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Biomedical subjects

J I Lopez

Publications and source records attributed to J I Lopez.

At least 19 recordsLinked to original sources
PubMed1996

Malignant fibrous histiocytoma of the renal capsule and synchronous transitional cell carcinoma of the bladder.

The synchronous association of malignant fibrous histiocytoma (MFH) of the kidney and transitional cell carcinoma of the urinary bladder is reported. This constitutes the ninth case of MFH definitely arising from the renal capsule. Fever was its first clinical manifestation. Despite complete surgical removal, the tumor was rapidly fatal. The current literature about MFH of the kidney is extensively reviewed.

Aged↗
PubMed1996

Primary cisplatin, methotrexate and vinblastine aiming at bladder preservation in invasive bladder cancer: multivariate analysis on prognostic factors.

PURPOSE: Although radical cystectomy is the standard therapy for invasive bladder cancer, cisplatin based multi-drug chemotherapy has proved to be effective for advanced transitional cell urothelial carcinoma. The potential for bladder preservation with neoadjuvant chemotherapy is currently under investigation. MATERIALS AND METHODS: A phase 2 protocol is presented for conservative treatment of muscle invasive transitional cell carcinoma of the bladder consisting of primary cisplatin, methotrexate and vinblastine chemotherapy followed by reevaluation for bladder sparing surgery and surveillance. A total of 61 patients completed the protocol with a mean followup of 41.4 months. RESULTS: Initial complete response to chemotherapy associated with tumor stage, size and configuration was noted in 20 patients (33%). Bladder preservation, intended only for the complete response group, was achieved in 16 patients (26%) but only 11 (18%) were alive with the bladder intact at study closure. Disease-free 5-year survival rate was 47% (95% confidence interval 65 to 26%). Tumor stage (p = 0.0007), size (p = 0.0003), response to chemotherapy (p = 0.002), patient age (p = 0.039) and tumor grade (p = 0.048) influenced survival. Multivariate analysis revealed response to chemotherapy (beta = 0.988, p = 0.034) and tumor size (beta = 0.978, p = 0.042) to be the only independent predictors. CONCLUSIONS: Induction of cisplatin, methotrexate and vinblastine chemotherapy is helpful in identifying patients with a greater chance for survival among those with locally advanced bladder cancer. However, a bladder preservation strategy based on this therapy is only of limited success.

Aged↗
PubMed1996

Combined acinic cell mucoepidermoid carcinoma of the parotid gland. Report of a case with immunohistochemical study.

A case where mucoepidermoid and acinic cell carcinoma occurred simultaneously in the left parotid gland of a 67-year-old man is presented. Histologically, the neoplasm contained diagnostic areas of these tumors close to each other within the same tumor mass. A complete immunohistochemical study was performed and confirmed the presence of both components. To the best of our knowledge no similar case has previously been reported.

Aged↗
PubMed1996

Histological changes mimicking papillary carcinoma following fine needle aspiration of the thyroid gland.

A puzzling artifact caused by previous fine needle aspiration of the thyroid in a 26 year-old woman is reported. The lesion, which mimicked a papillary microcarcinoma, was seen into a follicular adenoma with focal oncocytic changes. The literature concerning histological changes following aspiration cytology in the thyroid and other organs is reviewed. These morphologic changes (notably in the thyroid gland), can be varied and should always be kept in mind in order to avoid misdiagnoses.

Adult↗
PubMed1995

Muscularis mucosa differentiates two populations with different prognosis in stage T1 bladder cancer.

OBJECTIVES: Contrary to previous belief, the existence of a muscularis mucosa in the human urinary bladder has now been well described. Although the degree of development of this structure seems variable, it can frequently be used to differentiate two levels within the subepithelial connective tissue: the lamina propria and the submucosa. The present study evaluates whether this morphologic feature is potentially useful for the identification of two populations with Stage T1 bladder cancer: those with tumor invasion confined to the lamina propria (pT1A) and those with tumors infiltrating into the submucosa (pT1B). METHODS: A series of 170 Stage T1 papillary bladder tumors was analyzed pathologically to identify the level of subepithelial connective tissue invasion. Both the reproducibility of such a differentiation and its prognostic implication were evaluated using Kaplan-Meier survival estimates and the Cox regression model. RESULTS: In specimens from transurethral resection, categorization into T1A or T1B could be performed in 98 of 170 cases (58% of specimens). Such differentiation proved to be of prognostic value with significantly different 5-year survivals between the two subcategories (pT1A [n = 50] vs pT1B [n = 49]) (log-rank, P < 0.02). Cox's regression analysis of pT1 subcategory and grade was performed in the 99 cases in which the differentiation between pT1A/pT1B could be made. This demonstrated that the depth of subepithelial connective tissue invasion was an independent prognostic factor (P < 0.05). CONCLUSIONS: The depth of tumor infiltration can be assessed in a considerable proportion of Stage T1 bladder neoplasms. The present study validates the prognostic significance of such a distinction both by Mantel-Haenszel life table method and Cox's regression analysis.

