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PubMed1999

Total testosterone and DHEAS levels as predictors of androgen-secreting neoplasms: a populational study.

Androgen excess affects between 2% and 10% of women. While the majority of these patients suffer from polycystic ovary syndrome, a few present with an androgen-secreting neoplasm. An elevated circulating total testosterone level and dehydroepiandiosterone sulfate (DHEAS) level have been proposed as screening methods for detecting ovarian and adrenal androgen-secreting neoplasms, respectively. To determine the predictive value of these tests for androgen-secreting tumors in a population of consecutive hyperandrogenic patients, we studied 478 consecutive untreated hyperandrogenic patients presenting over a ten-year period (1987-97). All had at least two of the following features: (1) oligomenorrhea (i.e. cycles > 35 days or < 8 cycles/year), (2) hyperandrogenemia (i.e. a total or free testosterone, or DHEAS > 95th percentile of controls), or (3) hirsutism (i.e. a modified Ferriman-Gallwey score > or = 6). None of these patients had a prior diagnosis of an androgen-secreting neoplasm. Basal levels of testosterone and DHEAS were determined in all patients, with transvaginal sonography and an adrenal computed tomography scan in select individuals. Of the 478 patients included, 65% had hirsutism and oligomenorrhea; 20% had hyperandrogenic oligomenorrhea; and 15% had hirsutism and hyperandrogenemia, without overt oligomenorrhea. Overall, 11 (2.3%) patients had a total testosterone > 8.7 nmol/l (250 ng/dl), of which one actually had an androgen-secreting neoplasm (i.e. true-positive). This postmenopausal patient presented with rapidly progressive virilization, and demonstrated an ovarian hilar cell tumor at surgery. The calculated sensitivity of an elevated testosterone level (> 8.67 nmol/l) for a neoplasm was 100% (1/1), the specificity was 98% (467/477), and the negative predictive value was 100% (467/467), but the positive predictive value was only 9% (1/11). Ten subjects had DHEAS levels > 16.3 mumol/l (6000 ng/ml), and none was diagnosed with an adrenocortical tumor. Although the sensitivity and positive predictive value of a high DHEAS for a neoplasm could not be calculated due to the absence of a test case, the specificity was 98% (468/478) and the negative predictive value was 100% (468/468). These data suggest that the measurement of testosterone and DHEAS is not a cost-effective method of screening for these tumors, due to the low frequency of the disorder and the fact that clinical evaluation alone is often sufficient screening.

Adrenal Cortex Neoplasms↗
PubMed2005

Neurocytoma-like neoplasm of the thoracic spine in a 15-month-old child presenting with diffuse leptomeningeal dissemination and communicating hydrocephalus. Case report.

This unusual mixed glioneuronal neoplasm of the spine resembling central neurocytoma is only the second reported example of a neoplasm of this type involving the spinal cord and is, seemingly, the first to present with diffuse leptomeningeal dissemination and communicating hydrocephalus. This 15-month-old boy presented with somnolence, bilateral sixth nerve palsy, and lower-extremity weakness and was found to harbor a primary neoplasm within the thoracic spine and associated syrinx, widespread leptomeningeal dissemination, and communicating hydrocephalus. The patient underwent cerebrospinal fluid shunt placement, thoracic laminectomy for tumor debulking and biopsy, chemotherapy, and radiation therapy to the neuraxis. Immunohistochemically, the tumor was marked by evidence of mixed glial (glial fibrillary acidic protein-positive) and neuronal (synaptophysin-positive) differentiation. Mitotic activity was inconspicuous. No areas of vascular proliferation, necrosis, or marked nuclear pleomorphism were noted. Mixed glioneuronal neoplasms are a heterogeneous group of tumors whose biological potential remains incompletely defined. The present case illustrates the reality that some of these neoplasms can be clinically aggressive, despite comparatively bland histological features. The authors' goal is to acquaint neurosurgeons with the expanding spectrum of mixed glioneuronal neoplasms and with the potential of some of these lesions to pursue an aggressive clinical course.

