The utility of transrectal sonoelastography in preoperative prostate cancer assessment.

AIM: To determine the diagnostic quality of transrectal sonoelastography (SE) in the prediction and localisation of prostate cancer, we prospectively examined patients who had undergone radical prostatectomy in our urology department. METHODS: From April 2010 to January 2011, 61 patients with biopsy-proven prostate cancer underwent preoperative transrectal gray-scale (b-mode) ultrasound and SE of the prostate. Cancer-suspicious areas were documented for b-mode and SE, dividing the prostate into six topographic sectors. Suspicious areas in both modalities were compared to tumour localisation in the prostatectomy specimen. Sensitivity, specificity, positive- and negative predictive values were calculated for both investigation techniques. RESULTS: Prostate cancer was present in 232 of 366 pathological sectors (62 %). B-mode ultrasound showed 113 suspicious sectors, while SE indicated prostate cancer in 157 areas. The precise localisation of at least one pathologically confirmed cancerous lesion was possible in 42/61 (69 %) patients by b-mode ultrasound and 56/61 (92 %) patients by SE (P<0.005). The sensitivity for b-mode ultrasound was 33 % and specificity 74 %. For SE sensitivity was 53 %, while specificity was 74 %. CONCLUSIONS: SE offers a more precise localisation of prostate carcinoma than conventional ultrasound. To investigate the possible advantages of SE in during prostate biopsy and its value in the prediction of extracapsular cancer further studies are required.

[Mastitis with abscesses caused by esophageal fistula]. / Abszedierende Mastitis durch eine Osophagusfistel.

Mastitis originating from a fistula from intramediastinal esophago-jejunostomy following gastrectomy is an extremely rare event. We report on a 79-year old woman who had undergone repeated surgery due to recurrent breast abscesses for more than a year. The patient's history showed gastrectomy and esophago-jejunostomy two years earlier, with subsequent undetected insufficiency of the anastomosis and inflammation of the breast. The reason for the recurrent breast abscesses was found intraoperatively to be due to a fistula which could be followed to the anastomosis. Histologically, vegetable tissue (food particles) was detected in the fistula specimen. Detailed assessment of the patient's history could have helped detecting the circumstances when the first breast abscess appeared. Exact preoperative diagnosis and accurate wound débridement could have revealed the real cause of the recurrent abscess formation much earlier.

[Cytogenetic aberrations of esthesioneuroblastoma studied by comparative genomic hybridization].

OBJECTIVE: To characterize the cytogenetic alterations of esthesioneuroblastoma (ENB). METHODS: Comparative genomic hybridization (CGH) was performed on genomic DNA extracted from 12 patients with primary ENB, 4 patients with tumor recurrence and 7 with metastasis. Equal amounts of biotin-labeled tumor DNA and digoxigenin-labeled normal reference DNA were hybridized to normal meta phase chromosomes. Tumor DNA was visualized by fluorescein (FITC) and normal DNA by rhodamin (TRITC ) and detected by fluorescence microscopy. The signal intensities of the different fluorochromes were quantitated as gray levels along the single chromosomes. The over-and under-represented DNA segments were determined by computation of FITC/TRITC ratio images and average ratio profiles. RESULTS: Consensus deletion regions were most frequently observed on chromosomes 1p, 2q, 3p/q, 4p/q, 5p/q, 6q, 8p/q, 9p, 10p/q, 11p, 12q, 13q, 18q, and 21q. DNA over-representations were identified on chromosomes 1p, 7q, 9q, 11q, 14q, 16p/q, 17p/q, 19p/q, 20p/q and 22p/q. The genetic pattern of ENB was distinct from that of other small round-cell tumor types and neuroblastomas. The deletion on chromosome band 1p21-p31 was associated with bad prognosis. In particular, all patients died whose tumors had combined 1p21-p31 deletion, with tumors in clinical stage C or D, and of low differentiation (grade III or IV). Clonality analysis revealed a high concordance between pairs of primaries and metastases. CONCLUSION: CGH analysis identifies characteristic cytogenetic aberrations of esthesioneuroblastoma associated with its malignant phenotype.

CGH pattern of esthesioneuroblastoma and their metastases.

Comparative genomic hybridization (CGH) was used to screen 22 esthesioneuroblastomas (ENB) from 12 patients including 12 primary tumors and 10 metastasis/recurrent lesions for chromosomal imbalances being the most extensive study so far. The analysis revealed a characteristic pattern consisting of deletions on chromosomes 3p and overrepresentations on 17q in up to 100% of cases. Other important alterations being detectable in more than 80% of cases were deletions on 1p, 3p/q, 9p, 10p/q along with overrepresentation on 17p13, 20p and 22q. Particularly striking was the pattern for chromosomes 3, 10 and 17q and 20 being affected almost exclusively by deletions or overrepresentations, respectively. Pronounced overrepresentations suggestive for high copy amplifications were seen on 1p34, 1q23-q31, 7p21, 7q31, 9p23-p24, 17q11-q22, 17q24-q25, 19, 20p, 20q13 and 22q13. Comparing tumor pairs from the same patient revealed a high concordance indicating clonality and confirming the genetic homogeneity of the tumor entity. The analysis of metastatic/recurrent lesions indicated a higher percentage of pronounced alterations, e.g., high copy DNA gains at 1q34-qter, 7q11, 9p23-p24, 9q34, 13q33-q34, 16p13.3, 16p11, 16q23-q24 and 17p13. The analysis furthermore suggested specific alterations, e.g., deletions of chromosome 11 and gains of 1p to be associated with metastasis formation and/or worse prognosis. Our results indicate that ENB is a distinct entity and provides criteria for its genetic distinction from other small round cell tumor types.

Epstein-Barr virus DNA and epithelial markers in nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) belongs to the most common malignant tumours in certain parts of the world, e.g. South-East Asia. The undifferentiated type of NPC is associated with genomic Epstein-Barr virus (EBV) DNA. In normal epithelia of the nasopharynx cytokeratins (CK) 4, 5, 6, 13, 14, 15 and 19 are expressed. The aim of this study was to analyse the expression pattern of cytokeratins in NPC in the presence of EBV infection. Twenty primary or metastatic tumours from 13 patients suffering from a NPC were evaluated (formalin-fixed, paraffin-embedded). (35)S-labelled probes were used to detect EBV DNA in the tissue sections. Fourteen specimens (70%) were EBV positive. All positive specimens were undifferentiated NPC. All NPC were identified with broad-spectrum anti-CK antibody. Using a panel of anti-CK antibodies, there was no specific CK-expression pattern in NPC. In summary, undifferentiated NPC are strongly associated with EBV. The cytoskeleton of undifferentiated NPC reveals no specific pattern of CK expression.