Acta Oncologica
ISSN: 0284-186X (Print) 1651-226X (Online) Journal homepage: http://www.tandfonline.com/loi/ionc20
Correspondence and Short Communications: Primary Carcinoid Tumor of the Ovary — A Case Report Yildiz Erhan, Emel Dikicioǵlu, Murat B. Ålkanat & Necmettin Oüzdemir To cite this article: Yildiz Erhan, Emel Dikicioǵlu, Murat B. Ålkanat & Necmettin Oüzdemir (1992) Correspondence and Short Communications: Primary Carcinoid Tumor of the Ovary — A Case Report, Acta Oncologica, 31:7, 790-792, DOI: 10.3109/02841869209083873 To link to this article: https://doi.org/10.3109/02841869209083873
Published online: 08 Jul 2009.
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Article views: 21
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ionc20
790
CORRESPONDENCE
TIMOVAYRYNEN
Department of Radiation Therapy University of Oulu Oulu Finland
August 1992 Correspondence to: Dr Timo Vayrynen, Department of Radiation Therapy, OYKS, SF-90220 Oulu, Finland
MARIAALBERTSSON MAGDALENA CWIKIEL CARLHAKANHAKANSSON MARIANNE PALMEOREN
Department of Oncology University Hospital Lund Sweden
June 1992 Correspondence to: Dr Maria Albertsson, Department of Oncology, University Hospital, S-221 85 Lund, Sweden.
REFERENCES CONCOMITANT CHEMORADIOTHERAPY RESPONSE OF TRACHEAL AND ESOPHAGEAL EPITHELIUM IN RABBITS-AN ELECTRON MICROSCOPIC STUDY It has been a time-honoured axiom in cancer therapy that the two principal treatment modalities, chemotherapy and radiotherapy. should not be given simultaneously but staggered, to avoid unacceptable high toxicity in normal tissue ( I ) . For many years the main form of treatment in cases of inoperable squamous cell carcinoma of the head and neck, the esophagus or the lungs, has been radiotherapy, which has given palliation of brief duration, the patient often dying of uncontrolled local tumor. Cisplatinum. a chemotherapeutic agent with documented effectivity against squamous cell cancer, has also been found to have radiosensitizing properties, and clinical phase I1 trials have manifested better outcome in cases of squamous cell carcinoma of the head and neck or the esophagus when combined with radiotherapy and to be associated with acceptable toxicity. In a series of animal experiments, where rabbits were exposed to cisplatinum and irradiation of the superior mediastinum, and where damage, proliferation and reparative effects in normal tissue were investigated. recovery was better and more rapid in the parts of the trachea and esophagus exposed to the combined treatment than in unexposed areas (2, 3). Briefly, the drug was given daily as a sensitizer prior to each radiation treatment, at total dosages of 0.3 mg cisplatinum ( 2 Gy) to 3 mg cisplatinum (20 Gy), light microscopy (LM). scanning electron microscopy (SEM) and transmission electron microscopy (TEM) being performed I 10 days after the completion of treatment.Samples were taken both from the upper part of the esophagus and trachea (irradiated area: A l ) and the lower part of the esophagus and trachea (A2) where the absorbed radiation dose was ~ 0 . 0 5 Gy. Control investigations were also performed in the same way on untreated animals. As a result, no difference in ultrastructure between Al and A2 was found in the control animals. After treatment with cisplatinum and fractionated radiation superficial damage was manifest in the esophagus in the form of damaged microridges and increased cell loss and in the trachea as blebs on the cilia. bent cilia, broken cilia and loss of cilia on the ciliated cells and increased amount of mucus. The damage was manifest within a few days after treatment. dose-dependent and somewhat greater in that part of the tissue exposed to the combined treatment. From TEM micrographs the thickness of the total cell layer was calculated and LM measurements of the epithelial thickness were also performed. In the high-dose range the number of total cell layers as well as the thickness of the epithelium were higher in the part of the tissue exposed to the combined treatment. The phenomenon is interpreted as being due to accelerated epithelial proliferation in response to induced cellular damage. and as explaining the increased therapeutic ratio (i.e. effect versus side-effects) seen in association with concomitant chemotherapy and radiotherapy in cases of tumors of these types. ~
Steel GG. The search for therapeutic gain in the combination of radiotherapy and chemotherapy. Radiother Oncol 1988; 11: 31-53. Albertsson M, HHkansson, Palmegren M. The response of the tracheal epithelium to concomitant cis-diamminedichloroplatinum (11) and radiation. An electron microscopic study in rabbits. Scanning Microsc 1991; 5: 573-83. Albertsson M, Cwikiel M. Hikansson C-H, Plamegren M. Response of the esophageal epithelium to concomitant cis-diamminedichloroplatinum (11) and radiation treatment. An electron microscopic study in rabbits. Scanning Microsc 1992. (In press.)
