ABSTRACT
Carcinosarcoma is a rare malignant tumor with a biphasic morphology characterized by the presence of a malignant epithelial and mesenchymal component. It has been reported in many organs, including the genitourinary tract. We describe a case of a 47-year-old woman admitted to our hospital for history of recurrent urinary tract infection, dysuria and discharge of bloody fluid from the urethra at the end of urination. A tender palpable mass under the anterior vaginal wall was found and pathological examination showed a urethral carcinosarcoma. The histopathogenetic hypothesis and clinical management were considered in this report.
Subject(s)
Carcinosarcoma/diagnosis , Carcinosarcoma/pathology , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/pathology , Urethra/pathology , Carcinosarcoma/mortality , Cisplatin/administration & dosage , Fatal Outcome , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Neoadjuvant Therapy/methods , Neoplasm Recurrence, Local , Polyploidy , Positron-Emission Tomography , Ureteral Neoplasms/mortalitySubject(s)
Dissection/methods , Laparotomy/methods , Neurilemmoma , Ovarian Cysts/diagnosis , Retroperitoneal Neoplasms , Diagnosis, Differential , Female , Humans , Immunohistochemistry , Middle Aged , Neurilemmoma/diagnosis , Neurilemmoma/pathology , Neurilemmoma/physiopathology , Retroperitoneal Neoplasms/diagnosis , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms/physiopathology , Treatment OutcomeABSTRACT
Many drugs can be used for adjuvant therapy of breast cancer, including anthracyclines, cyclophosphamide, 5-fluorouracil (5-fU) and, recently, taxanes (TXT) have shown promising results. 5-FU blocks thymidylate synthase (TS) which cross-links p53 mRNA, inhibiting its synthesis. TS overexpression is one of the main mechanisms involved in 5-FU drug resistance. Enough p53 mutations can confer resistance to chemotherapy using anthracyclines and 5-FU, while are associated with improved responses to TXT. The aim of this study was to examine the TS and p53 levels in tumor samples and to compare the efficacy of FEC (5-FU, epirubicin, cyclophosphamide) and TXT chemotherapy in a group of patients with differing TS and p53 status. We examined 84 breast tumor samples using immunohistochemistry. TS and p53 levels were inversely related, and TS and p53 positivity was significantly associated with the failure of FEC treatment and with a good response to TXT therapy (p <0.001). This confirms the predictive role of these two markers, which should be considered when choosing the appropriate adjuvant therapy for breast cancer.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/metabolism , Bridged-Ring Compounds/therapeutic use , Taxoids/therapeutic use , Thymidylate Synthase/metabolism , Tumor Suppressor Protein p53/metabolism , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Biomarkers, Tumor/genetics , Biomarkers, Tumor/metabolism , Breast Neoplasms/enzymology , Breast Neoplasms/genetics , Chemotherapy, Adjuvant , Cyclophosphamide/administration & dosage , Epirubicin/administration & dosage , Female , Fluorouracil/administration & dosage , Humans , Immunohistochemistry , Neoplasm Staging , Prognosis , Thymidylate Synthase/antagonists & inhibitors , Thymidylate Synthase/genetics , Tumor Suppressor Protein p53/geneticsABSTRACT
To evaluate prostate cancer (PCa) detection and incidence of pathologically insignificant PCa (pIPCa) tumour using percent-free PSA (%f-PSA) in patients with total PSA ≤ 10 ng ml(-1). From February 2002 to October 2009, 14,453 patients (median 60.5 years) were enrolled in a case-finding protocol for the early diagnosis of PCa. Indications to biopsy were suspicious digital rectal examination; PSA >10 ng ml(-1); PSA ≤ 2.5 ng ml(-1), included between 2.6-4 and 4.1-10 ng ml(-1) with %f-PSA <15, <20 and <25%, respectively. A median of 18 and 26 cores in case of primary and repeated biopsy were determined; 2123 men underwent prostate biopsy, of whom 1589 (74.8%) had a PSA ≤ 10 ng ml(-1). A PCa was found in 777 (36.6%) and in 35 (23.3%) patients at primary and repeated biopsy: 459 and 26 men had PSA ≤ 10 ng ml(-1) and 419 and 26 patients underwent surgery, respectively, 244 (58.3%) and 18 (69.2%) had an organ-confined PCa with a pIPCa incidence equal to 1.4 and 7.7%, respectively. Cancer detection rate of 28.8% in patients with PSA ≤ 10 ng ml(-1) associated with a low incidence of pIPCa should induce to introduce %f-PSA in screening programmes to reduce the risk of overdiagnosis.
