Staining For AFP Research Articles

Colonic Tuberculosis Mimicking Colonic Cancer: A Multidisciplinary Diagnosis and Case Report

Gastrointestinal tuberculosis accounts for 1% to 3 % of all TB cases worldwide. Colonic tuberculosis is rare and can be mistaken for malignancy. It commonly presents as chronic abdominal pain along with night sweats, diarrhea, and fatigue and can resemble variety of other diseases making the diagnosis difficult. It presents with vague clinical and radiological picture making the diagnosis challenging for the clinicians. Its diagnosis is usually made by combining clinical features, radiological, tissue AFP staining and histopathologal examinations. The typical histopathologic findings include confluent large granulomas and langhans giant cells with caseating necrosis. Gastrointestinal tuberculosis responds well to standard antituberculous drugs and surgery is done for patients that have complications like strictures or obstruction which does not respond to medical therapy. This case illustrates a 40 year old man who presented with crampy lower abdominal pain and diagnosed as a colonic cancer both on imaging and clinically which later found to have colonic tuberculosis on a colectomy histopathologic sample. He was treated with anti-TB and respond well to his treatment. This case will give an insight for treating physicians to have a high index of suspicion for colonic TB in a patient who presented with lower abdominal pain and having colonic mass.

Yolk sac tumor of the liver: Presentation, diagnosis, and treatment review.

e16371 Background: Yolk Sac Tumor of the Liver (YSTL) is an extremely rare extragonadal germ cell tumor with gonadal origin and histology which presents in the liver. While uncommon, this tumor is often misdiagnosed due to the similarities between YSTL, HCC, and Hepatoblastoma (HB). As this cancer can present with serious mortality, our review aimed to evaluate clinical findings, diagnostic workup, and treatments in patients with YSTL. Methods: We performed a literature search in PubMed from 1950 to October 2023 using filters English language and full text with keywords “Yolk sac tumor of the liver”, “Endodermal Sinus tumor of liver”, “Hepatic Yolk sac tumor”, and “Hepatic Endodermal sinus tumor”. We also conducted a combined search query with all these search terms and “primary”. Patients were included in the study if they had primary YSTL and no other malignancy. Results: Our results looked at 19 patients ranging from 15 months to 64 years with median age being 27 years, including 13 female (68%) and 6 male (32%) patients, percentages reflect the total number of patients. The key presenting symptom in adults was abdominal pain (55%), while the key presenting symptom in children was abdominal distention (63%). All patients in the study had a diagnostic workup that included imaging and pathology. Imaging included CT Abdomen (68%) and MRI (37%), in 58% of patients a solitary mass was seen on imaging, while in 42% of patients multiple hepatic masses were seen. Histology workup mainly noted Shiller Duval Bodies(SDBs)(76%). Molecular Markers included AFP(42%), Alpha-1 anti-trypsin(A1AT)(26%), SALL4(21%), Pancytokeratin(PK)(11%), and Placental-like alkaline phosphatase(PALP)(11%). Treatment included chemotherapy(58%), surgery(47%), transplant(11%), and trans-arterial chemoembolization(5%). Out of the 11 patients who were treated with chemotherapy, 91% received the bleomycin, etoposide, and cisplatin (BEP) regimen. The remaining 9 % of patients received a regimen of cisplatin, adriamycin, and pepleomycin. Conclusions: YSTL is a unique tumor presenting in patients of all ages, tending to present vaguely often with abdominal pain or distension. Diagnostic workup often includes abdominal imaging (MRI and CT Abdomen) and pathology with a focus on SDBs on histologic examination and stains like AFP, A1AT, SALL4, etc. Treatment often focuses on surgery and chemotherapy, notably BEP. Though both HCC and HB traditionally present as a multifocal liver mass on imaging along with positive staining for AFP and PK, our study helps differentiate this tumor from others by emphasizing the importance of SDBs in diagnosis and highlighting new molecular markers to help make the diagnosis easier.

Establishment of image-guided radiotherapy of orthotopic hepatocellular carcinoma mouse model.

