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Malakoplakia of the prostate forming a fistulous tract to rectum: a case report.

Malakoplakia is a rare lesion of granulomatous inflammation which mainly affects urinary bladder but may involve other parts of the body. Differentiation from neoplastic process is often difficult due to its tumorous gross appearance and similarity to carcinoma microscopically. Malakoplakia of the prostate is even rare. We present a case of prostatic malakoplakia masquerading as a rectal tumor due to formation of a fistulous tract to the rectal muscular layers accompanied with ulceration of the rectal mucosa. Its clinical course is different from those of most reported cases, while the outcome is as satisfactory as in usual cases.

Diagnosis, Differential↗

Activity satellite association and polymorphism of Ag stained nucleolus organizer regions (Ag+ NORs) in lymphocytes from women with cervical uterine cancer.

Thirty five female patients with different stages of neoplastic lesions: cervical intraepithelial neoplasia (CIN) or dysplasia (CIN I and CIN II), in situ carcinoma (CIS), and adenocarcinoma, and 27 healthy women (controls) were studied to determine the activity, satellite association, and polymorphism of Ag stained nucleolus organizer regions (Ag+ NORs) in acrocentric chromosomes in metaphases obtained from peripheral blood lymphocytes. For each person, 25 to 50 metaphases stained with ammoniacal silver technique were scored. The average number of Ag+ NORs was higher in women with adenocarcinoma (7.66 +/- 0.72) than in controls (6.65 +/- 0.74). Non-associated chromosomes showing Ag+ NORs were found more frequently in patients (5.85 +/- 0.88) than in controls (4.81 +/- 0.67). Patients aged 30-39 and 60 or more had an increase of Ag+ NORs (7.99 +/- 1.04, and 7.81 +/- 0.71) with respect to their controls (6.36 +/- 0.052 and 6.17 +/- 0.88), but the frequency of satellite association showed lower values in 50-59 year-old patients (0.75 +/- 0.08) than in controls (1.02 +/- 0.19). The most frequent association in patients was the large type (patients = 38.96%, controls = 30.49%). The partial association showed higher values (6.49%) than controls (2.44%). Otherwise, the spherical association was more frequent for controls (37.80%) than for patients (28.57%). All these differences were statistically significant (p < 0.05). The frequency of Ag+ NORs and the type of polymorphism of satellite association could be related to the neoplastic process, while the frequency of satellite association and of polymorphism of Ag+ NORs seems to be irrelevant.

Adenocarcinoma↗

Advances in the analysis of cerebrospinal fluid.

The laboratory examination of cerebrospinal fluid (CSF) continues to play an important role in the clinical diagnosis and treatment of various disorders of the central nervous system (CNS). The major conditions currently include, as they have in the past, infectious diseases, neoplastic processes, multiple sclerosis, other demyelinating disorders, and intracerebral hemorrhage. Recent publications suggest a variety of new laboratory tests that may be useful in the evaluation of patients with both primary and metastatic malignancies, Alzheimer's disease, Creutzfeld-Jacob disease, global ischemia, various psychiatric disorders, CSF otorrhea and rhinorrhea, and in the differential diagnosis of cortical vs lacunar stroke, among others. Examples of these recent developments and their possible clinical usefulness are discussed.

Amines↗

Imaging of otolaryngologic manifestations of HIV infection.

Patients infected with HIV have severely depressed immune function and are therefore vulnerable to many infectious and neoplastic processes. Head and neck manifestations initially were reported in approximately 40% of patients with AIDS, but in the course of HIV infection and progression to full-blown AIDS, it is now recognized that most patients have abnormalities on head and neck examination at some point in their disease. These manifestations range from relatively benign lymphoid hypertrophy or candidal mucositis to life-threatening fungal infections and high-grade lymphomas. This article reviews the spectrum of imaging findings associated with otolaryngologic diseases in this patient population.

AIDS-Related Opportunistic Infections↗

Video-assisted thoracic surgery (VATS) for cancer. Risk of parietal seeding and of early local recurrence.

