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J I Epstein

Publications and source records attributed to J I Epstein.

At least 109 records · Page 6Linked to original sources
PubMed1999

Use of intervening unstained slides for immunohistochemical stains for high molecular weight cytokeratin on prostate needle biopsies.

Immunohistochemical stains (IHC) stains for high molecular weight cytokeratin (HMWCK) may show the presence or absence of basal cells in a small focus of atypical glands helping to establish a benign or malignant diagnosis respectively. From January 1994 to the present, we have generated intervening unstained slides on all prostate needle biopsies for potential IHC stains for HMWCK because lesions may not survive deeper sectioning into the block. Of 1105 prostate needle biopsy cases seen at Johns Hopkins from January 1994 to December 1996, IHC staining for HMWCK was initially done on 94 (8.5%). To see whether lesions would still have been present for evaluation if we did not have intervening slides, we repeated the IHC stains for HMWCK off the paraffin blocks in 74 cases for which material was available for study. Care was taken not to trim the blocks. In 52 cases, the original HMWCK helped to establish a diagnosis; in 31 of these cases the lesion was not present on repeat IHC stains from the block. Of these 31 cases, the original HMWCK from intervening unstained slides helped to establish cancer (n = 23) or a benign (n = 8) diagnosis. The use of intervening unstained slides was critical to establish a diagnosis in 31 (2.8%) of 1105 prostate needle biopsies and saved the cost of repeat biopsy ($68,200) and spared these patients from a second surgical procedure.

Humans↗
PubMed1999

Perineural invasion, mucinous fibroplasia, and glomerulations: diagnostic features of limited cancer on prostate needle biopsy.

The diagnosis of prostate cancer on needle biopsy is based on a constellation of histologic features. There are, however, three histologic findings that are diagnostic of prostate carcinoma: perineural invasion (PNI), mucinous fibroplasia, and glomerulations. We prospectively identified core needle biopsies during a 5-month period in which one of these three entities was the key diagnostic feature of carcinoma within the biopsy specimen. Of 1480 consult cases reviewed, the following were key features to the diagnosis of very limited carcinoma: PNI (n = 9; 0.6%), mucinous fibroplasia (n = 2; 0.1%), and glomerulations (n = 0). To assess the incidence of PNI as the key feature, we also analyzed reports from Dianon during a 1-year period. Of approximately 16,300 Dianon needle biopsies with cancer, 12(0.07%) cases had PNI as the key diagnostic feature. Six of these 12 cases were also consult cases. Of the total of 15 cases with PNI, cancer was limited with 11 of the cases showing involvement of only one nerve. The median number of glands per nerve was five (range, 1-15). In addition to PNI, malignant cytologic features included amphophilic cytoplasm in 11 of 11 assessable cases and nuclear enlargement and hyperchromasia in 11 of 15 cases. Other malignant features were limited. Twelve cases showed rare to no visible nucleoli. Two cases had eosinophilic intraluminal debris. Blue mucin, crystalloids, and mitoses were absent in all cases. Nine of the 15 cases of PNI and the two cases of mucinous fibroplasia were verified as carcinoma with immunohistochemistry using high molecular weight cytokeratin. In rare cases, PNI is virtually the sole finding necessary to establish the diagnosis of carcinoma on needle biopsy. Although mucinous fibroplasia and glomerulations are also considered diagnostic of carcinoma, their occurrence alone without more conventional forms of carcinoma is even more rare.

Adenocarcinoma↗
PubMed1999

Renal oncocytosis: a morphologic study of fourteen cases.

