bromochloroacetic-acid and Anus-Neoplasms

We present a case of mucoepidermoid carcinoma of the anal canal, with special reference to immunohistochemical analysis of the tumor to clarify its histogenesis. A 36-year-old man underwent surgery for mucoepidermoid carcinoma of the anal canal. Immunohistochemical analysis of the resected specimen was performed. Serial sections were stained immunohistochemically by the labeled streptavidin-biotin peroxidase method for various antigens, including epithelial membrane antigen (EMA); carcinoembryonic antigen (CEA); different types of cytokeratins, including CK10 and CAM 5.2; and p53 oncoprotein. The solid component of the tumor cells was immunohistochemically positive for EMA, CEA, and CAM 5.2, but negative for CK10. These staining patterns were different from those of anal squamous epithelium. These results confirm that mucoepidermoid carcinoma of the anus may arise from the anal transitional zone, and that it is biologically different from squamous cell carcinoma of the anus.

Topics: Adult; Anus Neoplasms; Biomarkers; Biomarkers, Tumor; Carcinoembryonic Antigen; Carcinoma, Mucoepidermoid; Humans; Immunohistochemistry; Keratins; Male; Mucin-1

Extramammary Paget's disease most commonly occurs on the female external genitalia and rarely occurs in the perianal region and male external genitalia. We present the clinical and pathologic features of 5 cases of perianal Paget's disease and review the literature.. Clinical and pathologic data were recorded for 5 cases of perianal Paget's disease. Cases were studied retrospectively with special stains, including periodic acid-Schiff, mucicarmine, Alcian blue, carcinoembryonic antigen, S100 protein, pan-keratin, gross cystic disease fluid protein-15 (GCDFP-15), lysozyme, CD15 (Leu-M1), cytokeratin 7 (CK7), and cytokeratin 20 (CK20).. Three (60%) of 5 patients had concurrent rectal adenocarcinomas. All cases reacted positively for pankeratin, although the intensity and distribution of staining varied. Both cases not associated with an underlying carcinoma showed strong GCDFP-15 and CK7 expression and an absence of CK20 expression. The 3 cases associated with an underlying malignancy demonstrated CK7 and CK20 expression and an absence of GCDFP-15 expression. All cases were negative for lysozyme and CD15 (Leu-M1).. The 5 cases reported herein demonstrate that perianal Paget's disease is a heterogeneous entity. The high frequency of associated underlying malignancies and resultant poor clinical outcomes highlight the importance of an aggressive search for a second malignancy. In some cases, perianal Paget's disease merely represents a cutaneous manifestation of an underlying rectal adenocarcinoma and demonstrates a CK7+/CK20+/GCDFP-15-/lysozyme-/Leu-M1- immunophenotype and signet ring Paget's cells. Other cases represent primary adenocarcinomas of the skin, which are associated with a CK7+/CK20-/GCDFP-15+/lysozyme /Leu-M1- immunophenotype and an excellent prognosis if adequately resected. Immunohistochemical studies, particularly CK20 and GCDFP-15, are useful adjuncts in distinguishing primary and secondary perianal Paget's disease.

Topics: Aged; Anus Neoplasms; Apolipoproteins; Apolipoproteins D; Biomarkers, Tumor; Carcinoembryonic Antigen; Carrier Proteins; Fatal Outcome; Female; Glycoproteins; Humans; Immunohistochemistry; Intermediate Filament Proteins; Keratin-20; Keratin-7; Keratins; Lewis X Antigen; Male; Membrane Transport Proteins; Middle Aged; Muramidase; Paget Disease, Extramammary; Retrospective Studies

Bowen disease, one of the common skin cancers, is defined as squamous cell carcinoma in situ, characterized by atypical keratinocytes occupying the full thickness of the epidermis, and predominantly occurs on sun-protected skin. There is no existing data on the impact of tumour and immune cell interactions or cytokeratin expression on the pathology of Bowen disease.. We analysed dynamic changes in cytokeratin expression and immune cell composition during the development and progression of Bowen disease.. Analysis was performed using immunohistochemistry and electron microscopy for samples from 140 patients with Bowen disease and 20 patients with invasive squamous cell carcinoma. We evaluated cytokeratin expression, the number of infiltrating immune cells and amyloid deposition by immunohistochemistry, and the ultrastructural relationship between tumour cells and immune cells by electron microscopy.. The results showed that the expression of CK14 is associated with tumour progression, keratotic status and amyloid deposition and that the expression of CK10 is associated with accumulation of immune cells in Bowen disease. The findings of electron microscopy indicated repeated battles involving immune cells in response to tumour invasion.. The expression of cytokeratins, hyperkeratosis, inflammatory infiltration and amyloid deposition are useful findings indicating the "stage" in Bowen disease.