Subject(s)
Early Detection of Cancer/methods , Prostate-Specific Antigen/analysis , Prostatic Intraepithelial Neoplasia/diagnosis , Prostatic Intraepithelial Neoplasia/epidemiology , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/epidemiology , Adult , Aged , Biopsy , Clinical Protocols , Early Detection of Cancer/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Prostate-Specific Antigen/blood , Prostatic Intraepithelial Neoplasia/blood , Prostatic Intraepithelial Neoplasia/pathology , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology , SolubilityABSTRACT
OBJECTIVES: To evaluate the incidence of indolent prostate cancer (PCa; <0.5 ml cancer and Gleason score, GS, Subject(s)
Prostate/pathology
, Prostatic Neoplasms/diagnosis
, Aged
, Biopsy, Needle
, Digital Rectal Examination
, Humans
, Incidence
, Italy/epidemiology
, Lymph Node Excision
, Lymph Nodes/pathology
, Lymph Nodes/surgery
, Male
, Middle Aged
, Neoplasm Invasiveness
, Neoplasm Staging
, Predictive Value of Tests
, Prostate/surgery
, Prostate-Specific Antigen/blood
, Prostatectomy
, Prostatic Neoplasms/epidemiology
, Prostatic Neoplasms/surgery
, Risk Assessment
ABSTRACT
To evaluate prostate cancer (PCa) detection after repeated negative saturation biopsy, 75 patients, aged 53-78 years, underwent transurethral resection of prostate (TURP) because of persistent suspicion of cancer; median PSA was 11.8 ng ml(-1) and 58 men complained lower urinary tract symptoms (LUTS). In 12 (16%) and 3 (4%) men a T1a and T1b PCa was found with median PSA and Gleason score equal to 14.2 vs 23.6 ng ml(-1) and 5.6 vs 7 ng ml(-1). In case of persistent suspicion of PCa after repeated negative saturation biopsy, TURP may be proposed, aside from the coexistence of LUTS, to rule out a PCa, in younger patients with high PSA values (> or =20 ng ml(-1)).
Subject(s)
Prostate-Specific Antigen/analysis , Prostate/pathology , Prostatic Neoplasms/diagnosis , Transurethral Resection of Prostate , Aged , Biopsy , Case-Control Studies , Humans , Male , Middle Aged , Prostatism/diagnosisABSTRACT
OBJECTIVES: To evaluate the role of quantitative histologic findings in predicting nonorgan-confined (non-OC) prostate cancer (PCa) in patients undergoing saturation prostate biopsy (SPBx). METHODS: A total of 69 patients who had undergone SPBx underwent radical retropubic prostatectomy. Their prostate-specific antigen level was <10 ng/mL, and 49 and 20 patients had T1c and T2 PCa, respectively. The following biopsy variables from the quantitative histologic examination were evaluated as predictive of OC vs non-OC PCa: Gleason score (
Subject(s)
Biopsy/methods , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/pathology , Aged , Humans , Male , Medical Oncology/methods , Middle Aged , Prostate-Specific Antigen/blood , Prostatectomy/methods , ROC Curve , Reproducibility of Results , Sensitivity and Specificity , Treatment Outcome , Urology/methodsABSTRACT
Malignant tumours of the prostate other than carcinomas are rare. One such malignant tumours arising from the specialised stromal tissue of the prostate is stromal prostatic sarcoma (namely low-grade and high-grade). Herein, we report the clinico-pathological features of a high grade stromal sarcoma of the prostate occurring in a 65-year-old man who presented for urinary obstructive symptoms. The clinical picture suggested a benign prostatic hyperplasia, and surgery consisting in a transcapsular adenomectomy was performed. Following a pathological diagnosis of high grade prostatic stromal sarcoma, a radical cystoprostatectomy and bilateral pelvic node dissection was performed showing residual high grade stromal sarcoma of the prostate and incidental in situ urothelial carcinoma of the bladder. No further medical treatments were planned. One year after surgery the patient is well with no evidence of local disease or distant metastases.
