (c-erbB-2, c-myc, L-myc, and N-myc). Seventy-one lung tumors (44 small cell carcinomas, 15 atypical and 12 bronchial) 28 thyroid tumors (medullary thyroid carcinoma), 27 adrenal gland tumors (pheochromocytomas), and 17 pancreas tumors (insulinomas) were tested. Oncoproteins from the c-erbB-2 oncogene were found in 15 percent of the lung tumors and in 22 percent of the adrenal tumors. Oncoproteins from the c-myc oncogene were found only in the lung tumors (32 percent), N-myc in thyroid tumors (21 percent), and L-myc in adrenal tumors (15 percent). It is concluded that different types of oncoproteins may be associated with different types of tumors, and that this may be useful for identifying different subtypes of endocrine tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract: Thirty tumors were collected from our archive of cervical adenocarcinomas. They were examined with respect to the content of oncogenic HPV and presence of mutations in the p53 gene exons 5 through 8. Furthermore, available clinical information on the cases was reviewed. For the detection of p53 gene and presence of oncogenic HPV, PCR followed by direct sequence analysis of the amplified DNA was employed. Seventeen tumors were identified as HPV-positive, comprising both HPV types 18 and 16. Six cases showed a p53 gene mutation, of which five were of the missence and one of the silent type. No statistical correlation between the occurrence of oncogenic HPV and presence of p53 gene mutation (p=0.67) was recorded. Among the tumors with p53 gene mutation, three were HPV-positive and three were HPV-negative. The determination of p53 gene mutations was not related to clinical findings such as the stage of the tumor or presence of metastases of the lymph nodes. However, p53 gene mutations were somewhat more prevalent in low differentiated tumors (p<0.02). The results indicate that oncogenic HPV and p53 gene mutations have independent carcinogenic roles in cervical adenocarcinomas.

Twenty-five patients with known neuroendocrine tumour disease were biopsied with 1.2 mm and 0.9 mm biopsy-gun needles to evaluate the respective diagnostic accuracy of the 2 needle sizes. The influence of treatment-related fibrosis on the histopathological diagnosis was also evaluated. The overall diagnostic accuracy with the 0.9 mm needle was 69% as compared to 92% with the 1.2 mm needle. This difference, however, seems more related to needle guiding difficulties with the 0.9 mm needle than to insufficient tissue yield. When the tumour was hit with both the 0.9 and the 1.2 mm needle the tissue yield was inferior with the 0.9 mm needle in only one of 16 cases. The increased amount of fibrous tissue due to interferon treatment did not seem to negatively influence the diagnostic accuracy.

125I‐labelled α rat atrial natriuretic peptide (28 amino acids: Ser 99–Tyr 126) ([125I]α‐rANP) was given i.v. to Sprague—Dawley rats and the distribution of radioactivity in the tissues was examined by whole‐body and microautoradiography at intervals from 2 min to 4 h after the administration. Inhibition of uptake of the [125I]α‐rANP by simultaneous injection of an excess of non‐labelled α‐rANP was taken as an indication that highly labelled structures in rats injected with [125I]α‐rANP alone are due to an abundance of specific receptors for the peptide. In the rats given only the [125I]α‐rANP a rapid and high radioactivity occurred in the renal glomeruli, the endocardium of the heart ventricles, the endothelium of the processus ciliares of the eyes, the portal vessels and a few larger vessels of the liver, the subcapsular vessels of the adrenal glands and the parenchyma of the lungs. Other tissues showing a distinct, but less prominent, radioactivity were the endocardium of the heart atria, the walls of the great afferent and efferent vessels in the thoracic cavity, the choroid plexuses of the brain ventricles, the pia mater, brown fat, the muscularis layer of the stomach and the intestines, the lamina propria of the villi in the small intestine and the walls of a few small blood vessels in the kidney medulla. The specific labelling was highest at 2 min after injection and then diminished at later intervals.

The frequency and distribution of polypeptide YY (PYY) and pancreatic polypeptide (PP) immunoreactive tumour cells of 14 small intestinal and of 27 rectal carcinoids were studied. All small intestinal and 14 rectal tumours were unreactive to both hormones. However, 13 rectal carcinoids contained a variable number of PP-immunoreactive cells. In four of these cases both PYY- and PP-immunoreactive cells were seen. The PP-immunoreactive cells greatly exceeded the number of PYY-immunoreactive cells. Two rectal carcinoids with PYY and PP immunoreactivities, but not the rest of the tumours, reacted also with an antiserum specific to the C-terminus of PP. This indicates that most PP immunoreactive rectal carcinoids lack the C-terminus sequence of the PP molecule.

One hundred and forty-eight randomly chosen neutral-buffered formaldehyde-fixed cervical biopsies in which cervical intra-epithelial neoplasia (CIN) I–III had been diagnosed were tested for HPV (human papilloma virus) DNA by in situ hybridization (ISH) and polymerase chain reaction (PCR). For ISH, we utilized a biotinylated panprobe and type-specific, genomic probe sets. For PCR, we used the general primers GP5/GP6 and their recently described, elongated version GP5+/GP6+, and included the modification of hot-start PCR. Amplified DNA was detected by gel electrophoresis and slot blot hybridization. The positivity rate of ISH was 59% for all biopsies and 69%, 62% and 46% for CIN I, II and III, respectively. The sensitivity of GP5/GP6 was 74% with cold-start PCR and 78% with hot-start PCR. When GP5+/GP6+ was used, the sensitivity increased to 89% with cold-start PCR and to 95% with hot-start PCR. Based on the most sensitive PCR technique, HPV detection was 93%, 95% and 96% in CIN I, II and III, respectively. The number of HPV types decreased with the severity of the lesion, and HPV 16 was the predominant type. Multiple HPVs were rare and almost all HPV-positive cases could be typed. ISH and slot blot hybridization correlated well regarding HPV typing specificity. Our results confirm that distinct HPV types are present in a high proportion of cases of CIN. The sensitivity of ISH is lower than that of PCR. Furthermore, the modified general primers GP5+/GP6+ give a higher yield than GP5/GP6, while hot-start PCR increases sensitivity even further.