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. Recently, developments in radiotherapy technology have led to radiotherapy becoming one of the main therapeutics of HCC. Therefore, a suitable animal model for radiotherapy of the orthotopic HCC mouse model is urgently needed. In the present study, Hepa1-6 cells were injected into the liver of C57BL/6 mice in situ to mimic the pathological characteristics of the original HCC. Tumor formation was monitored by applying magnetic resonance imaging techniques and verified by H&E histopathological staining, AFP staining, and Ki67 staining. A single dose of 10 Gy X-ray was applied to simulate clinical radiotherapy plans using image-guided radiotherapy (IGRT) equipment. The efficiency of radiotherapy was then assessed by examining tumor size and weight one week after radiation. Cleaved-caspase3 staining and TUNEL were used to assess apoptosis in tumor tissues. Intrahepatic tumor development was detected in the liver according using MRI. A high-density shadow could be seen 10 days after cell injection, which indicated the formation of HCC in vivo. The tumors grew steadily bigger, and underwent precision radiotherapy 20 days after injection. The typical pathological characteristics of HCC, such as large, deeply stained nuclei and irregular cell size, were visible with H&E staining. After radiotherapy, significantly higher expression of the immunohistochemical markers Ki67 and AFP were detected in tumor tissue than in the nearby normal tissue. Compared with the control group, the tumor volume (p = 0.05) and weight (p < 0.05) of the irradiated group were significantly reduced. In addition, a higher frequency of apoptosis was identified in irradiated HCC tumor tissue using the TUNEL and cleaved-caspase3 staining assay. In a well-established orthotopic HCC model, MRI was utilized to monitor the formation of tumors, and IGRT was used to simulate clinical radiotherapy. The present study could provide a suitable preclinical system for HCC radiotherapy-related studies.

Role of Advanced Imaging in Primary Hepatic Neuroendocrine Tumour with Borderline Raised AFP and Negative Chromogranin Staining: A Case Report

Role of Advanced Imaging in Primary Hepatic Neuroendocrine Tumour with Borderline Raised AFP and Negative Chromogranin Staining: A Case Report

An analysis of clinicopathological characteristics and prognosis on hepatoid adenocarcinoma of stomach.

e16558 Background: Hepatoid adenocarcinoma of the stomach(HAS) is a rare type of gastric adenocarcinoma(GAC). At present, histopathology is the gold standard for the diagnosis of HAS, however, HAS is easy to be missed diagnosis, and lack of a perfect diagnosis system and effective treatment strategy. In this research, clinical pathological features will be analyzed to improve the diagnostic system, judge prognosis and provide clues for exploration of pathogenesis and targeted therapy of HAS. Methods: 576 cases including 5 confirmed patients with HAS were enrolled onto this study from 1320 patients with GAC. 10 cases of HAS were diagnosed by the second histopathological examination from the other 571 enrolled cases. 30 cases from the remaining 561 enrolled patients were randomly selected as the control group. The information of the two group cases were completed by collecting the existing case data, detecting the missed immunohistochemical indicators and telephone follow-up. The clinicopathological features of the two group cases were compared, and the treatment and prognosis of 15 HAS cases were analyzed. Results: In this study, 15 cases of HAS were found in 576 patients with GAC, including 5 cases from the 1st pathological diagnosis and 10 cases from the 2nd pathological diagnosis. There was no significant difference in age, gender, HP positive rate, serum CEA or CA19-9 level, tumor size, TNM stage, tumor invasion depth, lymph node invasion, distant metastasis rate, differentiation degree, nerve/vascular invasion, and Ki-67 expression level between the two groups( P&gt; 0.05). Compared with the control group, the serum AFP level, and the expression level of GPC3, AFP, EGFR and VEGF protein of patients in HAS group were significantly high, as well as the patients in the HAS group were more likely to develop liver metastasis( P&lt; 0.05). The mOS was 12 mo vs 42 mo for HAS group vs control group( P&lt; 0.05). Multivariate analysis showed immunohistochemical AFP staining intensity was an independent risk factor for prognosis of HAS. Conclusions: As a special type of GAC, HAS is prone to developing liver metastasis with poor prognosis. Based on the higher missed diagnosis rate of HAS, it is suggested to make 2nd cancer histopathological diagnosis including immunohistochemical detection of AFP and GPC3 for GAC patients with significantly increased serum AFP level. The intensity of immunohistochemical AFP staining is an independent risk factor for the prognosis of patients with HAS. VEGF, EGFR and PD-1 / PDL-1 may be potential therapeutic targets of HAS, which is worth further study.

