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MR imaging with STIR technique and air insufflation for local staging of bladder neoplasms.

Fifty-six patients with bladder carcinoma were studied with MR imaging for the assessment of the local stage, using the inversion recovery pulse sequence with fat suppression (STIR) with air in the bladder. With this technique images of the inner and the outer parts of the bladder wall were obtained, showing high contrast between the latter and the tumor (tumor/muscle contrast 89.9%). Four tumor stages were recognized: superficial neoplasms (Tis, Ta, and T1), partial wall infiltrating neoplasms (T2); total wall infiltrating neoplasms (T3a, T3b), and neoplasms involving other pelvic organs (T4). MR imaging was compared with histopathologic diagnosis obtained at transurethral resection or cystectomy. True-positive diagnosis was obtained in 80.4%; false-positive in 14.3% of cases; false-negative in 5.3%. Despite the relatively high incidence of overstaged neoplasms, STIR technique combined with air in the bladder allowed a good accuracy in local staging.

Adult↗

[Treatment results in external and middle ear malignant neoplasms of patients treated at the Laryngology Department of Medical University of Silesia between 1991-2001].

The authors present 18 patients with malignant neoplasms of the ear and temporal bone who were treated in the Clinic of Laryngology Medical University of Silesia in Katowice in the years 1991-2001. The most frequent was squamous cell carcinoma (11 patients--61%). The neoplasm was located on the auricle in 7 patients (39%), in the external auditory canal in 4 (22%) patients, in the middle ear in 5 patients (28%) and in 2 cases (11%) it was difficult to establish primary site. Ten patients (55.5%) were treated in stage T4. All patients had surgery and in advanced cases the radiotherapy was added. The best outcomes were in auricular neoplasms. The treatment results were much worse in neoplasms of the external auditory canal and the middle ear. Over 3 year follow-up in 10 patients (55%) with ear and temporal bone neoplasms shows no recurrence.

Adult↗

Pathology of esophageal neoplasms and associated proliferative lesions induced in rats by N-methyl-N-benzylnitrosamine.

Multiple squamous cell neoplasms of the esophagus were induced in 24 inbred F344 rats by sc injection of N-methyl-N-benzylnitrosamine at a dose level of 2.5 mg/kg weekly for 20 weeks. All of these rats also developed papillomas, 67% developed pedunculated papillary carcinomas, and 63% developed carcinomas that invaded the wall. Of 191 total neoplasms, 66% were papillomas, 17% were papillary carcinomas, and 17% were carcinomas that invaded the wall. The neoplasms were well differentiated with various degrees of keratinization. Anaplastic areas were found in most lesions, but were more common in carcinomas. Neoplasms that invaded the wall were sessile, with prominent intraluminal growth, or infiltrating, with predominant intramural growth. Penetration through the wall was observed, but neither metastases nor invasion of adjacent tissues was found. In addition to neoplasms, atypical endophytic proliferation of basal and spinous cells was observed in some of these rats. Proliferative or neoplastic changes were not observed outside the upper gastrointestinal tract.

Animals↗

[The concentration of ferritin in blood serum of patients with neoplasms of the larynx and the maxillary-ethmoidal complex].

The increased level of ferritin is known as a nonspecific marker of inflammatory processes and neoplasms. A purpose of the article was to indicate concentration of ferritin in blood serum before treatment of 33 patients with cancer of larynx and 16 patients with malignant neoplasms of maxillo-ethmoid complex. The patients with cancer of larynx were characterized by significantly high level of ferritin in comparison to patients with malignant neoplasms of maxillo-ethmoid complex (p < 0.05) and to healthy people (p < 0.05) (respectively 241.9 +/- 154.9; 106.9 +/- 45.4 and 125.0 +/- 30.4 ng/ml). Contrary to patients with cancer of larynx patients with malignant neoplasms of maxillo-ethmoid complex did not differ in significant level of ferritin from healthy people. The concentration of hemoglobin in blood in both groups of patients was similar and was characteristically lower than values obtained in healthy people. The results achieved suggest that indicating of ferritin can be helpful while making a differentiation between cancer of larynx and malignant neoplasms of maxillo-ethmoid complex.

Aged↗

Pelvic neoplasms in children.