The endocrine pancreas of the desert lizard (Chalcides ocellatus) was investigated histologically and immunocytochemically. The endocrine tissue was concentrated in the dorsal lobe, where it constituted about 7% of the total volume. In the ventral lobe the endocrine tissue formed approximately 1% of the total volume. Four endocrine cell types were observed in the pancreas of this species, namely insulin-, glucagon-, somatostain- and pancreatic polypeptide (PP)-immunoreactive cells. The volume occupied by these cells was 1, 1, 0.6 and 0.3% of the total volume of the pancreas, respectively. Insulin-immunoreactive cells were located in the islet centre and comprised 3% of dorsal and 0.2% of the ventral lobe volume. Glucagon cells occurred at the islet periphery and amounted to 3 and 0.2% of the volume of the dorsal and ventral lobes, respectively. Somatostatin-immunoreactive cells were located at the islet periphery as well as in between the exocrine parenchyma. They constituted 1 and 0.2% of the volume of the dorsal and ventral lobes, respectively. PP-immunoreactive cells occurred mainly among the exocrine parenchyma as solitary cells. They formed only 0.03% of the volume of the dorsal lobe. The corresponding figure in the ventral lobe was 0.6%.

The distribution and ontogeny of polypeptide YY (PYY)-and pancreatic polypeptide (PP)-immunoreactive cells in the gastrointestinal tract of rat were investigated. PYY-immunoreactive cells were numerous in the pylorus, ileum and colon and only a few cells were observed in the corpus, duodenum, jejunum and rectum. On the other hand, a few PP-immunoreactive cells were seen in the colon only. Both PYY-and PP-immunoreactive cells were of the open type, i.e., they extended from the basal lamina to the gut lumen. PYY-immunoreactive cells were observed first in the lower half of the stomach and in the intestine of 19 day-old embryo. The localization of the cells seemed to move along towards the pylorus and the lower part of the intestine. PP-immunoreactive cells could only be detected for the first time in the colon of 2 day-old rat. These cells appeared temporarily in the pylorus and rectum during the period 7 to 21 days after birth. It was concluded that the difference between PYY-and PP-immunoreactive cells in the distribution, frequency and ontogeny provide further evidence that PYY and PP occur in two independent cell types.

Various parts of the human gastrointestinal tract were investigated immunocytochemically for the occurrence of polypeptide YY (PYY) and pancreatic polypeptide (PP). PYY-immunoreactive cells were observed in the lower part of the ileum, in the colon and in the rectum, and PP-immunoreactive cells were found in the colon and rectum. Both cell types were of the open type, i.e. they extended from the basal lamina to the gut lumen. PYY-immunoreactive cells were seen to emit cytoplasmic processes to the neighbouring goblet cells. This latter observation suggests that PYY cells may exert a paracrine action on the mucussecreting goblet cells. Staining of consecutive thin plastic sections and staining of the same section simultaneously for two peptides showed that PYY-immunoreactivity did not occur in PP- or enteroglucagon-immunoreactive cells. On the ultrastructural level PYY-immunoreactivity was localized in basal granulated endocrine cells. These cells contained round or slightly oval electron dense granules with a mean diameter of 150 nm (range 100–300 nm).

The distribution of the polypeptide which has an N-terminal tyrosine and a C-terminal tyrosine (PYY)- and pancreatic polypeptide (PP)-immunoreactive cells were investigated in the gut of the domestic fowl. PYY-immunoreactive cells were observed in the duodenum and jejunum. PP-immunoreactive cells were seen in the duodenum, jejunum, ileum and colon. Both PYY- and PP-immunoreactive cells were extended from the basal lamina to the gut lumen i.e. of open type. PYY-immunoreactive cells occurred mainly in the basal and middle portion of the villi. On the other hand, PP-immunoreactive cells were located mostly in the crepts. The occurrence of PYY-immunoreactive cells in the upper part of the small intestine is rather similar to that of amphibians and reptiles, than to that of mammals, where PYY-immunoreactive cells are located in the distal part of the small intestine and in the large intestine.

Using histological and immunhistochemical techniques, nine endocrine cell types were observed in the mucosa of the gastrointestinal tract of the toad,Bufo regularis, viz. enterochromaffin, somatostatin, glucagon, pancreatic polypeptide (PP), secretin, gastric inhibitory peptide (GIP), gastrin-C-terminal pentapeptide (GTPP), neurotensin and bombesin cells. The enterochromaffin cells were distributed throughout the gastrointestinal tract except the rectum. Somatostatin, glucagon, PP, secretin, GIP and GTPP cells were observed both in the ileum and bombesin cells only in the pyloric and antral parts of the stomach. Immunostaining of consecutive sections did not reveal more than one polypeptide hormone in any of these cell types. It is concluded from the present results that the toad gastrointestinal mucosa contains endocrine cell types that are more or less homologous to those in the mammal alimentary tract, though some of them exhibit a different topographic distribution.

Proximal duodenum was perfused with HC1 for 5 min and the effects on blood-to-lumen clearance of 51Cr-EDTA (ED-C1), morphology, luminal alkalinization, and blood flow determined in anesthetized rats. The rate of alkalinization was determined by back titration and blood flow assessed by laser Doppler flowmetry or by ultrasonic transit time flowmetry. Perfusion of duodenum with 30, 50 or 100 mM HC1 for 5 min increased ED-C1 in a concentration-dependent manner and induced a small increase in alkalinization but had no effect on blood flow. At 55 min after cessation of perfusion with 100 mM HO ED-C1 was 2.2-fold higher than control whereas the ED-C1 values in animals perfused with 30 or 50 mM HC1 were not different from pre-acid control values. 100 mM HC1 also induced an increase in 14C-mannitol and 14C-polyethylene glycol 4000 clearance, suggesting that HC1 does indeed increase mucosal permeability. The 100 mM HCl-induced rise in mucosal permeability most probably reflects disturbance of mucosal integrity because three of five animals exhibited villous tip damage. The increases in ED-C1 in response to 100 mM HC1 were the same in control rats as in rats with the renal pedicles ligated, indicating that the acid susceptibility is not affected by acute functional nephrectomy.