Topics: Anus Neoplasms; Bowen's Disease; Carcinoma, Squamous Cell; Humans; Keratins; Keratosis

Anal duct carcinoma is an uncommon malignancy of the glands of the anal duct. This entity poses a diagnostic challenge, both clinically and histologically. This article describes histopathologic findings in a case of anal duct carcinoma, including the initial diagnosis on biopsy and subsequent cytology specimens. Additionally, differential diagnoses of this neoplasm are discussed. With a high index of suspicion, and attention to histological and immunohistochemical features, anal duct carcinoma can be accurately diagnosed both on biopsy and on cytology.

Topics: Abdominal Pain; Anus Neoplasms; Ascites; Biopsy; Carcinoma, Ductal; Constipation; Cytodiagnosis; Diagnosis, Differential; Female; Hospice Care; Humans; Keratins; Middle Aged; Paracentesis; Peritoneal Neoplasms

Rectal squamous cell carcinoma (SCC) is a rare tumor with unresolved etiology. Human immunodeficiency virus-infected individuals and solid organ transplant recipients experience >30-fold and approximately 3-fold elevated rates of rectal SCC, respectively, suggesting immunosuppression plays a role.

Topics: Adenocarcinoma; Anus Neoplasms; Biomarkers; Carcinoma, Squamous Cell; Case-Control Studies; DNA-Binding Proteins; DNA, Viral; Human papillomavirus 16; Humans; In Situ Hybridization; Keratins; Oncogene Proteins, Viral; Papillomavirus Infections; Rectal Neoplasms; Repressor Proteins; Transcription Factors; Tumor Suppressor Proteins; Viral Envelope Proteins

Perianal Paget's disease is an uncommon intraepidermal carcinoma characterized by the presence ofPaget cells. It usually affects older patients and commonly presents as chronic perianal pruritus with scaly plaques. The disease is categorized into primary perianal Paget's disease ofcutaneous origin and secondaryperianal Paget's disease, which is due to extension of a visceral malignancy such as that of the anorectum or colon. Cytokeratin 7 (CK7), cytokeratin 20 (CK20), and gross cystic disease fluid protein-15 (GCDFP15) expression are useful for differentiation between these two types. A tumor immunohistochemical profile of CK7+/CK20-/GCDFP15+ suggests the primary type, whereas CK7+/CK20+/GCDFP15- suggests the secondary type. The expression of caudal homeobox 2 (CDX2) suggests the secondary type from anorectal or colonic adenocarcinoma. However, approximately one- third of patients without visceral malignancy have a tumor that is CK7+/CK20+/GCDFP15-. Two percents of primary perianal Paget ' disease can express CDX2. The author reports a case ofan 86-year-old man who presented with chronic perianalpruritus and a scaly plaque. A skin biopsy showed intraepidermal Paget cells with immunohistochemical profile of CK7+/CK20+/GCDFPJ5-/CDX2+. Initially, secondary perianal Paget's disease from colorectal adenocarcinoma was suspected. However, extensive investiga- tions found no visceral malignancy. The patient underwent wide excision of the perianal skin. Pathological examination showed diffuse intraepidermal Paget cells withfocal dermal invasion by intestinal-type adenocarcinoma and signet-ring cell differentiation. In conclusion, thefinal diagnosis was primary perianal Paget's disease withfocal adenocarcinona and signet- ring cell differentiation. The disease was consistent with primary perianal Paget's disease, because no visceral malignancy was found.