Arachnoid↗
PubMed2005

Renal neoplasms in younger adults: analysis of 112 tumors from a single institution according to the new 2004 World Health Organization classification and 2002 American Joint Committee on Cancer Staging System.

CONTEXT: Adult renal neoplasms have a predilection for older patients and are clinically and morphologically distinct from renal neoplasms found in pediatric age groups. Relatively rare tumors occur in younger adults (18-45 years of age). Whether these renal tumors are morphologically and clinically distinct from those of older adults has been the subject of controversy. Recent modification of the World Health Organization histologic classification and the American Joint Committee on Cancer staging system of adult renal tumors further highlighted the need for case analysis in this age group. OBJECTIVE: To analyze renal tumors in younger adults based on a large surgical series from a single institution. DESIGN: Of 780 renal mass nephrectomy (partial, total, or radical) specimens that were available for evaluation and had been obtained between 1986 and 2004 at Loyola University Medical Center, 112 specimens were from patients between 18 and 45 years of age. The tumors were reevaluated according to the 2004 World Health Organization classification and the 2002 American Joint Committee on Cancer staging system. RESULTS: The likelihood of clear cell renal cell carcinoma was significantly reduced from 65% in older adults to 53% in younger adults (18-45 years, P = .04). The reduction trend was more significant when comparing an even younger age group. The majority (64%) of clear cell renal cell carcinoma in younger adults was low stage, T1a. Seventeen percent of these tumors had multilocular cystic features involving more than 50% of the tumor volume (55%-85%). The number of oncocytomas was also significantly lower in younger adults than in older adults (2% vs 11%, P < .001), and this presumably age-related benign neoplasm was not identified in patients younger than 40 years in this study. In contrast, the miscellaneous tumor category showed a remarkable increase, from 4% in older adults to 26% in younger adults (P < .001). The youngest patient group (18-35 years) had a higher incidence of miscellaneous tumors, 37%. Younger female adults tended to have more benign miscellaneous neoplasms than did their male counterparts (64% vs 36%, P < .001). Clear cell and chromophobe renal cell carcinoma occurred more frequently in younger male adults than in female adults (2:1 and 8:1, respectively). CONCLUSIONS: Renal neoplasms are more heterogeneous in younger adults and have a different distribution pattern compared with that in older adults. Malignant and benign renal neoplasms tend to have a contrasting sex distribution in younger adults.

Adult↗
PubMedDate not supplied

Cytogenetic and corresponding flow cytometric DNA analysis of renal cell neoplasms.

Results of flow cytometric DNA content and cytogenetic analyses of six neoplasms representing the spectrum of the morphologic subtypes of renal cell neoplasms are compared. Flow cytometric determinations of DNA diploidy and near diploidy in two renal cortical neoplasms correlated with modal chromosome numbers; however, in three of four neoplasms with a highly aneuploid DNA content, the modal chromosome numbers indicated diploidy or near-diploidy. Our data suggest that the short-term culture conditions used in cytogenetic analysis may favor growth of cells with diploid or near-diploid DNA content. This may explain the discrepancy frequently observed between results obtained using flow cytometry and karyotyping after short-term culture. We also observed (1) abnormalities in the short arm of chromosome 3 in all three nonpapillary neoplasms, (both clear and granular cell types); (2) aberrations in chromosomes 3 and 17 in the two papillary tumors; and (3) normal chromosome 3 in the presence of various random karyotypic anomalies including telomeric associations and a pseudo-diploid modal chromosome number in the only oncocytic neoplasm studied.

Aneuploidy↗
PubMed1990

Immunohistochemistry in surgical pathology. The case of the undifferentiated malignant neoplasm.