Diffuse renal involvement by numerous oncocytic nodules has rarely been described. We report 14 cases (19 specimens) with innumerable oncocytic nodules in the kidney. Invariably, these kidneys showed additional associated findings. We suggest the term renal oncocytosis for this entire morphologic spectrum. Six (43%) cases had histologically or radiologically proven bilateral involvement. Each specimen had at least one dominant tumor (2.0-10.5 cm) in addition to numerous other microscopic to macroscopic oncocytic nodules. Additional features observed were: interstitial pattern, with the oncocytic tubules and acini diffusely intermingling with and infiltrating between non-neoplastic parenchyma (one case); diffuse oncocytic change in the nonneoplastic tubules, cytologically difficult to separate from the oncocytic nodules (seven cases); and benign oncocytic cortical cysts (four cases). The dominant mass in 13 specimens was a renal oncocytoma and in two, a chromophobe renal cell carcinoma. In four specimens, the largest tumor was considered a hybrid tumor because of the presence of mixed histologic features of both tumor types. Most smaller nodules had the morphologic features of renal oncocytoma, but a few had the appearance of chromophobe renal cell carcinoma or nodules with hybrid features. We conclude that the presence of numerous oncocytic nodules may be associated with a wide spectrum of oncocytic changes in the kidney. The association of numerous renal oncocytoma-like nodules with lesions having a mixed morphology or a morphology of pure chromophobe renal cell carcinoma suggests that they may constitute a morphologic spectrum of oncocytic tumors and that renal oncocytoma and chromophobe renal cell carcinoma may arise from a common progenitor lesion.

Adenoma, Oxyphilic↗
PubMed1999

Microcystic meningioma arising in a mixed germ cell tumor of the testis: a case report.

We report a case of a microcystic variant of meningioma arising in a mixed germ cell tumor of the testis composed predominantly of mature and immature teratoma with elements of seminoma and embryonal carcinoma. We believe this is the first such case of a meningioma arising in a teratoma within a gonadal or extragonadal site. The meningiomatous component showed positive immunohistochemical staining for epithelial membrane antigen and a lack of staining for cytokeratin, factor VIII, CD31, and alpha-fetoprotein. Recognition of a non-germ cell tumor arising in the setting of a teratoma in the testis may be prognostically important depending on the nature of the non-germ cell component and whether it has spread beyond the testis.

Adult↗
PubMed1999

Ductal adenocarcinoma of the prostate diagnosed on needle biopsy: correlation with clinical and radical prostatectomy findings and progression.

Ductal adenocarcinoma of the prostate, previously referred to as endometrioid cancer, is typically diagnosed on transurethral resection. When treated by radical prostatectomy (RP), it pursues a more aggressive clinical course than usual acinar prostate cancer does. The significance of prostate cancer with ductal features found on needle biopsies from the peripheral zone is unknown. We reviewed 58 prostate needle biopsy cases with ductal adenocarcinoma for which we were able to obtain clinical information. Patients had a mean age of 69 years (range, 50-89 years) and had a wide range of levels of serum prostate-specific antigen (median, 7.9 ng/mL) and clinical stages. Six (10%) had metastases at the time of diagnosis. Cribriform or papillary structures or a mixture of the two patterns were seen in 86% of cases, whereas in the remaining cases, discrete glands composed of tall columnar cells were present. Stromal fibrosis accompanied the ductal carcinoma in 67% of the cases. A coexisting acinar carcinoma component was identified in 48% of the biopsy specimens. On biopsy, the ductal component composed a mean of 82% of the tumor. Of the 20 tumors treated by RP, 63% had extraprostatic spread of tumor and 20% had positive margins. Two (10%) cases showed seminal vesicle invasion, but none had lymph node metastases. The number of positive needle cores correlated with RP margin status (p<0.004) and with likelihood of clinical progression (p<0.02), but not with organ-confined status. Tumor volume calculated on the 11 extensively sampled RPs ranged from 0.15 cm3 to 20.3 mL (mean, 2.8 cm3). Two years after therapy, the actuarial risk of progression was between 34% (RP patients) and 42% (all patients). A shortened average time to progression was observed relative to a previous study group of men with acinar carcinoma. Serum prostate-specific antigen levels correlated with neither RP organ-confined status nor tumor volume. We conclude that prostatic ductal adenocarcinoma seen on needle biopsy implies more advanced cancer with a shortened time to progression.