Actuarial Analysis↗
PubMed1995

The prognostic significance of vascular invasion in stage T1 bladder cancer.

Transurethral resection specimens from 170 T1 bladder carcinomas were reviewed for the presence of vascular (blood vessel and/or lymphatic) invasion by tumour cells. Such a finding was noted in 17 cases (10%), and occurred most frequently in high grade tumours. Tumour recurrence was documented in 11 of these cases (65%), including seven patients who showed progression to more invasive disease (T2-T4) and six patients (55%) who died of disease. Five-year survival for cases without vascular invasion was 81% versus 44% for those with. This was a statistically significant difference (log-rank, P = 0.004). Neoplasms of high grade (grades 2 to 3), without a papillary configuration, and exceeding 5 cm were associated with vascular invasion (chi-squared; P < 0.001, P = 0.043, and P = 0.061 respectively). In multivariate analysis vascular invasion proved to be an independent prognostic factor (Cox's regression, P = 0.015). We therefore stress the clinical relevance of a thorough evaluation of the state of vascular invasion in stage T1 bladder cancer.

Aged↗
PubMed1995

Combined therapy in a case of malignant mesothelioma of the tunica vaginalis testis.

Malignant mesothelioma of the tunica vaginalis testis is exceedingly rare. A new case mimicking hydrocele in a 47-year-old man is here reported. Clinical staging revealed scrotal cutaneous and funicular tumor invasion together with retroperitoneal adenopathies. Once visceral dissemination was ruled out, radical orchiectomy, left hemiscrotectomy and modified retroperitoneal lymph node dissection were performed. Adjuvant systemic chemotherapy and radiation were also administered. Histologically, an epithelial neoplasm with papillary pattern was evidenced. CAM 5.2 cytokeratin was positive in proliferating cells, but carcinoembryonic and Leu M1 antigens gave negative results. Three years later the patient is free of disease.

Combined Modality Therapy↗
PubMed1994

Burned-out tumour of the testis presenting as retroperitoneal choriocarcinoma.

A case of "burned-out" tumour of the testis in a 20-year-old man is reported. The tumour presented as widespread retroperitoneal metastases. Orchiectomy displayed a subalbugineal fibrous scar close to the rete testis. Diagnostic biopsy of the unresectable retroperitoneal tumour showed a choriocarcinoma. Although appropriate chemotherapy was promptly started, the patient died 7 months after the initial complaints.

Adult↗
PubMed1994

HIV infection presenting as renal polyarteritis nodosa.

We present a case of renal vasculitis (polyarteritis nodosa) in a 36-year-old female prostitute having undetected HIV infection (AIDS-related complex) and chronic B-hepatitis. The pathogenesis and significance of the association between these entities are reviewed.

AIDS-Related Opportunistic Infections↗
PubMed1994

Pseudosarcomatous myofibroblastic proliferation of the bladder: report of 2 cases and literature review.

We report 2 cases of pseudosarcomatous myofibroblastic proliferations of the bladder unrelated to urological trauma. To our knowledge, these cases represent the longest followup (12 and 19 years, respectively) reported in the literature, which confirms the long-term benign nature of an entity that may be clinically and even pathologically mistaken as malignancy. A review of the literature revealed a female predominance (3:1), 50% of the cases manifested in the first 2 decades of life and mean age was significantly lower in male patients (p < 0.005). These facts suggest the existence of a hormonal factor in the pathogenesis of this entity. A predilection for fundus, and the posterior and lateral walls also is demonstrated. In light of the complex embryogenesis of the cloacal territory, it could be hypothesized that this lesion arises from embryonal mesenchymal remnants of the endodermally derived urinary tract.

Adolescent↗
PubMed1994

Expression of keratin 20 in malignant eccrine poromas.

Eight cases of malignant eccrine poromas were studied immunohistochemically with a broad panel of antibodies in order to better characterise the spectrum of their differentiating pathways. Special attention was paid to the expression of cytokeratins, mainly the newly recognised keratin 20. In general, the pattern of staining agreed to previous studies. Anyway, a non-expected positivity with keratin 20 was seen in two cases. The usefulness of the immunohistochemistry to discover areas with masked differentiation in adnexal tumours of the skin was once more confirmed.

Acrospiroma↗
PubMed1994

Basaloid-squamous cell carcinoma of the larynx and hypopharynx. A clinicopathologic study of 7 cases.