The occurrence of gastrin and gastric inhibitory polypeptide (GIP) was investigated immunocytochemically in 17 foetal and neonatal human pancreata of gestational ages ranging from 12–41 weeks. GIP immunoreactive cells were observed in the pancreas of five foetuses with gestational ages of 18–20 weeks. These cells were located in islet-like cell clusters, at the base of tubular structures and among the exocrine-like acini. They were sometimes seen to emit a single long protrusion. The controls used, including preincubation of the antisera with anticomplement Clq, emphasized the specificity of the observed immunoreaction. No gastrin-immunoreactive cells were seen in any of the foetal or neonatal pancreata examined.

The effects of endogenous hypergastrinemia and hypogastrinemia on the exocrine and endocrine pancreas were studied in the rat. Hypergastrinemia was induced by antral exclusion, and hypogastrinemia by antral resection. The studies were made 14 weeks after surgery.The total weight of the pancreas was increased both in hypergastrinemic and hypogastrinemic animals, due to hypertrophy of the exocrine cells. In contrast, the volume and total weight of the pancreatic islets were decreased.There was no numerical difference in the A-, D-, PP-cells between the hyper-and hypogastrinemic animals, respectively, and the controls. The number of insulin-producing (B-) cells was certainly reduced after the induction of hypogastrinemia. There was, however, signs of increased B-cell activity, which might contribute to an underestimation of the number of B-cells with the technique used.These findings do not support the hypothesis that antral gastrin has trophic influence on either exocrine or endocrine pancreas.

Bouin-fixed tissues from non-diabetic adult human pancreata display an argyrophil reaction mainly in the periphery of the islets with the silver technique of Sevier-Munger. The nature of these argyrophil cells was examined after restaining by an indirect immunocytochemical method using antibodies against insulin, glucagon, somatostatin and pancreatic polypeptide. After this procedure the argyrophil cells were identified as glucagon (A-) cells and pancreatic polypeptide (PP-) cells, although the latter exhibited a weaker reaction. The insulin (B-) cells and somatostatin (D-) cells were unreactive. The results show that the Sevier-Munger stain is of equal value to the Grimelius silver nitrate stain in adult human pancreatic islets after fixation in Bouin's fluid.

Polyclonal antibodies directed towards synaptophysin were raised against a synthesised peptide corresponding to amino acids 246 to 260 of the human synaptophysin sequence. The antibodies, when applied for immunocytochemical staining, showed a staining pattern identical to that of the commercially available monoclonal antibody SY-38. A radioimmunoassay for measurements of synaptophysin was developed using these antibodies and the peptide as standard and tracer. The radioimmunoassay was used for optimising the conditions for purification of synaptophysin from rat brain. No synaptophysin was detected in blood plasma in humans, not even during an embolisation treatment of tumour metastases in the liver, which induced tumour cell necrosis, in a patient with carcinoid tumours. By radioimmunoassay, synaptophysin was detected in cell homogenate from the PC-12 (160 ng/mg) and LCC-18 (40 ng/mg) cell lines and in the cell culture media. In the LCC-18 cell line the synaptophysin immunoreactivity was found in the plasma membrane, and the presence of synaptophysin was confirmed both by radioimmunoassay measurements and by the Northern blot technique. These data indicate that measurements of synaptophysin using this radioimmunoassay are reliable and that the assay can serve as a useful tool in further explorations of the biological effects of synaptophysin.

Among 33 patients with endocrine pancreatic tumors due to multiple endocrine neoplasia type 1 (MEN-1), 19 (58%) patients had hypergastrinemia, 7 (21%) patients had hyperinsulinism, and 7 (21%) patients had clinically non-functioning lesions. At least one gross tumor was found in all patients undergoing pancreatic surgery, including those with negative localization studies prior to operation. The patients also had additional macroscopic tumors as well as numerous microadenomas, and the lesions frequently were positive for immunostaining with multiple hormones, mainly pancreatic polypeptide, insulin, glucagon, and somatostatin. Duodenal endocrine lesions were found in 4 of 5 investigated patients and stained with gastrin and somatostatin antibodies. Distal, mainly subtotal pancreatic resection, was performed in 18 patients, eventually combined with caput tumor enucleation or duodenotomy, while a few patients underwent only tumor enucleation or a Whipple procedure. The long-erm outcome of operation was most favorable in patients with hyperinsulinism; only 1 patient had clinical recurrence. Patients with hypergastrinemia experienced only transitory lowering of serum gastrin values after pancreatic surgery and 47% of them had or developed metastases. Such tumor spread was seen in 57% of the patients with non-functioning lesions. Nine patients died from progressive tumor disease during follow-up. Consistent with previous studies, we found that surgery is indicated in MEN-1 patients with hyperinsulinism even if a lesion is not visualized by radiology. In addition, these indications should be extended to also include patients with only biochemical markers of disease, including elevations of gastrin, as these indicate the presence of gross tumors. This strategy should be applied especially in patients with aggressive family histories to possibly reduce the risk of malignant tumor progression.

The increased knowledge of the pathobiology of gastrointestinal and pancreatic neuroendocrine tumours and the improved therapeutic possibilities have brought a demand for more precise diagnosis. Although the neuroendocrine tumours can often be tentatively recognized in routinely processed microscopic slides, their more accurate identification requires additional diagnostic procedures. General neuroendocrine markers, such as the argyrophil reaction of Grimelius and immunohistochemistry with application of antibodies against chromogranin A and of neuron-specific enolase are discriminatory staining methods which are used to reveal the neuroendocrine origin of almost all highly differentiated neuroendocrine tumours of the gastrointestinal tract (carcinoids) and pancreas (insulomas). Midgut carcinoids, which predominate among these tumours almost unexceptionally contain serotonin. This biogenic amine can be demonstrated by the argentaffin reaction of Masson, serotonin immunoreactivity or by formalin-induced fluorescence. The characteristic staining pattern of midgut carcinoids is almost invariably preserved in the metastases and can thus be used to reveal a primary midgut carcinoid. The enterochromaffin-like (ECL) cell carcinoids of the body and fundic area of the stomach are argyrophil with Sevier-Munger silver stain. Other neuroendocrine tumours, viz. antral, duodenal and rectal carcinoids and insulomas, should be studied by a battery of relevant peptide hormone antisera for adequate diagnosis. About 50% of all insulin-producing insulomas are endowed with stromal amyloid deposits, which chemically are composed of a peptide designated islet amyloid polypeptide. This molecule has been observed by electron microscopical immuno-cytochemistry to occur exclusively in the bT-cells and is co-stored with insulin in the bT-cell granules.

