ABSTRACT
Objective: The incidence of prostatic adenocarcinoma in Thailand has been increasing since 1989. Increased public awareness may have contributed to early detection of the disease. Findings of abnormal digital examination, elevated serum prostate-specific antigen (PSA) level and abnormal transrectal ultrasonography (TRUS) lead to more multiple core biopsies. The Gleason grading system is the most common histologic grading of prostate carcinoma as approved by the World Health Organization. The Gleason score, one of the prognostic predictors, thus plays an important part in the therapeutic decision. The correlation between Gleason scores in biopsies and subsequent prostatectomy specimens is the main purpose of this study. Associations of Gleason scores with organ confinement, perineural invasion and serum PSA levels before prostatectomy were also studied. Methods: The specimens from 100 patients, who underwent TRUS core biopsy and subsequent prostatectomy between January 2001 and June 2004, were included. Results: Gleason grade concordance was found in 35 cases. In TRUS core biopsy, 35, 9, and 1 cases were 1, 2, and 3 scores undergraded, respectively. Thirteen and 7 cases were 1 and 2 scores overgraded, respectively. Eighty three percent show a difference of not more than 1 score. Conclusion: We concluded that the Gleason scoring in prostatic biopsy remains a good predictor of the final Gleason grading of the radical prostatectomy specimen. However, the urologists and radiotherapists should keep in mind that undergrading and overgrading in TRUS core biopsies are both possible.
ABSTRACT
Two cases of disseminated Penicilliosis marneffei are reported; both were middle-aged female patients from the central part of Thailand who presented with multiple cystic skin lesion. Their systemic symptoms included chronic fever, weight loss, malaise, anemia, cervical lymphadenopathy and osteolytic bone lesions. They had no underlying disease causing immunosupression and both were HIV-negative. Skin manifestations occurred frequently in disseminated penicilliosis and abscesses were the most common manifestation in HIV-negative patients whereas umbillicated papules were common in HIV-positive ones. A biopsy from the skin lesions was good specimens for histopathological study and frequently yielded positive culture results. The characteristic histopathological feature is granulomatous inflammation with macrophages containing yeast-like organisms with septa which show a lack of budding. The characteristic mycologic feature of P.marneffei is a thermally dimorphic fungus which produces a mycelial phase colony appearing within 2 days at room temperature (25-30oC) and which produces a bright, purple-red, water-soluble pigment into the surrounding agar. The yeast form grows at 37oC as a whitish colony produced in 4 days and this produces less red pigment compared with the mycelial form. The first case was treated with oral itraconazole intermittently as a result of multiple recurrent episodes until she died of the disease after one year. The second case was treated with amphotercin B intravenously followed by oral itraconazole with a satisfactory result.
ABSTRACT
A double antibody sandwich ELISA was used for the determination of carcinoembryonic antigen levels in sera and pleural fluid samples of 25 cancer and 16 tuberculous patients. It was found that while cancer patients had pleural fluid CEA levels significantly higher than those in sera (p < 0.01), this was not true for tuberculous patients. When the CEA level at 20 ng/ml was used as the cut-off value for the diagnosis of malignancies, 8 of 25 (32%) cancer patients could be diagnosed from serum CEA level while 16 of them (64%) could be diagnosed from CEA level in the pleural fluid. In addition, none of tuberculous patients had CEA above the cut-off level. Based on the results of cytologic examination, only 11 of the 25 cancer patients (44%) could be diagnosed. However, if either positive cytologic examination or pleural fluid CEA level higher than 20 ng/ml was used as a criterion for diagnosis, then 20 of them (80%) could be diagnosed.