Gastric yolk sac tumour – A case report

This case report is of an 86-year-old lady who presented with nausea and a six-week history of increasing abdominal distension. She had a firm palpable mass across the abdomen on examination, which correlated with a CT scan showing a 20×16.5×13 cm mass within the abdomen thought to be a GIST. She was managed with surgical removal of the mass that was seen arising from the gastric antrum at the time of operation. Histopathological features of the lesion show a glandular like growth pattern, perivascular growth with Schiller-Duval bodies and positive immunohistochemistry staining for Glypican-3 and AFP. The combination of these findings is in keeping with a yolk sac tumour.

Diagnostic and Prognostic Aspects of Hepatocellular Carcinoma – A Retrospective Analysis in 145 Patients

BACKGROUND: Prognosis of advanced hepatocellular carcinoma (HCC) is still poor. In this retrospective study prognostic factors for long-term survival and an immunohistochemical panel for discrimination of HCC from other liver malignancies were analyzed. MATERIALS AND METHODS: In 181 primary liver tumors clinical data, tumor characteristics and the primary mode of treatment were analyzed using univariate and multivariate statistics. In 156 cases (145 HCC, 36 intrahepatic CCC) the immunohistochemical profile of the tumor tissue using molecular markers as HepPar-1, AFP, CD34, CK7, CK20, CA19-9 and CDX2 was established routinely. Significance of marker expression, sensitivity, specify and positive predictive value of the analyzed markers in relation to histological subtype were estimated using SPSS 10.0 RESULTS: Median overall survival (OS) was 15 ± 19.2 months. Multivariate analysis identified tumour size (p = 0.001), grading (p = 0.002), proliferative activity (Ki67 level; p = 0.032), multifocal tumour (p = 0.045), liver function (Child-Pugh score, p = 0.045) and performed tumour resection (p < 0.0001) as independent prognostic factors for survival. HepPar-1 was the most frequently expressed marker in HCC (positive in 71.8%; p < 0.0001) whereas positive AFP staining was less common (positive in 48.7%; p < 0.0001). The CD34 protein as a marker for vascular-associated tissue showed a positive reaction in 54.1% of tissues from HCC patients in comparison to 2 patients (6%) with cholangiocarcinoma (p < 0.0001). CONCLUSIONS: Our data identified tumor stage, tumor biology and performed surgical therapy as independent prognostic factors for OS in HCC. Best predictive markers for differentiation between HCC and CCC were HepPar-1, CK7 and CA19-9. Using this panel fast and accurate differentiation by IHC was possible in more than 95% of the patients.

MiR-429 regulates inflammatory infiltration, proliferative ability and differentiation of hepatocellular carcinoma

Objective To observe the effects of miR-429 on inflammatory infiltration,differentiation and proliferation of hepatocelluar carcinoma(HCC).Methods HCCLM3 cells were sorted into positive and-negative cells using magnetic activated cell sorting(MACS) according to Ep CAM marker.The Ep CAM-positive and negative cells were transfected with AntagomiR-429 and miR-429 mimic to construct over-expressed and down-regulated cells of miR-429,respectively.To validate the effect of transfection,control cells and constructed cells were tested by flow cytometry(FC) and real-time polymerase chain reaction(PCR).The proliferative curves of transfected cells were plotted using cell counting kit-8(CCK8) assay.Furthermore,tumor-bearing mice model was established by subcutaneous inoculation with transfected cells and related control cells into non-obese diabetic,severe combined immunodeficient mice(NOD-SCID).Mice were sacrificed after 6 weeks,and protein expressions of Ki67,AFP and F4 /80 in tumors were determined via immunohistochemistry(IHC) to examine the status of proliferation,differentiation and inflammatory infiltration,respectively.Results The proportion of Ep CAM-positive cells was decreased by down-regulating miR-429,and Ep CAM-negative cells could partially transfer to Ep CAM-positive cells by miR-429 over-expression.In vivo study showed that over-expressing miR-429 in Ep CAM-negative cells cound enhance the tumor forming ability; whereas Ep CAM-positive cells had an inhibited tumor-formation when down-regulating miR-429.Interestingly,F4 /80,a marker of macrophage,was strongly stained in tumor tissue with miR-429 over-expression.It was also found that in tumor tissue,Ki67 and AFP staining was suppressed with miR-429 down-regulation.Meanwhile,compared to the control,miR-429 significantly accelerated the proliferation of HCCLM3 in vitro compared with the control(P 0.05).Conclusion miR-429 can regulate the proportion of Ep CAM-positive cells of HCC in vitro and in vivo,and greatly increase the inflammatory infiltration and proliferative ability,accompanied by decreased differentiation.

