We evaluated the incidence of synchronous or metachronous multiple primary cancer, hereditary or familial cancer, and the familial aggregation of cancer in 142 patients who were treated for endometrial cancer at Tsukuba University Hospital in the period 1977 to 1995. Synchronous multiple primary cancers were identified in 6 of the 142 patients (4.2%). Eleven patients (7.7%) had a history of extraendometrial cancer. Patients with endometrial cancer had a significantly high incidence of a history of breast cancer. Endometrial cancer was diagnosed in two patients who were screened before menopause. Four patients with endometrial cancer (2.8%) subsequently developed extraendometrial forms of cancer. One patient (0.7%) was considered to have a hereditary form of cancer, and 5 patients (3.5%) had familial forms of cancer. A total of 86 cases of cancer were found among 53 kindred (37.3%). More detailed studies are needed to elucidate the aggregation of cancers in the families of patients with endometrial cancer in Japan. Patients with a history of breast cancer should be screened for the presence of endometrial cancer.

Significant progress has been made in the field of cancer metastasis, and the molecular mechanism of cancer metastasis is being studied extensively. Recent studies revealed that some oncogenes and metastasis-associated genes play important roles in cancer metastasis. Some nuclear transcription factors have appeared to be involved in this metastasis. Ets-related E1AF confers the invasive phenotype on cancer cells. E1AF that acts as a transcription factor is believed to play an important role in cancer invasiveness/metastasis through transcriptions of metastasis-related genes.

This is a report of the occurrence of familial ectopic pheochromocytoma in two brothers, whose father had bilateral adrenal pheochromocytoma. Both brother complained of hypertension. In the first case, a 22-year-old man presented with much higher than normal norepinephrine. Abdominal CT and chest CT scanning and 123I-MIBG scintigraphy revealed an extraadrenal tumor in the chest on the bilateral adrenal grands. Bilateral adrenectomy was performed. In the second case, the 20-year-old brother was found to have an abdominal mass that was diagnosed as ectopic pheochromocytoma originating in the intra-abdominal paraaorta according to abdominal CT scanning and 131I-MIBG scintigraphy. The tumor was resected.

We examined the abnormality of p16INK4a and p15INK4b genes in 14 cases of human acute lymphoblastic leukemias (L1; 8 sample from 6 cases, L2; 10 samples from 7 cases, L3; 1 sample from 1 case) using DNA from bone marrow cells. The frequency of homozygous deletion of p16INK4a was 21.4% (3/14) and that of p15INK4b was 7.1% (1/14) and both genes were deleted in 7.1% (1/14) according to Southern blot and PCR analysis. The deletion of p16INK4a and/or p15INK4b was detected in 50% (3/6) of L1, 28.6% (2/7) of L2. The frequency of deletion was 33.3% (3/9) of B cell origin, 66.7% (2/3) of T cell origin and 0% (0/2) of nonBnonT cell origin. By PCR-SSCP analysis on exon 1 and exon 2 of p16INK4a and p15INK4b genes, we detected one case of unusual migrated band in L1 B cell origin. The base substitution, C to G, located in intron 1 of p15INK4b, 9 base upstream of intron 1-exon 2 boundary, was determined by DNA sequencing analysis. Deletion of p16INK4a and/or p15INK4b gene may contribute to etiology of ALL.

Recent advances in molecular biological techniques have contributed to the tremendous progression made in the field of diagnosis of leukemia. Discovery of T- or B-lymphocyte associated genes, tumor specific genes and genes involved in chromosomal translocation has made it possible to detect leukemia cells by Southern blotting, PCR, RT-PCR or fluorescence in situ hybridization (FISH). The recently developed FISH is a simple, rapid and accurate method and requires a very small amount of specimen (about 500-1000 cells). It is possible to obtain results within 48 hours of sampling. This lecture were focused on two topics; 1) The application of FISH method in the diagnosis of leukemia using three types of probes (whole chromosome painting probe, centromeric probes and oncogene specific probes) and their combinations. 2) Clarification of concepts made by molecular biology especially in Philadelphia chromosome positive leukemia, Ph-negative chronic myelocytic leukemia, endemic/sporadic type of Burkitt's lymphoma, biphenotypic leukemia and leukemia with specific translocations.

