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• W2033463721 abstract "In their Clinical picture, Gabriella Bedolla and Grant Stemmerman (June 21, p 2113)1Bedolla G Stemmerman G Pulmonary small cell carcinocythaemia.Lancet. 2003; 361: 2113Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar report a case of carcinocythaemia in a patient with pulmonary small-cell carcinoma. To illustrate renal involvement in carcinocythaemia, a highly magnified glomerulus from a kidney section which was immunohistochemically stained with antibodies directed against the tumour marker thyroid transcription factor-1 (TTF-1) is shown on a photomicrograph. According to the authors, the photograph shows TTF-1-positive small-cell carcinoma cells that circulate through glomerular capillaries. Although the picture looks impressive at first sight, we have doubts about the authors' interpretation of the immunostaining pattern. A horseradish peroxidase system seems to have been used to visualise binding of the primary antibody to TTF-1, since the typical antibody-independent reactivity of the proximal tubular brush border as a result of endogenous peroxidase can be seen. However, another prominent location of endogenous peroxidase is red blood cells. Such cells are typically lit up by peroxidase detection systems if endogenous peroxidase is not blocked before immunohistochemistry.2Sherman DM Paull WK New method for visualization of vascular networks in nonperfused fixed tissues.Stain Technol. 1985; 60: 89-92PubMed Google Scholar To us it seems likely that most of the positively stained cells in the glomerular capillaries shown on the picture represent red blood cells, not TTF-1-positive tumour cells. The homogeneous staining throughout the positive cell bodies is characteristic of erythrocyte peroxidase. A specific immunosignal for the transcription factor TTF-1, on the other hand, should be primarily confined to the nucleus.3Kaufmann O Dietel M Thyroid transcription factor-1 is the superior immunohistochemical marker for pulmonary adenocarcinoma and large cell carcinomas compared to surfactant proteins A and B.Histopathology. 2000; 36: 8-16Crossref PubMed Scopus (241) Google Scholar Only a few of the positive intracapillary cells have discernible nuclei at all, and those cells appear surprisingly small even for small-cell carcinoma when compared with adjacent renal cells. We also note that the authors report a magnification of X100, although a much higher magnification was obviously used. A likely source of this mistake is the regularly overlooked fact that the total magnification of any specimen in a compound microscope is the product of the objective lens magnification (which in this case was X100) and the magnification of the ocular lens (usually X10). Although our considerations are not meant to challenge the overall diagnosis of carcinocythaemia in the presented case, we want to underline the importance of careful interpretations of seemingly unambiguous histochemical techniques used in diagnosis. Immunostaining of small-cell carcinoma: mistaken identity?Author's reply Full-Text PDF" @default.
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• W2033463721 title "Immunostaining of small-cell carcinoma: mistaken identity?" @default.
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• W2033463721 doi "https://doi.org/10.1016/s0140-6736(03)14754-x" @default.
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