PRIMARY CARCINOID TUMOR OF THE OVARY A CASE REPORT Carcinoid tumors are tumors of the diffuse peripheral endocrine system, producing biogenic amins and various polypeptides. They are most frequently localized in different parts of the gastrointestinal tract (GIT) and less frequently in bronchi, biliary tract and ovaries ( I ) . Primary ovarian carcinoid is very rare. It mostly occurs in women over 50 years of age and constitutes less than 1% of all carcinoid tumors (2). Ovarian carcinoid tumor is also called a 'specialized teratoma' due to the frequent coexistence of mature or immature teratoid components. Patients with ovarian carcinoid may also present clinical 'carcinoid syndrom'. This is especially common for large tumors. The neuroendocrine cells that give rise to carcinoid tumors ( Kulchitsky cells) are found scattered along the mucosal surface of GIT. The secretory granules of these cells have affinity to soluble silver salts. Tumors are categorized as foregut, midgut and hindgut carcinoids according to their site of origin. The most common carcinoid tumor encountered in the ovaries is the socalled 'insular carcinoid' of midgut type. Less common is the so-called 'trabecular carcinoid'. thought to be derived from foregut or hindgut. 'mixed carcinoids' have also been reported (3.4). Ovarian carcinoids. without other teratomatous components, are solid. grey-yellow tumors, usually well-encapsuled and slightly lobulated. When other teratomatous components coexist, cystic and semicystic foci are seen. According to previous reports. the diameter of these tumors range from 1-25 cm. Microscopically. 'insular carcinoid' tumors are composed of small acinar structures and polygonal cell nests. The hyperchromatic. round or oval. nucleus is located at the center of the cell and in the basophilic or acidophilic cytoplasm, red or brown secretory granules are seen. The cellular features are similar in the trabecular type. but the cells in this type form long and ondulated ribbons, rows and trabeculae lying in a compact fibrous connective tissue stroms ( 5 ) .
CORRESPONDENCE
The secretory granules have affinity to silver salts, and carcinoid tumors stain positively with Masson Fontana and Grimelius’ stains. Recently, immunohistochemical methods, visualizing peroxydase labelled antibodies against neuroendocrine substances (pancreatic polypeptide, glucagon, encephaline, somatostatine, substance P, calcitonin, VIP, neurotensin, beta endorphine and ACTH), have come into use. Case report: A 55-year-old postmenopausal woman, suffering from paroxysmal Bushings in the skin of her neck, chest, hands and feet, occasional abdominal cramps, diarrhea attacks, and cardiac problems, was admitted in August 1986. At physical examination, a tumor mass, originating from the right ovary, was discovered, as well as hypertension and chronic obstructive lung disease. The patient underwent total abdominal hysterectomy and right-sided salpingo oophorectomy. The removed ovary had a largest diameter of 8cm, was well encapsulated, had a smooth surface and a slightly lobular appearance. The cut surface was solid and gray-white. Microscopically the tumor tissue consisted of uniform tumor cells which formed small acini and numerous solid, poligonal islands. Occasional cribriform patterns were found. The tumor cells had round, hypercromatic and centrally localized nuclei and basophilic cytoplasm containing granular
Fig. 1. Ovarian carcinoid tumor. Tumor islands and acinar structures. H.E. x 110.
