The grading and prognostic assessment of oligodendrogliomas is severely constrained and there remains a need for improved diagnosis. Recently, we have identified the minichromosome maintenance (MCM) family of proteins as a novel class of proliferation markers. Mcm2 is a protein which forms part of the prereplicative complex. It is necessary for this complex to be assembled at origins of future DNA replication during the G1 phase to allow genome replication in the subsequent S phase. Our aim was to determine whether analysis of Mcm2 protein expression in oligodendrogliomas is of diagnostic value. Immunohistochemical staining for Mcm2 was performed on an archival series of 32 oligodendrogliomas. These tumours have been previously characterized for Ki67, mitotic labelling index and outcome. Cells showing expression of Mcm2 were quantified as a percentage to provide an Mcm2 labelling index. We have demonstrated a good correlation between Mcm2 and Ki67 labelling indices (r = 0.76, P < 0.01) but immunohistochemistry for Mcm2 consistently identified a higher proportion of cells. Mcm2 labelling index was higher in grade III than grade II tumours (P < 0.001). Cases with a high Mcm2 labelling index showed a poorer prognosis than those with a low index (P = 0.497) in univariate analysis, but with wide variation in this small series. Demonstration of Mcm2 expression is of value to demonstrate the proliferative fraction of tumours and is likely to be of prognostic value. Its study in a larger series is therefore warranted.
The oligodendroglioma has been considered to be a tumour showing oligodendrocyte differentiation, but studies of the expression of oligodendrocyte markers have not conclusively demonstrated this and the pattern of differentiation of this tumour remains uncertain. Recent studies have suggested that some oligodendrogliomas may show neuronal differentiation. The aim of this study was to determine whether there was evidence of neuronal differentiation in a series of oligodendrogliomas, and, if so, to determine whether this identified a biologically or clinically distinct group. Immunohistochemistry was carried out on paraffin sections using antibodies to synaptophysin, phosphorylated and non-phosphorylated neurofilament proteins. An archival series of 32 oligodendrogliomas had been previously characterized for histological features, histological grade, Ki-67 labelling index, apoptosis index and prognosis. Six per cent of tumours showed expression of synaptophysin. Thirty-one per cent of cases showed expression of neurofilament proteins with an antibody to non-phosphorylated epitopes, but no cases were positive with antibodies to phosphorylated neurofilament epitopes. Tumours showing expression of neuronal markers did not show a difference in the distribution of histological grade or GFAP expression from those which did not express these markers, and there was no difference in labelling indices or prognosis between the two groups. In conclusion, a subset of oligodendrogliomas showed expression of neuronal lineage markers; this is discussed in relation to histogenesis and differential diagnosis. The expression of such markers did not identify a biologically or clinically distinct subgroup.
Background
The purpose of this study was to examine the spatial resolution of unipolar atrial pace mapping by pacing at adjacent sites within the coronary sinus and the right atrium.
Methods and Results
Unipolar pacing from each pole of a quadripolar catheter was performed in the coronary sinus (n=29) and in the right atrium (n=10). Pacing from the distal electrode was used to simulate the site of origin of an atrial tachycardia. These P waves were compared with the P waves generated by unipolar pacing from each of the three proximal electrodes. The P waves were analyzed for changes in amplitude, duration, and configuration. Pacing within the coronary sinus resulted in significant changes in amplitude and duration at distances of 17 and 21 mm from the distal pole, respectively. Similarly, pacing in the right atrium resulted in significant changes in amplitude and duration at distances of 17 and 32 mm from the distal pole, respectively. No significant changes in configuration were noted in the coronary sinus in any lead at pacing sites ≤32 mm from the distal pole. Configurational changes were noted in the right atrium at pacing sites 17 mm from the distal pole.
Conclusions
The spatial resolution of unipolar atrial pace mapping is ≈17 mm. These findings indicate that mapping techniques that depend on the accurate discrimination of P-wave morphology, such as pace mapping or concealed entrainment, are likely to be imprecise when used in the atria.
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