High-grade prostate intraepithelial neoplasia shares cytogenetic alterations with invasive prostate cancer.

BACKGROUND: High-grade prostate intraepithelial neoplasia (PIN) is the most likely precursor of prostate adenocarcinoma. However, the relationship between this lesion and prostate cancer has not yet been established. The detection of cytogenetic changes in the lesions prior to prostate adenocarcinoma would be useful in demonstrating such a pathogenic relationship. METHODS: Twenty eight high-grade PIN cases were found among 57 specimens of radical prostatectomy performed for clinically localized prostate cancer. Fluorescence in situ hybridization (FISH) analysis using centromeric probes to enumerate chromosomes 7, 8, 10, and 12 was performed to study the numerical chromosome alterations. FISH analysis was carried out over isolated nuclei obtained from high-grade PIN areas and prostate cancer foci in the same prostatectomy specimen. RESULTS: Of the 28 suitable cases it was possible to complete the study in 26 tumor and 20 PIN areas. The remaining cases were excluded because of insufficient tissue or poor preservation. Cytogenetic alterations (aneuploidy) were found in 16 of the 26 (62%) tumors studied. The most frequent chromosome alteration was trisomy 7, detected in 12 (75%) aneuploid tumors, followed by monosomy 8 present in 5 (31%) aneuploid tumors. Trisomy 7 was also the most frequent isolated chromosome alteration since it was detected in 7 (44%) tumors. Thirteen of 20 (65%) PIN cases were aneuploid when studied by FISH. Trisomy 7, trisomy 8, and monosomy 8 were the most common cytogenetic alterations in the 20 PIN areas studied, being observed in nine (45%), six (30%), and four (20%) cases, respectively. FISH analysis showed a high correlation (75% cases) in ploidy and pattern of cytogenetic alterations between high-grade PIN areas and the paired prostate cancer focus in the same specimen. CONCLUSIONS: The above results show a cytogenetic link between high-grade PIN and prostate cancer, suggesting that the former could be an early form of prostate cancer.

Increased expression of proinflammatory cytokines in chronic lesions of human cutaneous leishmaniasis.

The nature of the host cellular immune response largely determines the expression of disease following infection with the intracellular protozoans Leishmania spp. In experimental animals control and resolution of infection are mediated by gamma interferon and tumor necrosis factor alpha (TNF-alpha), whereas disease progression is associated with the production of interleukin 4 (IL-4), IL-5, IL-10, and transforming growth factor beta (TGF-beta). We have analyzed the profile of cytokine gene expression directly in the lesions of 13 patients with localized cutaneous leishmaniasis due to Leishmania mexicana. All but one patient had a single lesion, and the time of evolution ranged from 8 days to 18 months. Cytokine gene expression was quantitated by reverse transcriptase PCR and interpolation from a standard curve. Gamma interferon, TNF-alpha, IL-1 alpha, IL-6, IL-10, and TGF-beta gene expression was present in all samples. IL-3 and IL-4 gene expression was barely detectable in 1 and 3 of 13 samples, respectively. IL-2 and IL-5 mRNAs were not found. A significant increase in the expression of IL-1 alpha, TNF-alpha, IL-10, and TGF-beta was observed in late lesions (> or = 4 months) compared with that in early lesions (< or = 2 months). Because of their inhibitory effects on macrophage function, the expression of IL-10 and TGF-beta may play a role in the immunopathogenesis of chronic cutaneous leishmaniasis.

Tumores vesicales de células transicionales en pacientes menores de 20 años / Transitional cell vesical tumors in patients younger than 20 years old

En los dos últimos decenios han sido motivo de numerosas revisiones los tumores de células transicionales en personas menores de 20 años de edad. Se presenta un estudio retrospectivo de seis pacientes con tumores vesicales de urotelio que, en el momento de iniciarse la sintomatología, tuvieran edad de 20 años o menor. En todos los casos el primer signo fue la hematuria, y el diagnóstico se confirmó entre dos y 60 meses después. El tratamiento de elección fue la electrorresección transuretral y, en un caso, consistió en cistectomía parcial con reimplantación de los uréteres. Se trata de carcinomas de buen pronóstico, por su baja tendencia invasora que se pone de manifiesto en la revisión bibliográfica y se confirma en esta serie. Es un padecimiento poco frecuente (0.4 por ciento) en este grupo etario; sin embargo, se debe tener en cuenta en el diagnóstico diferencial de la hematuria en el paciente joven. Se proponen la ecografía y la citología urinarias como métodos para el seguimiento de estos tumores.

Vesical tumors in patients under 25 years of age.

Behavior of transitional cell carcinoma of the bladder during the third decade of life remains a controversial subject. During the period 1980-1988, we treated 7 patients (4 male and 3 female), 25 years of age or less (mean age 19.3, range 14-25), with transitional cell carcinoma of the bladder. Until now, all patients are alive and without disease during 12-50 months after surgery. In 6 of the 7 patients, endoscopic resection was the choice treatment for superficial stage A/O. The seventh patient underwent a partial cystectomy for a B1 Jewet stage cell carcinoma. We conclude that transitional cell carcinoma of the bladder in patients under 25 years of age has a less aggressive biological behavior. Therefore, ultrasonographic examinations and serial urine cytology represent the elective test for follow-up. Cystoscopy would only be performed in doubtful cases.

Incidence of localized cutaneous leishmaniasis (chiclero's ulcer) in Mexico.

Cutaneous leishmaniasis in Mexico was first described in 1912. Since then, its existence has been repeatedly confirmed in the forest regions of the peninsula of Yucatan. In order to obtain reliable knowledge about the magnitude of this problem, we questioned and skin-tested a sample of 449 persons randomly selected from men aged 15-45 years. We found a positivity rate of 24 to 90% (mean 43%) in the seven rural health posts studied. Furthermore, 72 patients were examined between January and December 1987 by parasitological investigation (smear, isolation, culture and/or biopsy) and the Montenegro skin test; 56 had acquired the disease in 1987. Based on these data, we found an annual incidence rate of 508 per 100,000 inhabitants. Further long-term studies are indicated to determine the incidence and prevalence rates for this disease in other parts of the country.

[Multiple gastrointestinal familial poliposis (Peutz-Jerghers syndrome). Report of a clinical case]. / Polipósis familiar gastrointestinal múltiple (Síndrome de Peuts Jeghers). Presentación de un caso clínico.

The authors review a single case history of intestinal polyposis (Peutz-Jeghers syndrome) of a patient followed by them for eleven years. The paper includes a review of the pertinent literature. The present case was diagnosed as a result of the clinical observation of pigmented spots in the oral mucosa and crises of spasmodic abdominal pain accompanied by bowel movements containing mucus and blood. In other members of the family only a younger sister had slightly pigmented spots in the oral mucosa. None had radiologic findings suggestive of the syndrome of Peutz-Jeghers. Recently the patient under study suffered an intestinal intussuception which led to the surgical resection of a segment of small intestine and permitted pathologic confirmation of the diagnosis. Surgical resection of nodules in both breasts resulted in diagnoses of sclerosing adenosis in the left and an epidermoid cyst in the right.