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[Ileo-ceco-colic invagination. Apropos of a case caused by lymphoma of the last ileal loop].

An unusual case of intestinal invagination due to lymphoma of the last ileal segment serves as a basis for a review of the pathogenetic mechanisms underlying the invagination process and its different onset modalities. Special attention is paid to how chronic invaginations, as a result of their varied, unremarkable symptomatology, often involve mistaken or late diagnosis. The present case is noteworthy because of the summing of factors proper to primary invagination with those of secondary invagination. The hyperperistaltism resulting from the presence of a non-pedunculated mass acted on an intestinal segment in which the anatomico-functional conditions for the establishment of primary invagination were often present., All this was responsible for a chronic basic ileo-caecal invagination process, the cause of progressive limming with acute episodes of further advance of the invaginated part to the transverse colon. It was these acute episodes that gave clinical dignity to the insidious symptomatology reported by the patient thus allowing speedy, correct diagnosis of the ongoing neoplastic process and hence radical surgery with favourable prognosis.

Adolescent↗

Fine needle aspiration diagnosis of intramuscular bacillary angiomatosis. A case report.

BACKGROUND: Bacillary angiomatosis (BA) is a localized infectious process that affects primarily patients with the acquired immunodeficiency syndrome. The microorganisms implicated in the pathogenesis of this disease belong to the Rickettsiaceae family. CASE: A 43-year-old, human immunodeficiency syndrome-positive male presented with diffuse swelling in the right deltoid area. A neoplastic process was considered in the differential diagnosis. Fine needle aspiration biopsy showed proliferation of blood vessels lined with plump endothelial cells, and the interstitial space was occupied by neutrophilic infiltrate, leukocytoclastic debris and clumps of characteristic amphophilic, granular material. Warthin-Starry stain demonstrated clusters of bacilli diagnostic of bacillary angiomatosis. CONCLUSION: The diagnosis of this entity, made by fine needle aspiration cytology (as the only diagnostic procedure), was instrumental in preventing further surgical manipulation and in initiating appropriate and immediate antibiotic therapy.

AIDS-Related Opportunistic Infections↗

Pulmonary infections mimicking cancer: a retrospective, three-year review.

Pulmonary infections can mimic or occasionally co-exist with pulmonary neoplasms. In order to determine the frequency and nature of these infections, we conducted a retrospective analysis, covering a 3-year period, of patients who were referred to our center with presumed lung cancer but turned out to have pulmonary infection instead. The overwhelming majority of patients (93.3%) referred to "rule out" lung cancer were documented as having a neoplastic process, and only 1.3% had an infection. Fungal infections (histoplasmosis, cryptococcosis, coccidiomycosis) accounted for 46%, mycobacteria for 27%, bacteria for 22%, and parasitic lesions (dirofilariasis) for 5% of these infections. The most common clinical manifestations were cough and chest pain, and the most common radiographic finding was a solitary pulmonary nodule. There were no specific clinical or radiographic features predictive of either infection or neoplastic disease. All patients responded to specific anti-infective therapy with or without surgical excision. Our data indicate that pulmonary infections mimic neoplasms very infrequently. However, establishing a specific diagnosis is critical, since the management and outcome of these two processes are entirely different.

Adolescent↗

Fine-needle aspiration for the diagnosis of primary epithelial tumors of the lacrimal gland and ocular adnexa.