Aged↗
PubMed1999

Long-term effects of finasteride on prostate tissue composition.

OBJECTIVES: To determine the long-term effects of finasteride treatment on prostate tissue composition; to relate these effects to clinical outcomes; and to test the hypothesis that finasteride exerts a selective or preferential action on the transition zone. METHODS: Nineteen men with symptomatic benign prostatic hyperplasia (BPH) who completed a 6-month double-blind trial of finasteride were enrolled in a 24-month open-label extension study of drug responders. Magnetic resonance imaging and prostate biopsy for morphometric analysis were performed together 70 times: at baseline (n = 19), after treatment periods of intermediate duration (6 to 18 months, n = 32), and after long-term drug treatment (24 to 30 months, n = 19). At baseline, prostate volume averaged 51 cc, of which 57% was transition zone. RESULTS: Decreases in symptom score, dihydrotestosterone and prostate-specific antigen levels, and prostate volume occurred at 6 months (P <0.01), stabilized, and were maintained without further long-term decreases. Prostate epithelium contracted progressively from baseline (19.2% tissue composition; 6.0-cc volume; 3.2 stroma/epithelial ratio) to intermediate (12.5%, 3.3 cc, and 5.6, respectively) to long-term treatment (6.4%, 2.0 cc, and 17.4, respectively, P <0.01 for all). Percent epithelial contraction was similar in the peripheral and transition zones (P = NS). The transition zone remained a relatively constant proportion (53% to 58%) of whole-prostate volume from baseline to long-term observation. CONCLUSIONS: Long-term finasteride treatment (24 to 30 months) results in a marked involution of the prostate epithelium, which continues to progress for many months after clinical effects stabilize. The effect on the epithelium is similar in the peripheral and transition zones for both morphometric and volumetric changes. Progressive contraction of the prostate epithelium appears to constitute the underlying mechanism for sustained action of finasteride.

Double-Blind Method↗
PubMed1999

The significance of prior benign needle biopsies in men subsequently diagnosed with prostate cancer.

PURPOSE: We determine the relationship between a history of benign needle biopsies, and the volume and location of cancer. MATERIALS AND METHODS: We evaluated 395 men who underwent radical prostatectomy for stage T1c (nonpalpable) prostate cancer. RESULTS: Of the men 74 had 1 or more prior benign needle biopsies. Prior benign biopsy correlated with tumor in the anterior or lateral portion of the radical prostatectomy specimen (p = 0.044) and prostate weight (p = 0.002). The likelihood of prior benign biopsy was 32.5% for men with a 75 gm. or greater prostate compared to 15.2% for those with a less than 75 gm. prostate. Although prior benign biopsy correlated with "very limited" tumor in the prostate (less than 0.2 cc, no Gleason pattern 4 or 5 and organ confined disease) (p = 0.005), only 28.4% of patients with prior benign biopsy had "very limited" tumor. In a multivariate analysis prior benign biopsy correlated only with anterior or lateral distribution and enlarged prostate size. Of the prior benign biopsy cases 12% had positive margins, average tumor volume was 1.15 cc and 27% had nonorgan confined disease. These figures were not different from those in cases with cancer on the first biopsy. In prior benign biopsy cases although PSA velocity predicted tumor volume and "very limited" tumor, a specific clinically useful cutoff value was not present. Needle biopsy grade and number of positive cores were not predictive of tumor volume or "very limited" cancer. CONCLUSIONS: Prior benign biopsy in men subsequently diagnosed with prostate cancer does not indicate indolent tumor. Benign biopsies are more likely in larger prostate glands and when cancer is in the anterior and lateral regions of the gland, suggesting the need for different biopsy strategies to improve cancer detection.

Biopsy, Needle↗
PubMed1998

Diagnoses rendered on prostate needle biopsy in community hospitals.