Topics: Aged, 80 and over; Anus Neoplasms; Carrier Proteins; Glycoproteins; Humans; Keratin-7; Keratins; Male; Membrane Transport Proteins; Paget Disease, Extramammary; Perineum

Topics: Anus Neoplasms; Carcinoma, Signet Ring Cell; Colonoscopy; Fatal Outcome; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Mucins; Neoplasm Proteins

To investigate a possible follicular origin of extramammary Paget's disease (EPD). EPD is a predominantly intraepidermal tumour with extensive involvement of adnexal structures and high recurrence rates suggesting a follicular stem cell origin. Cytokeratin (CK) 15 and CK19 are considered markers for follicular stem cells located in the hair follicle bulge region.. Formalin-fixed paraffin-embedded tissues of 12 cases of primary EPD (three anal, nine vulvar) were studied immunohistochemically with antibodies to CK15 and CK19. All cases of EPD showed polygonal Paget cells in the interfollicular epidermis, hair follicles, sebaceous and apocrine glands distributed individually, in nests and in gland-like areas. The polygonal Paget cells were intimately associated with small, flat, mitotically active, 'compressed' keratinocytes. The large Paget cells uniformly expressed CK19 in 12/12 EPD. The small 'compressed' keratinocytes showed strong cytoplasmic CK15 staining in 9/12 EPD with focal accentuation, while the polygonal Paget cells were negative.. These histological and immunohistochemical observations allow the following conclusions: (i) the small, flat, 'compressed' keratinocytes are an integral part of EPD; (ii) the dual cell population is reminiscent of sebaceous glands with mature sebocytes and germinative keratinocytes; (iii) since both cell types express cytokeratins typical for follicular differentiation, EPD may be a proliferation of adnexal stem cells residing in the infundibulo-sebaceous unit of hair follicles and adnexal structures.

Topics: Aged; Anus Neoplasms; Cell Proliferation; Female; Hair Follicle; Humans; Immunohistochemistry; Keratin-15; Keratinocytes; Keratins; Male; Paget Disease, Extramammary; Sebaceous Glands; Vulvar Neoplasms

Two cases of a distinctive variety of basaloid squamous carcinoma (BSC) of the anal canal are described. Both occurred in female patients who presented with bleeding per rectum. Histologic evaluation of the tumors showed lobules and aggregates of medium-sized basaloid cells with distinctive peripheral palisading and focal areas of central, comedo-necrosis. Accompanying dysplasia of the overlying squamous mucosa was absent. However, the microscopic pattern was dominated by the presence of eosinophilic, hyaline, paucicellular basement membrane-like material around and within tumor nests. This appearance together with microcystic spaces simulated that of an adenoid cystic carcinoma. Immunohistochemistry of the tumors revealed the following profile: CK7, CK5/CK6, 34betaE12 positive, CK14 focally positive but CK20 negative. The following were all negative: EMA, CEA, smooth muscle and muscle-specific actin, calponin, and S-100. The tumor cells exhibited diffuse nuclear positivity with p63. The eosinophilic basement membrane hyaline material was positive for collagen type IV and also for laminin. BSC of the anal canal with an adenoid cystic pattern is an infrequently encountered and reported variant, although it is seen more often in the aerodigestive tract. There may be an increased propensity for BSC with an adenoid cystic pattern to metastasize to the liver, but the number of cases encountered are too small to be definitive. The histologic differential diagnosis is true salivary gland-type adenoid cystic carcinoma and basal cell adenocarcinoma. Immunohistochemistry and awareness of this unusual pattern of BSC will facilitate the correct diagnosis being reached.

Topics: Anal Canal; Antibiotics, Antineoplastic; Antigens, CD20; Antimetabolites, Antineoplastic; Antineoplastic Agents; Anus Neoplasms; Biomarkers, Tumor; Carcinoma, Adenoid Cystic; Carcinoma, Basal Cell; Carcinoma, Basosquamous; Cell Nucleus; Cisplatin; DNA-Binding Proteins; Female; Fluorouracil; Follow-Up Studies; Genes, Tumor Suppressor; Humans; Immunohistochemistry; Keratins; Middle Aged; Mitomycin; Phosphoproteins; Radiotherapy; Time Factors; Trans-Activators; Transcription Factors; Treatment Outcome; Tumor Burden; Tumor Suppressor Proteins; Ultrasonography

Topics: Adenocarcinoma; Amputation, Surgical; Anal Canal; Anus Neoplasms; Carcinoma, Squamous Cell; Colostomy; Combined Modality Therapy; Female; Humans; Keratin-20; Keratin-7; Keratins; Middle Aged; Neoplasms, Second Primary

This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal.. Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3).. Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal.. The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.