The nuclear DNA contents of tumor cells in 73 patients with endocrine gastrointestinal tumors, 19 patients with endocrine pancreatic tumors (EPT) and 54 patients with malignant carcinoid tumors were determined before and after treatment. The DNA profiles were divided into diploid and aneuploid. In untreated patients, 9 out of 10 (90%) primary EPT and all 9 primary malignant carcinoid tumors (100%) were diploid. Tumor cell imprints from liver metastases of patients with untreated EPT showed aneuploidy in 5 of 11 cases, but only in 7 out of 46 DNA records from patients with untreated carcinoid liver metastases. DNA alteration from diploid to aneuploid profiles occurred in 2 patients with endocrine pancreatic tumors who had received chemotherapy. A change from diploid to aneuploid records was also seen in 7/23 (30%) carcinoid tumors after treatment. The DNA patterns before and after treatment did not show any correlation with survival or treatment response.

Medullary thyroid carcinoma (MTC) was identified in 276 patients (in 27 diagnosed at autopsy) by a review of virtually all 6513 notifications of primary thyroid cancer ot the National Cancer Registry in Sweden 1959 through 1981. The diagnosis was confirmed in 268 of the 276 cases by histophatological and histochemical reexamination. Anamnestic data and morphological characteristics indicated that 208 (75%) patients had sporadic and 68 (25%) familial MTC. The mean ages at diagnosis of these two groups were 57.0 and 42.6 years respectively. The age-standardized incidence rate per 105 inhabitants was 0.18 for males and 0.23 for females. The age-specific incidence of sporadic MTC increased markedly with age, whereas no unequivocal rise was found after the age of 20 for familial disease. Standardized morbidity ratios (SMR), calculated separately for each of the six Swedish health care regions, revealed a roughly two-fold and mostly non-significant geographical variation in the occurrence of sporadic MTC. SMR for familial disease varied, however, between 0 and 306 and deviated highly significantly from the national average in four of the six regions. Regional differences in diagnostic intensity were considered unlikely as the sole explanation of this finding.

Islet amyloid peptide (IAPP) or amylin is a recently discovered polypeptide without settled physiology in man. We present a patient with an endocrine pancreatic tumor secreting huge amounts of IAPP-like immunoreactivity (20,000 mol/l) and a concomitant development of diabetes mellitus. The release of insulin and pancreatic polypeptide (PP) was totally absent after an oral glucose load and a mixed meal, respectively. Tumor secretion of IAPP-like immunoreactivity seemed to be influenced by cholinergic mechanisms and by nutrients. The observed effects on insulin and PP secretion by high circulating levels of IAPP-like immunoreactivity may be of beneficial value for further studies of the physiology of IAPP in man.

The aim of the study was to determine if and by what mechanism(s) nitric oxide inhibition modulates the susceptibility of the duodenum to hydrochloric acid‐induced disturbances of mucosal integrity. A second aim was to investigate whether basal permeability is a determinant of epithelial acid barrier function. Using an in situ duodenal perfusion model, mucosal permeability, alkaline secretion and morphology were investigated in anaesthetized rats. Luminal perfusion with 50 mmhydrochloric acid increased duodenal mucosal permeability in the control animals. In animals receiving the nitric oxide synthase inhibitor N‐nitro‐l‐arginine methyl ester (l‐NAME 3 mg kg−1and 1 mg kg−1h−1) and in those receiving vasopressin (1 IU kg−1h−1), however, the mean increase in permeability in response to acid was markedly higher. In rats treated with either hexamethonium (20 mg kg−1) or atropine (0.5 mg kg−1) l‐NAME failed to augment the acid‐induced increase in permeability. Perfusion with hypotonic saline (25 mm) increased basal permeability but did not influence the response to acid. Exposure of the duodenum to hydrochloric acid caused very subtle changes of duodenal morphology. It is concluded that both inhibition of endogenous nitric oxide synthesis and vasopressin treatment augment the acid‐induced increase in mucosal permeability. The mechanisms involved may be related to changes of Starling forces in the microcirculatory bed. Endogenous nitric oxide may protect the duodenal mucosa by regulating vascular permeability and interstitial fluid pressure.

Seventeen patients with neuroendocrine liver metastases, 14 of whom were treated with interferon, were examined with MRI before and after contrast administration to evaluate whether there were signal characteristics, differences in homogeneity and/or contrast enhancement patterns that indicated response to or failure of treatment. Of the treated patients 6 objectively responded to treatment (OR), 3 had progressive disease (PD) and 5 had stable disease (SD). A significant difference was found between the SD, untreated (UT) and OR groups of patients in terms of T1 (P = 0.01) and contrast enhancement (P = 0.02). The signal intensity ratio (SIR) in T2-weighted images between tumour and liver was significantly different (P = 0.05) between the OR and PD groups. This indicates that MRI may be used in therapy monitoring of patients with neuroendocrine metastases. Neuroendocrine metastases in the OR group had the same T1 and SIR values as those reported for haemangiomas, while patients in the PD, SD and UT groups had SIR values similar to those for colorectal metastases.

The parafollicular cells of the thyroid gland were visualized by means of the Sevier-Munger silver technique in normal mice and in mice receiving 131I in amounts sufficient to completely destroy the thyroid tissue. The destruction of the C-cells was observed in all 131I injected mice, and no histologic signs of recovery were seen during a period of 40 days following the treatment.