BACKGROUND: Reported incidences of various diagnoses made on needle biopsy of the prostate vary significantly in the literature, most of which has originated from large, academic medical centers. METHODS: We recorded all the prostate needle biopsy results from three community hospitals for 1990-1993 to determine the rates of, and trends in, various diagnoses in these practices. RESULTS: Hospital H1 (1,192 cases) halved the rate of atypical, nondefinitive diagnoses from 11.8% in 1990 to 5.7% in 1993 (P < 0.001). The rate at H2 (2,792 cases) remained essentially unchanged at 5.95+/-0.55%, and H3 (1,306 cases) went from 2.3% to 6.0% (0.1 < P < 0.2). In the setting of an atypical, nondefinitive diagnosis, H1 and H2 recommended repeat biopsy less than 7% of the time. H3 made this recommendation in an average of 22.1% of atypical cases. Annual rates of high-grade prostatic intraepithelial neoplasia (PIN) showed no trend over time, and averaged 2.0% (1.2-3.25%) at H1 and 1.2% (0.3-2.0%) at H2. The diagnosis was never made at H3. The fraction of cancers diagnosed as low-grade (Gleason sum < or = 4) showed a statistically significant decreasing trend over time at all three hospitals (P < 0.05). These data are compared with those from the Johns Hopkins Hospital (JHH), a large academic center in geographic proximity to hospitals H1-H3. CONCLUSIONS: At these three community hospitals, we discerned (1) convergence to a rate of approximately 6.0% of atypical, nondefinitive diagnoses; and (2) a progressively more appropriate fraction of carcinomas diagnosed as low-grade on needle biopsy. The rates of diagnosis of high-grade PIN and recommendation of repeat biopsy varied. These rates of PIN, atypical, nondefinitive diagnoses, and low-grade cancer represent an assessment of diagnostic habits.

Adenocarcinoma↗
PubMed1998

CD44 and CD44v6 downregulation in clinical prostatic carcinoma: relation to Gleason grade and cytoarchitecture.

BACKGROUND: Altered expression of CD44 has been implicated in tumor progression and metastasis in multiple neoplasms. METHODS: CD44 expression in archival tissues of prostate carcinoma was examined by immunohistochemistry with monoclonal antibodies against core CD44 and the RNA splice variant CD44v6 (v6). RESULTS: Core CD44 expression was reduced in the majority of primary neoplastic foci (n = 94) and loss of expression correlated with increasing Gleason grade. Staining for v6 was absent in most carcinomas and metastases. Expression of core CD44 in pelvic lymph node (n = 27) and bone metastases (n = 21) was significantly reduced. In addition, CD44 expression correlated with cytoarchitecture. Tall columnar tumor cells typically stained positively, yet more rounded cells forming cribiform structures or nests showed reduced expression. All cases of high-grade prostatic intraepithelial neoplasia were positive for core CD44 yet, there was decreased expression in cribiform and micropapillary variants. CONCLUSIONS: The majority of clinically relevant human prostatic carcinomas and metastases downregulate expression of CD44. Additional studies to determine whether CD44 cell surface expression relates to clinical outcome independent of other established clinicopathologic risk factors are warranted.

Alternative Splicing↗
PubMed1998

Novel nuclear phosphoprotein pp32 is highly expressed in intermediate- and high-grade prostate cancer.

BACKGROUND: pp32 is a differentiation-regulated nuclear phosphoprotein that is highly expressed in many cancers, but is restricted to self-renewing and long-lived normal cell populations. During murine embryogenesis, pp32 is expressed in primitive cell populations, diminishing as tissues terminally differentiate. Functionally, pp32 confers resistance to programmed cell death and, paradoxically, inhibits transformation mediated in vitro by a broad range of oncogenes, suggesting that pp32 is a multifunctional molecule with potentially complex activities in cancer. METHODS: We studied pp32 expression in prostatic adenocarcinomas and benign prostatic hyperplasia by in situ hybridization. RESULTS: In benign prostatic tissues, moderate pp32 expression occurs only in the basal cells. This study found elevated pp32 expression in 98% (54/55) of prostatic adenocarcinomas of Gleason score > or = 5 (P < 0.0001). CONCLUSIONS: These results suggest that pp32 may be diagnostically useful and may contribute mechanistically to prostate tumor development. In comparison to other molecular alterations, increased pp32 expression is one of the most frequent events in primary prostate cancer.