Topics: Aged; Antigens, Neoplasm; Anus Neoplasms; Carcinoma, Squamous Cell; Feasibility Studies; Female; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sentinel Lymph Node Biopsy

Pagetoid dyskeratosis is considered a selective keratinocytic response in which a small part of the normal population of keratinocytes is induced to proliferate. Pagetoid dyskeratosis has been found incidentally in the squamous epithelium of the skin in various locations and in the ectocervix in uterine prolapse. In cases in which these pale cells are conspicuous, there is a hazard of overdiagnosis. It has been suggested that friction is the most probable inductor of the lesion. To the best of our knowledge, pagetoid cells have not been reported in surgically resected hemorrhoids.. We here describe the location of pagetoid dyskeratosis in the squamous epithelium of hemorrhoids and the incidence of this lesion in a group of 100 unselected patients surgically treated for hemorrhoidal disease. In addition to the conventional histologic method, special staining procedures and an immunohistochemical study of cytokeratins were performed in selected cases.. Pagetoid dyskeratosis was found in 68 cases (68%) and was a prominent finding in 22 cases (22%). The cells of pagetoid dyskeratosis were strongly positive for high-molecular weight cytokeratin. These cells showed an immunohistochemical profile that was different from that of the surrounding squamous cells and indicative of premature keratinization.. In hemorrhoidal disease, the cushions are susceptible to trauma as a result of prolapse. In this setting, friction may be the stimulus for the appearance of pagetoid dyskeratotic cells. These cells must be distinguished from the artifactual clear cells of the squamous epithelium, glycogen-rich cells, and koilocytes. The lesion must also be distinguished from extramammary Paget disease, pagetoid spread of carcinoma cells, pagetoid Bowen disease, and pagetoid melanoma. Pathologists should be familiar with the histologic features of pagetoid dyskeratosis in hemorrhoidectomy specimens to avoid misdiagnosis. Routine histologic study is usually adequate for recognizing this lesion.

Topics: Adult; Aged; Anus Neoplasms; Carcinoma in Situ; Coloring Agents; Diagnosis, Differential; Epithelium; Female; Hemorrhoids; Histocytochemistry; Humans; Keratinocytes; Keratins; Male; Middle Aged; Paget Disease, Extramammary

Anal gland carcinoma is a rare entity. The authors conducted a joint study of cases coded as definite or possible anal gland carcinoma from the archives of the Armed Forces Institute of Pathology and the Canadian Reference Center for Cancer Pathology.. Seven cases of potential anal gland carcinoma were identified from the Canadian files and 12 from the Armed Forces Institute of Pathology archives. Of these 19 cases, 14 had adequate material to allow clinical, histologic, and immunohistochemical analysis.. Seven of these 14 cases met a modified World Health Organization (WHO) definition of anal gland carcinoma. The mean age of these patients was 66 years (range, 60-72 years), with a male-to-female ratio of 6:1. The tumors were composed of haphazardly dispersed, small glands with scant mucin production that invaded the wall of the anorectal area with no obvious intraluminal component observed clinically or microscopically. Immunohistochemical studies were performed on all seven of these cases, revealing cytokeratin (CK) 7+/CK 20- expression in six cases, and CK 7+/CK 20+ expression in one case. The remaining seven cases showed no intraluminal component but did not meet a modified WHO definition of anal gland carcinoma. This group included three mucinous adenocarcinomas (two clinically arising in anal fistulas), all of which were CK 7+/CK 20+, and a rectal-type adenocarcinoma that was CK 7-/CK 20+. There was also a tumor interpreted as probable rectal-type adenocarcinoma that was CK 7+/CK 20+, and a tumor interpreted as probable squamous cell carcinoma that was CK 7-/CK 20-. The seventh tumor in this group, which could not be classified, was CK 7+/CK 20-.. A useful and discriminating definition of anal gland carcinoma is an anal canal tumor composed of haphazardly dispersed, small glands with scant mucin production invading the wall of the anorectal area without an intraluminal component. The glands are positive for CK 7.