An ideal immunohistochemical screening panel would be one in which each antibody is 100% sensitive and specific for the target cell type (e.g., markers for epithelial neoplasms, lymphomas, sarcomas, etc.). Anyone who has practiced immunochemistry is well aware that this situation does not exist. High sensitivity is hindered by the loss of key antigens through formalin fixation and routine tissue processing. Although sensitivity can be improved by dealing with fresh-frozen, lyophilized, or plastic-embedded specimens, these procedures are often perceived as inconvenient by pathologists. Specificity is a more insidious problem. With the advent of monoclonal antibody technology, many individuals equated the monospecificity (e.g., marking one antigen a determinant) with tissue specificity. This, of course, is not the case as determinants recognized by one monoclonal antibody may be expressed on cells of different lineage. High sensitivity and high specificity are important for different reasons. By definition, an undifferentiated neoplasm lacks morphologic features to unequivocally substantiate sarcoma, lymphoma, carcinoma, or melanoma. Thus, antibodies with low sensitivity that fail to mark a significant percent of cases will provide inconclusive or erroneous information. The failure of an antibody to stain a particular tissue could be a true-negative (valuable information) or a false-negative (misleading information) result. Obviously, when antibodies have a sufficiently low sensitivity, their use is a liability rather than an advantage. Specificity is obviously important. When an undifferentiated neoplasm is found to be "positive" for a particular marker, there is a tendency to immediately categorize the neoplasm. In this setting, when histologic features of cellular differentiation are totally lacking, an extreme degree of trust is being placed on the immunohistochemical technique. From our earlier discussion it is apparent that perfect sensitivity and specificity do not exist among most immunohistochemical reagents. Accordingly, the safest approach is to use a panel of antibodies that will disclose anomalous immunohistochemical reactions (e.g., a neoplasm positive for both keratin and LCA). Specimens from such cases should be carefully evaluated with additional monoclonal antibodies and scrutinized by light microscopy. Furthermore, while immunohistochemistry provides for rapid and cost-effective diagnosis, electron microscopy may still contribute valuable information. Despite our best intentions and desires, it is also clear that a small percentage of "undifferentiated" neoplasms will remain undifferentiated. Quality control and quality assurance are two final, but important, issues to address. An extraordinary large number of variables in tissue selection, fixation, and processing can skew results.(ABSTRACT TRUNCATED AT 400 WORDS)

Antigens, Neoplasm↗
PubMedDate not supplied

[Proteases and protease antagonists in neoplasms].

The maintenance of equilibrium between proteases and their inhibitors has substantial significance for the pathogenesis of the neoplastic disease. It concerns especially the invasiveness of the neoplasms, which increases with rising of the proteases activity or with the decrease of the inhibitory activity of antiproteases. The neoplastic cell has the faculty of producing numerous proteases which by damaging connective tissue facilitates the invasion by the neoplasm. Invasiveness of the neoplasms may be augmented by the production of proteases by the host cells stimulated by the neoplasm. The condition of the proteases--antiproteases balance is also influenced by the production of antiproteases by neoplastic cells. Among numerous antiproteases alpha-2-macroglobulin has most intensive cytotoxic action in relation with the neoplasm. According to data collected from the literature, antiproteases can be regarded as anticarcinogenic agents. On account of this, the estimation of the antiproteases level can be regarded as a measure of the ability of the body system to resist the invasiveness of neoplasms.

Connective Tissue↗
PubMedDate not supplied

Regulatory peptides in neuronal neoplasms of the central nervous system.

Neuronal tumors of CNS were examined immunohistochemically for regulatory peptides. Thirteen ganglion cell neoplasms, one cerebellar ganglioneuroblastoma, one cerebellar neuroblastoma, and four medulloblastomas were studied. Sixteen non-neuronal intracranial neoplasms were examined as controls. Immunoreactive vasoactive intestinal polypeptide (VIP) was observed in seven cases of ganglion cell neoplasm and in the one cerebellar ganglioneuroblastoma. The cerebellar neuroblastoma, all of the medulloblastomas, and all of the non-neuronal intracranial neoplasms were negative. Four additional ganglion cell neoplasms were tested for the presence of neurotensin and somatostatin. Two contained neurotensin. The results suggest that CNS ganglion cell neoplasms share with their extracranial counterparts the production of certain hormonal polypeptides. Since these peptides are presumed to be specific markers for neurons, the immunohistochemical detection of these substances may provide diagnostically useful technique in the diagnosis of such lesions.

Adolescent↗
PubMed1986

Congenital granular-cell neoplasms. An unusual case report with ultrastructural findings and a review of the literature.