Adenocarcinoma↗
PubMed1998

Immunoreactivity for prostate-specific antigen and prostatic acid phosphatase in adenocarcinoma of the prostate: relation to progression following radical prostatectomy.

BACKGROUND: Although, in general, immunoperoxidase staining for prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) cannot distinguish between benign and malignant prostatic epithelium, immunoreactivity of these antigens may be helpful in predicting prognosis of prostate cancer. The purpose of this study was to evaluate intensity and extent of immunoperoxidase staining for PSA and PSAP as a prognostic tool in prostate adenocarcinomas. METHODS: We studied radical prostatectomy specimens from 68 patients with the following stages: organ-confined, 34.3%; focal capsular penetration, 38.8%; established capsular penetration, 25.3%; and seminal vesicle invasion, 1.6%. Ninety-one percent of cases were Gleason score 5-7. The mean follow-up for those men without progression was 8.9 years, compared to 3.5 years for those with progression. Progression was defined as an elevated postoperative serum PSA level (> 0.2 ng/ml). Intensity of PSA and PSAP staining was recorded and based on a scale of 0-3 (0, no staining; 1, weak; 2, moderate; 3, intense). Extent was quantitated on a scale of 0-4 (0, 0-5% staining; 1, 6-35%; 2, 36-65%; 3, 65-95%; 4, 95-100%). A score (0-12) was computed by multiplying intensity and extent of the stain in the tumor area. RESULTS AND CONCLUSIONS: Intensity and extent of PSA and PSAP immunoreactivity did not predict progression in adenocarcinomas of the prostate following radical prostatectomy.

Acid Phosphatase↗
PubMed1998

Prostate stem cell compartments: expression of the cell cycle inhibitor p27Kip1 in normal, hyperplastic, and neoplastic cells.

The stem cells of rapidly renewing tissues give rise to transiently proliferating cells, which in turn give rise to postmitotic terminally differentiated cells. Although the existence of a transiently proliferating compartment has been proposed for the prostate, little molecular anatomical evidence for its presence has been obtained to date. We used down-regulation of the cyclin-dependent kinase inhibitor p27Kip1 to identify cells capable of entering the proliferative phase of the cell cycle and, therefore, competent to fulfill the role of the transiently proliferating compartment. We examined the expression of p27Kip1 in relation to its role in the development of prostatic carcinoma. Formalin-fixed paraffin-embedded specimens from matched samples of normal-appearing prostate tissue, benign prostatic hyperplasia, high-grade prostatic intraepithelial neoplasia, primary adenocarcinomas, and pelvic lymph node metastases were evaluated by comparative immunohistochemistry against p27Kip1. In normal-appearing prostate epithelium, moderate to strong nuclear staining of p27Kip1 was present in greater than 85% of the terminally differentiated secretory cells. The normal basal cell compartment, believed to contain prostatic stem cells, showed distinctive p27Kip1 expression; acini in epithelial benign prostatic hyperplasia tissue contained more p27Kip1-negative basal cells than acini from non-benign prostatic hyperplasia tissue. A third layer of cells was identified that was sandwiched between the basal cells and the luminal cells, and this layer was consistently p27Kip1 negative. This intermediate layer was accentuated in the periurethral region, as well as in prostate tissue that had been subjected to prior combined androgen blockade. We hypothesize that, on appropriate additional mitogenic stimulation, cells in this layer, and other p27Kip1-negative basal cells, are competent for rapid entry into the cell cycle. Consistent with the fact that cancer cells are capable of cell division, all cases of high-grade prostatic intraepithelial neoplasia and invasive carcinoma also showed down-regulation of p27Kip1 as compared with the surrounding normal-appearing secretory cells. In pelvic lymph node metastases, p27Kip1 expression was also reduced. In summary, our results suggest that lack of nuclear p27Kip1 protein may delineate a potential transiently proliferating subcompartment within the basal cell compartment of the human prostate. In addition, these studies support the hypothesis that reduced expression of p27Kip1 removes a block to the cell cycle in human prostate epithelial cells and that dysregulation of p27Kip1 protein levels may be a critical early event in the development of prostatic neoplasia.