Subject(s)
Diagnostic Errors , Prostatic Neoplasms/pathology , Sarcoma/pathology , Aged , Carcinoma in Situ/pathology , Carcinoma in Situ/surgery , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/surgery , Cystectomy , Humans , Incidental Findings , Lymph Node Excision , Male , Neoplasms, Multiple Primary , Prostatectomy , Prostatic Hyperplasia/diagnosis , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/surgery , Sarcoma/diagnosis , Sarcoma/surgery , Stromal Cells/pathology , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgeryABSTRACT
Microscopic foci of prostatitis may induce prostate-specific antigen (PSA) increase. PSA reduction after antibiotics might identify those patients in whom biopsy can be avoided. Ninety-nine patients received ciprofloxacin for 3 weeks, of whom 59 showed PSA reduction. Histology detected small foci of prostatitis in 65% of cases. Carcinoma was found in 40 and 20.3% of patients with unchanged or decreased PSA, respectively (P=0.03). No cancer was detected if PSA decreased below 4 ng/ml or more than 70%. Biopsy can be postponed, with a low risk of missing a cancer, if PSA decreases more than 70% or below 4 ng/ml.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Biopsy, Needle , Ciprofloxacin/therapeutic use , Prostate-Specific Antigen/blood , Prostate/pathology , Prostatitis/drug therapy , Unnecessary Procedures , Aged , Aged, 80 and over , Diagnosis, Differential , Follow-Up Studies , Humans , Male , Middle Aged , Organ Size , Palpation , Patient Selection , Prostate/diagnostic imaging , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/pathology , Prostatitis/blood , Prostatitis/diagnosis , Risk , Time Factors , Ultrasonography, InterventionalSubject(s)
Ki-67 Antigen/analysis , Papillomavirus Infections/diagnosis , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Dysplasia/virology , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/virology , Female , Humans , Papillomaviridae/isolation & purification , Papillomavirus Infections/pathology , Papillomavirus Infections/virology , Uterine Cervical Neoplasms/pathology , Uterine Cervical Dysplasia/pathologyABSTRACT
BACKGROUND: The development of oesophageal adenocarcinoma is generally closely associated with the presence of a specialised intestinal-type epithelium such as that found in Barrett's oesophagus (BO). A particular histological condition is when the distal oesophagus showing cardiac and/or fundic mucosa without intestinal metaplasia cannot be defined as 'Barrett's mucosa' [condition that we call 'columnar-lined oesophagus' (CLO)] and up till now, there has been no agreement in literature about the management of this condition. Aurora-A overexpression leads to centrosome amplification, chromosomal instability and aneuploidy in mammalian cells. PATIENTS AND METHODS: A prospective study was carried out on 28 consecutive patients who presented columnar mucosa above the gastro-oesophageal junction (GOJ) at endoscopy. As controls, two more biopsies were obtained, one on the normal-appearing squamous oesophagus above the GOJ, as far as possible from the columnar mucosa (controls A), and one taken 1 cm below the GOJ (controls B). The Aurora-A and p53 expression levels were analysed respectively by Quantitative Real Time PCR and immunohistochemistry. RESULTS: Twelve patients were affected by BO (43%) while the other 16 patients (57%) had a CLO. Nine of 28 (32%) cases were focally positive for p53 immunostaining. All the BO/CLO samples were positive for the Aurora-A transcript with regard to controls. Furthermore, 13 of 28 (46%) cases showed overexpression (above the median for the whole group). CONCLUSION: Due to the low number of cases, we are not at present able to state that statistically significant quantitative differences in Aurora-A messenger RNA expression exist between CLO and BO cases with and without dysplasia and p53-positive immunostaining. Further studies on a larger number of cases with a follow-up period are necessary in order to establish the risk of progression and the correct management of these subjects.