Cervical cancer incidence and mortality can be reduced by removal of precursor lesions detected at cytological screening. Organised screening, i.e. regular invitation of defined target groups, is generally considered more effective than opportunistic screening. The latter method however, is predominant in most settings. There is no scientific basis for advocating one type of screening or the other. Our aim was to compare the two types and to analyse their efficiency. We analysed 466,275 smears taken in an open cohort of 118,890 women during 1969-88. A computerised database permitted standardised classification of all smears and complete ascertainment of cancer in situ through record linkage. The number of in situ cancers detected per 1000 smears, the detection ratio, was used as an outcome measure both in univariate analyses and in multivariate logistic regression models. Cancer in situ was detected in 1076 women in the study cohort, with a detection ratio of 3.0 at organised and 2.1 at opportunistic screening, yielding an unadjusted odds ratio of 0.69 (95% CI 0.61-0.79). After adjustment for age and time period, the probability of detecting cancer in situ was around 25% higher with opportunistic than with organised screening (OR = 1.26; 95% CI 1.09-1.46). This difference in favour of opportunistic screening was most pronounced in the first 10 year period and disappeared during the last decade. The difference in efficiency between organised and opportunistic screening in the detection of cancer in situ was slight, if any. The dogma that organised screening is significantly more efficient than the opportunistic type needs reconsideration.

The expression of bcl-2 was studied in normal ovaries and in ovarian tumours by immunohistochemical analysis. Normal epithelium was strongly stained in all nine examined ovaries. In comparison, all tumour groups showed a substantially decreased tumour cell expression of the same order of magnitude. Thus, benign tumour cells were weakly stained in two and unstained in two samples, while the remaining eight showed strong expression. Of ten borderline samples, one was unstained and five had weakly and four strongly bcl-2 positive tumour cells. Finally, 24 of 50 malignant tumours showed strong staining, while weak or no expression in tumour cells was found in 16 and 10 samples respectively. The reduced staining deviated significantly from normal ovary for both borderline (P = 0.02) and malignant groups (P = 0.01). Tumour cell staining with the bcl-2 antibody was significantly reduced when tumour mass had to be left behind compared with those with no visible remaining tumour (P = 0.03 and 0.003 for weakly and strongly stained tumours respectively). The expression of bcl-2 in malignant tumour cells was inversely correlated with the expression of p53. Bcl-2 expression was correlated with survival with significantly reduced survival in weakly (P = 0.02) and unstained (P < 0.001) groups compared with those patients having strongly stained malignant tumour cells. This correlation between the presence of bcl-2 and survival was maintained in the subgroups of patients with advanced disease or with residual tumour bulk and was also the case in patients having p53-positive tumours. Our results indicate an inhibitory role of bcl-2 in development and progression of ovarian tumours.

A specific immunofluorescence for enteroglucagon or substance P or for both hormones was demonstrated in nine out of 12 examined rectal carcinoids. One tumor was argentaffin, contained ultrastructurally pleomorphic granules of the entero-chromaffin cell type, and showed immunofluorescence for substance P. The rest were non-argentaffin but were argyrophil with the Grimelius technique and contained round granules. The argyrophil carcinoids were immunoreactive to one or both hormones in eight cases and not fluorescent in three cases. In two of the non-argentaffin carcinoids a small number of argyrophil cells was found with the method of Sevier-Munger.

Amyloid deposits localized to the islets of Langerhans are typical of non-insulin-dependent human diabetes mellitus and of diabetes mellitus in adult cats. Amyloid deposits also commonly occur in insulin-producing pancreatic tumors. We have purified a major protein--insulinoma or islet amyloid polypeptide (IAPP)--from human and cat islet amyloid and from amyloid of a human insulinoma. IAPP from human insulinoma contained 37 amino acid residues and had a theoretical molecular mass of 3850 Da. The amino acid sequence is unique but has greater than 40% identity with the human calcitonin gene-related peptide. A partial amino acid sequence of cat islet IAPP corresponding to positions 1-27 of human insulinoma IAPP was identical to the human IAPP except for substitutions in three positions. An antiserum raised to a synthetic human insulinoma IAPP-(7-17) undecapeptide showed specific immunohistochemical reactivity with human and cat islet amyloid and with islet B cells. The significance of this pancreatic neuropeptide-like protein is unknown, but it is suggested that it may exert an important endocrine regulatory effect.

A series of 12 carcinoid tumours of the appendix were examined with regard to S-100 protein immunoreactivity. All tumours were both argentaffin and argyrophil, and displayed immunoreactivity after application of a monoclonal antibody against serotonin. The S-100 protein immunoreactivity appeared in 11 of the 12 tumours, preferably in cells presumably of Schwann cell origin with long slender processes localized at the periphery of the carcinoid tumour buds. Immunoreactive cells with cytoplasmic processes were also seen extending between individual tumour cell in the tumour aggregates. In a few tumours S-100 immunoreactivity occurred in the cytoplasm of tumour cells with or without cytoplasmic extensions. The presence of S-100 protein immunoreactive cells, apparently as an integral component, and its shape and distribution indicate that the peripheral nervous system (PNS) is histogenetically involved in the development of carcinoid tumours of the appendix.

A novel peptide, islet amyloid polypeptide (IAPP), with structural resemblance to calcitonin gene-related peptide has recently been purified from amyloid deposits in an insulinoma and from islets of Langerhans. By immunohistochemical methods, using antisera to a synthetic undecapeptide of IAPP and to insulin, we show that freshly fixed islet B cells in man, guinea pig, rat, mouse and hamster exhibit strong IAPP-immunoreactivity while A cells are unreactive. In human autopsy material, all of 11 non-diabetic individuals had IAPP immunoreactivity of the islets. In comparison 8 of the 13 patients with Type 2 (non-insulin-dependent) diabetes had no IAPP immunoreactive cells. The proportion of islet cells having IAPP immunoreactivity exceeded 10% in only 1 of the 5 remaining diabetic patients while in all 13 patients substantially more than 10% of the islet cells contained immunoreactive insulin. IAPP-positive amyloid deposits were found in 20–99% of the islets in 12 of the Type 2 diabetic patients while 6 of 11 non-diabetic subjects had amyloid in 3–11% of their islets. In islets with IAPP-immunoreactive amyloid, very few IAPP-cells were seen despite a strong reaction of the B cells with antiserum to insulin. This study shows that IAPP is a normal islet B cell component and that IAPP immunoreactivity in B cells is diminished in Type 2 diabetes while IAPP is deposited as amyloid fibrils in the islets of Langerhans. Although the function of IAPP is unknown, its occurrence in the islet B cells and its structural relation to calcitonin gene-related peptide makes a hormonal nature probable. The present study indicates an altered expression or metabolic fate of IAPP in Type 2 diabetes.