Clinicopathologic features of combined hepatic carcinoma

To investigate clinicopathological features of combined hepatocellular-cholangiocarcinoma (C-HCC-CC) with neuroendocrine carcinoma (NEC) differentiation and to review the literature. The clinical data, histological manifestations and immunohistochemical staining results of two cases of C-HCC-CC were analyzed along with a review of the current literature. Both patients were male with an average age of 57.5 years. Both patients were positive for hepatitis B virus antigen. The tumors of both cases demonstrated the following 3 unequivocal mixed elements: (1) polygonal epithelial tumor cells growing in nests or trabeculae with positive staining for Hepatocyte and AFP, diagnostic of hepatocellular carcinoma (HCC). Cytoplasmic bile production was present in the tumor cells in one case; (2) elliptic or short spindle-shape small blue tumor cells growing in nests or organoid pattern with Syn/CgA/CD56 positivity confirming the presence of neuroendocrine carcinoma (NEC) component; (3) oval tumor cells growing in nests or glandular forms with positivity of CK19 and CK7 confirming differentiation of cholangiocarcinoma (CC). In both cases, the tumors contained at least 20% of each of HCC, NEC and CC components. C-HCC-CC with NEC is a rare form of primary malignancy of the liver with a poor prognosis.

Cutaneous Metastasis of Hepatocellular Carcinoma Following Skin Injury after Transcatheter Arterial Chemoembolization

Dear Editor: Transcatheter arterial chemoembolization (TACE) is widely used as an approach for patients with hepatocellular carcinoma (HCC). Cutaneous complications related to TACE such as erythema, necrosis, and scarring may rarely occur1. This report describes the first known case of cutaneous metastasis of HCC following skin injury after TACE. A 39-year old man had been diagnosed with HCC in January 2010. On the initial computed tomography (CT) image, a 7.8 cm sized tumor was noted. The patient was treated with TACE from February 2010 via the femoral artery. On a follow-up CT in May 2010, the tumor size decreased, however, daughter nodules were noted. The 7th TACE was performed via the internal mammary artery (IMA) due to the presence of collateral pathways. In November 2010, an 8th course of TACE of the IMA was performed. However, an erythematous to violaceous patch developed shortly after the infusion of chemotherapeutic agents and resulted in pigmentation and induration. In January 2011, the patient was referred to the dermatology clinic with two erythematous papules on the right chest that developed at the end of December 2010 (Fig. 1). The papules had developed within the pigmented induration, which was associated with skin injury after the TACE in November 2010. Fig. 1 Two, asymptomatic, erythematous papules and underlying pigmentation and wood plate-like induration on the right chest. Histopathologic examination of the erythematous papule showed asymmetrical, lobulated nests invading the dermis (Fig. 2A). The large cells had a polyhedral shape, eosinophilic cytoplasm, large central nuclei and prominent nucleoli (Fig. 2B). The specimen was negative for AFP (Fig. 2C). CD31 stain did not show evidence of hematogenous spread of tumor nests (Fig. 2D). Fig. 2 (A) Asymmetrical, lobulated cords and nests invading the dermis (H&E, ×40). (B) The large epithelial cells of polyhedral shape showed granular, eosinophilic cytoplasm, large, vesicular, central nuclei and prominent nucleoli (H&E, ... As the papules occurred on the scar and a series of examinations showed no other metastasis, the lesions were thought to be associated with the skin injury after TACE. The biopsy specimen was negative for AFP. However, positive staining for AFP has been reported to be present in 2 to 61% of HCC2. Expression of AFP can be weak, especially in small biopsies. Tumor seeding of HCC after interventional procedures is a rare complication. Cutaneous tumor seeding of HCC along the tract of the needle used in the diagnosis has been reported3. The frequency of needle tract implantation after radiofrequency ablation ranges from 0 to 4.4%.3 Iatrogenic cutaneous tumor seeding by ultrasound-guided percutaneous ethanol injection has also been rarely reported4. TACE via the IMA may be performed when collateral pathways are evident. Repetitive TACEs or large tumor sizes may be associated with the presence of collateral pathways. In our case, TACE-induced injury may have caused inflammatory changes or adhesion of the chest wall that helped the progression of the residual viable tumor along the liver surface to the skin. Adhesion between the HCC and other tissues including vessels such as the peritoneum and/or omentum after TACE has been shown in a laparoscopic study5. We have presented a case of cutaneous metastasis from HCC following skin injury after TACE that was thought to be relevant to the cutaneous complication of the chemoembolization procedure. The potential cutaneous complications of TACE must be taken into consideration.