Ovarian cancer is one of the significant and deadly disease. Since 1980 when cisplatin was introduced in the chemotherapy, about 30% of the patients with advanced disease have achieved 5-year survival. However, remaining patients have had progressive disease or recurrence after achieving NED. Forty-seven% of recurrent disease was discovered as distant metastasis, while at initial therapy. In the recurrent disease, distantly metastatic lesions were encountered more frequently than those in primary disease. In the recurrent tumor, expression of immunohistochemical markers of malignancy, such as p53 protein and CD44v6 antigen were increased. These clinical data suggest that recurrent ovarian cancer which are exposed to anticancer agents attain increased metastatic potential. In order to assure that anticancer agent contribute to this increment, an experimental system using two human ovarian cancer cell lines (HRA, KF) and nude mice in which cancer cells were exposed to cisplatin in vivo was introduced. Cancer cells exposed to cisplatin in vivo (treated cells) made spontaneously more metastatic nodules in the mouse lung than those exposed to PBS (untreated cells). This result suggest that cisplatin induce the increase of metastatic potential of cancer cells in vivo. Treated cells showed higher invasiveness compared with untreated cells when inoculated in the footpad. Three major factors which were generally proposed to be necessary for cancer cell to give rise to invasion, such as attachment to extracellular matrix, production of proteolytic enzyme, and cellular mobility. For all of these factors, treated cells were superior to untreated cells. These results obtained suggests that cisplatin could increase the metastatic potential of cancer by enhancing potential of invasion. To investigate the mechanism of this phenomenon from the standpoint of genetic mutation, clonal analysis of experimental cancer in vivo was performed using southern blot method. Cancer cells before inoculation to the mice consisted of multiple clones. In 5 week after inoculation, tumor was wholely occupied by only one clone which showed one band on the lane. At this point cisplatin were administered. In 6 week, new single clone appeared with different band pattern from that of the clone at the administration of cisplatin. Furthermore, the cisplatin-induced new clone metastasized to the lung, while no metastasis was observed in the mouse with PBS-treated tumor during the same period. These data suggest that increased metastatic potential after cisplatin treatment is due not to selection but to creation of highly metastatic clone caused by potential of genetic mutation of cisplatin. In conclusion, chemotherapeutic agent has a potential to create highly malignant cancer cells as well as a potential to kill cancer cells.

Rat glutathione transferase P (GST-P) is expressed at low levels in the normal liver but becomes highly expressed in hyperplastic nodules and in hepatocellular carcinomas during chemical hepatocarcinogenesis. To understand the regulation mechanisms of this gene, we have characterized the 5'-flanking region and have found that GST-P gene is regulated by at least two elements: one is a strong enhancer and the other is a silencer. GST-P enhancer I (GPEI), located at -2.5 Kb, consists of two TPA-responsive element (TRE)-like sequences that are palindromically oriented with 3 bp in between. It is well known that TRE is activated by two nuclear oncogenes, c-Jun and c-Fos. Although GPEI is trans-activated by these oncogenes, it is also active in F9 embryonal carcinoma cells that lack c-Jun protein, suggesting that it can function with some trans-activator other than AP-1 (c-Jun/c-Fos heterodimer). Indeed, another protein is identified from the F9 nuclear extract. We have also identified a silencer element at 300 bp upstream from the cap site. There are several cis-elements in this region and at least three trans-acting factors bind to these elements. We purified SF-A (silencer factor A) which binds to several regions in this silencer, and determined the partial amino acid sequence. Interestingly, SF-A seemed to be a related protein to NF1 (nuclear factor 1) which is an activator for the transcription and DNA replication. Another factor SF-B (silencer factor B) has been cloned and found to be the same as LIP (liver inhibitory protein) which is a competitor for LAP (liver activator protein), both are from the same gene designated as C/EBP beta. By transfection analysis using GAL4 DNA binding domain we found LIP is not only a competitor but a direct repressor. In the normal liver, another C/EBP family member, C/EBP alpha also acts as a negative regulator, and this expression decreases during hepatocarcinogenesis, resulting in the loss of silencer function. We carried out the carcinogenesis experiments using transgenic rats harboring a chloramphenicol acetyltransferase (CAT) reporter gene with -2900 to + 59 of the GST-P gene. Liver foci and nodules produced by chemical carcinogens were found to express high levels CAT activity by both CAT assay and immunohistochemical study, while normal liver cells did not express any CAT activity. These results demonstrate that the GST-P gene is trans-activated locus-independently during rat hepatocarcinogenesis. Moreover, the similar results were obtained using transgenic rats carrying GPEI-CAT, indicating that GPEI is an important cis-element for activation of GST-P gene during hepatocarcinogenesis.