Adenocarcinoma↗
PubMed1998

Distinction of basaloid carcinoma of the prostate from benign basal cell lesions by using immunohistochemistry for bcl-2 and Ki-67.

The distinction of rare basaloid carcinomas (BC) of the prostate from more common basal cell hyperplasia may be difficult, because basal cell hyperplasia (BCH) may have prominent nucleoli and may appear infiltrative. Using immunohistochemistry, we studied bcl-2 and p53 expression and Ki-67 proliferation index in eight cases of typical BCH, eight cases of BCH with nucleoli, and six cases of BC. Bcl-2 expression (P < .0001) and Ki-67 index (P=.005) were elevated in BC compared with typical BCH or BCH with nucleoli, whereas there was no significant difference between typical BCH and BCH with nucleoli. P53 was not discriminative in separating benign from malignant basal cell lesions of the prostate. Bcl-2 may play a role in the pathogenesis of basal cell lesions of the prostate. Elevated expression of bcl-2 and higher Ki-67 index may aid in the diagnosis of basal cell proliferative lesions of the prostate.

Biomarkers, Tumor↗
PubMed1998

Accuracy of biopsy Gleason scores from a large uropathology laboratory: use of a diagnostic protocol to minimize observer variability.

OBJECTIVES: To examine the correlation of biopsy Gleason scores with radical prostatectomy specimens from a laboratory that uses protocols designed to minimize observer variability. This protocol mandates consensus case review of all nonbenign cases. METHODS: Between August 24, 1993 and June 26, 1997, 106 patients who underwent radical prostatectomy at Johns Hopkins Hospital, Baltimore, Maryland had their prostate cancer diagnosed and graded at one laboratory (DIANON Systems). We analyzed the Gleason scores from the biopsy and radical prostatectomy specimens. RESULTS: Exact correlation existed between biopsy and radical prostatectomy Gleason scores for 72 (68%) cases; 103 (97%) correlated within 1 grade, all cases correlated within 2 grades; 26 (25%) biopsies were undergraded and 8 (8%) were overgraded. Positive predictive values for biopsy Gleason scores 5, 6, and 7 were 66%, 67%, and 71%, respectively. Grouped Gleason scores (well differentiated [2 to 4], moderately differentiated [5, 6], moderately to poorly differentiated [7], and poorly differentiated [8 to 10]) correlated exactly for 74 (70%) cases and within 1 group for all cases. Patient age, digital rectal examination results, total number of positive cores, and maximum percentage of tumor on biopsy did not affect correlation, but prostate-specific antigen (PSA) levels did affect correlation (exact correlation 96% when the PSA level was less than 5 ng/mL; 50% when the PSA level was 11 ng/mL or greater, P <0.01). CONCLUSIONS: The combination of experience and the protocol described minimizes intra- and interobserver variability, thereby improving the predictive value of biopsy Gleason grading. Biopsy and radical prostatectomy Gleason scores correlate more poorly when the PSA level is high (11 ng/mL or greater) than when the PSA level is low (less than 5 ng/mL).

Adult↗
PubMed1998

Ability of sextant biopsies to predict radical prostatectomy stage.