Juvenile granulosa cell tumour of testis in a 9-week-old infant: a case report

Background Juvenile granulosa cell tumour (JGCT) is a rare benign neoplasm of testicular stroma that accounts for 1–5% of tumours arising in prepubertal testis. JGCT is uncommon in older children and adults. Occasional JGCT have occurred in undes-cended testis of infants with intersex disorders. Case report We present a case of 9-week-old infant with a mass in the right testis for which right orchidectomy was performed. Macroscopically, there was a 1 cm cystic lesion confined to the testis. Microscopically, the lesion was multicystic with a follicu-lar pattern. Follicles were lined by single to multiple layers of large cells with oval nuclei, inconspicuous nucleoli and abundant pale eosinophilic to clear cytoplasm. Follicles contained baso-philic secretions which were PAS and mucicarmine positive. There were frequent mitoses. The tumour showed positive staining for inhibin and S100. There was no staining for AFP and PLAP. Discussion JGCT usually presents in the first 6 months of life. Common differential diagnosis is yolk sac tumour, particularly when the tumour has a reticular pattern with brisk mitotic activity. AFP and alpha-inhibin immunostains are helpful in distinguishing these entities. JGCT follows a benign clinical course with no reports of metastasis. Some case series have advocated partial orchiectomy in management of these tumours.

α-fetoprotein involvement during glucocorticoid-induced precocious maturation in rat colon

To investigate the role of α-fetoprotein (AFP), a cancer-associated fetal glycoprotein, in glucocorticoid-induced precocious maturation in rat colon. Colons from suckling Sprague-Dawley rats were used in this study. Corticosterone acetate at a dose of 100 μg/g body weight was given to normal pups on days 7, 9 and 11 after birth to induce hypercorticoidism. Control animals were injected with identical volumes of normal saline. Some rats receiving corticosterone 7 d after birth were also treated with mifepristone (RU38486), a glucocorticoid cytoplasm receptor antagonist to investigate the effects of glucocorticoids (GCs). The morphological changes of the crypt depth and villous height of the villous zone in colon were observed as indices of colon maturation. Expression levels of AFP in colons were detected by reverse transcriptase polymerase chain reaction and Western blotting. To identify the cellular localization of AFP in developing rat colons, double-immunofluorescent staining was performed using antibodies to specific mesenchymal cell marker and AFP. Corticosterone increased the crypt depth and villous height in the colon of 8- and 10-d-old rats with hypercorticoidism compared with that in the control animals (120% in 8-d-old rats and 118% in 10-d-old rats in villous height, P = 0.021; 145% in 8-d-old rats and 124% in 10-d-old rats in crypt depth, P = 0.017). These increases were accompanied by an increase of AFP expression in both mRNA and protein (2.5-folds in 8-d-old and 2.5-folds in 10-d-old rats higher than in control animals, P = 0.035; 1.8-folds in 8-d-old and 1.3-folds in 10-d-old rats higher than in control animals, P = 0.023). Increased crypt depth and villous height and increased expression of AFP in the colon of rats with hypercorticoidism were blocked by mifepristone. Both had positive staining for AFP or vimentin, and overlapped in mesenchymal cells at each tested colon. GCs promote the development of rat colon. AFP appears to be involved, in part, in mediating the effects of GCs in the developmental colon.