Islet amyloid polypeptide or amylin is a polypeptide secreted mainly from the pancreatic beta cells together with insulin upon stimulation. High levels of islet amyloid polypeptide have also been shown to increase the peripheral insulin resistance and consequently a role for islet amyloid polypeptide in the glucose homeostasis has been suggested. We have studied the glucose homeostasis in a patient with a malignant endocrine pancreatic tumour producing large amounts of an islet amyloid polypeptide-like molecule (about 400 times the upper reference level for islet amyloid polypeptide). This patient developed insulin-requiring diabetes mellitus shortly after the tumour diagnosis. Both intravenous and oral glucose tolerance tests revealed inhibited early responses in insulin and C-peptide release, but the insulin and C-peptide response to glucagon stimulation was less affected. Aneuglycaemic insulin clamp showed normal insulin-mediated glucose disposal. In vitro experiments, where isolated rat pancreatic islets were cultured with serum from the patient, showed a moderately decreased islet glucose oxidation rate and glucose-stimulated insulin release compared to islets cultured with serum from healthy subjects. However, culture of rat islets with normal human serum supplemented with synthetic rat islet amyloid polypeptide did not affect the glucose-stimulated insulin release. In conclusion, the observed effects show that the diabetic state in this patient was associated with an impaired glucose-stimulated insulin release but not with an increased peripheral insulin resistance. Thus, the results suggest that if islet amyloid polypeptide has diabetogenic effects they are more likely to be exerted at the level of insulin secretion than at the level of peripheral insulin sensitivity.

Background: Studies in different species have suggested, but not established, that sex hormones influence gastric acid secretion. We studied how acid output is affected by the sex hormones estradiol or testosterone in vivo and in vitro. Methods: In gastric fistula rats that were normal, sham-operated, neonatally gonadectomized, or treated with estradiol or testosterone, 24-h basal and pentagastrin-stimulated acid secretion was measured. The in vitro effects of estradiol and testosterone on histamine-induced aminopyrine accumulation in isolated parietal cells were also determined. Results: Basal acid output was similar in the two sexes, but stimulated secretion was significantly higher (34%; P < 0.01) in males. Ovariectomy did not influence acid output, whereas orchidectomy reduced basal (18%; NS) and stimulated 24-h secretion (P < 0.01). Estradiol decreased (23%; NS) the 24-h basal output in females but not in males. Estradiol suppressed stimulated secretion in females (29%, P <0.01) and males (42%, P < 0.01) during the day. At night the stimulated secretion increased in both females (17%, NS) and males (32%, P < 0.05). A similar pattern was found when rats were treated with testosterone. In vitro, estradiol and testosterone reduced histamine-stimulated aminopyrine accumulation in both female and male isolated parietal cells. Conclusions: Estradiol and testosterone both appear to influence gastric secretion in rats, and their action differs between day and night, between the sexes, and between basal and stimulated secretion.

Background. Radiologic diagnosis of pancreatic tumors exhibits limited precision. The aim of this study was to investigate the outcome and complications of pancreatic core biopsy in patients with suspected pancreatic neoplasms. Methods. One hundred patients underwent ultrasonography-guided core biopsy of 1.2 mm external diameter. Medical charts were examined for biochemical and clinical signs of complications. Final diagnosis was settled by operation, autopsy, and clinical signs of the disease including survival with at least 2.3 years of follow-up. Results. Histopathologic biopsy evaluation showed correct discrimination between exocrine and endocrine tumors and nonneoplastic conditions in 89 patients. No false-positive cancer diagnosis was sensitivity was 91% for exocrine and 87% for endocrine pancreatic tumors, and negative predictive values of these diagnoses were 83% and 97%, respectively. No clinically significant complications were noted. Conclusions. Core biopsy is an attractive alternative to diagnostic laparotomy in unresectable pancreatic cancer and efficiently provides diagnosis of endocrine tumors and pancreatic metastases in conjunction with rare complications. Benign biopsy findings cannot be used to exclude presence of primary or metastatic pancreatic neoplasms.

This study was performed with the aim of ultrastructurally localizing serotonin and polypeptide YY (PYY) in the endocrine cells of the human rectum. Existing basic methods for immunolocalization of antigenic sites in ultrathin sections were tested and modified to allow reproducible results with distinct localization of marker (colloidal gold probes coupled either to IgG or protein A). Probes signifying presence of serotonin were distinctly localized over all heteromorphous granules in argentaffin cells and, in addition, over some of the more monomorphous, rounded granules in a second cell type whose granules all were covered by probes showing localization of the PYY antigen. The results suggest that serotonin in endocrine cells of the gut is not confined to the enterochromaffin type but may also be present in trace amounts in non-enterochromaffin endocrine cells storing peptide hormones. Since probes marking sites of PYY were deposited over some heteromorphous granules in enterochromaffin cells, the evidence obtained also suggests that PYY may occur in low concentration in these cells. The distribution of probes in the sections indicated that antigenic sites were confined to granules in the cells.

Male rats were made diabetic with streptozotocin or alloxan. After a week, the rats were put on a 25% casein or a protein-free diet. 5 days later they were intraperitoneally administered3H-cytidine and killed after 18 h. Liver ENA synthesis was estimated by determining the ratio, spec. RNA activity/spec. acid-soluble nucleotide activity, and the product of the above mentioned ratio and the RNA/DNA ratio. The protein-fed, diabetic rats showed about 175% increase in liver RNA synthesis (P< 0.001) and a decreased amount of rough-surfaced endoplasmic reticulum in the liver cell cytoplasm, as compared to protein-fed, non-diabetic rats. The protein-deprived, diabetic rats showed about 40% increase in RNA synthesis as compared to protein-deprived, non-diabetic rats (P< 0.01), but no differences could be ascertained in liver ultrastructure. The protein-deprived, non-diabetic rats had a decreased amount of rough-surfaced endoplasmic reticulum and an 82% increased ratio, spec. RNA activity/spec. acid-soluble nucleotide activity, as compared to the protein-fed, non-diabetic rats (P< 0.01). The RNA labelling profiles following gel electrophoresis were of the same shape in all groups.