Topics: Aged; Anus Neoplasms; Carcinoma; Female; Humans; Immunohistochemistry; Keratin-7; Keratins; Male; Middle Aged

Carcinomas of the anus are subdivided into those of the anal canal and those of the anal margin. It has been postulated that the various types of tumours of the anal canal represent a spectrum of differentiation rather than tumours of a separate origin. We compared the expression of Pan-cadherin, cytokeratins (CKs) 5/6, 7, 13, 18 and 19, p53 and MIB-1 in 17 cases of carcinoma of the anal canal and 5 cases of carcinoma of the anal margin. Expression of Pan-cadherin was decreased in 70% of carcinomas of the anal canal but preserved in all five carcinomas of the anal margin. Most of the carcinomas of the anal canal expressed all of the CKs studied. Carcinomas of the anal margin showed expression of CK 5/6 and CK 13, whereas CK7, CK18 and CK19 were rarely expressed. Loss of expression of CK 18 and 19, but not CK 7, is a marker of dedifferentiation in anal canal carcinoma. Of the carcinomas of the anal canal and anal margin, 46% and 80%, respectively, expressed p53. The immunhistochemical findings support the opinion that the various subtypes of carcinoma of the anal canal represent variants in differentiation of squamous cell carcinomas of the anal canal. They confirm the separate histogenetic origin of tumours from the anal canal and anal margin.

Topics: Adult; Aged; Aged, 80 and over; Antigens, Nuclear; Anus Neoplasms; Biomarkers, Tumor; Cadherins; Carcinoma, Squamous Cell; Cell Nucleus; Female; Humans; Keratins; Ki-67 Antigen; Male; Middle Aged; Mitotic Index; Neoplasm Recurrence, Local; Nuclear Proteins; Tumor Suppressor Protein p53

Despite the similarity in clinical appearance, there is a significant difference in the prognosis between primary extramammary Paget's disease (EPD) and the pagetoid spread of underlying regional internal malignancy (secondary EPD, pagetoid phenomenon). Fifteen cases of primary EPD (11 carcinoma in situ and four invasive carcinoma), seven cases of secondary EPD (five colorectal adenocarcinoma and two urothelial carcinoma), and six cases of anal canal carcinoma were retrieved and analysed immunohistochemically using six kinds of monoclonal anticytokeratin antibodies. No expression of cytokeratins 1, 5, 10, 13 and 14 was observed in any cases examined in this study. All 15 cases of primary EPD had the immunophenotype cytokeratin (CK)7+/CK20-. CK20 expression was diffusely positive in six cases of secondary pagetoid spread (two urothelial carcinoma and four colorectal adenocarcinoma), and focally in one case (a colorectal adenocarcinoma). In anal canal carcinoma, three of six cases showed CK20 diffuse expression and the remaining three cases expressed CK20 focally. CK7 expression was observed in three of six cases of anal canal carcinoma and in two of five cases of secondary EPD associated with colorectal adenocarcinoma. The combination of CK7 and CK20 demonstrates these to be useful markers in distinguishing 'primary' EPD from a pagetoid spread of extracutaneous malignancies. Namely, immunophenotypes other than CK7+/CK20- in Paget cells suggest underlying regional internal malignancy.

Topics: Adenocarcinoma; Anus Neoplasms; Biomarkers, Tumor; Carcinoma, Transitional Cell; Colorectal Neoplasms; Diagnosis, Differential; Humans; Immunoenzyme Techniques; Intermediate Filament Proteins; Keratin-20; Keratin-7; Keratins; Neoplasm Proteins; Paget Disease, Extramammary

Topics: Aged; Antigens, Neoplasm; Anus Neoplasms; Biomarkers, Tumor; Biopsy; Carcinoembryonic Antigen; Carcinoma, Squamous Cell; Colonoscopy; Female; Humans; Immunoradiometric Assay; Keratins; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tissue Polypeptide Antigen; Tomography, X-Ray Computed

The keratin expression of 40 frozen tissue specimens of anal carcinoma was investigated using a panel of 17 monoclonal antibodies to 14 individual keratins. The tumours were divided into three histological subgroups showing pure squamous, squamous and basaloid, or squamous and glandular differentiation. A further assessment of the tumour grade was made. The overall profile was of expression of keratins 4, 13, 17, 18 and 19 across the majority of the tumours, with the minority expressing keratins 1 and 10, and keratin 7. Dedifferentiation was associated with loss of expression of keratinocyte keratins, particularly the cornification markers keratin 1 and 10, and K6 and 16 associated with keratinocyte hyperproliferation and differentiation. This correlated with acquisition of the simple epithelial keratins 7 and 8. Compared with the tumours as a whole, well differentiated squamous tumours (the most easily identifiable histological group) showed consistent positivity for keratins 6 and 16, expressed suprabasally, while simple keratins 18 and 19 were also found. Independent of grade, mixed tumours showed more widespread positivity for simple epithelial keratins 7, 8 and 18 and loss of expression of cornification keratins 1 and 10 and K6 and 16 compared with pure squamous tumours. The relatively limited keratin profile of pure squamous tumours, predominantly consisting of keratinocyte keratins, suggests that these malignancies are less likely to originate from the region of the anal canal where the keratin profile is heterogeneous, i.e. the anal transitional zone.