The pelvis of the infant and child has different anatomic relationships than the adolescent or adult pelvis, and the knowledge of congenital anomalies of the rectum and bladder can assist in treating the primary neoplasms of the pelvis. The most common neoplasms are rhabdomyosarcomas of the bladder, prostate, and vagina; sacrococcygeal teratoma; and the germ cell tumors, including teratomas, endodermal sinus tumors, and the choriocarcinomas. Rapidly improving chemotherapy for all of these lesions has resulted in a changed role for the surgeon. Less radical resection of these tumors is being performed whereas it is necessary to have more precise histologic and genetic identification of the tumor and the specific anatomic location and extent of the tumor in the pelvis. Survival for all types of childhood pelvic neoplasms has improved dramatically under the influence of the combined children's cancer study groups, which have been functioning for the last 20 years. Because of the complexities of diagnosis and treatment of these pelvic neoplasms in childhood and because the survival rates have dramatically improved with the most current therapy, these children should be cared for in a children's center that is part of the major children's cancer study groups.

Child↗

Epidemiology of gynaecological and female breast neoplasms in Papua New Guinea.

The incidences of gynaecological and female breast neoplasms in Papua New Guinea (PNG) and in various other developing and developed countries for the period 1958 - 1980 are analysed and compared. In PNG gynaecological and breast carcinomas constituted 24.5 and 9% respectively of all neoplasms registered in females. The commonest gynaecological neoplasms registered were cervical carcinoma (62%) followed by carcinoma of the ovary (20.3%), carcinoma of corpus uteri (6.5%), carcinoma of the vulva (5%), choriocarcinoma (4.7%) and carcinoma of the vagina (1.2%). The mean annual incidence rates for carcinoma of the cervix was 3/100,000, for carcinoma of the ovary 1/100,000 and for carcinoma of the corpus uteri 0.32/100,000 females respectively; for carcinoma of the breast it was 1.26/100,000. The mean age of patients with these neoplasms was less than in developed countries and in most developing countries. Possible reasons for the low incidence rates are presented.

Adolescent↗

Multiple primary neoplasms of the anogenital region.

The anogenital region, comprising the cervix, vagina, vulva, perineum, and anus, has the potential for the development of multicentric and multiple primary malignancies. Fifteen patients with 3 or more primary neoplasms in this region are presented. Awareness of the existence of these tumors as a regional disease and the possible long intervals between successive malignancies are emphasized. The presence of a vulvar neoplasm should arouse suspicion of a synchronous primary tumor elsewhere in the region. Conversely, sequential neoplasms occur more commonly after an initial cervical primary neoplasm and should be anticipated.

Adult↗

Swine lymphoid and myeloid neoplasms in Italy.

In the decade 1973-1982, data from all the principal diagnostic centers in Italy reveals that swine lymphoid and myeloid neoplasms (LMN) have been observed only few times (78 cases). In a 25-year period (1950-1984) 48 cases were diagnosed in our Institute, among which all the known forms of LMN, including the most uncommon such as multiple myeloma (1) and myeloid forms (4) including 1 chloroma and 1 erythraemic neoplasm. The incidence remains low; 1.17% of the diseased swine sent for necropsy, with no significant increase during the years. In the same period the incidence of other neoplasms was 1.14%. Also the data from the abattoir of Bologna confirm a low incidence: in the last 2 years lymphoid neoplasms were observed only twice among 130,000 slaughtered pigs (15 cases per million). This incidence is therefore similar to that noticed in slaughterhouses in other European countries and in the U.S.A. As for the anatomohistopathological features, lymphosarcoma presents a constant autochthonous production of immature collagen fibrils, but the degree of this production has no significant relation with either the macroscopic type of lesions, nodular or infiltrating (diffuse), or the level of cellular differentiation. Diffusely haemorrhagic lesions were observed in a relatively high percentage (14%) of lymphosarcomas. The incidence of myeloid neoplasms is relatively high compared with that of lymphosarcomas: from 5% of Italian cases as a whole to 14% of the cases studied in our Institute. This confirms that the pig is second to the dog as a domestic animal showing most of these myeloid neoplasms.

Animals↗

Optimal primer selection for clonality assessment by polymerase chain reaction analysis. III. Intermediate and high-grade B-cell neoplasms.

