muramidase and Gallbladder-Neoplasms

Extramedullary myeloid tumors (myeloid sarcomas) are rare neoplasms that are composed of myeloid precursors. They usually arise concurrently with a diagnosis of acute myeloid leukemia, chronic myeloid leukemia, or other myeloproliferative disorders. They may also indicate relapsing disease in a patient with a prior history of leukemia or myeloproliferative disorder. We present our findings of a 63-year-old female diagnosed with extramedullary myeloid tumor first presenting in the gallbladder. She subsequently developed respiratory failure; pre- and postmortem bone marrow studies were negative for leukemia by morphology, flow cytometry, and karyotypic analysis. However, the myeloid neoplasm was disseminated throughout most of her remaining organs. Immunohistochemical stains of the cells indicated a neoplasm of myelomonocytic derivation (CD4, CD43, CD45, CD68, myeloperoxidase, and lysozyme positive). To our knowledge, this is the first report of an extramedullary myeloid neoplasm of the gallbladder with disseminated disease without involvement of the bone marrow.

Topics: Antigens, CD; Antigens, Differentiation, Myelomonocytic; Bone Marrow; Female; Gallbladder Neoplasms; Humans; Middle Aged; Muramidase; Peroxidase; Respiratory Insufficiency; Sarcoma, Myeloid

Ninety-two cases of adenocarcinoma of the gallbladder were classified into the metaplastic or non-metaplastic type, based on the presence or absence of metaplastic changes in the tumour tissues. The differences in biological characteristics were compared between these tumour types. The metaplastic type was more common than the non-metaplastic type in females and the survival rate in this type was better than that in the non-metaplastic type. The modes of tumour spread also differed, the metaplastic type frequently showed lymphatic metastasis, whereas the non-metaplastic type often metastasized by direct invasion. The difference in prognosis might be explained by the different modes of tumour spread. This classification corresponded well to that of gastric carcinoma into intestinal type and diffuse type and the results suggest that it might provide a basis for evaluating various aspects of gallbladder carcinoma.

Topics: Aged; Biomarkers, Tumor; Carcinoma; Female; Gallbladder Neoplasms; Humans; Male; Metaplasia; Middle Aged; Models, Theoretical; Muramidase; Prognosis; Time Factors

A total of 66 cases of well differentiated adenocarcinomas of the gallbladder comprising 12 mucosal carcinomas and 54 advanced carcinomas were examined histologically and immunohistochemically for metaplastic changes in the tumor tissue and non-neoplastic mucosa adjacent to the tumor tissue in order to elucidate the histogenesis of gallbladder carcinoma. Among the various kinds of metaplastic changes in the gallbladder mucosa, the occurrence of endocrine cells and lysozyme immunoreactivity were used as markers. The 66 cases of adenocarcinoma were divided into 12 cases showing no metaplastic changes (non-metaplastic type) and 54 cases containing at least one marker of metaplastic changes (metaplastic type). The frequency of metaplastic changes was compared between mucosal carcinoma and advanced carcinoma to determine whether these metaplastic changes could be a phenotypic expression of the original tissue from which the tumor was derived or a secondary phenomenon associated with the progression of the tumor. No difference could be observed between the two. Moreover, the carcinoma of the non-metaplastic type was often surrounded by an ordinary mucosa without metaplastic changes, whereas the carcinoma of the metaplastic type was frequently surrounded by a metaplastic mucosa. Some cases among the non-metaplastic type carcinomas showed a morphological transition between the ordinary mucosa and the carcinoma or contained the residue of ordinary type adenoma within the tumor. On the other hand, 5 cases of the metaplastic type carcinoma contained adenomatous residue of the metaplastic type. These results suggest that there might be two types of adenocarcinoma, one being derived from the ordinary epithelium of the gallbladder and the other from the metaplastic epithelium.

Topics: Adenocarcinoma; Aged; Biomarkers, Tumor; Cell Transformation, Neoplastic; Epithelium; Female; Gallbladder Neoplasms; Humans; Immunohistochemistry; Male; Middle Aged; Mucous Membrane; Muramidase; Phenotype

A total of 89 gallbladders with various conditions were examined histologically and immunohistochemically to detect various kinds of metaplastic changes. The gallbladder mucosa of the fetus and normal gallbladder showed no metaplastic changes. In 32 cases of chronic cholecystitis, metaplastic changes, such as mucous gland metaplasia (23 cases), Paneth's cells (six cases), and goblet cells (four cases) were observed. All cases containing Paneth's cells or goblet cells showed simultaneous lysozyme immunoreactivity and also contained argyrophilic cells. Among 23 cases with mucous gland metaplasia, 15 cases showed lysozyme immunoreactivity, eight contained argyrophilic cells, and 16 showed lysozyme immunoreactivity and/or argyrophilic reaction. The other seven cases showed only mucous gland metaplasia without endocrine cells or lysozyme immunoreactivity. These results suggest that the presence of lysozyme and/or endocrine cells is a conventional marker of gastrointestinal metaplasia of the gallbladder mucosa. Using these markers, 14 (28.6%) of 49 cases of adenocarcinoma of the gallbladder contained endocrine cells; 18 (36.7%) showed lysozyme immunoreactivity; and 25 (51.0%) contained at least one marker of endocrine cells or lysozyme immunoreactivity. These results suggest that at least half of adenocarcinomas of the gallbladder might be derived from metaplastic changes.

Topics: Adenocarcinoma; Adenocarcinoma, Mucinous; Adolescent; Adult; Argyria; Child; Child, Preschool; Cholecystitis; Cholelithiasis; Fetus; Gallbladder; Gallbladder Neoplasms; Histocytochemistry; Humans; Immunoenzyme Techniques; Infant; Metaplasia; Muramidase; Precancerous Conditions; Serotonin; Staining and Labeling

We have studied the distribution of lysozyme (Ly), a1-antitrypsin (a1AT) and a1-antichymotrypsin ( a1AChy ) in the normal, chronically inflamed and neoplastic gall bladder mucosa using the peroxidase-anti-peroxidase (PAP) method. Ly was absent from the normal mucosa but it was found only in areas of glandular metaplasia of true antral type and in crypts of possible early metaplastic nature in cases of chronic cholecystitis. a1AT and a1AChy were also found in such metaplastic areas, but their presence was also observed immunohistochemically in areas of essentially normal and in non-metaplastic, chronically inflamed gall bladder mucosa. The possible local production of these substances by gall bladder epithelial cells is discussed. Ly, a1AT and a1AChy were also found in various histological types of adenocarcinoma of the gall bladder in varying degrees of frequency and intensity, unrelated to the histological type and invasiveness of the tumour.

Topics: Adenocarcinoma; alpha 1-Antichymotrypsin; alpha 1-Antitrypsin; Cholecystitis; Chymotrypsin; Gallbladder; Gallbladder Neoplasms; Histocytochemistry; Humans; Immunoenzyme Techniques; Muramidase