Topics: Anus Neoplasms; Biopsy; Carcinoma, Squamous Cell; Cell Differentiation; Humans; Immunohistochemistry; Keratins

We report a case of syringoma clinically presenting as milia in the perianal region. Milium-like syringoma is an unusual clinical variant of the tumor, and this is, to our knowledge, the first reported case occurring perianally.

Topics: Adult; Anus Neoplasms; Cytoplasm; Diagnosis, Differential; Epidermal Cyst; Epithelium; Female; Humans; Keratins; Skin Diseases; Sweat Gland Neoplasms; Syringoma

The histologic and immunohistochemical characteristics of 49 skin biopsy specimens from 49 patients with extramammary Paget's disease were studied. Patients with extramammary Paget's disease with and without underlying malignant disease were identified. Associated malignant lesions, present in 16 patients (33%), were transitional cell carcinoma of the bladder (n = 8), adenocarcinoma underlying the skin (n = 3), adenocarcinoma of the anus (n = 1), adenocarcinoma of the vulva (n = 1), apocrine carcinoma (n = 1), prostate carcinoma (n = 1), and carcinoma metastatic to the lung (n = 1). The main histologic feature was the presence of Paget's cells, predominantly at the base of the epidermis. In 6% of the cases, well-defined nests of large Paget's cells mimicked melanocytic nests. Carcinoembryonic antigen and Cam 5.2 (a monoclonal antibody that stains 40-kDa, 45-kDa, and 52.5-kDa low molecular weight keratins) were localized to the Paget's cells in 42 of 45 (93%) and 29 of 41 cases (71%), respectively. Forty-four of 46 lesions (96%) were mucin positive, as determined by Hale's colloidal iron stain. Absence of staining for colloidal iron and carcinoembryonic antigen occurred somewhat more frequently in patients with underlying malignant disease than in patients without tumors (13% vs. 0% mucin negative and 13% vs. 3% carcinoembryonic antigen negative, respectively). Although immunohistochemical staining for low molecular weight keratin may be used to confirm the diagnosis of extramammary Paget's disease, Cam 5.2 is not as sensitive as the colloidal iron or carcinoembryonic antigen stain.

Topics: Aged; Aged, 80 and over; Anus Neoplasms; Carcinoembryonic Antigen; Female; Genital Neoplasms, Male; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Mucins; Paget Disease, Extramammary; S100 Proteins; Skin Neoplasms; Vulvar Neoplasms

The aim of the present study was to explore the origin of cloacogenic carcinoma in the anal canal by immunohistochemical methods. We compared cytokeratin polypeptide expression of a cloacogenic carcinoma to normal and epithelia, to anal squamous cell carcinoma and to basal and squamous cell carcinoma of the skin, using a battery of monoclonal anti-cytokeratin, polypeptide-specific antibodies. Our results indicate that cloacogenic carcinoma expresses cytokeratin polypeptides similar to those of the basal layer of anal squamous epithelium, of the anal transitional zone epithelium and of a layer of basal cells in the anal glands. Thus we concluded that each of the above cell types may be the cell of origin of cloacogenic carcinoma.

Topics: Anal Canal; Antibodies, Monoclonal; Anus Neoplasms; Carcinoma, Transitional Cell; Epithelial Cells; Epithelium; Humans; Immunohistochemistry; Keratins

Optically clear cytoplasm in tumor cells in the absence of mucin is most often associated with renal cell carcinoma. However it is important to recognize the rare occurrence of "clear-cell" variants among tumors arising in other sites. This report describes a clear-cell carcinoma arising in the transitional zone of the anal canal.

