ORIGINAL ARTICLE

Blood cells with fetal haemoglobin (F-cells) detected by immunohistochemistry as indicators of solid tumours

M Wolk¹, J E Martin² and R Constantin³

¹ Department of Morbid Anatomy and Histopathology, The Royal London Hospital, Central Laboratory, Israel Ministry of Health, Jerusalem 91342, Israel
² Pathology Group, Institute of Cell and Molecular Sciences, The Royal London Hospital, London E1 1BB, UK
³ Department of Pathology, Shaare-Zedek Medical Centre, Jerusalem 91301, Israel

Correspondence to:
Correspondence to:
Dr M Wolk
Central Laboratories, Israel Ministry of Health, Ya’akov Eliav St 9, PO Box 34410, Jerusalem 91342, Israel; moshe.wolk{at}eliav.health.gov.il

Aims: Fetal hemoglobin (HbF) is an established serological indicator of cancer. However, its distribution in tumour tissues is rarely investigated. Therefore, HbF was studied immunohistologically in different cancers characterised by high blood HbF concentrations.

Methods: Anti-HbF was immunoaffinity purified and used to study HbF immunohistochemically in the following cancers: germ cell tumour (GCT), trophoblastic disease (TD), lymphoma, myelodysplastic syndrome (MDS), multiple myeloma (MM), and ovarian adenocarcinoma (OA).

Results: In GCT a distinction was made between tumours substantially without HbF positive red blood cells (F-RBC) and those with F-RBC. Those without F-RBC were non-metastatic mature teratomas and dermoid cysts. Those containing F-RBC were mainly embryonal carcinomas and metastatic teratomas. HbF positive myeloid cells (F-MLC), HbF positive normoblasts (F-NBS), and F-RBC were common in the bone marrow and in the lymphoid tissues of lymphoma, MDS, and MM. In TD, normal and nucleated F-RBC were seen in the trophoblastic villi in one case with incomplete molar pregnancy (ICM) but not in other cases of ICM and complete molar pregnancy. However, F-RBC and F-MLC were seen in the decidua of both types of TD. Generally, F-cells were observed either within blood vessels or concentrated in certain areas of the neoplastic tissue.

Conclusions: HbF was evaluated as an inducible marker within different tumour tissue blood cells. The dual distribution of these cells—circulating in the blood or concentrated in areas of the neoplastic tissues—might reflect the two independent serological indicators of HbF: one in whole blood and the other in plasma of patients with cancer.

Abbreviations: AFP, fetoprotein; CM, complete molar pregnancy; EC, embryonal carcinoma; F-MLC, fetal haemoglobin positive myeloid cells; F-NBS, fetal haemoglobin positive normoblasts; F-RBC, fetal haemoglobin positive red blood cells; GCT, germ cell tumour; hCG, human chorionic gonadotrophin; HbF, fetal haemoglobin; HbFSRBC, fetal haemoglobin coated sheep red blood cells; ICM, incomplete molar pregnancy; MDS, myelodysplastic syndrome; MM, multiple myeloma; MMT, metastatic mature teratoma; NMT, non-metastatic mature teratoma; NSS, normal sheep serum; OA, ovarian adenocarcinoma; OD, optical density; PBS, phosphate buffered saline; RBC, red blood cells; TD, trophoblastic disease; YS, yolk sac

Keywords: immunoaffinity purification; oncofetal marker; fetal haemoglobin

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