Fig. 2. Peripheral staining of the tumoral islands. MassonFontana x 1 I0
79 1
Fig. 3. Tumor islands composed of uniform cells with chromogranin positive tiny granular material. Chromogranin monoclonal avidin-biotin antiperoxidase staining. x 440.
elements (Fig. I). In Masson-Fontana and Grimelius’ staining, tiny granular material was found in the cytoplasm of the tumor cells, especially at the periphery of the tumor islands (Fig. 2). Monoclonal immunoperoxidase staining against chromogranin revealed subnuclear, tiny granular material (Fig. 3). Subsequent clinical examinations of the patient did not reveal any extraovarian carcinoid tumor and the ovarian tumor was regarded as a primary tumor. Unfortunately, it has not been possible to follow the patient after her discharge from hospital. Discussion. Since primary ovarian carcinoid is very rare, the differential diagnosis is important as well as deciding whether the tumor is primary or metastatic. Frequently, primary ovarian carcinoid coexists with other teratomatous components and it is nearly always uniteral. Metastatic ovarian carcinoids. on the other hand are often bilateral (6). Especially insular ovarian carcinoids can sometimes be confused with Brenner tumor. However, the ‘coffee-bean’appearance of the nuclei in Brenner tumor and the configuration of the acinar elements are somewhat different. The Call Exner bodies in granulosa cell tumor also differ as they do not form a complete acinar pattern. Immunohistochemical assays are available for the differential diagnosis of carcinoid tumors. The frequency of positive immunoreactivity has been reported to be as low as 7% in a series of tumors among which nearly half of the cases represented the insular type. However, this low rate of reactivity may possibly be due to the use of more specialized antisera instead of neuron-specific enolase (NSE) and/or chromogranin. which are frequently used antisera in the labelling of carcinoid tumors. Also, as is stressed in the same article, the routine tissue processing may cause false negative results by destroying the antigenic structures (7). Since the cells of the carcinoid tumors carry some neuroendocrine granules in common with the cells of pancreatic islets (8.9). antichromogranin immunoperoxidase staining ( i n which pancreatic tissue is used for positive control) may be useful in diagnostic procedures. However, this staining can, of course, not differentiate between primary and metastatic carcinoids, nor detect undifferentiated carcinoids which cannot synthesize the specific polypeptides. In a paper by Aguirre et al. ( lo), it is stressed that ovarian small cell carcinomas like their counterparts in the lungs and elsewhere in the body, can synthesize neuroendocrine substances and, due to this property, might be related to carcinoid tumors. In the same
192
CORRESPONDENCE
study, chromogranin A was said to be the second most commonly immunoreactive substance, after a cytokeratin subtype antibody (CAM 5.2). against small cell carcinomas and stained four out of five tumors. In this study, chromogranin was negative in all adult and juvenile granulosa cell tumors and positive in only 50% of Sertoli cell tumors (10). Despite the fact that chromogranin is positive also in some other types of tumors it has a definite value for diagnosis of carcinoid tumors. Since carcinoid tumor cells produce many different kinds of neuroendocrine substances, immunohistochemical assays should preferably be performed with a broad set of different primary antibodies. However, in the present case, the combined clinical, histopathological and immunohistochemical studies gave strong evidence for the carcinoid nature of the tumor, and that it represented a primary, ovarian carcinoid. YILDIZERHAN EMELDIKICIOGLU MURATB. ALKANAT NECMETTIN~ Z D E M I R
Department of Pathology Faculty of Medicine Ege University Bornova lzmir Turkey
April 1992 Correspondence to: Dr Murat B. Alkanat, Ege University Medical School, Department of Pathology, TR-35 100 BornovaIzmir, Turkey.
REFERENCES I . Robbins SL, Cotran RS, Kumar V. Pathologic basis of disease. Canada: W. B. Saunders, 1984 842-5. 2. Robboy SJ, Norris HJ, Scully RE. Insular carcinoid primary in the ovary. Cancer 1975; 36: 44-18. 3. Czernobilsky B, Segal M,Ogani R. Primary ovarian carcinoid with marked heterogeneity of microscopic features. Cancer 1984; 54: 585-9. 4. Nogales F. Germ cell tumors of ovary. In: Fox H, ed. Obstetrical and gynecological pathology. London: ChurchillLivingstone, 1987: 635-7. 5. Talerman A. Germ cell tumors of ovary. In: Blaustein A, ed. Pathology of female genital tract NY: Springer Verlag, 1982: 602-64. 6. Robboy SJ, Scully RE, Norris HJ. Primary trabecular carcinoid of the ovary. Obstet Gynecol 1977; 49: 202 -7. 7. Sporrong B, Falkmer S, Robboy SJ, et al. Neurohormonal peptides in ovarian carcinoids. Cancer 1982; 49: 68-74. 8. Morgello S, Schwartz E, Horwith M, King ME, Gorden P, Alonso DR. Ectopic insulin production by a primary ovarian carcinoid. Cancer 1988; 61: 800-5. 9. Sakura H. Hamada Y, Tsuruta Y, Okamoto K, Nakamura S. Large glucagon-like immunoreactivity in a primary ovarian carcinoid. Cancer 1985; 55: 1001-6.
