Low grade urothelial carcinoma mimicking basal cell hyperplasia and transitional metaplasia in needle prostate biopsy

ABSTRACT Purpose The vast majority of urothelial carcinomas infiltrating the bladder are consistent with high-grade tumors that can be easily recognized as malignant in needle prostatic biopsies. In contrast, the histological changes of low-grade urothelial carcinomas in this kind of biopsy have not been studied. Materials and Methods We describe the clinicopathologic features of two patients with low-grade bladder carcinomas infiltrating the prostate. They reported dysuria and hematuria. Both had a slight elevation of the prostate specific antigen and induration of the prostatic lobes. Needle biopsies were performed. At endoscopy bladder tumors were found in both cases. Results Both biopsies showed nests of basophilic cells and cells with perinuclear clearing and slight atypia infiltrating acini and small prostatic ducts. The stroma exhibited extensive desmoplasia and chronic inflammation. The original diagnosis was basal cell hyperplasia and transitional metaplasia. The bladder tumors also showed low-grade urothelial carcinoma. In one case, the neoplasm infiltrated the lamina propria, and in another, the muscle layer. In both, a transurethral resection was performed for obstructive urinary symptoms. The neoplasms were positive for high molecular weight keratin (34BetaE12) and thrombomodulin. No metastases were found in either of the patients, and one of them has survived for five years. Conclusions The diagnosis of low-grade urothelial carcinoma in prostate needle biopsies is difficult and may simulate benign prostate lesions including basal cell hyperplasia and urothelial metaplasia. It is crucial to recognize low-grade urothelial carcinoma in needle biopsies because only an early diagnosis and aggressive treatment can improve the prognosis for these patients.

Phase IIa clinical trial of trans-1-amino-3-18F-fluoro- cyclobutane carboxylic acid in metastatic prostate cancer

We performed a phase IIa clinical trial of trans-1-amino-3-[18]Ffluoro-cyclobutane carboxylic acid [anti-[18]F-FACBC], a synthetic amino acid analog for PET, in patients with metastatic prostate cancer. The study subjects consisted of 10 untreated prostate cancer patients having lymph node and/or bone metastasis. Five patients underwent whole-body PET 5 and 30 min after intravenous injection of anti-[18]F-FACBC. The other five patients underwent 60 min dynamic PET of the pelvis. Safety assessment was performed before and 24 h after injection. PET/CT images were assessed visually, and time courses of anti-[18]F-FACBC uptake were evaluated from dynamic imaging. Two mild adverse events were observed and resolved without treatment. All 10 patients showed increased accumulation of anti-[18]F-FACBC in the primary prostate lesion. CT revealed five enlarged lymph nodes indicating metastasis, and all showed increased uptake. Additionally, anti-[18]F-FACBC PET delineated unenlarged lymph nodes as hot spots. Anti-[18]F-FACBC PET demonstrated metastatic bone lesions, similar to conventional imaging. In one of two patients with lung metastasis, some lesions showed increased uptake. Regarding the time course, increased uptake of anti-[18]F-FACBC in the lesion was demonstrated immediately after injection, followed by gradual washout. The results of this phase IIa clinical trial indicated the safety of anti-[18]F-FACBC in patients with prostate cancer and the potential of anti-[18]F-FACBC PET to delineate primary prostate lesions and metastatic lesions. This clinical trial was registered as JapicCTI-101326

Ipsilateral ethmoid sinuses metastasis and proptosis: rare presentation of metastatic prostate cancer

Metastatic paranasal sinuses and orbital cancer is very rare. The patient with sinusitis and orbital symptoms warrants a detailed history, complete physical examination and serial radiological tests [sinus radiographs and CT scan] to rule out any metastatic disease and prompt treatment. We present a case of 65 years old patient with metastatic prostate cancer who presented to us with left ethmoid sinuses and orbital metastasis causing ipsilateral proptosis

Management of advanced prostate cancer: [revisão] / Tratamento do câncer de próstata avançado: [review]

Geriatricians and general practitioners often follow patients with metastatic prostate cancer. The epidemiology and basic treatment principles of metastatic prostate cancer are discussed aiming to update the topic for the non-oncologist. Hormone manipulation remains the basis of treatment, usually up to a second line of therapy. Selected cases are treated successfully with intermittent androgen ablation. When new hormone-independent clones arise, chemotherapy should be added to therapy that confers improved survival as well as better quality of life when based on taxanes. In specific situations, additional measures such as bisphosphonates and radiation therapy should be included in the treatment. As a rule, the public health system makes available the necessary medication to ensure treatment for the vast majority of patients in Brazil.

Pacientes com câncer de prostata metastático estão freqüentemente sob os cuidados de geriatras e clínicos gerais. Discutimos a epidemiologia e os princípios básicos do tratamento do câncer de próstata metastático, visando atualizar o não-oncologista no assunto. A base do tratamento continua sendo a manipulação hormonal, inclusive como tratamento de segunda linha. Casos selecionados podem ser tratados com ablação androgênica intermitente de maneira eficaz. Quando se desenvolvem clones de células hormônio-independentes, quimioterápicos são incorporados na terapia. A quimioterapia confere não só benefício em sobrevida, mas também na qualidade de vida, quando baseado em taxanos. Medidas adicionais como o uso de bisfosfonados e radioterapia devem ser incorporadas no tratamento em situações especiais. De modo geral, o sistema público de saúde do Brasil disponibiliza todas as medicações necessárias ao adequado tratamento dos pacientes no país.