Results of fine-needle aspiration (FNA) of solid-tissue neoplasms arising in the periocular glands are infrequently reported in the literature. To our knowledge, no previous series relating to this topic exist. Neoplastic processes that arise in the semiconfined area of the orbit behave as space-occupying lesions. Such lesions can exert significant pressure on the globe, be responsible for altered vision, and result in proptosis. When noninvasive techniques fail to confirm or rule out the suspicion of a neoplastic lacrimal or adnexal lesion, FNA may be of use in establishing a diagnosis in an efficient, reliable, timely, cost-effective, and safe manner. During the 14-yr interval from 1986-1999, 77 orbital/ocular needle aspiration biopsies were conducted by staff ophthalmologists at Allegheny General Hospital (Pittsburgh, PA). Review of the diagnoses for these specimens revealed seven primary solid-tissue lesions of the lacrimal gland and other adnexal glands, all arising in adult patients (age range, 45-92 yr; mean age, 74 yr). Primary lacrimal and adnexal gland neoplasms were found to represent approximately 9% of orbital fine-needle aspirations (7/79). The 7 cases included 3 lacrimal gland lesions diagnosed as benign mixed tumors, 3 lesions diagnosed as adenoid cystic carcinoma of the lacrimal gland, and 1 tumor diagnosed as sebaceous carcinoma of the meibomian holocrine glands. Cytologic diagnoses were rendered using standard criteria for salivary gland-type tumors. Tissue confirmation was available from surgical follow-up in 4 of the 7 cases, with 100% correlation. Although primary neoplasms of the lacrimal gland and glands of the eyelids are rare, accurate diagnoses of such lesions may be established with minimally invasive aspiration techniques. Preoperative aspiration biopsy diagnoses provide a great advantage to ophthalmic surgeons who routinely operate in a conservative fashion in an area of the body requiring great attention to cosmesis. Our experience indicates that FNA is a reliable and effective tool in the diagnosis and management of primary lacrimal and ocular adnexal tumors.

Adenocarcinoma, Sebaceous↗

A discussion of the roles of oestrogen and progestin in human mammary carcinogenesis.

Oestrogens and progestins are important for both the genesis of human breast cancer and growth of those tumours once formed. Their role at different stages of the neoplastic process are reviewed and discussed within the context of a change in sensitivity of epithelial cells during either initiation or promotion stages. Evidence favours, but does not conclusively prove, the view that progestins are the predominant mitogen for normal breast epithelium whilst oestrogen assumes that function in neoplastic epithelium. Alterations in oestrogen receptor levels could provide the key for such a change. There are insufficient data on physiological progestin concentrations to judge their effect on established cancer. Models for steroidal effects on cell proliferation and oestrogen and progestin receptor regulation that are based on endometrial data are not appropriate for breast.

Breast↗

Recognizing genes differentially regulated in vitro by the multiple endocrine neoplasia type 1 (MEN1) gene, using RNA interference and oligonucleotide microarrays.

BACKGROUND: Data on downstream effects of MEN1 gene inactivation is scarce. In an effort to identify genes regulated by MEN1, we designed a silencing experiment in a human endocrine pancreatic tumor cell line (BON1). METHODS: By using RNA interference, MEN1 mRNA expression was knocked-down by >85%. Gene expression was assessed by oligonucleotide microarrays and compared to expression in nonsilenced controls. We also investigated if genes were differentially expressed in 6 malignant endocrine pancreatic tumors (EPTs) with homozygous MEN1 inactivation compared to 2 without MEN1 gene alterations. RESULTS: Using a cut-off of > or =2 times, 66 genes were found to be upregulated, and 22 were downregulated in the MEN1-silenced clones. We corroborated the microarray findings by performing quantitative-PCR on the RNA from the silencing experiments for 7 of the 88 differentially regulated genes. Genes involved in endocrine cell fate determination, as well as genes known to be involved in NFkappaB, Notch, and Wnt signaling pathways, were among genes verified as differentially regulated in vitro. CONCLUSIONS: The demonstration of pathways affected by silencing of MEN1 in vitro provides novel insight into neoplastic processes of potential importance in vivo, which warrants further study.

Cell Line, Tumor↗

Psychoneuroendocrine influences on immunocompetence and neoplasia.

