A comparative study of immunohistochemical staining for neuron-specific enolase, protein gene product 9.5 and S-100 protein in neuroblastoma, Ewing's sarcoma and other round cell tumours in children A comparative study of immunohistochemical staining for neuron-specific enolase (NSE), protein-gene product 9.5 (PGP 9.5) and S-100 was made in 71 undifferentiated round cell tumours from 65 children using formalin-fixed tissues and a standard alkaline phosphatase-anti-alkaline phosphatase method. All of 29 neuroblastomas marked for NSE and 2 7 for PGP 9.5; staining was diffuse and usually strong in all tumour elements, irrespective of the degree of differentiation. Patterns of staining remained consistent in primary, recurrent and metastatic tumours and were not modified by previous chemotherapy. S-1 00 staining was weak and confined to cell processes and schwannian elements in less than half of the tumours studied. Two primitive neuroectoderma1 tumours both stained strongly for NSE and PGP 9.5. Staining for NSE was observed in single maturing cells in 3/12 rhabdomyosarcomas and in tubular elements in 2/ 4 Wilms' tumours: primitive rhabdomyoblasts and undifferentiated renal blastema were negative: seven lymphomas were negative. Six of 1 7 skeletal Ewing's sarcomas showed light to moderate cytoplasmic staining for NSE and PGP 9.5. The site, histology and clinical course of these marker-positive Ewing's sarcomas showed no distinctive features. Staining for PGP 9.5 is a useful additional marker for neural differentiation in round cell tumours.
Immunohistochemical staining for ferritin was examined in 35 neuroblastomas from 27 children and compared with serum ferritin levels. All but two of the patients presented with advanced (stages III and IV) disease, and the adrenal was the most common primary site (20/27, 74%). Immunostaining was positive in only one of 14 tumour biopsies taken at the time of diagnosis (7%), but eight of 21 neuroblastomas (38%) marked for ferritin after chemotherapy. No consistent association was established between tumour- and serum-associated ferritins in the untreated or treated groups. Ferritin staining in treated neuroblastomas was usually more marked in partly differentiated tumour cells. The increased frequency of ferritin positive neuroblastomas after chemotherapy appeared to be associated with large local accumulations of ferritin and haemosiderin within the treated tumours, and (probably) with the blood transfusions which these children received.
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