Derivation of the first human embryonic stem cell line with Charcot Marie Tooth disease

OBJECTIVE: Affected embryos from patients undergoing pre-implantation genetic diagnosis (PGD) have been used to derive human embryonic stem cells (hESC). These cell lines can be used to generate in vitro models for the study of disease mechanisms and treatment. We report the derivation of the first hESC line from a patient with Charcot Marie Toot (CMT) disease. CMT is an autosomal dominant disease in the hereditary sensory motor neuron disorder spectrum affecting 1:2500. It presents with peripheral motor neuropathy and muscle wasting. In type 1A, the symptoms are due to a duplication of the peripheral myelin protein (PMP22) gene resulting in dysfunction of the Schwann cells. DESIGN: University laboratory research. MATERIALS AND METHODS: Patients undergoing PGD were recruited to donate affected embryos under an IRB approved protocol. ESC were derived from the inner cell mass after laser isolation and plating on mouse fibroblast feeder cells. hESC were identified by morphology and passaged using mechanical and chemical techniques. Pluripotency was confirmed by immunohistochemical (IHC) staining for ESC markers, as well as formation of embryoid bodies and differentiation to distinct primary germ lines. RESULTS: Two cell lines were derived from a patient carrying the PMP22 duplication. On blastomere biopsy, one embryo demonstrated the abnormal allele, while the other had no signal. Both lines expressed ESC pluripotency markers nanog, oct 3/4, and Tra-181. Cells formed embryoid bodies in suspension culture and spontaneously differentiated into endoderm, mesoderm, and ectoderm as evidence by IHC staining for AFP, SMA, and Tuj1. CONCLUSIONS: This represents the first reported hESC line for CMT1A. The directed differentiation of these cells to Schwann cells is in progress, thus creating an in vitro model for the study of this disease. Further experiments include karyotype and genotype analysis, as well as attempts to quantify the myelination activity and manipulate its expression in response to various compounds.

Prepubertal testicular teratomas.

Testicular teratomas in prepubertal children are distinct from adult testicular teratomas as well as from teratomas located elsewhere in the body, both with respect to their pathologic features and biologic behavior. Over a period of 12 years, testicular teratomas comprised 25% (5 of 20) of all testicular tumors in prepubertal children, treated at our institution. Their clinical presentation and pathologic profile was analysed. Their mean age at presentation was 6.7 m (range 1 m to 18 m) with the mass having been noted at birth in 3 infants. The right testis was involved in all except one patient. Serum AFP was elevated preoperatively in only one case with an immature (grade II) teratoma containing fetal liver tissue. Immunohistochemical staining for AFP and alfa-1-antitrypsin were positive in these fetal liver cells. Serum AFP levels returned to normal after orchiectomy in this patient. While a high inguinal orchiectomy was the standard operative procedure, testicular-sparing surgery was planned in the last two patients. However the tumor had replaced the entire testis in one of these patients, while in the other, the mass was homogeneous, with no visible cystic areas or dermal elements on cut section. Hence both of these patients also underwent orchiectomy. Histologic examination and immunohistochemical staining for AFP were performed on the specimen. Peri-tumor testicular parenchyma was found to be unremarkable and did not stain for placental alkaline phosphatase, a marker for carcinoma in situ. All these children are doing well with no evidence of residual or recurrent disease at a mean follow-up of 4.7 years (range 4 m to 11 yrs).

Antigen expressed alternatively to α-fetoprotein of rat hepatomas

Rat hepatoma cell line McA Rh 7777 produces α-fetoprotein (AFP)in vitro. This line is subcloned into ATP-producing and nonproducing subclones. The AFP-negative clone is used to generate hybridomas producing monoclonal antibodies recognizing AFT− and AFP+ clones. One of these hybridomas (A2/3) reacts only with AFP− clones. Double staining for AFP and A2/3 antigen (AG A2/3) reveals alternative expression of AFP and AG A2/3 on McA Rh 7777 hepatoma and its clones. The antigen is present on transplantable H-27 hepatoma (AFP−) and is not expressed by Zaidel hepatoma cells (AFP+). AG A2/3 is absent from the liver of normal adult rats and rat embryos. The antigen is inducedin vivo by the injection of lead nitrate andin vitro by treatment of McA RH 7777 hepatoma and its clones with cadmium chloride. It is likely that AG A2/3 is a cell stress protein.

A CASE OF HEPATOID ADENOCARCINOMA OF THE STOMACH

A 77-year-old man was admitted to the hospital because of anorexia and vomiting. Upper GI series and gastric endoscopy revealed a nodular tumor locating at the antrum and its resulting pyloric stenosis. A biopsied specimen of the tumor showed moderately differentiated adenocarcinoma and the tumor was associated with a high serum alpha-fetoprotein (4232ng/ml). At surgery, a Borrmann I type tumor, measuring 6×4.5×3cm was located at the pre-pylorus, invading the doudenal bulb. No distant metastasis was noted and a subtotal distal gastrectomy was performed. Histological examination revealed trabecular pattern of the tumor cells, and immunohistochemical AFP staining was positive. With these findings, it is considered that the case is of typical hepatoid adenocarcinoma of the stomach.