Both parietal seeding and early local recurrence have been anecdotally (24 cases) reported in the surgical literature after video-assisted thoracic surgery (VATS) for cancer. However, not all the cases reported were undoubtedly related to the thoracoscopic approach itself, several of those thoracoscopic procedures addressed locally advanced neoplastic processes, and protective measures against parietal contamination were not taken in one half of the patients. Strict adherence to the classic principles of carcinologic surgery should minimize the risk of both parietal and pleural grafting after VATS for cancer.

Humans↗

Cytochemistry of nucleoproteids and some cathionic proteins in the peripheral blood leukocytes of patients with lung cancer.

In 40 patients with untreated lung cancer cytochemical studies of the peripheral blood leukocytes were conducted by means of a cytological method for the simultaneous staining of nucleoproteids (RNP and DNP) and some cathionic proteins (after Zvetkova and Zvetkov [60]). Changes were detected in the RNP cytoplasmic contents of lymphocytes, of which the most outstanding were the reduction and uneven distribution of RNP granules, their frequent extracellular expulsion by means of microclasmatoses, as well as changes in the staining of cathionic proteins of RNP accompanied by an increased nuclear chromatin condensation in the small and medium-sized lymphocytes. Parellel to reducing of the percentage of these cells in the peripheral blood of patients with advanced neoplastic disease an increased number of lymphoblastoid and monoblastoid cells is established with RNP diffusely stained, but reduced in quantity and localized in the cytoplasmic periphery and projections (compared to Downey type II atypical cells). By means of one of the variants of the method (modified type of Feulgen's reaction) a characteristic distribution and structuring of the nuclear chromatin is established in mono- and polymorphonuclear cells, most clearly expressed in the nuclei of monocytes and monoblastoid cells, as well as in nuclei of neutrophil granulocytes. In these cellular types a more specific nuclear modelling (microhypersegmentation) is observed resulting in multiple irregular nuclear projections on the nuclear surface, probably caused by subkaryolemal distribution of uneven chromatin thickenings. The changes are also recorded in the cathionic protein containing secondary cytoplasmic granules in granulocytes-neutrophils and eosinophils, probably associated with changes in the lysosomal and phagocytic functions of these cells in neoplastic diseases. The authors discuss the importance of the obtained results in connection with data on the participation of lymphocytes and neutrophils in the immune response to tumour antigenic stimuli during the course of the neoplastic process, as well as with data on the suppressive effect of antigenic (serum, viral) factors, possibly affecting the synthesis and the transport of cellular nucleoproteids (RNP and DNP) in leukocytes of cancer patients.

Blood Proteins↗

Nucleolar organizer regions (AgNORs) in intraepithelial neoplasia of the uterine cervix.

The authors have studied the AgNORs counts in intraepithelial lesions of the uterine cervix. The following values were obtained (mean +/- SD AgNORs/cell): normal specimens--2.11 +/- 0.98; mild dysplasia--2.83 +/- 1.12; moderate dysplasia--3.42 +/- 1.13; severe dysplasia--3.55 +/- 1.28; carcinoma in situ--4.63 +/- 1.34; glandular extensions of carcinoma in situ--4.64 +/- 0.98. The values in moderate and severe dysplasia were similar, an argument for grouping these categories in the high-grade lesions. AgNORs counts in carcinoma in situ were, however, higher than in severe dysplasia, suggesting a continuous evolution of the neoplastic process.

Female↗

Glutathione and glutathione metabolizing enzymes in tissues and blood of breast cancer patients.

Many reports indicate that glutathione and enzymes cooperating with it are important in neoplastic processes. Glutathione (GSH) concentrations and glutathione S-transferase (GSH STr) and glutathione peroxidase (GSH-Px) activities were determined in breast cancer tissue and adjacent healthy tissues, as well as in blood of 28 patients. There were considerable differences in the investigated parameters among individual patients. Therefore we analyzed the paired samples of normal and cancerous tissues from the same individual. In 68% of the patients the activities of GSH-Px and in 85% patients those of GSH STr were found to be higher in the tumor than in the normal tissue. GSH concentration in 48% tumor samples were higher and in 44% lower than in corresponding normal tissues. Statistically significant correlation was found between GSH-Px and GSH STr in normal (r = 0.51, p < 0.005) and in cancer tissues (r = 0.64, p = 0.001). Correlation coefficient between GSH Px activity in normal and corresponding cancer tissues was r = 0.71 (p < 0.001), however this correlation in the case of GSH STr was much lower but still significant (r = 0.38, p < 0.05). No significant correlation in the determined parameters was found between erythrocytes or plasma and normal or cancer tissues.