Topics: Adenocarcinoma; Anus Neoplasms; Carcinoembryonic Antigen; Carcinoma, Transitional Cell; Humans; Immunohistochemistry; Keratins; Male; Membrane Glycoproteins; Microscopy, Electron; Middle Aged; Mucin-1

Twenty-one cases of Paget's disease have been studied using histochemical, ultrastructural, and immunohistochemical methods. Eight of the tumors involved the nipple, and 13 were extramammary (11 vulvar and two anal). The antibodies used were directed against different classes of cytokeratin proteins, epithelial membrane antigen, carcinoembryonic antigen, gross cystic disease fluid protein-15, and S-100 protein. The findings of this study provide conclusive evidence that Paget's cells, regardless of their location, are adenocarcinoma cells. Intracytoplasmic mucin is scanty in Paget's cells within the nipple, but typically plentiful in the extramammary sites where the cells are frequently signet-ring cells. The common mechanism for the evolution of Paget's disease is extension of cells from an underlying carcinoma, but the possibility that some cases, particularly in the vulva, develop from intraepithelial precursors cannot be excluded.

Topics: Antibodies, Monoclonal; Anus Neoplasms; Apolipoproteins; Apolipoproteins D; Breast Neoplasms; Carcinoembryonic Antigen; Carcinoma, Intraductal, Noninfiltrating; Carrier Proteins; Female; Glycoproteins; Humans; Keratins; Membrane Proteins; Membrane Transport Proteins; Mucin-1; Paget Disease, Extramammary; Paget's Disease, Mammary; Protein Precursors; S100 Proteins; Vulvar Neoplasms

We report a case of polypoid spindle cell squamous carcinoma (pseudosarcoma) occurring in the anal canal. Electron microscopic findings and the demonstration of keratin by an immunoperoxidase method, gave clear cut evidence of the epithelial nature of the sarcomatoid cells forming this tumour. To our knowledge, this is the first reported case in the literature.

Topics: Anus Neoplasms; Carcinoma; Humans; Keratins; Male; Microscopy, Electron; Middle Aged

Epithelia-derived tumors (carcinomas) can be distinguished from mesenchymally derived tumors by the presence of intermediate-sized filaments of the cytokeratin type, which usually coincides with the absence of other types of intermediate-sized filaments such as vimentin filaments. In the course of diagnostic examinations of human tumors, using immunofluorescence microscopy, we have come across a case of an unusual carcinoma (Primary tumor and lymph node metastasis) positively stained not only with cytokeratin antibodies but also with immunoglobulins present in vimentin antisera. Therefore, this tumor, a cloacogenic carcinoma apparently derived from the rectal-anal transitional region, has been examined in greater detail using both immunofluorescence microscopy and immuno-electron microscopy as well as gel electrophoretic analysis of cytoskeletal polypeptides from total tumor tissue and from microdissected nodules enriched in carcinoma cells. The unusual reaction of the carcinoma cells with immunoglobulins present in seven different (rabbit or guinea pig) antisera raised against vimentin, has been found to be diminished after absorption on purified cytokeratin or total epidermal cytoskeletal material, but not after absorption on purified vimentin. Gel electrophoretic analysis of tumor cytoskeletons showed an unusual complex pattern of cytokeratin polypeptides containing relatively large (Mr 68,000 and Mr 58,000) neutral-to-slightly basic cytokeratins, as are typically found in epidermis and other stratified squamous epithelia, as well as several smaller acidic cytokeratins, including a Mr 40,000 polypeptide found in certain nonstratified epithelial such as colon and small intestine. Total tumor also showed the inclusion of some vimentin which, however, was significantly decreased in analysis of excised carcinoma nodules. Examining antibody binding to polypeptides separated by gel electrophoresis and blotted on nitrocellulose paper, we have found that antisera raised against vimentin contained not only vimentin antibodies but also immunoglobulins which specifically bound to the largest cytokeratin component. We conclude that the unusual reaction of immunoglobulins present in vimentin antisera with cytokeratin filament bundles does not represent specific binding to vimentin in these carcinoma cells, but is due to a component obviously widespread in vimentin antisera which binds specifically to a cytokeratin present in this type of tumor but not in most othe

Topics: Aged; Anus Neoplasms; Carcinoma, Transitional Cell; Cytoskeleton; Female; Humans; Isoelectric Point; Keratins; Molecular Weight; Muscle Proteins; Rectal Neoplasms; Vimentin

Topics: Adult; Age Factors; Aged; Anus Neoplasms; Carcinoma, Squamous Cell; Female; Humans; Inguinal Canal; Keratins; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Metastasis; Pelvic Neoplasms; Sex Factors