10. Aguirre P, Thor AD, Scully RE. Ovarian small cell carcinoma. Am J Clin Pathol 1989; 92: 140-9.
COMMENTS ON THE ARTICLE ‘RADIOTHERAPY OF METASTATIC SPINAL CORD COMPRESSION’ BY B. JEREMIC ET AL. IN ACTA ONCOLOGICA 1991; 30: 985-6. We have read the article published in Acta Oncologica Vol. 30, No. 8, 1991, entitled ‘Radiotherapy of metastatic spinal cord compression’. (pp. 985-6) and were somewhat surprised not to find any reference to our paper which was published in Radiotherapy and Oncology (1989; 15: 227-33), entitled ‘Role of radiotherapy in metastatic spinal cord compression: preliminary results from a prospective trial’, although the data are very similar to ours. Our preliminary results, cited above, were followed by a prospective analysis of 105 consecutive patients, published in Cancer 1991; 67 (No. 5): 1311-7. The problem of metastatic spinal cord compression is of interest to any oncologic center and it is correct that it should be approached with clinical trials in qualified institutions. We therefore think that the problem calls for more cooperation between the various centers trying to work out best treatment approach for patients with epidural metastasis. We are continuing our study and have now 250 cases treated in a homogeneous manner. PAOLOLATINI ERNESTOMARANZANO
U.O. Radioterapia Oncologica Policlinico Monteluce 1-06100 Perugia Italy
July 1992 Correspondence to: Professor Paolo Latini (address as above).
Authors’ comments
We have read the comments by Drs. Latini and Maranzano from Perugia and can only agree about the interest and importance of epidural metastasis, especially in view of the increasing survival of patients with malignant diseases. We regret not having included their work among the references in our Short Communication. It will be included in a future paper in which we will discuss place and role or radiotherapy as well as time-dose fractionation patterns. BRANISLAV JEREMIC
July 1992
Department of Oncology KBC ‘KRAGUJEVAC’ Zmaj Juvina bb YU-34000 Kragujevac Yugoslavia
ISSN: 0284-186X (Print) 1651-226X (Online) Journal homepage: http://www.tandfonline.com/loi/ionc20
Correspondence and Short Communications: Primary Carcinoid Tumor of the Ovary — A Case Report Yildiz Erhan, Emel Dikicioǵlu, Murat B. Ålkanat & Necmettin Oüzdemir To cite this article: Yildiz Erhan, Emel Dikicioǵlu, Murat B. Ålkanat & Necmettin Oüzdemir (1992) Correspondence and Short Communications: Primary Carcinoid Tumor of the Ovary — A Case Report, Acta Oncologica, 31:7, 790-792, DOI: 10.3109/02841869209083873 To link to this article: https://doi.org/10.3109/02841869209083873
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 21
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ionc20
790
CORRESPONDENCE
TIMOVAYRYNEN
Department of Radiation Therapy University of Oulu Oulu Finland
August 1992 Correspondence to: Dr Timo Vayrynen, Department of Radiation Therapy, OYKS, SF-90220 Oulu, Finland
MARIAALBERTSSON MAGDALENA CWIKIEL CARLHAKANHAKANSSON MARIANNE PALMEOREN
Department of Oncology University Hospital Lund Sweden
June 1992 Correspondence to: Dr Maria Albertsson, Department of Oncology, University Hospital, S-221 85 Lund, Sweden.