Emotional, psychosocial, or anxiety-stimulated stress produces increased plasma concentrations of adrenal corticoids and other hormones though well-known neuroendocrine pathways. A direct consequence of these increased corticoid concentrations is injury to elements of the immunological apparatus, which may leve the subject vulnerable to the action of latent oncogenic viruses, newly transformed cancer cells, or other incipient pathological processes that are normally held in check by an intact immunological apparatus. This article describes studies that examine the adverse effects of increased plasma concentrations of adrenal corticoids on the thymus and thymus-dependent T cells, inasmuch as these elements constitute a major defense system against various neoplastic processes and other pathologies. The studies demonstrate that anxiety-stress can be quantitatively induced and the consequences measured through specific biochemical and cellular parameters, providing that authentic quiescent baselines of these conditions are obtained in the experimental animals by the use of low-stress protective housing and handling techniques.

Animals↗

Cervical cytology and immunohistochemical features in endometrial adenocarcinoma simulating microglandular hyperplasia. A case report.

BACKGROUND: The histology of a few cases of adenocarcinoma simulating cervical microglandular hyperplasia (MGH-AdCa) has been reported. However, the cytologic features of MGH-AdCa in cervical smears and the immunohistochemical profile have not been described. CASE: A 73-year-old female presented with vaginal bleeding. The cervical Pap smear was initially interpreted by the cytotechnologist as "reactive endocervical cells" and was referred for cytopathologist review. The final interpretation was atypical glandular cells of undetermined significance (AGUS), probably neoplastic. Endometrial biopsy and total abdominal hysterectomy with bilateral salpingo-oophorectomy showed International Federation of Gynecologists and Obstetricians grade 1 endometrial carcinoma. The superficial component of the tumor resembled cervical microglandular hyperplasia (MGH); the deeper component had an endometrioid pattern. The Pap smear predominantly showed a glandular component with features of MGH. However, the presence of scattered single cells with hyperchromatic nuclei, one to three nucleoli, easily detectable mitotic figures, randomly scattered apoptotic bodies and focal, watery diathesis suggested a neoplastic process. Immunohistochemistry was studied on paraffin sections. In addition to other markers, the tumor cells were immunoreactive for carcinoembryonic antigen (CEA). CONCLUSION: Although the cervical Pap smear in this case had an MGH-like pattern, some features were atypical enough to suggest a diagnosis of AGUS, probably neoplastic. CEA immunoreactivity of MGH-AdCa could also help to differentiate it from MGH.

Adenocarcinoma↗

Perivascular cells harboring multiple endocrine neoplasia type 1 alterations are neoplastic cells in angiofibromas.

Although neoplasia is caused by clonal proliferation of cells, the resulting tumors are frequently heterogeneous, being composed of both neoplastic and reactive cells. Therefore, identification of tumors as neoplastic processes is frequently obscured. We studied cutaneous angiofibroma, which is a tumor of unknown etiology. Combined analysis using immunohistochemistry, selective tissue microdissection, fluorescence in situ hybridization, sequencing analysis, and deletion analysis of the multiple endocrine neoplasia type 1 locus succeeded in the identification of a population of genetically altered, neoplastic cells in these tumors. This approach may be valuable in the future in identifying the etiology of other tumors of unknown etiology.

Angiofibroma↗

Hyperplastic and neoplastic changes in the mammary glands of feral mice free of endogenous mouse mammary tumor virus provirus.

Laboratory colonies of feral mice (Mus musculus domesticus) have been established with specific mouse mammary tumor virus (MuMTV) genotype, including colonies lacking any proviral DNA (ev-) or carrying only a single copy of MuMTV DNA (ev+). No evidence of a decline in reproductive capacity has been observed in the first 8 generations. Both the ev- and ev+ mice showed normal mammary gland development and the development of hyperplastic lesions in the older females. The mice were very resistant to spontaneous or chemically induced mammary tumors. However, the occurrence of 1 mammary tumor in an ev- mouse indicates that mammary neoplasias can occur in the absence of MuMTV DNA. The few tumors that do occur in the ev- mice provide a unique opportunity to study the neoplastic process in the absence of proviral DNA.

Animals↗

Diffuse alveolar injury in two dogs.