Subject(s)
Barrett Esophagus/genetics , Gastroesophageal Reflux/genetics , Protein Serine-Threonine Kinases/biosynthesis , Protein Serine-Threonine Kinases/genetics , Adenocarcinoma/enzymology , Adenocarcinoma/genetics , Adenocarcinoma/pathology , Adult , Aurora Kinases , Barrett Esophagus/enzymology , Barrett Esophagus/pathology , Biomarkers/metabolism , Esophageal Neoplasms/enzymology , Esophageal Neoplasms/genetics , Esophageal Neoplasms/pathology , Female , Gastroesophageal Reflux/enzymology , Gastroesophageal Reflux/pathology , Humans , Male , Middle Aged , Mucous Membrane/enzymology , Mucous Membrane/pathology , Prospective StudiesABSTRACT
Breast cancer is a heterogeneous disease, so therapeutic predictive biological markers need to be identified. To date an accurate evaluation of predictive markers is mainly done at the primary site; however, the main goal of adjuvant therapy for breast cancer is the control of micrometastases. The aim of this study is to assess as therapeutic and/or prognostic marker, the proliferation status of primary tumors and involved nodes as measured by Ki67 and thymidylate synthase (TS) expression, in 30 breast cancer node positive patients. TS is the main target of 5-fluorouracil (5-FU) activity, and its overexpression is one of the mechanisms of 5-FU drug resistance; however, in some studies its absence is responsible for a worse response to 5-FU. Our results show that malignant cells of involved nodes were in a post mitotic phase of the cell cycle, and show a low proliferation index and TS expression, while the primary tumours and controls, were strongly positive. On these basis we can hypothesize that these cells could be less sensitive to 5-FU. Further studies are necessary to identify other mechanisms responsible for their metastasing capability and/or for their aggressiveness.
Subject(s)
Breast Neoplasms/metabolism , Gene Expression Regulation, Enzymologic , Gene Expression Regulation, Neoplastic , Ki-67 Antigen/biosynthesis , Thymidylate Synthase/biosynthesis , Antigens, Neoplasm/biosynthesis , Antimetabolites, Antineoplastic/pharmacology , Breast Neoplasms/pathology , Cell Proliferation , Female , Fluorouracil/pharmacology , Humans , Lymphatic Metastasis , Neoplasm Metastasis , PrognosisABSTRACT
UNLABELLED: The aim of the study was to verify by Ki-67 immunostaining if any difference exists in the cell proliferating fraction between primary breast tumors (PTs) and matching positive axillary lymph nodes (ALNs). PATIENTS AND METHODS: Immunohistochemistry with the monoclonal antibody against Ki-67 was performed in 160 node-positive breast carcinomas and in their respective lymph node metastases. RESULTS: An increase of Ki-67 immunoreactive cells in ALN compared with that of PTs was observed in 84% of cases (ALN: mean 17%, PTs: mean 8%; p < 0.001), whereas 16% of the cases showed Ki-67 value two to six times lower in the ALNs than in the corresponding PTs (ALN: mean 3.2%, PTs mean 12.5%; p < 0.005). The decrease of Ki-67 positive cells in the ALN was independent from the histotype and the histological grade of the tumor. CONCLUSION: A different cell proliferation fraction between PTs and matching positive ALNs was demonstrated and underlined that the existence of a group of patients with decreased number of Ki-67 immunoreactive cells in lymph node metastases compared with that of the primary tumors could be taken into account in the choice of therapeutic strategy.
Subject(s)
Breast Neoplasms/immunology , Ki-67 Antigen/immunology , Lymphatic Metastasis/immunology , Female , HumansABSTRACT
OBJETIVOS: Presentar un caso de recurrencialocal de tumor renal 16 años después de nefrectomíaradical; analizar los datos de la literatura sobre tratamiento y pronóstico.MÉTODOS/RESULTADOS: Presentamos un caso de recurrencialocal asociado con trombosis de la vena cava que fue intervenido mediante resección en bloque del tumor y la vena cava con sustitución por una prótesis PTFE.CONCLUSIONES: La recurrencia local después de nefrectomíaradical es rara, siendo comunicada entre el 2-4% de los pacientes. Esta condición es incluso más rara después de diez años, especialmente si está asociada con trombosis de la vena cava.Se describe un caso de recurrencia local aislada de carcinoma de células renales con afectación de la cava 16 años después de nefrectomía radical. Pensamos que éste es el primer caso comunicado en la literatura. Este caso destaca la oportunidad de las revisiones periódicasde los pacientes sometidos a nefrectomía radical incluso muchos años después de cirugía
