Mucin production in prostatic adenocarcinoma: A retrospective study of 51 radical prostatectomy specimens in Thai population.

Background: Intraluminal and extracellular acid mucin secretion is one of the ancillary findings of prostate adenocarcinoma and can aid in diagnosis. Objective: To determine the actual frequency and percentage of acid mucin production in prostatic adenocarcinoma from radical prostatectomy specimens at the Department of Pathology, Siriraj Hospital. Methods: This is a retrospective study of 51 cases of radical prostatectomy with diagnosis of prostatic adenocarcinoma at the Department of Pathology, Siriraj Hospital from January to March 2008. Results: Forty-nine cases (96%) of these prostatic adenocarcinomas showed positive mucicarmine stain. Among these, 24 (47.1%) cases were graded as Gleason score (GS) 7; 12 (23.5%) cases as GS 9; 8 (15.7%) cases as GS 6; 4 (7.8%) cases as GS 8, and 1 (1.9%) case as GS 5. Two cases (3.8%) without mucin production were gradeda as GS 7 and 9. Conclusion: Intraluminal acid mucin is one of the useful ancillary findings in diagnosing prostatic adenocarcinoma, particularly when combined with other architectural and cytological findings. The high frequency and percentage of actual acid mucin production in prostatic adenocarcinoma studied in radical prostatectomy can be applied to a questionable positive core biopsy with confidence.

Accuracy of modified gleason grading on prostatic biopsies.

Objective: The Modified Gleason Grading System was proposed by the 2005 International Society of Urological Pathology (ISUP) Consensus Conference. In Thailand, prostatic biopsies are mostly diagnosed by general pathologists. The accuracy of the Gleason grading on prostatic biopsies is still questioned. We assessed the accuracy of modified Gleason Grading on prostatic biopsies and detected pitfalls in the grading. Methods: Sixty-nine cases of prostatic biopsies which diagnosed adenocarcinoma were re-examined according to the modified Gleason grading system by an experienced pathologist, four general pathologists and two pathology residents. Results: The accuracy of modified Gleason scores on prostatic biopsies ranged from 79.7% to 98.6% with 68.3 to 100 of 95% CI. Most biopsies with more than one score of difference were missed from Gleason pattern 5. Gleason pattern 5 was found in 25 biopsies. Percents of Gleason pattern 5 were classified into <5% (12 biopsies), 5-10% (6 biopsies), 11-50% (5 biopsies), and >50% (3 biopsies) of the tumor volume. The mean of the number of the observers who fail to detect Gleason pattern 5 in each category was 4 (SD 1.2), 3.6 (SD 1.8), 1.3 (SD 0.95), and 0.33 (SD 0.5), respectively. We found a small amount of Gleason pattern 5 was significantly missed (p = 0.01). Conclusion: The accuracy of Gleason grading on prostate biopsies among general pathologists and pathology residents in this study was fairly good. The missed Gleason pattern 5 is the most common pitfall. Pathologists should be aware of Gleason pattern 5 because it might be present in a prostate biopsy of less than 5 % of the tumor volume.

Correlation between Gleason scores of prostatic biopsies and radical prostatectomy specimens.

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.

Isospora belli infection associated with chronic cholecystitis and sclerosing cholangitis in immuncompetent host : A case report.

Isospora belli (I. belli) is a spore-forming protozoa that primarily infects enterocyte. The clinical manifestation may very from asmptomatic to self-limited diarrhea in healthy persons. Rarely, in the normal hosts,5 chronic persistent or intermittent symptom may continue for many years.1,2 Treatment with cotrimoxazole is usually effective in both normal patients19 and patients with AIDS20,21 Nevertheless, relapse is common and is believed to be associated with the presence of extraintestinal infection.3,4,17 Few cases of extraintestinal I. belli infection have been documented in patients with AIDS,3-5 and one case in an immuncompetent patient.24 This report presents a unique case of isosporiasis in a 58-year-old anti-HIV negative Thai female suffering from chronic recurrent diarrhea due to I. belli, despite two episodes of complete 4-week cotrimoxazole and another course of nitazoxanide. Abdominal computer tomographic examination and ultrasonography identified sclerosing cholangitis and chronic cholecstitis. Histologic examination of the cholecystectomy specimen recovered schizonts and merozoites in the parasitophorous vacuoles located in gallbladder epithelium.

Two unusal primary carcinomas of the glans penis: Mucoepidermoid carcinoma and adenosquamous carcinoma.