REFERENCES CONCOMITANT CHEMORADIOTHERAPY RESPONSE OF TRACHEAL AND ESOPHAGEAL EPITHELIUM IN RABBITS-AN ELECTRON MICROSCOPIC STUDY It has been a time-honoured axiom in cancer therapy that the two principal treatment modalities, chemotherapy and radiotherapy. should not be given simultaneously but staggered, to avoid unacceptable high toxicity in normal tissue ( I ) . For many years the main form of treatment in cases of inoperable squamous cell carcinoma of the head and neck, the esophagus or the lungs, has been radiotherapy, which has given palliation of brief duration, the patient often dying of uncontrolled local tumor. Cisplatinum. a chemotherapeutic agent with documented effectivity against squamous cell cancer, has also been found to have radiosensitizing properties, and clinical phase I1 trials have manifested better outcome in cases of squamous cell carcinoma of the head and neck or the esophagus when combined with radiotherapy and to be associated with acceptable toxicity. In a series of animal experiments, where rabbits were exposed to cisplatinum and irradiation of the superior mediastinum, and where damage, proliferation and reparative effects in normal tissue were investigated. recovery was better and more rapid in the parts of the trachea and esophagus exposed to the combined treatment than in unexposed areas (2, 3). Briefly, the drug was given daily as a sensitizer prior to each radiation treatment, at total dosages of 0.3 mg cisplatinum ( 2 Gy) to 3 mg cisplatinum (20 Gy), light microscopy (LM). scanning electron microscopy (SEM) and transmission electron microscopy (TEM) being performed I 10 days after the completion of treatment.Samples were taken both from the upper part of the esophagus and trachea (irradiated area: A l ) and the lower part of the esophagus and trachea (A2) where the absorbed radiation dose was ~ 0 . 0 5 Gy. Control investigations were also performed in the same way on untreated animals. As a result, no difference in ultrastructure between Al and A2 was found in the control animals. After treatment with cisplatinum and fractionated radiation superficial damage was manifest in the esophagus in the form of damaged microridges and increased cell loss and in the trachea as blebs on the cilia. bent cilia, broken cilia and loss of cilia on the ciliated cells and increased amount of mucus. The damage was manifest within a few days after treatment. dose-dependent and somewhat greater in that part of the tissue exposed to the combined treatment. From TEM micrographs the thickness of the total cell layer was calculated and LM measurements of the epithelial thickness were also performed. In the high-dose range the number of total cell layers as well as the thickness of the epithelium were higher in the part of the tissue exposed to the combined treatment. The phenomenon is interpreted as being due to accelerated epithelial proliferation in response to induced cellular damage. and as explaining the increased therapeutic ratio (i.e. effect versus side-effects) seen in association with concomitant chemotherapy and radiotherapy in cases of tumors of these types. ~
Steel GG. The search for therapeutic gain in the combination of radiotherapy and chemotherapy. Radiother Oncol 1988; 11: 31-53. Albertsson M, HHkansson, Palmegren M. The response of the tracheal epithelium to concomitant cis-diamminedichloroplatinum (11) and radiation. An electron microscopic study in rabbits. Scanning Microsc 1991; 5: 573-83. Albertsson M, Cwikiel M. Hikansson C-H, Plamegren M. Response of the esophageal epithelium to concomitant cis-diamminedichloroplatinum (11) and radiation treatment. An electron microscopic study in rabbits. Scanning Microsc 1992. (In press.)
PRIMARY CARCINOID TUMOR OF THE OVARY A CASE REPORT Carcinoid tumors are tumors of the diffuse peripheral endocrine system, producing biogenic amins and various polypeptides. They are most frequently localized in different parts of the gastrointestinal tract (GIT) and less frequently in bronchi, biliary tract and ovaries ( I ) . Primary ovarian carcinoid is very rare. It mostly occurs in women over 50 years of age and constitutes less than 1% of all carcinoid tumors (2). Ovarian carcinoid tumor is also called a 'specialized teratoma' due to the frequent coexistence of mature or immature teratoid components. Patients with ovarian carcinoid may also present clinical 'carcinoid syndrom'. This is especially common for large tumors. The neuroendocrine cells that give rise to carcinoid tumors ( Kulchitsky cells) are found scattered along the mucosal surface of GIT. The secretory granules of these cells have affinity to soluble silver salts. Tumors are categorized as foregut, midgut and hindgut carcinoids according to their site of origin. The most common carcinoid tumor encountered in the ovaries is the socalled 'insular carcinoid' of midgut type. Less common is the so-called 'trabecular carcinoid'. thought to be derived from foregut or hindgut. 'mixed carcinoids' have also been reported (3.4). Ovarian carcinoids. without other teratomatous components, are solid. grey-yellow tumors, usually well-encapsuled and slightly lobulated. When other teratomatous components coexist, cystic and semicystic foci are seen. According to previous reports. the diameter of these tumors range from 1-25 cm. Microscopically. 'insular carcinoid' tumors are composed of small acinar structures and polygonal cell nests. The hyperchromatic. round or oval. nucleus is located at the center of the cell and in the basophilic or acidophilic cytoplasm, red or brown secretory granules are seen. The cellular features are similar in the trabecular type. but the cells in this type form long and ondulated ribbons, rows and trabeculae lying in a compact fibrous connective tissue stroms ( 5 ) .