Previous studies have reported that low-grade B-cell lymphoproliferative disorders have variable B-cell monoclonality detection rates by polymerase chain reaction (PCR) analysis. For instance, monoclonal B-cell populations from chronic lymphocytic leukemia/small lymphocytic leukemia and mantle cell lymphoma are most often readily amplified with a single primer pair, whereas follicular lymphomas and plasma cell neoplasms require alternative strategies to approach these higher diagnostic sensitivity standards. Because most published reports have not focused on the variation in PCR B-cell monoclonality detection among subtypes of intermediate and high-grade B-cell neoplasms, additional information is necessary to determine primer selection strategies and identify problematic tumor subtypes within this group. The current investigation, the third part in a series, was aimed at documenting the efficiency of B-cell monoclonality detection by PCR in 71 aggressive B-cell neoplasms of various types using a comprehensive approach. A predetermined panel of primer sets was used in an algorithmic fashion. Specifically, all samples were analyzed with the standard VH-FRIII/JH assay previously shown to have the highest efficiency of monoclonality detection within low-grade B-cell lymphoproliferative disorders. Negative samples were further evaluated with primer sets in the following order until a positive result was observed, or all primer sets were used: (1) bcl-2/JH, (2) VH-FRI family specific/JH, and (3) VH-FRI consensus/JH. Forty-three (61%) of the 71 B-cell neoplasms evaluated with VH-FRIII/JH showed monoclonal B-cell populations. Sequential use of the three reserve primer sets in samples negative with this initial primer pair resulted in an overall improvement in PCR detection from 61% to 82% (58 of 71 specimens) (P < .001). The VH-FRI family specific assay identified B-cell monoclonality in 11 (73%) of these 15 specimens and was the most productive reserve primer set. Individual categories exhibited the following initial (I) and final (F) PCR detection rates: acute lymphoblastic leukemia/lymphoblastic lymphoma, 11 specimens (I = 91% to F = 91%); small noncleaved cell lymphoma, 14 specimens (I = 79% to F = 86% [P > .25]); diffuse large cell lymphoma, 33 specimens (I = 52% to F= 85% [P < .005]) and large cell, immunoblastic lymphoma, 13 specimens (I = 38% to F = 62% [P < .01]). The authors have shown that comprehensive PCR analysis is capable of detecting B-cell monoclonality in a significant proportion of samples from each subtype of intermediate and high-grade B-cell neoplasm. The VH-FRIII/JH assay was an adequate initial primer set, but required augmentation with the reserve PCR assays to attenuate the false negative rate and improve diagnostic sensitivity. The B-cell clonality PCR assay is optimally used as a screening tool and when used in this fashion, the more laborious and time-consuming restriction fragment-Southern blot hybridization (RF-SBH) method for IgH gene rearrangement detection may be limited to a relatively small proportion of PCR-negative aggressive B-cell neoplasms.

Algorithms↗

Epstein-Barr virus-positive B-cell lymphoproliferative disorders arising in immunodeficient patients previously treated with fludarabine for low-grade B-cell neoplasms.

We describe five patients with treated low-grade B-cell neoplasms who subsequently developed Epstein-Barr virus (EBV)-positive B-cell lymphoproliferative disorders (BLPDs). The low-grade B-cell neoplasms were B-cell chronic lymphocytic leukemia in four patients and splenic marginal zone lymphoma in one patient. All patients had received treatment with fludarabine for the low-grade B-cell neoplasm, and three had also received Campath-1H. The EBV-BLPDs arose 2-12 months after completion of fludarabine therapy and morphologically resembled the EBV-BLPDs that occur in the setting of iatrogenic immunodeficiency. Molecular genetic studies showed that these lesions were clonally distinct from the low-grade B-cell neoplasm in three of four cases assessed. Two patients did not receive therapy for the EBV-BLPD. The lesions regressed spontaneously in both patients but recurred in one. One patient underwent surgical excision and remains without evidence of the EBV-BLPD. One patient received aggressive multiagent chemotherapy with a complete response initially, but the EBV-BLPD recurred after 12 months. One patient received antiviral therapy and responded completely but died 2 months later of an opportunistic infection. We conclude that patients with low-grade B-cell neoplasms treated with fludarabine, possibly in combination with other immune suppressive agents, may subsequently develop EBV-BLPDs that morphologically resemble other iatrogenic immunodeficiency-associated BLPDs. Most are clonally distinct from the underlying low-grade B-cell neoplasm. A subset of these lesions may regress without systemic therapy.

Antineoplastic Agents↗

Increasing age is associated with faster progression to neoplasms but not opportunistic infections in HIV-infected homosexual men.

OBJECTIVE: To characterize the associations of age and progression rates to AIDS-defining neoplasms and opportunistic infections (OI) in HIV-infected homosexual men. METHODS: Data from 407 homosexual men with documented dates of HIV seroconversion participating in cohort studies from four geographic locations were merged. Kaplan-Meier and Cox proportional hazards analyses were conducted with respect to the association of age with time from seroconversion to the first AIDS-defining neoplasm and OI. RESULTS: Among the 407 participants, 139 (34%) were diagnosed with AIDS; 45 (11%) with neoplasms and 90 (22%) with OI. Older age at seroconversion was significantly associated with faster progression to neoplasms, but not to OI. For each 10-year increase in age the risk for neoplasms increased 1.65-fold [95% confidence interval (CI), 1.12-2.43], after adjustment for clinical treatments. For OI this risk estimate was 0.98 (95% CI, 0.72-1.34). CONCLUSIONS: Increasing age is associated with faster progression to AIDS-defining neoplasms, but not with progression to OI. This has not been previously reported and may explain conflicting results in other studies among homosexual men that considered AIDS as a single entity. Our findings suggest that age and AIDS manifestations should be considered, particularly in the context of natural history studies, clinical trials and mathematical modelling.