Congenital granular-cell tumors are uncommon benign neoplasms of unknown cause that develop primarily in gingival tissue and usually do not recur after surgical excision. Untreated, these neoplasms either cease to grow or "spontaneously" regress after birth. In this report, we describe an unusual case of a child with several congenital granular-cell neoplasms that arose on the lips and continued to increase in size as the child grew. Histologic examination of the neoplasms revealed them to be composed of granular and mesenchymal cells associated with abundant collagen fibers and prominent vascular structures. Ultrastructural study disclosed typical granular cells and a preponderance of immature mesenchymal cells, some of which appeared to be transitional or early granular cells. We interpreted these findings to mean that primitive mesenchymal cells are the proliferative elements and precursors of granular cells in congenital granular-cell neoplasms. The presence of numerous immature mesenchymal cells corroborates the clinical impression that the lesions were growing. Based upon the histological and ultrastructural findings reported here, and a review of the literature, we favor a mesenchymal or endothelial-cell origin for congenital granular cell neoplasms.

Child, Preschool↗
PubMed1986

[Clinico-genetical studies of colonic cancer. III. Primary multiple malignant neoplasms].

The results of clinico-genealogic analysis of 46 patients with primary-multiple malignant neoplasms are given (among them 16 patients with primary-multiple malignant neoplasms of colon cancer and 30 patients with one or more neoplasms in combination with different malignant tumors of other organs). The values of segregation rates obtained for primary-multiple malignant neoplasms are lower than theoretically expected for simple monogeneous types of inheritance. The relation analysis of primary-multiple malignant neoplasms and colon cancer revealed that these tumors are likely to appear among relatives of probands under the influence of the same genetic system of determination. Risk of the colon cancer development for relatives of the patients with primary-multiple malignant neoplasms is higher than for relatives of the patients with colon cancer.

Adult↗
PubMed1977

Neoplasms of Equidae.

In a retrospective study of neoplasms in Equidae pre;ented to the Animal Disease Diagnostic Laboratory, Purdue University, from Jan 1, 1970, to Dec 31, 1974, data were compiled on numbers and anatomic sites of neoplasms as well as on age, sex, and breed of subjects from which the neoplasms were taken. During this 5-year period, 21 neoplasms were diagnosed from 687 equine necropsies (3.1%) and 215 from 635 biopsies (33.9%), totaling 236 neoplasms from 1,322 cases (17.9%). The most common neoplasms were sarcoids (43.6%) and squamous cell carcinomas (24.6%). Papillomas (5.5%), nerve sheath tumors (4.2%), melanomas (3.8%), lipomas (3.0%), granulosa cell tumors (2.5%), fibromas (2.1%), cholesteatomas (1.3%), and lymphosarcomas (1.3%) were less common.

Animals↗
PubMed1994

The influence of subsequent neoplasms on incidence trends in childhood cancer.

The purpose of this analysis was to evaluate to what extent subsequent malignant neoplasms account for the increasing rates of cancer occurrence among children. Data from the population-based Surveillance, Epidemiology, and End Results program were used to calculate age-standardized annual incidence rates from 1974-1989 for 10 common cancers among children 14 years of age or younger. Mean rates and linear trends were evaluated using least squares regression, first for all neoplasms and then excluding subsequent neoplasms, to determine if the removal of subsequent neoplasms would attenuate increasing trends. Increasing annual incidence rates were found for all childhood cancers combined, acute lymphoid leukemia, and brain tumors, but not for other cancer types. Excluding subsequent neoplasms from the analysis had a negligible effect on the trends we observed. Although it remains largely undetermined why childhood cancer incidence rates are increasing in the United States, this study presents evidence that subsequent primary neoplasms do not substantively contribute to these observed trends.

Adolescent↗
PubMed1979

Secondary malignant neoplasms following radiotherapy of a mouse mammary carcinoma.