CORRESPONDENCE
The secretory granules have affinity to silver salts, and carcinoid tumors stain positively with Masson Fontana and Grimelius’ stains. Recently, immunohistochemical methods, visualizing peroxydase labelled antibodies against neuroendocrine substances (pancreatic polypeptide, glucagon, encephaline, somatostatine, substance P, calcitonin, VIP, neurotensin, beta endorphine and ACTH), have come into use. Case report: A 55-year-old postmenopausal woman, suffering from paroxysmal Bushings in the skin of her neck, chest, hands and feet, occasional abdominal cramps, diarrhea attacks, and cardiac problems, was admitted in August 1986. At physical examination, a tumor mass, originating from the right ovary, was discovered, as well as hypertension and chronic obstructive lung disease. The patient underwent total abdominal hysterectomy and right-sided salpingo oophorectomy. The removed ovary had a largest diameter of 8cm, was well encapsulated, had a smooth surface and a slightly lobular appearance. The cut surface was solid and gray-white. Microscopically the tumor tissue consisted of uniform tumor cells which formed small acini and numerous solid, poligonal islands. Occasional cribriform patterns were found. The tumor cells had round, hypercromatic and centrally localized nuclei and basophilic cytoplasm containing granular
Fig. 1. Ovarian carcinoid tumor. Tumor islands and acinar structures. H.E. x 110.
Fig. 2. Peripheral staining of the tumoral islands. MassonFontana x 1 I0
79 1
Fig. 3. Tumor islands composed of uniform cells with chromogranin positive tiny granular material. Chromogranin monoclonal avidin-biotin antiperoxidase staining. x 440.
elements (Fig. I). In Masson-Fontana and Grimelius’ staining, tiny granular material was found in the cytoplasm of the tumor cells, especially at the periphery of the tumor islands (Fig. 2). Monoclonal immunoperoxidase staining against chromogranin revealed subnuclear, tiny granular material (Fig. 3). Subsequent clinical examinations of the patient did not reveal any extraovarian carcinoid tumor and the ovarian tumor was regarded as a primary tumor. Unfortunately, it has not been possible to follow the patient after her discharge from hospital. Discussion. Since primary ovarian carcinoid is very rare, the differential diagnosis is important as well as deciding whether the tumor is primary or metastatic. Frequently, primary ovarian carcinoid coexists with other teratomatous components and it is nearly always uniteral. Metastatic ovarian carcinoids. on the other hand are often bilateral (6). Especially insular ovarian carcinoids can sometimes be confused with Brenner tumor. However, the ‘coffee-bean’appearance of the nuclei in Brenner tumor and the configuration of the acinar elements are somewhat different. The Call Exner bodies in granulosa cell tumor also differ as they do not form a complete acinar pattern. Immunohistochemical assays are available for the differential diagnosis of carcinoid tumors. The frequency of positive immunoreactivity has been reported to be as low as 7% in a series of tumors among which nearly half of the cases represented the insular type. However, this low rate of reactivity may possibly be due to the use of more specialized antisera instead of neuron-specific enolase (NSE) and/or chromogranin. which are frequently used antisera in the labelling of carcinoid tumors. Also, as is stressed in the same article, the routine tissue processing may cause false negative results by destroying the antigenic structures (7). Since the cells of the carcinoid tumors carry some neuroendocrine granules in common with the cells of pancreatic islets (8.9). antichromogranin immunoperoxidase staining ( i n which pancreatic tissue is used for positive control) may be useful in diagnostic procedures. However, this staining can, of course, not differentiate between primary and metastatic carcinoids, nor detect undifferentiated carcinoids which cannot synthesize the specific polypeptides. In a paper by Aguirre et al. ( lo), it is stressed that ovarian small cell carcinomas like their counterparts in the lungs and elsewhere in the body, can synthesize neuroendocrine substances and, due to this property, might be related to carcinoid tumors. In the same
192
CORRESPONDENCE
study, chromogranin A was said to be the second most commonly immunoreactive substance, after a cytokeratin subtype antibody (CAM 5.2). against small cell carcinomas and stained four out of five tumors. In this study, chromogranin was negative in all adult and juvenile granulosa cell tumors and positive in only 50% of Sertoli cell tumors (10). Despite the fact that chromogranin is positive also in some other types of tumors it has a definite value for diagnosis of carcinoid tumors. Since carcinoid tumor cells produce many different kinds of neuroendocrine substances, immunohistochemical assays should preferably be performed with a broad set of different primary antibodies. However, in the present case, the combined clinical, histopathological and immunohistochemical studies gave strong evidence for the carcinoid nature of the tumor, and that it represented a primary, ovarian carcinoid. YILDIZERHAN EMELDIKICIOGLU MURATB. ALKANAT NECMETTIN~ Z D E M I R
Department of Pathology Faculty of Medicine Ege University Bornova lzmir Turkey
April 1992 Correspondence to: Dr Murat B. Alkanat, Ege University Medical School, Department of Pathology, TR-35 100 BornovaIzmir, Turkey.