We present a 15-year-old woman with acute myelomonocytic leukemia without marrow eosinophilia, M4 in the FAB classification. She was admitted to our hospital with nausea and headaches. Upon admission, the leukocyte count was 284,000/microliters with 95% leukemic cells. The bone marrow aspirate was hypercellular with 74.8% blasts and 0.2% eosinophils. Leukemic cells were positive for myeloperoxidase and esterase staining. Initially, the karyotype of the bone marrow cells on admission was considered to be normal. However, the PEBP2 beta/MYH11 fusion transcript was detected in the bone marrow mononuclear cells by using the reverse transcriptase-polymerase chain reaction (RT-PCR). Reevaluation of karyotypes showed a t(16;16) (p13;q22) in the bone marrow cells. After achieving complete remission, she was treated with low-dose etoposide. Chromosome analysis showed a normal karyotype and no amplified chimeric transcripts were observed. This case indicates that the molecular analysis of PEBP2 beta and MYH11 genes is a useful tool to detect inv (16) and t(16;16) which were often difficult to find, and that leukemic cells from some cases of M4 without marrow eosinophilia have these chromosome abnormalities.

DNA cytofluorometry and fluorescence in situ hybridization (FISH) with centromeric repetitive probes of chromosomes 1, 7, 11, 17, X and Y were used to detect numerical chromosomal aberrations in 13 squamous cell carcinomas of the tongue. In 4 of the 6 DNA-diploid tumors examined, significant numerical aberrations in at least 1 of the chromosomes were detected. The main line of 1 tumor showed trisomy 1 and the other 3 tumors had significant sublines that showed trisomy or monosomy of the 1 or 2 chromosomes examined. No common specific aberrations were detected in these tumors. Cytofluorometrically we found polyploidy in all 4 of the tumors with numerical chromosomal aberrations. These results suggest that subpopulations which are aneuploid at the chromosome level arise preferentially from DNA-diploid tumors with polyploidy before the ploidy of the main line shifts to overt DNA-aneuploidy. In all of the 7 DNA-aneuploid tumors examined, we detected numerical chromosomal aberrations. Most of the aberrations were thought to occur after tetraploidization because a gain in chromosomal copy number including tetrasomy was common. In 3 DNA-aneuploid tumors, however, the main line showed disomy 11, whereas the other chromosomes examined had 3 or more copies. In 1 of the 3 tumors there was a significant subline of monosomy 11. In these 3 tumors disomy 11 may have been preceded by a DNA-diploid stage with monosomy 11 before tetraploidization.

Forty-eight cases of human uterine cervical cancer were examined for the expression of c-myc protein by immunohistochemical staining. The overexpression of c-myc was detected in 17 of 48 cases (35%), which is consistent with previous reports. The frequency of c-myc overexpression was not associated with the clinical stage. Relapse was observed in 7 of 15 cases (47%) which had overexpression of c-myc (mean follow-up period: 35 months), whereas relapse was observed in only 3 of 30 cases (10%) which did not overexpress c-myc (mean follow-up period: 33 months). The five-year survival rate was significantly lower in the cases overexpressing c-myc than in those not overexpressing it. This indicates that the overexpression of c-myc may be associated with a high risk of relapse and poor prognosis. We also analysed the correlation between lymph node metastasis, cervical stromal invasion and c-myc overexpression, and did not find any correlation between them. These results suggest that the overexpression of c-myc in cervical cancer may be a prognostic indicator for predictive testing.

