Concomitant detection of hematological neoplasm and carcinoma: report on seven cases / Detecção concomitante de neoplasia hematológica e carcinoma: relato de sete casos

CONTEXT: The presence of multiple neoplasms in one patient is an uncommon event. Its occurrence ranges from 1.2 percent to 4.5 percent of cancer patients in autopsy and clinical studies. In the present article, cases of synchronous diagnoses of carcinoma and lymphoid neoplasms are reported. The intention of this report was to alert clinicians and pathologists to the possibility of the existence of concomitant neoplasms, in order to prevent inaccurate or delayed diagnosis and staging. CASES:Seven patients (four female and three male) with a median age of 61.4 years were diagnosed as having concomitant epithelial and hematological neoplasms. DISCUSSION AND CONCLUSION: Lymph nodes should be carefully examined when searching for metastases, because of the possibility of a second hematological malignancy. Whenever uncommon suspicious morphological features are seen in such neoplasms, an immunohistochemical analysis is essential.

CONTEXTO: A presença de múltiplas neoplasias em um mesmo paciente é evento infreqüente, correspondendo a 1,2 por cento-4,5 por cento dos pacientes com câncer em estudos clínicos e de autópsias. Neste artigo, os autores relatam casos de diagnósticos sincrônicos de carcinomas e neoplasias linfóides. Ao apresentar estes casos, tenciona-se alertar clínicos e patologistas para a possibilidade da ocorrência de neoplasias concomitantes, para evitar atrasos ou erros diagnósticos ou de estadiamento da doença. SÉRIE DE CASOS:Sete pacientes, quatro mulheres e três homens, com média de idade de 61,4 anos, foram diagnosticados com neoplasias epitelial e hematológica concomitantes. DISCUSSÃO E CONCLUSÃO: Os linfonodos devem ser cuidadosamente examinados quando se buscam metástases, dada a possibilidade de uma neoplasia hematológica concomitante. Sempre que aspectos morfológicos suspeitos forem detectados, um estudo imunoistoquímico faz-se necessário.

Prostate cancer pathologic stage pT2b (2002 TNM staging system): does it exist?

OBJECTIVE: In the 1997 TNM staging system, tumors were classified into a single subdivision: T2a, and bilateral tumor involvement (T2b). In the 2002 TNM staging system, tumors are subclassified as T2a (less than one half of one lobe involvement), T2b (more than one half of one lobe involvement), and T2c (bilateral involvement). A recent study questioned the existence of a true pathologic pT2b tumor. The aim of our study is to verify this question. MATERIALS AND METHODS: The study population consisted of 224 men submitted to radical retropubic prostatectomy. The surgical specimens were histologically evaluated by complete embedding and whole-mount processing. Tumor extent was evaluated by a point-count method. The surgical specimens were staged according to the 2002 TNM staging system. RESULTS: Using the 2002 TNM criteria, the surgical specimens were classified as pT2a, 28 (12.50 percent); pT2b, 0 (0 percent); pT2c, 138 (61.61 percent); pT3a, 30 (13.39 percent); and, pT3b, 28 (12.50 percent). Using the point-count method for tumor extent evaluation, the minimum and maximum total points obtained in unilateral tumors were 192 and 368 points, respectively; the most extensive unilateral tumor showed 68 positive points (less than half the minimum total point-count). CONCLUSIONS: Using the point-count method for tumor extent, our study questions a real existence for pathologic stage pT2b tumors (unilateral tumors involving greater than one-half of one lobe).