Adult↗

Mucocutaneous paraneoplastic syndromes.

Mucocutaneous paraneoplastic syndromes represent a group of dermatoses of variable morphology, pathology, and etiology that can occur as idiopathic conditions or in association with a visceral malignancy. These conditions can be categorized with respect to their predominant pathologic change: dermal "depositions," neutrophilic dermatoses, papulosquamous disorders, proliferative reactions, reactive erythemas, vacuolar degeneration of the basal layer, vasculitis, and vesiculobullous disorders. Some of these dermatoses occur more frequently in patients with hematologic malignancies whereas others are more prevalent in patients with solid tumors. The major clinical characteristics and commonly associated malignancies in patients with mucocutaneous paraneoplastic syndromes are reviewed. Suggested workups to evaluate for cancer in patients with these dermatoses are summarized. The appearance of a mucocutaneous paraneoplastic syndrome can either precede, occur concurrently with, or follow the detection of an associated neoplastic process. Therefore, the dermatosis can be the presenting feature of a previously unsuspected neoplasm or the earliest sign of recurrent cancer in an oncology patient. When the possibility of a mucocutaneous paraneoplastic syndrome is entertained, the diagnosis of the dermatosis should be confirmed either based on the clinical morphology of the lesions, the pathologic changes observed after lesional biopsy, or both. Once the diagnosis of a malignancy-associated dermatosis has been established, either an appropriate evaluation for an asymptomatic neoplasm in a cancer-free individual or an investigation for recurrence of malignancy in an oncology patient can be initiated.

Hematologic Neoplasms↗

[Malignant tumors of internal organs and dermatoses].

According to the author there are five possible kinds of relationship between visceral neoplasmas and diseases of the skin. 1. Instances in which neoplasma induces dermatosis (the so-called paraneoplastic diseases). 2. Instances in which defective immune mechanism or long-lasting immune suppression promote the development of neoplasma as well as of skin diseases due to microorganism and viruses. 3. Instances in which the tumor and dermatosis are associated without causal relationship. 4. Cases of malignant lymphoma arising from neoplastic proliferation of the cells of the reticulohistiocytic system involving visceral organs and the skin. 5. Skin metastases of internal neoplastic processes.

Humans↗

[Congenital granular-cell epulis. A histochemical case study].

Following a review of the literature the author reports the various different hypotheses regarding the origin and nature of congenital epulis, a pedunculated neoformation with a gingival or more rarely mandibular localisation. Epulides present dimensions varying from a few millimetres to a couple of centimetres and they may exceptionally be multiple in the same subject. A case of granulocellular congenital epulis is reported covered by integral mucosa, located in correspondence with the maximally gingiva in a paramedical site. The epulis, removed a few days after birth since it prevented the child from sucking, did not present any other pathological element and underwent optical microscope examination using hematoxylin staining, eosin, PAS, argentic impregnation according to Gomori, Masson's Trichromic, Alcian Bleu. The results are discussed in relation to the histogenesis of this rare gingival lesion: the histogenetic question is still unresolved given that even the ultrastructural tests performed by various authors have yielded discordant results. The hypothesis of an hamartomatous nature of the epulis is however more plausible than the hypothesis of a neoplastic process in the strict sense of the term.

Female↗

[En block hysterectomy. Institutional experience of 6 years].

On block hysterectomy is defined as the removal of the gravid uterus with its gestational content in situ. The described indications for the realization of this procedure are neoplastic process as the most frequent cause; septic process, persistent trophoblastic diseases, and hemorrhage due to anomalous placentation. This is a retrospective, descriptive study of twelve cases of on block hysterectomy collected from January 1989 to December 1994 at Instituto Nacional de Perinatología. An average age of 33.4 years was found. The number of pregnancies for this patients in average was found to be 4.1. The gestational age was established between 9 to 29 weeks. Four patients with a 4 or more previous miscarriage background. There were two reported cases having a multiple gestation. Among the complications found, there were three cases of hipovolemic shock and one with abcess of vaginal cupula. The average days of hospitalization was 5.3 days. We found no mortality at all in this study, and the histopathologic correlation accorded in 100% of the cases. In this five year review, 12 cases of on block hysterectomy were found, being the most frequent reason for it's realization the persistent trophoblastic diseases; severe hemorrhage in second place, and serious infection process in third. The observed complications were derived from the hemodynamic compromise of each patient. Even though on block hysterectomy is one rarely seen procedure, it most be in mind as an alternative therapeutical instance it most be carried out in third level institutions, with technology and human resources capable of solving any complication derived from this kind of surgery.