Long-term observations were made for the development of secondary neoplasms following radiotherapy of animal tumors. Experimental tumors were 3rd generation isotransplants of a mammary carcinoma which arose spontaneously in a C3Hf/He mouse. A single dose of TCD20-TCD98 was followed by weekly observations. Most recurrences were observed in the first 150 days, while only a few were seen in the subsequent 150 days. Secondary neoplasms developed frequently following this period, i.e., 41 out of 67 animals surviving more than 300 days developed secondary neoplasms. They were osteogenic and soft tissue sarcomas, and half the new tumors were found within 490 days after radiotherapy. The results obtained were compared with literature reports of secondary neoplasms following postoperative radiotherapy for carcinoma of the breast and treatment of retinoblastomas. Most of these secondary human neoplasms were nonepithelial sarcomas as in the present study. Secondary carcinomas have been reported following radiotherapy of carcinoma in other locations, i.e., the cervix or head and neck; however, only a limited number of studies have been reported.

Animals↗
PubMedDate not supplied

Metastases to the breast from extramammary neoplasms. A report of six cases with diagnosis by fine needle aspiration cytology.

BACKGROUND: Metastatic deposits to the breast from extramammary neoplasms are rare. Clinically and radiologically, metastatic neoplasms may mimic primary benign and malignant neoplasms of the breast. A correct diagnosis of metastasis to the breast is of considerable importance since the treatment of primary and secondary malignancies of the breast is different. CASES: Six cases of metastatic neoplasms in the breast were diagnosed by fine needle aspiration biopsy (FNAB). The cases included poorly differentiated squamous carcinoma of the cervix, endometrial adenocarcinoma, gastric signet-ring cell carcinoma, small cell carcinoma of the lung, large cell carcinoma of the lung and plasma cell myeloma. Four of the patients were female and two male. Four had a previously diagnosed extramammary malignancy, but in two cases the breast mass was the first manifestation of cancer. A correct cytologic diagnosis was made in all six cases. CONCLUSION: FNAB can distinguish metastatic deposits from primary breast tumors even when this is the first presentation of an extramammary neoplasm. A good knowledge of cytomorphology and histomorphology, together with clinical correlation and comparison with previous cytologic/histologic material, will prevent an incorrect diagnosis.

Aged↗
PubMed1994

Papillary squamous neoplasms of the head and neck.

Papillary squamous neoplasms of the upper respiratory tract are rare variants of squamous cell carcinoma and are related temporally to proliferative verrucous leukoplakia. Fifty-two cases of papillary squamous neoplasms were selected from 2366 cases of squamous cell carcinoma. This is the first study to characterize the biological behavior of papillary squamous neoplasms. Papillary squamous neoplasms exhibit two distinct, yet sometimes overlapping, histologic patterns including an exophytic papillary and an inverting verrucous morphologic appearance. A high rate of synchronous or metachronous lesions were found, especially with the inverting-type of papillary squamous neoplasm. Stage T3 and T4 lesions had a high rate of neck metastasis. Early surgical intervention and close long-term follow-up is mandatory.

Adult↗
PubMed1995

[Multiple primary malignant neoplasms].

The laryngological ward of the district hospital in Piła has been carrying out the diagnosis of neoplastic cases. There were 34 cases of carcinoma of the larynx and or with the lower part of the pharynx were discovered. 4 out of there were confirmed to have second primary neoplastic region. Two patients the neoplasm synchronously developed and in two other patients the neoplasm metachronously developed. In there cases the region of second primary neoplasm was found in the area of the head and neck (thyroid gland, lower lip and the side of the nose) and in one case the second region was found in the urinary bladder, Amongst the patients treated for neoplasms in the laryngological ward of the district hospital in Piła in 1994, 11.7% were patients with second primary malignant neoplasm.

Aged↗
PubMed1988

Immunohistochemistry of germ cell and trophoblastic neoplasms.