AIDS-Related Opportunistic Infections↗

Progress in the classification of hematological neoplasms. From REAL to WHO concept

Recent advances in immunology, molecular biology and cytogenetics as well as the development of new diagnostic techniques set out the necessity for the redefinition and reclassification of hematological malignancies. Therefore, WHO in 1995 assigned the Society of Hematopathology and European Association for Hematopathology to create a new classification of these neoplasms. The result of collaborative efforts of leading hematopathologists from both organizations is the World Health Organisation (WHO) classification of hematological neoplasms. WHO classification adopted basic concepts, defined criteria introduced by REAL classification of lymphoid neoplasms and extended them to myeloid, histiocytic and mastocytic neoplasms. WHO classification of hematological neoplasms is represented by a list of disease entities and its variants, opened for inclusion of new entities, updating of diagnostic criteria and changes of nomenclature. The clinical relevance of the proposed entities has been evaluated by the clinicians, members of Clinical Advisory Committee. The proposed classification is a challenge to the clinicians to create new treatment strategy, directed towards particular disease entities. The presentation of WHO classification in our review is limited to myeloid and lymphoid neoplasms.

Journal Article↗

Rearrangements of T-cell antigen receptor delta chain gene in hematologic neoplasms.

Rearrangements of the T-cell antigen receptor (TCR) delta chain gene were studied in primary neoplastic cells from 137 patients with leukemia or lymphoma. TCR delta gene rearrangements or deletions were observed in all 50 T-cell neoplasms: 5 of 8 CD3- T-cell neoplasms showed rearrangements, whereas biallelic deletion of TCR delta gene was the most common pattern in CD3+ T-cell neoplasm (39 of 42 patients). Rearrangements of TCR delta gene were also detected in 23 of 40 immature B-cell leukemias, including 22 of 25 patients with rearrangements of TCR gamma gene, 2 of 17 mature B-cell neoplasms, and 3 of 30 myeloid leukemias. Thus, TCR delta gene rearrangement or deletion is always found in T-cell neoplasms and is frequently found in immature B-cell leukemias associated with TCR gamma gene rearrangement. Furthermore, TCR delta gene rearrangements associated with the germline configuration of the TCR beta, gamma, and immunoglobulin heavy chain genes were observed in two immature T-cell leukemias, suggesting that TCR delta gene rearrangements precede TCR gamma and beta gene rearrangements. These results indicate that an analysis of TCR delta gene rearrangement provides potential tools to establish the clonality of immature T-cell neoplasms and to identify the normal stages of lymphocyte differentiation.

Antigens, CD↗

"Well-differentiated" lymphocytic neoplasms. Immunologic findings correlated with clinical presentation and morphologic features.

The authors studied 48 cases of well-differentiated lymphocytic neoplasms using a panel of monoclonal antibodies applied to frozen sections. Forty-seven tumors expressed monotypic immunoglobulin, one or more B-lineage antigens, and Ia (HLA-DR) antigen. Proliferation centers expressed the T9 antigen and increased numbers of Ki-67-positive cells. One tumor was of T-cell origin, had a cytotoxic/suppressor cell phenotype, and showed anomalous loss of Leu-1 antigen. Immunophenotypic findings were correlated to the clinical presentation and morphologic features of each neoplasm. Sixteen tumors were associated with peripheral lymphocytosis (greater than 4000/cu mm), 13 biopsies were obtained from extranodal sites, 16 tumors had proliferation centers, and 11 neoplasms had plasmacytoid features. The authors found no absolute and few statistically significant immunologic differences between the B-cell tumors according to their clinical presentation or morphologic features. Tumors associated with peripheral lymphocytosis more commonly expressed the Leu-1 antigen (P less than 0.01) and IgD (P less than 0.01) and less frequently were stained by BA-2 (P less than 0.05) and OKT9 (P less than 0.05). Plasmacytoid neoplasms more frequently expressed the Tac (P less than 0.01) and T9 antigens (P less than 0.05), and all expressed kappa light chain (P less than 0.05). Extranodal neoplasms more commonly expressed IgM (P less than 0.01). In contrast to the markedly different clinical presentation and morphologic appearance these tumors may have, the immunologic data suggest that B-cell small lymphocytic neoplasms are relatively homogeneous. For an individual case, immunophenotype does not predict clinical presentation or morphologic features.