Abortion, Induced↗

[Slow-resolution pneumonia: radiologic and tomodensitometric features].

To assess the radiologic findings of unresolving pneumonias (radiologic signs not normalized at the end of the fourth week of antibiotic therapy), the radiologic (192) and CT examinations (33) of 50 patients were reviewed, for a total of 64 pulmonary parenchymal lesions. These lesions presented as masses (3; 4.6%), parenchymal thickenings with aerial bronchogram (41; 63.7%), sometimes escavated (4; 10%), alveolar ground glass alterations (4; 6.2%), more frequent on the right side (49; 73%), mostly in the upper lobe (21; 32.8%). Pleural effusion was demonstrated in 16 patients (32%) and lymphadenopathies were shown in 8 patients (8%). When possible, the responsible germ was isolated with microbiological expectoration test (14; 35.3%), bronchoscopy associated with bronchoalveolar lavage (7; 37.5%) and needle biopsy in the mass (2; 5%). The germs were Candida (9), haemophilus influentiae (1), Klebsiella (1), pneumococcus (1), Pseudomonas (3), Staphylococcus aureus (4), streptococcus alpha hemoliticus (6). There are no typical radiologic and CT findings for the described lesions in different-patients and different germs can produce the same changes. Therefore, pulmonary inflammations must be followed to their complete resolution, to rule out the chance of a neoplastic process (obstructive pneumonia). The first radiologic control must be made at least 15 days after the beginning of therapy for the anatomo-pathologic processes of recovery to show radiographically. CT can be fundamental in the differential diagnosis with neoplasm, in unresolving pneumonia, to study the tracheobronchial tree, to study lymphadenopathies and to guide needle biopsy.

Adult↗

Identification of a new P-glycoprotein-like ATP-binding cassette transporter gene that is overexpressed during hepatocarcinogenesis.

The liver is remarkably insensitive to a variety of cytotoxins and expresses a number of known drug resistance genes. To isolate new P-glycoprotein (Pgp)-related genes, we screened a normal rat liver cDNA library at low stringency with a MDR1 cDNA fragment containing the P-loop and ATP binding site. We isolated a novel cDNA closely related to the Pgps that is dramatically increased in hepatic neoplasia and refer to it as P-glycoprotein-related protein (PRP). The predicted protein shows PRP to be a member of the ATP-Binding Cassette (ABC) family of proteins, and a multisequence comparison of the nucleotide binding domain and the ABC family signature sequences reveals that PRP sequences are highly conserved with the greatest similarity to the yeast heavy metal transporter encoded by hmtl. However, the hydropathy plot analysis suggests that PRP does not have any prominent membrane-spanning domains and thus is not typical of ABC transporters. The PRP transcript is detected in many normal tissues. In the H35 hepatoma cell line, PRP was overexpressed compared to normal liver. Southern blot analysis of DNA from the H35 rat hepatoma cells reveals that the PRP gene was amplified compared to normal liver. The orotic acid model of hepatocarcinogenesis was used to determine if during stepwise progression to liver cancer, PRP changed with hepatocarcinogenesis. At the hyperplastic nodule stage, PRP expression was increased over its expression in normal surrounding liver. More dramatic increases in PRP expression were found in frank hepatic carcinomas. Cumulatively, these studies are the first to link a novel ABC family member to the hepatic neoplastic process, a role that may be recapitulated in other cells, considering the ubiquitous expression of PRP.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

[GnRH analogs for treatment of ovarian cancer].

To make use of antigonadotropin and antiproliferating action of the synthetic analogs of GnRH there was applied this decapeptide in 33 patients with ovarian cancer who were treated traditionally by chemotherapeutics PAC and radiotherapy. The monitoring of treatment was supported on the clinical opinion of the whole and locally state of health, the USG examinations of pelvic and diaphragm, the measure of level of CA-125 and second-look operations. There were got statistically characteristic rise of remissions and stabilizations of neoplastic process.