OBJECTIVE: To report a case of local recurrence 16 years after radical nephrectomy; to analyse literature data concerning, treatment and prognosis. METHODS/RESULTS: We report a case of local recurence associated with caval trombosis who was underwent an enbloc resection of vena cava along with pericaval lesion and caval replacement with PTFE prosthesis. The Authors reviewed and analysed literature data. CONCLUSIONS: Local recurrence after radical nephrectomy is rare as it is reported only in 2-4% of patients. This condition is even rarer beyond 10 years especially if associated with caval trombosis. A case of isolated local recurrence of renal cell carcinoma with caval involvement 16 years after radical nephrectomy is described herein. To the best of our knowledge, this is the first case reported in literature. This case highlights the opportunity of a periodic check-up of patients submitted to radical nephrectomy, even many years after surgery
Subject(s)
Female , Aged , Humans , Nephrectomy , Kidney Neoplasms/surgery , Neoplasm Recurrence, Local/surgery , Time FactorsABSTRACT
OBJECTIVE: To establish the incidence of prostate cancer (PCa) in Sicily in patients who entered an early detection protocol. METHODS: From February 2002 to February 2004, 16,298 subjects aged 40-75 entered the protocol. Patients with suspicious DRE, PSA>10 ng/ml, PSASubject(s)
Prostatic Neoplasms/epidemiology
, Adult
, Age Distribution
, Aged
, Biopsy, Needle
, Humans
, Incidence
, Male
, Middle Aged
, Odds Ratio
, Palpation/methods
, Prevalence
, Prostate/diagnostic imaging
, Prostate/pathology
, Prostate-Specific Antigen/blood
, Prostatic Neoplasms/blood
, Prostatic Neoplasms/diagnosis
, Retrospective Studies
, Risk Factors
, Sicily/epidemiology
, Ultrasonography
ABSTRACT
AIMS: To find a predictor of extraprostatic extension in clinically localized prostate cancer (PCa), pre-operative ultrasound-guided prostate needle biopsies and clinico-pathological data were reviewed. METHODS: One hundred and eighty-three consecutive patients who underwent radical retropubic prostatectomy for clinical T1-T2 PCa and serum PSA <10 ng/ml were reviewed. Pre-operative biopsy was performed according to an extended protocol and whole-mount prostatectomy specimens were processed. The following biopsy variables were categorized to this analysis: Gleason score (< or =6, >6), TPC (< or =20%; >20%), GPC (< or =50%; >50%), cancer-positive cores (< or =2; >2), cancer-positive cores in both lateral portions (yes; no), PCa (monolateral; bilateral). RESULTS: Only 60/183 specimens showed an organ-confined PCa; the remaining ones showed pT3a in 57 cases, pT3b in 11 and pT3 with positive surgical margins in 55. A locally advanced PCa was found in 60.2 and 76.8% of T1c and T2 clinical stage, respectively. The positive predictive value and negative predictive value of biopsy findings to predict a locally advanced PCa was 89.9 and 75%, respectively. All biopsy variables associations were statistically significant; however, among these variables (non-categorized), in multivariate logistic regression analysis, only GPC was significantly associated with pathologic stage (odds ratio estimate was 1.075, 95% CI: 1.053-1.098). CONCLUSIONS: Quantitative histology, especially GPC, seems to be helpful for pre-operative staging of PCa in patients with T1c-T2 clinical stage and PSA < 10 ng/ml.
Subject(s)
Prostate-Specific Antigen/blood , Prostatic Neoplasms/pathology , Aged , Biopsy , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Neoplasm Staging , Odds Ratio , Predictive Value of Tests , Prostatic Neoplasms/immunology , ROC Curve , Sensitivity and SpecificityABSTRACT
OBJECTIVE: To report a case of local recurrence 16 years after radical nephrectomy; to analyse literature data concerning, treatment and prognosis. METHODS/RESULTS: We report a case of local recurence associated with caval trombosis who was underwent an en-bloc resection of vena cava along with pericaval lesion and caval replacement with PTFE prosthesis. The Authors reviewed and analysed literature data. CONCLUSIONS: Local recurrence after radical nephrectomy is rare as it is reported only in 2-4% of patients. This condition is even rarer beyond 10 years especially if associated with caval trombosis. A case of isolated local recurrence of renal cell carcinoma with caval involvement 16 years after radical nephrectomy is described herein. To the best of our knowledge, this is the first case reported in literature. This case highlights the opportunity of a periodic checkup of patients submitted to radical nephrectomy, even many years after surgery.