Pulmonary metastases of breast carcinomas: Ligandohistochemical, nuclear, and structural analysis of primary and metastatic tumors with emphasis on period of occurrence of metastases and survival

Background and Objectives: Pulmonary metastases of breast carcinomas have a high frequency and are often subject to surgical intervention. To contribu te to advances in the knowledge about morphometric and biochemical paramete rs of primary tumors and their metastatic lesions, analysis of syntactic st ructure and thermodymanic aspects as well as of expression of distinct glyc ohistochemical features with respect to period of metastasis occurrence and patient survival is desirable. Methods: Clinical history, surgical findings, histopathological reports, su rvival of the patients with a maximum follow-up of 15 years, and paraffin b locks of 32 breast carcinoma specimens and their pulmonary metastases were examined. Only potentially curative resections of both the breast carcinoma and their metastases have been included for anlysis. The following markers were applied: neoglycoconjugates with histoblood group A- and H-trisacchar ides, lactose, alpha-N-acetyl-D-galactosamine and the Forssman disacchauide , a polyclonal immunoglobulin G fraction from human serum with specificity for 9-0-acetylated sialic acid, which is a tumor marker for melanomas, the serum lectins serum amyloid P component and mannan-binding lectin, the mann ose-specific plant lectin concanavalin A, and monoclonal antibodies specifi c for estrogen and progesterone receptors, respectively. In addition, measu rements of the integrated optical density (IOD) and tissue structure were p erformed. Results: The frequency of expression of hormone receptors and expression of binding capacities to most of the applied probes was similar between the p rimary and metastatic tumors; however, it varied markedly between different patients. For the IOD parameters, a close association between the primary tumors and their metastases was seen, especially a rather low S-phase-relat ed tumor cell fraction and a high percentage of tumor cells with an IOD >5C . The mean time for the development of intrapulmonary metastases measured 4 3 months. It was considerably longer in progesterone receptor-negative tumo rs (49.7 months) and those with a lack of expression of sites with specific ity for the Forssman disaccharide (48.7 months). The survival was positivel y correlated with the presence of binding capacity of histoblood group A-tr isaccharide and certain structural parameters, especially the structural en tropy and its current. The presence of estrogen and progesterone receptors was not associated with the total survival at a statistically significant l evel. Conclusions: Histochemical features between the primary breast carcinoma an d their intrapulmonary metastases can evidently vary. Analysis of the hormo ne receptor status in metastatic lesions seems to be useful for diagnostic purposes only in rare cases, i.e., distinguishing metastases from primary l ung carcinoma. Nonetheless, the survival of patients with metastasizing bre ast carcinoma is associated with features of the primary tumors, especially the detection of binding capacities for the Forssman disaccharide and the histoblood group A-trisaccharide. Extent of lymph node involvement of the b reast carcinoma is not prognostic for later pulmonary involvement. J. Sur-g . Oncol. 1998;69:137-146. (C) 1998 Wiley-Liss, Inc.