Proliferative interstitial pneumonia of undetermined cause was diagnosed in 2 dogs. The clinical signs in both dogs consisted primarily of acute onset, rapid breathing, and raspy lung sounds. Radiography revealed a diffuse increase in pulmonary alveolar density. In both dogs, the primary pathologic process was diffuse alveolar pneumocyte injury, and the pulmonary lesions were similar. Proliferation of type II pneumocytes (some of which were atypical mononucleated, and others multinucleated) was a prominent feature of the interstitial pneumonia. Because of the atypical features of some pneumocytes in such cases, biopsy findings may suggest a neoplastic process. Proliferative interstitial pneumonia should be included in the differential diagnosis of a diffuse pulmonary disease that is poorly responsive to medical treatment.

Animals↗

The effect of vitamin C on the hamster cheek pouch treated with the water soluble carcinogen 4-nitroquinoline-1-oxide (4NQO).

Vitamin C is an essential nutrient whose protective influence is carcinogenesis has been reported frequently, suggesting that vitamin C inhibits the formation of some carcinogens and decreases the incidence and delays of the neoplastic lesions. However, the mechanisms by which this occurs are unknown. In this study, the water soluble carcinogen 4-nitroquinoline-1-oxide (4NQO) has been used to induce a high yield of tumours in the oral cavity either singly or in combination with tobacco. Since the mucosa of rats is less susceptible to carcinogens than the hamster cheek pouch, the hamster cheek pouch has been used to study the influence of vitamin C on 4NQO-induced oral malignancy. The aim of this study was to determine whether topically applied vitamin C had an effect on the oral carcinogenesis induced by application of 4NQO. Similarly, an attempt was made to study the modulating effect of vitamin C on the histopathological and ultrastructural changes during the neoplastic process in the hamster. Vitamin C appeared to delay tumour induction and had other protective effects against neoplasia.

4-Nitroquinoline-1-oxide↗

Epstein-Barr virus-induced transformation of cutaneous plasmacytoma into CD30+ diffuse large B-cell lymphoma.

A unique, previously unreported case of transformation of cutaneous plasmacytoma into CD30+ large B-cell lymphoma is described. Both neoplastic components were immunophenotypically distinct. The plasma cells were CD20-, CD30-, CD43+, CD45+, lambda +; the blasts were CD20+, CD30+, CD43-, and CD45-. The large B-cell lymphoma has gradually become a predominant component of the neoplastic nodules. While plasma cells and blasts were both positive for Epstein-Barr virus-encoded nuclear RNAs (EBER-1), the EBV-latent membrane antigen 1 (EBV-LMP1) was expressed only in the minority of the blasts and not in the plasma cells. The neoplastic process has remained confined to the skin for more than six years since its development.

Aged↗

Involvement of the X chromosome in non-Hodgkin lymphoma.

Gain of an X chromosome is observed as a secondary, acquired karyotypic alteration in a significant proportion of malignant lymphomas. To determine the potential involvement of X-linked genes in neoplastic development, we have analyzed the inactivation status of the supernumerary X chromosome in lymphomas in both male and female patients. In males, neither methylation of FMR1 nor expression of XIST was detected, demonstrating that the duplicated chromosome was not subject to inactivation. In females, both expressed polymorphisms and polymorphisms associated with methylation differences between the active and inactive X chromosome were analyzed to determine whether the duplicated chromosome was active or inactive. To facilitate this analysis, allele-specific PCR primers were designed for detection of previously described polymorphisms in the IDSX and G6PD genes. The female lymphomas were shown to be clonal in origin, and duplication of either the active (5 cases) or inactive (4 cases) X chromosome was observed. Correlations between clinical status and the inactivation status of the X chromosome involved in the duplication were not observed in our relatively small sample, although 4/4 informative cases with a t(14;18) showed duplication of the active X chromosome. In the course of these studies, we detected hypermethylation of the androgen receptor (AR) locus in an extremely high proportion of both male (7/9) and female (9/10) samples. These results are discussed with respect to whether sex chromosome aneuploidies in tumors are involved in, or simply the result of, the neoplastic process. Genes Chromosomes Cancer 28:246-257, 2000.

Adult↗

[Rhabdomyosarcoma at site of pacemaker implantation].

