Can interpectoral nodes be sentinel nodes?

BACKGROUND: This study was designed to determine if interpectoral nodes could be sentinel nodes for some breast cancers. METHODS: Thirty-five consecutive breast cancer patients undergoing axillary node dissection had a dissection of the interpectoral nodes. These were sent to pathology as a separate specimen. RESULTS: Three patients were identified with isolated interpectoral nodal metastasis. CONCLUSION: In upper quadrants or deep breast cancers the interpectoral nodes may be the earliest site of nodal metastasis. This may lead to false negative results in some sentinel node biopsies.

Falcotentorial plasmacytoma. Case report.

Intracranial solitary plasmacytomas are extremely rare tumors and are often misdiagnosed preoperatively. The authors report the successful treatment of a patient who harbored such a tumor involving both the falx and tentorium; this is the second case reported. A 59-year-old woman suffered from a seizure disorder due to a falcotentorial lesion, which had been identified 3 years earlier and was thought at the time to be an en plaque meningioma. Most recently, the patient presented with symptoms of increased intracranial pressure and hemiparesis. Computerized tomography and magnetic resonance imaging of her head revealed progressive growth of the tumor. The patient underwent partial resection of the tumor and chemo- and radiation therapies. Intracranial plasmacytomas must always be included in a differential diagnosis because potential complete cure can be achieved using fairly conservative treatment modalities.

Increased expression of the src proto-oncogene in hairy cell leukemia and a subgroup of B-cell lymphomas.

The c-src proto-oncogene encodes a M(r) 60,000 phosphoprotein, pp60c-src, with tyrosine-specific protein kinase activity. We have used an immune complex protein kinase assay for pp60c-src to analyze a spectrum of B-cell neoplasms. pp60c-src activity was elevated in all five hairy cell leukemia specimens and in a number of the large cell and immunoblastic lymphomas; neoplasms representing later stages in B-cell development. pp60c-src activity was low in neoplastic cells which correspond to early and intermediate stages in B-cell development (acute and chronic lymphatic leukemia, lymphoblastic lymphoma, small lymphocytic lymphoma). The enhanced pp60c-src activity was associated with high levels of pp60c-src protein. However, increased expression of c-src was not associated with amplification or gross structural rearrangement of the c-src gene. This preliminary study demonstrates elevated levels of pp60c-src protein and tyrosine protein kinase activity in neoplasms corresponding to the later stages of B-cell ontogeny.

Luetic cervical adenitis in patients with human immunodeficiency virus type 1 infection.

The clinical course of syphilis may be altered in some patients with human immunodeficiency virus type 1 infection. We report two cases of syphilis in patients with human immunodeficiency virus type 1 infection who presented with marked unilateral anterior cervical adenopathy after engaging in oral-genital sex. Neither of the patients had evidence of oropharyngeal chancres. One patient developed a cutaneous rash of secondary syphilis soon after the cervical adenopathy developed. Both patients responded well to antibiotic therapy.

c-Ki-ras mutations in dysplastic fields and cancers in ulcerative colitis.

A sensitive restriction fragment length polymorphism assay and DNA sequencing were used to detect c-Ki-ras mutations in 56 specimens of colonic epithelium from 18 patients with chronic ulcerative colitis. Mutations were not detected in biopsy specimens that were negative or indefinite for dysplasia. In 4 of 8 patients with high-grade dysplasia, a c-Ki-ras codon 12 or 13 mutation was detected. In three colectomy specimens, a wide area of dysplastic cells (greater than 10 cm2) contained a specific ras mutation. In two of these specimens, an invasive cancer contained a c-Ki-ras mutation identical to that found in adjacent dysplastic epithelium. These studies indicate that mutations of c-Ki-ras may be an excellent molecular genetic marker to map dysplastic fields and invasive cancer in ulcerative colitis.

Retroperitoneal fibrosis as host response to papillary renal cell carcinoma.

A case of papillary renal cell carcinoma associated with retroperitoneal fibrosis is described. This type of fibrosis has not been previously reported to be associated with renal cell carcinoma. The case is of additional interest in that it implicates an immune phenomenon in the pathogenesis of the fibrosis, involving both putative tumor antigens and antigens associated with tumor growth but unrelated to tumor cells.

c-src structure in human cancers with elevated pp60c-src activity.