Analysis of the molecular background underlying the development and progression of human cancer is very important for understanding the disease as well as to obtain new molecular markers indicating the prognosis. Several important genes such as oncogenes and tumor suppressor genes might be altered in stepwise fashion in human carcinogenesis. Here, molecular changes of these genes found in major urogenital cancers were described from the viewpoint of new molecular prognostic markers.

Recent advances in molecular biology have revealed various genetic lesions in lung cancer. Mutations of the K-ras gene, amplification or overexpression of myc family genes, erbB2 gene, or bcl2 gene are frequent genetic changes of oncogenes in lung cancer. Inactivation of tumor suppressor genes such as Rb gene, p53 gene, or p16 gene are also seen rather frequently. Furthermore, loss of heterozygosity at certain chromosomal arms such as 3p, 5q, 18q and 22q suggesting inactivation of yet unidentified tumor suppressor genes, also occurs in a significant proportion of lung cancers. Most of these genetic lesions have been reported to be associated with a poor prognostic outcome of the patients. However, great controversy exists as to whether a certain genetic lesion is really a prognostic marker. For example, although about 20 studies have been published, the prognostic implications of the p53 gene for patients with lung cancer still remain unclear. Little is known about the mechanism through which a certain genetic change affects the patient's prognosis. To ultimately improve the prognosis of patients with this deadly disease, definitive studies on which subsequent clinical trials can rely are much awaited.

It has been reported that several genes may be good indicators for determining biological behavior, including the prognosis, of colorectal cancers. We have summarized these reported genes, such as tumor suppressor gene, oncogenes, metastasis suppressor gene, adhesion molecules, growth factors, proteinases, and others, including microsatellite instability. Some of the genes such as p53, DCC, c-met, or matrix metalloproteinase are considered to be reliable for determining biological aggressiveness. We introduced several interesting genes which we are focusing using cDNA subtraction library analysis. We hope that these genes are well combined for best analysis of the biological behavior of colorectal cancers and use for practical clinical analysis. In addition, we hope that novel important genes indicative for prognosis will be found.

The prognostic factors for esophageal cancer from the viewpoint of molecular biology are reviewed. Among several oncogenes and suppressor genes erbB, int2/hst1/Cyclin D1 and MDM2 gene amplifications are significant prognostic factors for esophageal cancer. The value of p53 mutation, and expression of matrix metalloproteinase (MMPs) in the prediction of patients' survival are controversial, so further research is needed. High expression of tumor proliferation-related factors (Ki67, PCNA, and AgNOR), abnormalities of adhesion molecule (E-Cadherin, alpha-Catenin), activation of autocrine mechanism of growth factor (EGFR-TGF alpha, EGF), and DNA ploidy pattern, which is thought to be the result of an accumulation of genomic abnormalities are also prognostic factors for esophageal cancer.

The usefulness of prognostic factors in gynecological cancer was evaluated using the oncogenes, tumor suppressor genes and DNA viruses detected with the molecular biological technique. In uterine cervical cancer, HPV types 16 and 18 are considered to have a high oncogenic risk, and are commonly associated with high grade CIN and invasive cancer under persistent HPV infection. C-myc overexpression in advanced stage and p53 mutation in HPV negative case are associated with poor survival. In endometrial cancer, oncogene activation and expression are less frequent than in cervical and ovarian cancer. K-ras point mutation (codon 12) tumors are more aggressive and c-erbB-2 overexpression are associated with metastasis and poor survival. In ovarian cancer, there are numerous abnormalities of oncogenes and tumor suppressor genes. Especially, EGF-R and PDGF-R alpha expression are associated with decreased survival. p53 mutation also decreases survival and response to chemotherapy. Recently. MSH2 (Lynch II syndrome) and BRCA1 gene are known to relate with familial ovarian cancer.

Clinical significance of DNA ploidy pattern and its DNA heterogeneity is examined in prostate cancer.