BACKGROUND: Malignant proliferation at the site of implantation of a pacemaker generator is uncommon. We report the case of a patient who developed rhabdomyosarcoma. CASE REPORT: A 85-year-old man presented with a voluminous and rapidly evolving tumor localised beneath the right clavicle. This inflammatory and necrotic lesion developed on the area where a titanium pacemaker had been implanted five years earlier. Rhabdomyosarcoma was diagnosis on the basis of immunohistochemistry findings. In spite of a wide surgical excision of this primitive tumour, visceral dissemination appeared, rapidly leading to the patient's death. DISCUSSION: This observation rises the question of the role of the pacemaker implantation in tumor development. The excellent in vivo tolerance and the widespread utilization of titanium as biomaterial is an argument against its carcinogenic action. Inversely, a metal-related chronic inflammatory reaction could favor the neoplastic process in predisposed subjects as has been observed with prosthetic materials used in orthopaedics.

Aged↗

Elevated expression of Unph, a proto-oncogene at 3p21.3, in human lung tumors.

The murine Unp proto-oncogene encodes a nuclear ubiquitin protease whose overexpression leads to oncogenic transformation of NIH3T3 cells. We have cloned cDNAs originating from the human homolog of this gene, designated herein as Unph (Unp, human), and have used these cDNAs to map the gene to 3p21.3, a region frequently rearranged in human tumor cells. Unph mRNA levels are consistently elevated in small cell tumors and adenocarcinomas of the lung, suggesting a possible causative role for the gene in the neoplastic process.

3T3 Cells↗

Proto-oncogene activation in rodent and human tumors.

The transformation of a normal cell into a tumorigenic cell involves both the activation and concerted expression of proto-oncogenes and inactivation of suppressor genes. The activation of ras proto-oncogenes represents one step in the multistep process of carcinogenesis for a variety of rodent and human tumors. This activation is probably an early event in tumorigenesis in many cases and may be the 'initiation' event in some cases. Thus, a chemical that induces rodent tumors by activation of ras proto-oncogenes can potentially invoke one step of the neoplastic process in humans exposed to the chemical. Moreover, dominant transforming oncogenes other than ras have been detected in human tumors as well as rodent tumors. The involvement of these putative proto-oncogenes in the development of neoplasia is unclear at present.

Animals↗

Electrodiagnostic approach to the patient with suspected brachial plexopathy.

Of the four major PNS plexuses, disorders of the brachial plexus are encountered far more frequently than those of the others. The EDX examination is probably the best procedure available by which to evaluate brachial plexus lesions. It provides localizing, pathologic, pathophysiologic, severity, and prognostic information. By localizing the lesion and identifying the underlying pathophysiology, it often predicts the underlying etiologic process; for example, (1) major T1 APR involvement with true neurogenic thoracic outlet syndrome; (2) C8 APR involvement with postmedian sternotomy brachial plexopathies; (3) supraclavicular demyelinating conduction block with classic postoperative paralysis (often confined to the upper plexus); (4) widespread infraclavicular demyelinating conduction blocks with radiation plexopathy; (5) severe progressive axon loss with neoplastic processes; (6) motor NCS abnormalities exceeding sensory NCS abnormalities for the same peripheral nervous system segment with intraspinal canal lesions (e.g., avulsions); (7) demyelinating conduction block with sparing of the pertinent sensory NCS study with multifocal motor neuropathy; and (8) lack of EDX abnormalities with hysteria, conversion reactions, and malingering, as well as with disputed neurogenic thoracic outlet syndrome. In addition, incorrect clinical considerations may be excluded (e.g., when abnormal SNAPs are identified, an isolated radiculopathy is excluded). Among the various EDX study components, the sensory NCS are the most useful for brachial plexus element localization. One drawback of the sensory NCS for localization occurs in the setting of concomitant carpal tunnel syndrome; the latter negates the utility of the median sensory NCS for brachial plexus localization. The motor NCS and NEE often overcome this drawback and, regardless of sensory NCS findings, are always performed.

Brachial Plexus↗