Aged↗

The role of morphologic features, phenotype, genotype, and anatomic site in defining extranodal T-cell or NK-cell neoplasms.

Excluding mycosis fungoides, almost one third of T-cell lymphomas arise as primary tumors in extranodal sites, and these lymphomas are biologically different from their nodal counterparts. The revised European-American classification of lymphoid neoplasms and the World Health Organization classification have emphasized the importance of site in defining T-cell neoplasms and have included such new categories as hepatosplenic gamma delta T-cell lymphoma, subcutaneous panniculitis-like T-cell lymphoma, nasal and nasal-type T-cell lymphoma, enteropathy-type intestinal T-cell lymphoma, and primary cutaneous anaplastic large cell lymphoma. Although site is important, different lymphomas may occur at a particular location, and multiple parameters are required to define each type precisely. Cytologic features usually are not specific, and there are no morphologic correlates, such as follicular nodulation or plasmacytic differentiation in the B-cell system, to help define T-cell neoplasms. The T-cell system is biologically complex, consisting of populations with alpha beta and gamma delta receptors and helper and suppressor/cytotoxic phenotypes. In addition, NK cells resemble T cells in antigen expression, function, and patterns of disease, adding to the difficulty in defining T-cell and NK-cell neoplasms. Therefore, a complete workup with a combination of clinical, immunophenotypic, cytogenetic, and molecular genetic studies often is necessary to characterize these neoplasms. The role of each of these parameters in the diagnosis of T-cell and NK-cell neoplasms is discussed.

Antigens, CD↗

Multiple primary neoplasms and the nervous system.

Studies of multiple primary neoplasms and their relation to the nervous system should consider two important principles: 1) neoplasms of the nervous system have certain unusual features that distinguish them from tumors occurring elsewhere in the body; and 2) there is good evidence that the various histologic types of nervous system tumors should be regarded as separate diseases. The association of nervous system neoplasms and tumors of other sites may occur in patients with phacomatoses or particular genetic syndromes. In addition, certain nervous system neoplasms may be multicentric in origin. Retinoblastoma and osteosarcoma occur together in the same patient more often than expected by chance, as do meningioma and breast cancer. These relationships are important in that they serve to identify the high risk patient, may provide etiologic clues, may point to the presence of genetic syndromes, and may highlight sites in which subsequent tumors are most likely to develop.

Brain Neoplasms↗

Incidence of spontaneous neoplasms in F344 rats throughout the natural life-span.

The age-related incidence of spontaneously occurring neoplasms and degenerative diseases in the F344 inbred rat strain was established from the histologic examination of tissues from 160 male and 192 female rats kept throughout their natural life-span. The most common neoplasms were leukemias (25%), mammary tumors (females, 40.6%; males, 23.1%), pituitary adenomas (females, 35.9%; males, 23.8%), and testicular interstitial cell tumors (males, 85%). Various less common neoplasms were observed: thyroid interstitial cell tumors, adrenocortical adenomas, carcinomas of the genitourinary tract, representative central nervous system tumors, pheochromocytomas, and tumors of mesodermal origin including mesotheliomas, myoblastomas, fibromas, and fibrosarcomas. Multiple tumor types were found in 176 of the rats; metastatic tumors were uncommon. Degenerative diseases including myocardial degeneration and nephrosis were often observed. The incidence rate of these neoplasms and degenerative diseases generally increased with advancing age of the animals.

Adenoma↗

Thymoma and multiple malignancies: a case of five synchronous neoplasms and literature review.

The presence of five discrete synchronous or metachronous primary neoplasms in a single patient is an extremely rare event. This is a report of a patient with a malignant (invasive) thymoma and four other independent primary neoplasms including: gliosarcoma, papillary thyroid cancer, meningioma and metastatic adenocarcinoma of the colon, found synchronously at autopsy. Thymoma patients appear to have an inherent predisposition towards developing additional neoplasms. Other than the thymoma, the presented patient had no obvious risk factors for neoplasia. This case provides evidence for an unusual syndrome of thymoma and multiple primary neoplasms. Further research is required to elucidate the mechanism of this association. Meanwhile, heightened awareness of this association may allow earlier detection and treatment of additional cancers in patients with a history of thymoma.

Adenocarcinoma↗