Two cases of rare histologic subtypes of carcinomas involving glans penis are reported. Both contained two distinct cellular differentiation, squamous cells and mucin-producing cells. The first case was a 34-year-old Thai male with chronic ulcer at penis, showing predominant squamous cell carcinoma with interspersed small sheets of mucin-producing cells without discrete glandular structure, thus designated as “muco-epidermoid carcinoma”. The involved inguinal lymph node revealed both squamous and mucin-producing cells. Another case is a 39-year-old Thai male with penile, histologicaly proved to be carcinoma mainly constituted by malignant sqlignant part and focal glandular differentiation. The glands lined by colummer cells contained intraluminal and intracellular mucin. The bilateral sentinel lymph nodes were negative for malignancy. The immunoperoxidase staining for carcinoembryonic antigen was positively marked with mucin-producing cells in both cases. In addition, transmission electron microscopic study of mucoepidermoid carcinoma identified three populations of cells, namely squamous cells with tonofilament, mucin-producing cells with microvilli, and lastly intermediate cells bearing dual differentiation. These unusual carcinoma of glans penis are extremely rare conditions of unknown origin with a poorly defined prognosis. Discussion and review literature on the histologic definition and origin of these tumors are included.

A study of color distortion on specimen photography using the same object on different background colors.

Due to an attempt to take photographs of colorful flowers on 5 different background colors, it was found that the color of the background in every photograph looked natural but the color of the flowers seemed to be distorted in both color tone and brightness. The only photograph that provided the most natural image was the one using black as the background color. It was obvious that the darker the flower's color was, the more color distortion would be found. This finding Ied to a question that "When it comes to specimen photography, will there be any color distortion as found in this one?". A study was then conducted using fresh liver tissue and formalin-fixed liver tissue with 5 difference background colors ; black, deep blue, green; light grey and red. The study indicated that black background provided the most natural image while deep blue caused a very slight distortion and the other three caused even more distortion. The study also revealed that the fresh specimens may cause more distortion than the formalin

The attitude of chronically ill patients and personnel of Siriraj Hospital to a recreational therapy service.

A study of the attitudes of 507 patients with chronic illnesses and 961 personnel working with these patients towards a recreational activity service was performed using a questionnaire. Most of them agreed that the hospital should arrange recreational activity for patients with chronic illnesses in addition to physical treatment (95.6, 99.0 percent of patient and personnel groups respectively). Both groups evaluated the benefit of recreational activity with a score of 7.93 ฑ 2.09 and 8.71 ฑ 1.42. Activities ranked first were reading books, watching television or a video, gardening and singing/listening to music. Concerning health professionals willingness to join these activities, 80% of the nurse group (registered nurses and practical nurses) were willing to do so whereas only 51.4 percent of the doctor group were available due to different working styles. Most of the personnel accepted that the recreational therapist should be the one who arranges this service. Both groups agreed that a recreational activity service should be free of charge (45.2-51.4 percent). From the results of this study, we can conclude that patients and personnel appreciate a recreational activity service for chronically ill patients, so we should develop and distribute this service to patients in order to improve their quality of life and the quality of our service.

Ewing's sarcoma arising in prostate gland: A case report.

An 18-year-old Thai male presented with weight loss and urinary retention. Physical examination revealed an enlarged prostate gland. Serum prostate specific antigen (PSA) level was 0.3ng/ml. Histologic section demonstrated a small round cell tumor with intracytoplasmic glycogen. Immunohistochemical and ultrastructural studies were compatible with Ewing's sarcoma. Since no other osseous or extraosseous lesions of the same tumor were found in this patient, we concluded that this was a case of primary extraskeletal Ewing's sarcoma of the prostate gland. Case follow-up after one year revealed a good response to chemotherapy.

Thymolipoma simulating cardiomegaly: A case report.

A routine chest radiograph of a 27-year-old woman who presented with chronic cough for four weeks disclosed an anterior mediastinal mass simulating cardiomegaly. The computed tomography revealed a mass with diffuse fat density intermingled with soft tissue density. At thoracotomy a thymolipoma weighing 750 g was completely resected and typical histological findings were demonstrated. She made a good recovery and remained in good health at her most recent follow-up visit.

Tuberculous cervicitis in a menopause woman: A case report.

Tuberculous cervicitis is seldomly encountered with the gross lesions being misinterpreted as carcinoma of cervix. Since endometrium and tube are commonly sites of infection in the majority of cases the diagnosis of tuberculous cervicitis can be made by cervical biopsy with appropriate staining in association of microorganium. Reported herewith a 78 years old women presented with leucorrhea noticed few days prior to be seen. On pelvic examination the vagina contained some amount of foul smell purulent discharge. There were discrete pinhead-like lesions at the ectocervix and apparently beneath the cervical mucosa. The uterus and both adnexae appeared normal. Indurated parametria was also noted on rectal examination. Cervical biopsy was carried out with the diagnosis of tuberculous cervicitis made thereafter. The acid-fast bacilli were also demonstrated in the Fite’s stain specimen. Antuberculous drugs were given and one month after treatment the lesions disappeared completely.