Pancreatic carcinoma: report of two cases presenting with unusual metastases.

We report two patients with adenocarcinoma of the body and tail of the pancreas who presented with features localized to the metastatic sites. A 67-year-old gentleman presented with right groin mass due to spermatic cord metastasis and later developed duodenal obstruction; the other gentleman was 69 years old and presented with change of bowel habit as a result of pelvic/pararectal metastasis.

Coexistence of prostate neoplasia in patients undergoing radical cystoprostatectomy due to vesical neoplasia

OBJECTIVE: To assess the incidence of bladder carcinoma infiltrating the prostate and prostate adenocarcinoma in patients undergoing radical cystoprostatectomy due to bladder cancer, as well as to assess if the characteristics of the bladder neoplasia influence the prostatic involvement by this neoplasia. MATERIALS AND METHODS: We retrospectively assessed 60 male patients, who underwent radical cystoprostatectomy between July 1997 and December 2003. Mean age was 66.7 years (40 and 93 years). The product of radical cystoprostatectomies was checked for involvement of urethra and prostate parenchyma by the primary neoplasia, and for the presence of associated prostate adenocarcinoma. Bladder neoplasia characteristics, such as localization, size, multifocality, association with in situ carcinoma and histological grade, were studied in order to assess the possibility of using such characteristics as predictive factors of prostate infiltration by bladder urothelial carcinoma. RESULTS: We observed the presence of 20 percent of patients with bladder carcinoma infiltrating the prostatic urethra, 23.3 percent of patients with infiltration of the prostate parenchyma and 28.3 percent of patients with associate prostate adenocarcinoma, resulting in a total of 55 percent of patients with prostatic involvement (infiltrative bladder carcinoma and/or adenocarcinoma). We also observed a statistically significant correlation between tumor location in the trigone, the presence of in situ carcinoma and the histological grade of the bladder tumor with prostatic infiltration by the vesical neoplasia. CONCLUSION: The coexistence of prostatic neoplasia in patients operated for bladder neoplasia was frequent in our sample (55 percent). We observed that the prostatic infiltration by bladder tumors occurs more frequently with tumors located in the trigone, with associated in situ carcinoma and with high histological grade. There was no correlation between neoplastic infiltration of prostate and multifocality or size of the bladder tumor in the studied sample.

Isolated prostatic metastasis from primary sigmoid colon carcinoma.

Metastasis to the prostate is extremely uncommon. We report a 38-year-old man with sigmoid colon carcinoma, treated with surgery and adjuvant chemotherapy, who developed isolated metastasis to the prostate four years after initial treatment. He was treated with chemoradiation and remains disease-free three years after detection of metastasis.

Detección de mRNA de antígeno prostático específico en sangre periférica de pacientes con cáncer de próstata / Detection of mRNA of prostatic specific antigen in peripheran blood of patients with prostate cancer

El cáncer de próstata (CaP) es una neoplasia de alta incidencia en la población adulta masculina. Con el objeto de mejorar los actuales métodos de estadificación y monitoreo de estos tumores, se ha aplicado la técnica Transcripción Reversa y Reacción en Cadena de la Polimerasa (RT-PCR) para antígeno prostático específico (PSA) en pacientes con dicha patología. Este ensayo detecta la presencia de RNA mensajero de PSA (mRNA PSA) proveniente de células prostáticas en sangre periférica, brindando un método no invasivo y simple, que ayudaría a diferenciar pacientes con CaP localizado, de aquellos con CaP diseminado, aun en estadios tempranos de metástasis. Se estudiaron 27 pacientes con CaP, a los cuales se realizó en sangre entera RT-PCR para mRNA PSA dosándose además en suero la proteína PSA. De los 27 pacientes estudiados, catorce evidenciaron presencia de mRNA PSA. Los resultados indican que esta técnica es específica para el estudio de pacientes con CaP. Se ha observado que la probabilidad de RT-PCR positiva se incrementa con el tamaño del tumor. Un resultado positivo podría predecir metástasis a largo plazo y sería de utilidad pronóstica respecto al éxito quirúrgico en las prostatectomías radicales

A velocidade da captaçäo de 99mTc-MDP em lesöes metastáticas ósseas antes e depois da terapia com 89mSr / Uptake velocity of 99mTc-MDP in bone metastatic injuries before and after of therapy with 89mSr

O metabolismo do estrôncio-89m no homem vem sendo investigado desde 1955 mas as mudanças na taxa de captação do difosfonado depois de uma dose terapêutica de (89m)Sr não foram ainda determinadas. O objetivo deste trabalho é avaliar a velocidade de captação de (99m)Tc-MDP em lesões metásticas ósseas, antes e depois de uma terapia com (89m)Sr.

Strontium metabolism in man has been under investigation since 1955 but the changes in dyphosphonate uptake after a therapeutic dose of 89msr has not yet been determined. The aim of this paper is to evaluate the rate of 99mTc-MDP uptake in metastatic bone lesions, before and after 89msr therapy.