REFERENCES I . Robbins SL, Cotran RS, Kumar V. Pathologic basis of disease. Canada: W. B. Saunders, 1984 842-5. 2. Robboy SJ, Norris HJ, Scully RE. Insular carcinoid primary in the ovary. Cancer 1975; 36: 44-18. 3. Czernobilsky B, Segal M,Ogani R. Primary ovarian carcinoid with marked heterogeneity of microscopic features. Cancer 1984; 54: 585-9. 4. Nogales F. Germ cell tumors of ovary. In: Fox H, ed. Obstetrical and gynecological pathology. London: ChurchillLivingstone, 1987: 635-7. 5. Talerman A. Germ cell tumors of ovary. In: Blaustein A, ed. Pathology of female genital tract NY: Springer Verlag, 1982: 602-64. 6. Robboy SJ, Scully RE, Norris HJ. Primary trabecular carcinoid of the ovary. Obstet Gynecol 1977; 49: 202 -7. 7. Sporrong B, Falkmer S, Robboy SJ, et al. Neurohormonal peptides in ovarian carcinoids. Cancer 1982; 49: 68-74. 8. Morgello S, Schwartz E, Horwith M, King ME, Gorden P, Alonso DR. Ectopic insulin production by a primary ovarian carcinoid. Cancer 1988; 61: 800-5. 9. Sakura H. Hamada Y, Tsuruta Y, Okamoto K, Nakamura S. Large glucagon-like immunoreactivity in a primary ovarian carcinoid. Cancer 1985; 55: 1001-6.
10. Aguirre P, Thor AD, Scully RE. Ovarian small cell carcinoma. Am J Clin Pathol 1989; 92: 140-9.
COMMENTS ON THE ARTICLE ‘RADIOTHERAPY OF METASTATIC SPINAL CORD COMPRESSION’ BY B. JEREMIC ET AL. IN ACTA ONCOLOGICA 1991; 30: 985-6. We have read the article published in Acta Oncologica Vol. 30, No. 8, 1991, entitled ‘Radiotherapy of metastatic spinal cord compression’. (pp. 985-6) and were somewhat surprised not to find any reference to our paper which was published in Radiotherapy and Oncology (1989; 15: 227-33), entitled ‘Role of radiotherapy in metastatic spinal cord compression: preliminary results from a prospective trial’, although the data are very similar to ours. Our preliminary results, cited above, were followed by a prospective analysis of 105 consecutive patients, published in Cancer 1991; 67 (No. 5): 1311-7. The problem of metastatic spinal cord compression is of interest to any oncologic center and it is correct that it should be approached with clinical trials in qualified institutions. We therefore think that the problem calls for more cooperation between the various centers trying to work out best treatment approach for patients with epidural metastasis. We are continuing our study and have now 250 cases treated in a homogeneous manner. PAOLOLATINI ERNESTOMARANZANO
U.O. Radioterapia Oncologica Policlinico Monteluce 1-06100 Perugia Italy
July 1992 Correspondence to: Professor Paolo Latini (address as above).
Authors’ comments
We have read the comments by Drs. Latini and Maranzano from Perugia and can only agree about the interest and importance of epidural metastasis, especially in view of the increasing survival of patients with malignant diseases. We regret not having included their work among the references in our Short Communication. It will be included in a future paper in which we will discuss place and role or radiotherapy as well as time-dose fractionation patterns. BRANISLAV JEREMIC
July 1992
Department of Oncology KBC ‘KRAGUJEVAC’ Zmaj Juvina bb YU-34000 Kragujevac Yugoslavia