We used RNAase protection and restriction fragment length polymorphism assays to detect activating mutations of c-src in a spectrum of human tumours. No mutations were detected at codons 98, 381, 444, and 530. We conclude that mutational activation is not the mechanism of enhancement of pp60c-src-specific kinase activity found in a number of human cancer types.

Inverted T helper/T suppressor lymphocyte ratio is not a reliable indicator of coexistent HIV infection in the presence of carcinoma: report of a patient with ovarian carcinoma and inverted TH/TS ratio.

Patients with non-HIV (Human Immunodeficiency Virus) related cancers may also have HIV infection. Inverted peripheral blood lymphocyte T helper/T suppressor ratios with selective loss of T helper cells may be used as a clinical screening test for HIV infection in these patients since they may be seronegative for retrovirus infection early in the course of infection. We describe a case in which carcinoma alone appeared to induce systemic changes that resembled coexistent HIV infection. Many of these abnormalities, including inverted TH/TS ratio with selective loss of T helper cells, improved in the immediate postoperative period, indicating that HIV infection was not present. We conclude then, that diagnosis of HIV infection should not be made without more definitive evidence of its presence than an inverted TH/TS ratio in a patient with carcinoma.

Phenotypic and genetic alterations in pre-cancerous cells in the colon.

Cell dysplasia in polyps and in ulcerative colitis are thought to be the pre-cancerous lesion leading to invasive colon cancer. Many polyps and dysplastic lesions in ulcerative colitis have phenotypic changes (blood group antigen, cytokeratins, CEA, TAG-72.3 antigen expression) and genetic changes (c-K-ras mutation, enhanced c-myc expression and pp60c-src activity) which are characteristic of invasive cancers. Thus, these early pre-cancerous lesions may be a late stage in the genetic evolution of colon cancer.

Leukemia derived from intermediately differentiated lymphocytic lymphoma.

The availability of monoclonal antibodies has facilitated the immunophenotypic characterization of malignant lymphocytes from patients with lymphoma and leukemia. The chronic lymphocytic leukemias are diseases of both clinical and morphological diversity and the application of monoclonal antibodies can prove helpful in their classification. Enzyme cytochemistry, surface markers, mouse rosetting, and electron microscopy were used to determine the phenotype of cells from an atypical case of B-CLL. The use of monoclonals Leu-1, CALLA and BA-2 on bone marrow and peripheral blood provided the opportunity to diagnose this patient's disease as intermediately differentiated lymphoma. Leu-1 was found to be a useful alternative to mouse rosetting, a technique not easily performed in a routine setting. Ultrastructural studies helped to prove the prolymphocytic component of this patient's disease. It was concluded that phenotypic characterization of lymphoid cells using monoclonal antibodies directed against membrane antigens facilitated the assessment of this patient's disease.

ras p21 expression in the progression of breast cancer.

The differential expression of the ras oncogene product p21 in the primary tumor, regional nodes, and distant metastatic sites in patients with disseminated breast cancer was examined to define the biologic and clinical significance of the ras oncogene in the progression of breast cancer. The avidin-biotin peroxidase complex method was used on formalin-fixed, paraffin-embedded tissues from 16 patients with metastatic disease. The primary antibody used in this protocol was RAP-5, an anti-p21 murine monoclonal IgG2a. p21 antigen staining was similar in the primary tumor and regional nodes from the same patient (P less than 0.05), but the staining of distant metastases was more variable. Expression of ras p21 was consistently increased in invasive components of the primary tumor as compared with intraductal tumor. In addition, a high level of p21 expression was seen in tumor emboli in lymphatics and blood vessels as compared with contiguous tumor in parenchymal tissue. Although p21 staining is present in aggressive primary breast cancers and most metastatic sites, our findings indicate that markedly enhanced p21 expression is associated with the earlier stages (invasion and dissemination) of aggressive breast cancers.

Anaplastic solitary extramedullary plasmacytoma of the cecum. Report of a case confirmed by immunoperoxidase staining.

Solitary extramedullary plasma cell tumors, although uncommon, have been reported with increasing frequency over the last few years. Approximately 5 to 10 percent of the tumors arise in the gastrointestinal tract. This report demonstrates that a solitary anaplastic cecal extramedullary plasmacytoma can mimic a polypoid carcinoma, both grossly and, to an extent, microscopically. Immunoperoxidase stains for cytoplasmic immunoglobulin proved useful in establishing the correct diagnosis.