During a 16-year period (1974-1989), a retrospective review of 468 surgical specimens of laryngectomy yielded 7 cases (0.66%) of basaloid-squamous cell carcinoma. They were all males between 42 and 63 years of age. Four cases were supraglottic and one transglottic. The other two arose in the left pyriform sinus and vallecula, respectively. At diagnostic time, 4 cases were Stage III and 2 Stage IV, only one being Stage II. Glanz index of histologic malignancy was high (> 5) in most cases (6/7). Mitotic rate was also high (22-78 mitoses/10 HPF). Lymph node metastases were documented at diagnosis in 5 cases, 3 of them presenting with extracapsular extension. One case developed liver metastases. During the follow-up, lymph nodes of the neck were again metastasized in 4 cases, and stomal recurrence was present in another one. Death of disease was confirmed in 5 cases after 10 to 35 months of follow-up. Overall survival was 28.5% after 3 years.

Adult↗
PubMed1994

Small cell carcinoma of the urinary bladder. A clinicopathological study of six cases.

OBJECTIVE: To study the clinical, histological, and immunohistochemical findings of small cell carcinoma (SCC) of the urinary bladder, and also to delineate its behaviour in comparison with transitional cell carcinomas of the bladder. MATERIALS AND METHODS: A retrospective review of 552 patients with bladder cancer yielded six cases (1%) of small cell carcinoma which were histologically identical to pulmonary small cell anaplastic carcinoma. Clinical data and follow-up were collected. Aside from the conventional histological parameters, an immunohistochemical study with AE1-AE3 and Cam 5.2 keratins, epithelial membrane antigen, neuron-specific enolase, chromogranin, synaptophysin, ACTH, calcitonin, and prostatic specific antigen was performed. RESULTS: The clinical presentation did not differ from conventional transitional cell carcinoma, haematuria being the most frequent complaint (four cases). All the cases presented as flat tumours. On light microscopy, there were oat cell (four cases), intermediate (one case) and mixed oat-cell/intermediate (one case) variants. Three cases were associated with transitional cell carcinoma. Dysplastic changes were observed in the adjacent urothelium in one case only. At the time of diagnosis, all tumours were deeply invasive (pT3). Three cases were Stage III and three Stage IV, with involvement of regional lymph nodes and metastases to the liver (two cases) and lung (one case). Immunohistochemically, epithelial markers were variably expressed as AE1-AE3 keratin (5/6), Cam 5.2 keratin (2/6) and epithelial membrane antigen (3/6). Neuron specific enolase was demonstrated in every case. Chromogranin, however, was expressed in only one case. Synaptophysin, ACTH, calcitonin, and prostatic specific antigen all gave negative results. All the patients died of the disease and the overall length of survival was very poor (range 5-25 months, mean 13.3). CONCLUSION: Small cell carcinomas show the same histological patterns as their pulmonary counterpart. Immunohistochemistry reveals a wide spectrum of activity, enolase and keratins being the most constant. The present study confirms that the overall prognosis of this tumour is very poor.

Aged↗
PubMed1994

Lethal cytomegalovirus adrenalitis in a case of AIDS.

The clinico-pathologic report of a case of cytomegalovirus (CMV) necrotizing adrenalitis arising in an intravenous drug-abuser and HIV-infected young is presented. CMV urinary tract infection, genital Kaposi's, and demyelinating changes in central nervous system were associated findings.

AIDS-Related Opportunistic Infections↗
PubMed1994

Pathogenetical considerations on a case of bilateral pelvic renal ectopia.

The clinical finding of a case of bilateral pelvic renal ectopia, incidentally discovered in a 31 year-old female, leads us to revise the current theories explaining simple renal ectopia. The pathogenesis of this anomaly of kidney position and rotation is far from being clearly understood. However, in the light of normal process of kidney ascension, we understand this entity can be regarded as an example of time-dependent developmental disorder taking place between the 6th and 9th weeks of human embryogenesis.

Adult↗
PubMed1994

Gliosarcoma. Case report with immunohistochemical study.

A typical case of gliosarcoma in a 74 year-old woman is reported. The exact origin of sarcomatous areas of this tumor has been a matter of debate. Our immunohistochemical findings, using a panel of antibodies (GFAP), vimentin, keratins, F-VIII related antigen, muscle specific actin, KP-1 and HMB-45), support its undifferentiated nature. The literature concerning this topic is reviewed and briefly discussed.

Aged↗
PubMed1993

Urinoma formation secondary to ureteral obstruction by metastatic squamous cell carcinoma of the appendix. Case report.

We report a case of secondary squamous cell carcinoma of the appendix causing spontaneous extravasation of urine and urinoma formation. On the basis of clinical findings, we interpret this rare lesion as metastatic from a cervical carcinoma surgically resected 8 years earlier. Ureteral continuity was restored by retrograde catheterization and the urinoma was drained percutaneously. The final diagnosis was made at laparotomy.

Aged↗