OBJECTIVES: There are few studies evaluating multiple variables on sextant biopsies with the intent to predict stage in radical prostatectomy specimens. METHODS: We studied 113 sextant biopsies with corresponding totally submitted radical prostatectomy specimens. Variables evaluated on sextant biopsies included total length and percent of cancer; maximum length and percent of cancer on one core; location (apex, mid, base); bilaterality; Gleason grade; number of cores involved; serum prostate-specific antigen (PSA) level; and serum PSA density (PSAD). Radical prostatectomy stage was classified as organ versus non-organ confined. RESULTS: The following variables individually correlated with radical prostatectomy stage: total cancer measured in millimeters (P <0.0001) or percent (P <0.0005); biopsy Gleason score (P <0.0001); number of involved cores (P <0.0001); maximum cancer on one core measured in millimeters (P = 0.0001); maximum percent of cancer on one core (P = 0.01); bilaterality (P = 0.01); PSA level (P = 0.03), and PSAD (P = 0.001). The most predictive sets of two variables that correlated with stage included high Gleason score (P <0.0001) combined with numbers of cores involved (P = 0.002). When biopsies had Gleason scores of 6 or less, two or fewer positive cores, and serum PSA of 0 to 4 ng/mL, 89% were organ confined. When biopsies had Gleason scores of 6 or less with two unilaterally positive cores, 87% were organ confined. In biopsies with Gleason scores of 7 or more and more than one positive core, only 10% were organ confined. CONCLUSIONS: The most important predictors of stage by sextant needle biopsy evaluation are numbers of cores involved with carcinoma and high Gleason score. Bilaterality and serum PSA values improved prediction in two small subgroups. In 37% of our population we were able to predict with a greater than 87% probability the organ-confined versus non-organ-confined status.

Biopsy↗
PubMed1998

A quantitative histologic analysis of collagen subtypes: the primary obstructed and refluxing megaureter of childhood.

OBJECTIVES: To analyze and identify collagen subtypes in the primary obstructed and refluxing megaureter of childhood. METHODS: Anticollagen monoclonal antibodies to collagen types I, III, and IV were used in control ureters (n = 4), obstructed (n = 7), and refluxing (n = 13) megaureters. Additionally, all were stained with Masson's trichrome to further define the extracellular matrix. After staining and serial sectioning, representative ureteral sections, focusing on the muscularis and lamina propria regions, were digitized and analyzed with a color image analysis system. RESULTS: Immunohistochemical studies demonstrated increases in collagen types I and III for both obstructed and refluxing megaureters compared with controls (P <0.05). Collagen type IV was not detected in statistically significant amounts in any ureter. In control ureters most was type I (83% +/- 9%) collagen. Obstructed megaureters produced similar results with virtually all collagen being type I (84% +/- 26%) with very little type III collagen present, 5.3% +/- 3%. Refluxing megaureters contained only 55% +/- 15% type I collagen. However, there was an increase in type III collagen (16% +/- 4%) versus (4.5% +/- 2%) in controls (P <0.05). CONCLUSIONS: These data suggest that the greater contribution of type III collagen may play a role in the pathophysiology of refluxing megaureters. Because type III collagen is a less distensible fiber, it may cause an intrinsically stiffer ureter and play a role in the lower surgical success in the reimplantation of refluxing megaureters.

Antibodies, Monoclonal↗
PubMed1998

Isolated vasculitis of the seminal vesicle.

We present 2 cases of histologically identified necrotizing vasculitis found in the seminal vesicles of radical prostatectomy specimens containing prostatic adenocarcinoma. In neither case did the patient suffer from symptoms nor show signs of systemic vasculitis. In 1 case, the vasculitis correlated clinically with dense adhesions noted at surgery that simulated extraprostatic tumor extension. Isolated vasculitis of the seminal vesicle is similar to reports of isolated vasculitis limited to other organs, in that local clinical findings may or may not be present, but the patient is free of systemic disease. Careful clinical follow-up is warranted to exclude the subsequent development of systemic vasculitis in these patients.

Aged↗