Adult↗

Cancer chemotherapy in the older patient: what the medical oncologist needs to know.

This review explores the effectiveness and safety of cancer chemotherapy in older individuals and outlines potential guidelines for the management of these patients. Cancer chemotherapy appears less effective in three neoplasms of older individuals: acute myelogenous leukemia, large cell lymphoma, and coelomic carcinoma of the ovary. In the case of acute myelogenous leukemia, a higher prevalence of MDR-1 expression and involvement of the pluripotent hematopoietic stem cells in the neoplastic process contribute to chemotherapy resistance. Chemotherapy-related myelodepression, cardiotoxicity, and peripheral and central neurotoxicity are more common and more severe in older individuals. This toxicity results from the increased vulnerability of target organs and delayed excretion of renally excretable agents. The complications of chemotherapy may be ameliorated by modifying the doses of drugs according to the patient's creatinine clearance, by using antidotes to drug toxicity, and by the early diagnosis and timely management of therapeutic complications. A comprehensive assessment of the older person with cancer allows clinicians to predict the benefits and risks of cancer chemotherapy in individual circumstances.

Aged↗

B lymphocytes from patients with chronic lymphoproliferative disorders are equipped with different costimulatory molecules.

Several costimulatory molecules play a key role in the differentiation of B lymphocytes and in T-B-cell interactions. In this study, we addressed the question of whether different receptors and counter-receptors may be expressed on malignant B lymphocytes from chronic B-cell malignancies. Using flow cytometry and reverse transcription PCR analyses, the expression of molecules belonging to the tumor necrosis factor receptor (TNFR) and tumor necrosis factor ligand (TNFL) families, as well as the expression of CD80 and CD86 molecules, was analyzed in normal B cells and in different chronic lymphoproliferative disorders of B-cell type, including B-cell chronic lymphocytic leukemia (CLL), mantle cell lymphoma, hairy cell leukemia (HCL), and HCL variant. Different patterns of expression of TNFR and TNFL superfamily molecules were demonstrated among B-cell malignancies. In particular, CD40 was commonly observed on all B cells (both tumor and normal), whereas its ligand (CD40L), which is usually undetectable on resting normal B lymphocytes, was expressed in CLL and HCL but not in other chronic lymphoproliferative disorders. CD27 was not shown in normal B cells, although it was present in all malignancies and with particularly high density in mantle cell lymphoma. CD70 was widely distributed on tumor B lymphocytes, but not on the CD5+ normal counterpart. CD30 was strongly expressed in HCL variant and weakly in B-cell CLL, whereas its ligand showed a wide pattern of expression, including all neoplastic and normal B cells. TNFR II (CD120b) and CD80 were distributed on neoplastic B cells from all groups, usually at an intermediate to high degree of intensity, whereas the CD86 molecule was present at lower intensity than CD80. Finally, reverse transcription PCR analysis confirmed the presence of CD40L, CD30, and CD30L mRNAs in those B cells expressing the corresponding membrane-bound proteins at low density. Our data indicate that TNFR and TNFL molecules are of use clinically both in differentiating B-cell malignancies from the normal counterpart (i.e., CD27, CD70, CD40L, CD30, and CD80) and in defining different chronic B-cell disorders (i.e., CD40L, CD27, and CD30). Interestingly, the observation that several receptors and their ligands (i.e., CD40/CD40L, CD30/CD30L, and CD27/CD70) can be expressed on the same cell suggests that these molecules play a role in initiating and maintaining the neoplastic process by mediating B-T and B-B interactions.

Adult↗

[Muscular metastasis in a patient with adenocarcinoma of the colon. An infrequent complication].

Muscular metastases are unusual. Primary neoplasm use to be breast or lung, although any neoplastic process can have muscular metastatic potential. The usual location in psoas and paravertebral muscles. For its diagnosis we need a high index of suspicion, and can be helpful, electromyography and magnetic nuclear resonance. The follow up of a patient with colon adenocarcinoma and muscular metastases and a review of the subject is presented.

Adenocarcinoma↗