Infantile (desmoid type) fibromatosis with extensive ossification.

Solitary congenital or infantile (desmoid-type) fibromatosis is a benign, but potentially locally aggressive lesion that is best treated by wide local excision. It has been confused with congenital fibrosarcoma and other soft-tissue malignant tumors. To our knowledge, ossification has not been reported previously in this lesion. A case of ossifying solitary congenital fibromatosis is presented with a discussion of its differential diagnosis and histologic distinction from other soft-tissue lesions, including soft-tissue and parosteal osteosarcoma.

Elevated ras oncogene expression correlates with lymph node metastases in breast cancer patients.

The protein product of the ras cellular oncogene(s) (p21) was assayed in primary breast carcinomas from two groups of patients who had different axillary lymph node status. Using an immunohistochemical assay, the intensity and percent of neoplastic cells demonstrating ras p21 antigen staining were significantly higher in the primary tumors from patients with lymph nodes positive (LN+) for malignancy (20 patients) compared with the lymph node negative (LNO) group (21 patients). The expression of p21 also correlated with tumor size. Age and estrogen receptor status did not influence p21 staining. The antigen expression of p21 was similar in intensity and distribution in the primary tumor and regional lymph node metastases. Enhanced expression of p21 in primary breast cancers that metastasize to regional nodes indicates that ras p21 may be a determinant of the malignant potential of breast cancer cells and may represent a new class of more biologically relevant tumor markers.

Endometrial immunofluorescence associated with endometriosis and pelvic inflammatory disease.

Anti-immunoglobulin G (anti-IgG) staining in the endometrium by immunofluorescence has been associated with endometriosis. To investigate this phenomenon further, we took endometrial samples from 42 patients who underwent laparoscopy or laparotomy, which were tested for immunofluorescence. Fluorescein-labeled anti-IgG was incubated with tissue samples. Of 18 patients with documented endometriosis, 16 had positive immunofluorescence (89% sensitivity). Of 24 patients with no evidence of endometriosis, 9 had false-positive immunofluorescence and 15 had negative immunofluorescence. Of the 9 false-positive samples, 8 had evidence of old pelvic inflammatory disease. In the absence of this condition, there was only one false-positive study for immunofluorescence. The implications of these findings in terms of the pathophysiology of endometriosis-associated infertility is that it may be an immune-mediated process. With regard to diagnosis, the high predictive value of endometrial immunofluorescent IgG may be a useful tool in indicating early laparoscopic examination of the infertile period.

Squamous cell carcinoma in congenital ichthyosis with deafness and keratitis. A case report and review of the literature.

The first case of invasive squamous cell carcinoma (SCC) arising in the skin of a patient afflicted with keratitis, ichthyosis, and deafness (KID) syndrome is reported. A 35-year-old man, diagnosed as having KID syndrome in early childhood, developed bilateral fungating lesions on his feet. The entire left foot became involved with a multinodular fungating mass which proved to harbor a SCC, necessitating a left below-knee amputation. Although rare, KID syndrome can be associated with SCC of the skin.

Expression of ras oncogene p21 in prostate cancer.

The major neoplastic transformation-inducing genes of human solid tumors are members of the ras oncogene family. We used an immunohistochemical assay to assess expression of both the unaltered and the mutated ras oncogene protein (p21) in normal and neoplastic prostatic cells. With the concentration of monoclonal antibody used in this study, epithelial and stromal cells from subjects with normal prostates and from 19 patients with benign prostatic hyperplasia were negative for p21 antigen. This antigen was detected in 2 of 6 prostates with Grade I carcinoma, 4 of 6 with Grade II, and all of 17 with higher grades. A semiquantitative immunohistochemical method demonstrated that expression of the p21 antigen in a carcinoma strongly correlated with nuclear anaplasia and was inversely related to the degree of glandular differentiation. However, markedly anaplastic tumors were often more heterogeneous in expression of p21 and contained areas of low staining for the antigen. Comparison of p21 antigen with tumor carcinoembryonic antigen and prostate-specific antigen demonstrated that ras p21 was the only phenotypic marker that correlated with histologic tumor grade. Thus, ras oncogene p21 may represent a new class of biologically relevant tumor markers and may be a useful adjunct to histopathologic examination in determining the prognosis of patients with prostate cancer.