A CASE OF MALIGNANT TERATOMA OF THE ANTERIOR MEDIASTINUM PRODUCING ALPHA-FETOPROTEIN-

A case of AFP producing malignant teratoma of the anterior mediastinum which rapidly enlarged is reported. A 30-year-old man was found having an anterior mediastinal tumor on a chest X-ray film on a regular check-up. AFP level that had increased preoperatively to 2221.0ng/ml was normalized postoperatively. Histologically, the tumor was diagnosed as malignant teratoma with yolk sac carcinomatous area, with metastasis to mediastinal lymph nodes. Immunohistochemical staining for AFP was positive in tumor cells. The tumor seemed to have originated from the thymus. The patient postoperatively received two courses of combination chemotherapy with cisplatinum and ectoposide. Fourteen months later, pleural dissemination occurred despite a normal AFP level. After another four courses of combination chemotherapy with cisplatinum, bleomycin and vinblastine, the pleural nodules were reduced in size and number. In a review of the Japanese literature, 18 cases of malignant teratoma with yolk sac tumor were compared with 62 cases of pure yolk sac tumor for AFP level and prognosis.

A CASE OF CANCER OF THE GALLBLADDER WITH A HIGH LEVEL OF ALPHAFETOPROTEIN (AFP)

This paper presents a case of gallbladder cancer with a high level of AFP, 34, 230.9 ng/ml. A 71-year-old woman was admitted to the hospital because of a palpable tumor below the right costal margin. Based on various examinations the patient was diagnosed as having a gallbladder cancer. Extended resection of the gallbladder was carried out. Histopathologically most part of this tumor was comparsed of hepatoid tubular adenocarcinoma and the other part papillary type. Immunohistochemically, the carcinoma cells showed positive staining for AFP at the part of hepatoid pattern, and PIVKA-II was also positive. After the operation, the level of AFP converted to negative. It was suggested that carcinoma cells produced AFP. The AFP pattern analyzed by Dowble afinity electrophoresis with concanavalin A and Lens culinaris agglutinin was similar to hepatocellular carcinoma rather than yolk sac tumors. AFP-prognosis. Further studies about correlation with the AFP productivity are strongly expected.

Selective localization of alpha-fetoprotein and serum albumin within the sensory ganglia cells of developing chicken

The presence of α-fetoprotein (AFP) and serum albumin (SA) has been described within developing brain cells of mammals and chicken. In order to avoid the influence of the choroid plexuses in the transport, via cerebrospinal fluid, of these proteins to brain cells, we studied the presence of AFP and SA within chicken sensory ganglion cells during ontogeny using the indirect immunoperoxidase technique. Our results show that before day 9 of egg incubation, both AFP and SA can be detected within the trigeminal and spinal ganglia cells. Henceforth, the labeling for AFP starts decreasing in the spinal ganglia but not in the trigeminal ganglion. The labeling for SA remains constant in both structures. Differences between AFP and SA staining in the spinal ganglia are maximal on day 11 of incubation, when AFP is no longer detected. It is concluded that at this time, the uptake of AFP by spinal ganglia cells is switched-off while SA is still taken up. As the blood concentration of both proteins is similar at this time, the finding reported here gives support to the advanced hypothesis suggesting the presence of specific receptors for AFP and/or SA in embryonic neural cells.

Immunofluorescent Localization of Alpha‐fetoprotein Synthesis in the Endodermal Sinus of Rat Placenta

Specific immunofluorescence staining for AFP of the rat yolk sac showed that the synthesis was confined to the visceral layer of the yolk sac endoderm. The AFP synthesis took place not only in the extraplacental yolk sac as demonstrated by Gitlin in 1967, but also in the endodermal sinus structures within the placenta. No immunofluorescence staining was found of Reichert's membrane close to the parietal layer of the yolk sac. These findings are in accordance with the earlier demonstrated AFP synthesis in the visceral layer of the endodermal sinus structures in the tumors.