The clinical and pathological features of 164 patients with anal epidermoid carcinoma were investigated in a population-based study between 1978 and 1984. Twenty-three tumours, the majority of which were small and well differentiated squamous cell carcinomas, were situated in the perianal region. Twenty of these patients are alive and disease-free. Of 141 tumours in the anal canal two-thirds were of the cloacogenic type, i.e. displaying transitional cell differentiation. The overall 5-year survival was between 40 and 50% for both cloacogenic and squamous cell carcinomas, respectively. However, poorly differentiated squamous cell carcinomas and cloacogenic carcinomas without any squamous cell differentiation (subtype A) had a more aggressive course, especially in men, than the other subgroups. Clinical stage also had an impact on prognosis. Both stage, sex, degree of differentiation and histologic subtypes revealed independent prognostic information. Although the primary aim of this study was not to evaluate therapy, it was noted that patients primarily treated with irradiation (with or without chemotherapy) had a more favourable course than patients treated with surgery alone.

The distribution of the mRNAs for chromogranin A and B was analyzed by in situ hybridization with 35S-labeled oligonucleotide probes in formalin-fixed paraffin-embedded carcinoid tumor tissues. All the 15 mid-gut carcinoid tumors examined contained both mRNAs for chromogranin A and B at high level in tumor cells. Sixteen of 18 bronchial carcinoid tumors but only 2 of 5 rectal carcinoid tumors expressed one or both species of chromogranin mRNAs. The same tendency was seen with the argyrophil reaction according to Grimelius where most of the mid-gut tumor cells were uniformly stained, while considerable variation in reactivity was seen in some of the bronchial and rectal carcinoid tumor cells. The sequential sections were stained with a monoclonal antibody against chromogranin A and a polyclonal antiserum which reacts with both chromogranins. The expression of the mRNA for chromogranin A on the carcinoid tumors was almost concordant with that of chromogranin B as well as with the chromogranin A protein, whereas almost all tumors stained positively with the polyclonal antibodies. Analyses of mRNA expression of chromogranin A before and after interferon therapy on 4 patients with mid-gut carcinoids indicated an inhibition at pre-translational level. In conclusion, the mRNAs for chromogranin A and B are good markers for the carcinoid tumors, especially of mid-gut origin. Fore-gut, mid-gut and rectal carcinoid tumors are different in their endocrine properties regarding the expression of the chromogranins.

Amyloid deposition is the most typical islet alteration in Type 2 (non-insulin-dependent) diabetes. In the present study we show by immunohistochemistry that the amyloid reacts with an antiserum against insulin B chain. Islet amyloid was also purified, dissolved in guanidine-HCl and gel filtered on a Sepharose 6B column. Immunization of a guinea pig with a high molecular weight fraction from this gel filtration resulted in an antiserum with insulin-binding capacity. This binding was partially blocked with pure insulin B chain. The results indicate that islet amyloid contains insulin B chain and that the amyloid is a product of the islet B cells. Thus the study support previous morphological studies.

Pancreatic islet volumes of patients with and without maturity onset diabetes mellitus were estimated. The islet volume of the diabetic patients was 1.01±0.12 cm3(SEM) and that of the nondiabetic patients 1.60±0.16 cm3with considerable overlap between the two groups. Islet amyloidosis was found in all the diabetic and in 9 of the 15 nondiabetic patients. When the amyloid deposits were excluded, the islet volume of the diabetic patients was 0.89±0.10 cm3, while that of the non-diabetic patients was unchanged, 1.60±0.16 cm3. There was still some overlapping. Since amyloid deposits seem to destroy the B cell membranes, it was postulated that a comparison of the volumes of islets completely free of amyloid might give a more true picture of the quantitative islet alterations in maturity onset diabetes. It was found that this islet volume of the diabetics was only 0.41±0.05 cm3and that of the nondiabetic patients 1.58±0.16 cm3. These values correspond better to the altered insulin secretion in maturity-onset diabetes mellitus.

The chemical background of silver stains used for visualization and characterization of peripheral neuroendocrine cells in the gastrointestinal tract and pancreas, and of their corresponding tumours, was studied in tissue sections and by a dot-blot technique. Sequential staining of pancreatic islets with an immunohistochemical procedure and silver staining of the same tissue section revealed that chromogranin A immunostained cells also displayed an argyrophil reaction with the Grimelius method, but no argentaffin reaction with the Masson technique. Accordingly, purified chromogranin A (15 μg or less) treated in formalin and applied to nitrocellulose did not show any argentaffin reaction but displayed a dose-related argyrophil reaction. Equal quantities of other polypeptide components did not give rise to any silver reaction. Further dot-blot studies showed that the tryptophan and tyrosine metabolites, dopamine, norepinephrine, 5-hydroxytryptamine and 5-hydroxindole caused strongly argentaffin and argyrophil reactions while epinephrine, 5-hydroxyindole-3-acetic acid and 5-hydroxytryptophan gave only the former reaction. Among other chemical components studied, only guanine displayed weak silver staining. The results indicate that the reaction products between aldehydes and the granular content of biogenic amines synthesized from tryptophan and tryosine display an argentaffin reaction and that the granular chromogranin A caused an argyrophil but no argentaffin reaction.