The immunoprofiles of 121 germ cell and trophoblastic neoplasms were defined, using a battery of antibodies against cytokeratin (CK), vimentin (VIM), epithelial membrane antigen (EMA), placental alkaline phosphatase (PLAP), S-100 protein, leukocyte common antigen (LCA), UCHL-1, LN-2, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), chromogranin A, Leu-7, alpha-fetoprotein (AFP), alpha-1-antitrypsin (AAT), and the beta subunit of human chorionic gonadotropin (BHCG). In addition to 85 neoplasms of testicular origin, the cases included eight ovarian germ cell tumors and 28 extragonadal neoplasms. All tissues had been subjected to formalin fixation and paraffin embedding. Similar immunoreactivity patterns were seen in gonadal and extragonadal neoplasms, gestational and nongestational choriocarcinomas, components of mixed germ cell tumors and their pure counterparts, and metastatic and primary lesions. Placental alkaline phosphatase was a sensitive marker of germ cell differentiation, and expression of this marker in the absence of EMA appeared to be a staining pattern unique to germ cell tumors. Both LCA and S100 were absent in neoplastic germ cells, and thus were useful in differentiating these tumors from malignant lymphoma and malignant melanoma, respectively. Cytokeratin was helpful in distinguishing seminomas/dysgerminomas from nonseminomatous germ cell tumors, although 10% of seminomas showed focal or diffuse cytokeratin reactivity. Finally, 75% of all germ cell neoplasms displayed NSE, calling the specificity of this determinant into question.

Alkaline Phosphatase↗
PubMed1994

Comparative flow cytometric analysis of Ki-67 and proliferating cell nuclear antigen (PCNA) in solid neoplasms.

The proliferation associated antigens, Ki-67 and proliferating-cell nuclear antigen (PCNA), have been widely used in studies assessing the growth fraction in human malignancies. It remains unclear, however, whether these markers yield similar assessments of proliferative activity in any given neoplasm. In this study, we compared Ki-67 and PCNA expression in 93 malignant solid neoplasms using bivariate flow cytometric analysis of these antigens and DNA content. The growth fractions measured by Ki-67 and PCNA were compared and correlated with acridine orange (AO) analysis and tumor grade. Our results indicate a significant difference between Ki-67 and PCNA values in neoplasms of low and intermediate grade (P = 0.002); Ki-67 values were significantly lower than those obtained by PCNA in this group. No statistical difference between Ki-67 and PCNA values was found in high grade neoplasms (P = 0.38). Analysis of different cell cycle compartments indicates that the observed difference in the positivity of these markers was due to their differential expression in the G0/1 segment of the cell cycle. We conclude that Ki-67 may better reflect the proliferative activity in solid neoplasms than does PCNA.

Biomarkers, Tumor↗
PubMed1987

Clinical, morphologic, immunophenotypic, and molecular genetic analysis of bilateral ocular adnexal lymphoid neoplasms in 17 patients.

We investigated the clinical, morphologic, immunologic, and molecular genetic characteristics of the lymphoid tumors occurring in 17 patients with bilateral ocular adnexal lymphoid neoplasia. We found no obvious differences in the age, sex, clinical appearance, or ophthalmic findings between patients with unilateral and those with bilateral ocular adnexal lymphoid neoplasms. Five orbital and two conjunctival lymphoid neoplasms removed from five patients were polyclonal pseudolymphomas, while nine orbital, eight conjunctival, and two eyelid lymphoid neoplasms removed from 12 patients were monoclonal B cell non-Hodgkin's lymphomas. Each pair of simultaneously bilateral lesions occurring in a single individual was morphologically and immunologically identical and exhibited identical immunoglobulin gene DNA rearrangement patterns. None of the five patients with polyclonal pseudolymphomas developed nonocular non-Hodgkin's lymphoma, but one developed a contralateral conjunctival monoclonal B cell non-Hodgkin's lymphoma. Six of the 12 patients with ocular adnexal monoclonal B cell non-Hodgkin's lymphomas developed nonocular non-Hodgkin's lymphoma. The incidence of previous or subsequent systemic nonocular non-Hodgkin's lymphoma in patients with bilateral ocular adnexal lymphoid neoplasms is comparable to that of patients with unilateral disease. In both patient groups, the development of nonocular non-Hodgkin's lymphoma is most commonly associated with ocular adnexal lymphoid neoplasms displaying follicular or diffuse small cleaved cell (poorly differentiated lymphocytic) morphologic characteristics.

Adult↗