Chromogranins A, B, and C, proteins that are co-stored and co-released with peptides and amines, have been identified in a variety of neuroendocrine tissues, both normal and neoplastic. We examined the secretion of chromogranin A and chromogranin A + B by hormone-producing tumours in patients with endocrine pancreatic tumours, carcinoid tumours, pheochromocytomas, and small cell lung cancer. The radioimmunoassay determining the plasma concentrations of chromogranin A + B showed a greater sensitivity than that determining chromogranin A alone. All patients with endocrine pancreatic tumours, carcinoids, and pheochromocytomas had increased levels of chromograin A + B, whereas a small number of the patients (5/18 with endocrine pancreatic tumours and ⅓ with pheochromocytomas) had normal levels of chromogranin A. Also in immunocytochemical stainings, our polyclonal antiserum detecting both chromogranin A andB showed a greater sensitivity than other available antisera against chromogranin A, B and C. We have demonstrated that a polyclonal antiserum against a mixture of chromogranin A and B might be a more sensitive marker than chromogranin A alone for diagnosing neuroendocrine tumours. This is not surprising, since both chromogranins are widely distributed in neuroendocrine cells.

Islet amyloid polypeptide is a novel 37 amino-acid-residues polypeptide which has been isolated from amyloid deposits in an insulinoma, and in human and cat islets of Langerhans. The molecule has 46% homology with the calcitonin gene-related peptide. Light microscopy examination of the pancreas shows that islet amyloid polypeptide immunoreactivity is restricted to the islet B cells. The present study utilized a rabbit antiserum against a synthetic peptide corresponding to positions 20–29 of islet amyloid polypeptide, a sequence without any amino-acid identity with calcitonin gene-related peptide. By applying the immunogold technique at the ultrastructural level, it was shown that both insulin and islet amyloid polypeptide immunoreactivity occurs in the central granular core of the human B cell secretory granules, while the A cells remain unlabelled. The demonstration that islet amyloid polypeptide is a granular protein of the B cells may indicate that it is released together with insulin. Further studies are necessary to evaluate the functional role of islet amyloid polypeptide.

The immunoreaction of a rabbit chromogranin A and B antiserum was studied in normal human pancreatic islets. By examination of consecutive light microscopical sections, it was revealed that, at high antiserum concentrations (1:2000 or less), the whole islet area was heavily labelled, although the peripheral glucagon (A)-cells were the most intense in their immunoreaction. At low antiserum concentrations (1:4000 or more) the A-cells still showed the same intense labelling reaction, but the central B-cells were weakly labelled. Electron microscopically, reactivity towards the chromogranin A and B antiserum and the monoclonal insulin antibodies was present in the same central electron-dense core of the B-cell secretory granules, as demonstrated after application of the immunogold technique at different antibody dilutions. In the A-cells, the chromogranin immunoreactivity was concentrated at the peripheral mantle of the secretory granules. The D-cell granules showed a weak immunolabelling. Examination of human islets with the monoclonal chromogranin A antibody LK2H10 revealed immunogold labelling only in the peripheal mantle of the A-cell granules, while the B-cell granules were unlabelled. The present results show that a chromogranin peptide is co-stored with insulin the in normal human B-cell secretory granules. Although the exact composition of this B-cell chromogranin is unknown, it is not identical to that of the chromogranin A present in the A-cell granules.

The enterochromaffin cells of the human small intestinal mucosa were stained immunocytochemically with monoclonal antibodies against serotonin. The staining results were compared with those obtained with other methods for identifying serotonin-containing endocrine cells such as the argentaffin reaction, formalin-induced fluorescence and the argyrophil reaction of Grimelius. The different techniques gave similar, but not identical, results. The serotonin-immunoreactive cells outnumbered the argentaffin cells by 7%. Almost all (99%) serotonin-immunoreactive cells showed formalin-induced fluorescence but only a small population (5%) were fluorescent. In a subsequent study, these techniques were applied to 14 small intestinal carcinoids. It was shown that formalin-induced fluorescence and the argentaffin reaction were positive in 14 and 13 tumours, respectively, while the monoclonal serotonin antibodies failed to stain seven of the tumours. It is concluded that formalin-induced fluorescence and the argentaffin reaction are more useful techniques than serotonin immunocytochemistry for defining these tumours in routine formalin-fixed surgical specimens.

Endocrine cells of human small intestinal mucosa, small intestinal carcinoids and carcinoid liver metastases were stained with an immunocytochemical technique using an antiserum against neuron-specific enolase (NSE), with the argyrophil technique of Grimelius and with the argentaffin technique of Masson. In the normal mucosa, scattered NSE-immunoreactive cells were seen mainly in the deeper parts of the crypts. These cells, as shown in the same sections, corresponded to the argentaffin and/or argyrophil cells indicating that they were of endocrine type. All intestinal carcinoids (16 cases) displayed NSE immunoreactivity. However, this reaction did not correlate on the cellular level with the silver techniques employed. Thus, many tumour cells were NSE immunoreactive but lacked an argentaffin or argyrophil reaction and vice versa. On the light microscopical level the silver techniques reveal the presence of neurohormonal granules in the tumour cells, while the NSE immunoreactivity appears to disclose neuroendocrine differentiation of the tumour cells irrespective of their hormone and granular content. Out of 13 carcinoid liver metastases, eight displayed strong NSE immunoreactivity, three were weakly stained and two were unreactive. Consecutive or the same tumour sections showed an argentaffin and argyrophil reaction in all carcinoid metastases. Since silver staining provides one type of information and NSE immunocytochemistry another, they provide in combination a good discriminator for neuroendocrine tumours.

Chromogranins A, B and C, proteins that are costored and coreleased with peptides and amines, have been identified in a variety of endocrine and nervous tissues, both normal and neoplastic. We examined the secretion of chromogranin A and chro-mogranin A + B by hormone-producing tumors in patients with endocrine pancreatic tumors (EPT), carcinoid tumors, pheochro-mocytomas and small cell lung cancer (SCLC). Radioimmunoassay (RIA) of the plasma/serum concentrations of chromogranin A + B showed a greater sensitivity than RIA of chromogranin A alone. All patients with EPT, carcinoids and pheochromocytomas had increased levels of chromogranin A + B, whereas a small number of the patients (5/18 with EPT and 1/3 with pheochromocytomas) had normal levels of chromogranin A. Also in immunocytochemical stainings, our polyclonal antiserum detecting both chromogranin A and B showed a greater sensitivity than other available antisera against chromogranin A, B and C.