Massive osteolytic bone metastases from a primary aortic sarcoma: a case report.

We present an unusual case of an aortic intimal sarcoma, which originally manifested itself by the presence of extensive radiologically osteolytic lesions in the long bones of the lower limbs. The histology of these was puzzling and was first considered to represent a low grade sarcoma of vasoformative tissue and subsequently skeletal angiomatosis. Despite a good initial clinical response to disodium etidronate, the patient ultimately developed small bowel infarction and the true diagnosis only came to light at autopsy. This revealed a tumour in the lower thoracic aorta which, unusually for aortic sarcoma, consisted of loosely packed bland spindle cells with no necrosis and infrequent mitoses. Immunocytochemistry was unhelpful but electron microscopy suggested myofibroblastic differentiation. The majority of previous reports of the tumour in the literature lack information on electron microscopy and immunocytochemistry and have suggested that these tumours are generally pleomorphic in appearance. Embolic phenomena and post mortem diagnosis are usual although occasional antemortem diagnosis has been made using computed tomography (CT) and magnetic resonance imaging (MRI) scanning with the latter being the investigation of choice.

A hot spot for p53 mutation in transitional cell carcinoma of the bladder: clues to the etiology of bladder cancer.

Twenty-eight transitional cell carcinomas of the bladder, grade 2 or 3, were analyzed for the presence of p53 mutations. Thirteen tumors were found to contain 14 mutations. These were all base substitution mutations, of which nine were GC-->AT transitions (three at CpG sites). The remaining five mutations were transversions (three GC-->CG, one GC-->TA, and one AT-->TA). Four of the mutations were found at codon 280. A comparison with other studies of bladder tumors reveals that a region encompassing codons 280 and 285 represents a hot spot for p53 mutation in bladder cancer. The 280/285 hot spot lies within two purine-rich sequences that may provide some clues to the identity of potential bladder carcinogens. A comparison of mutations from bladder tumors of smokers and nonsmokers reveals no significant differences.

Intrahepatic splenic tissue.

Intrahepatic splenic tissue is uncommon being reported to date in three humans and one pig. This report is of a 54 year old man with chronic asthma who died from acute bronchial asthma. Twenty years previously he had undergone a splenectomy (the spleen was histologically normal). Necropsy revealed a well defined, smooth bordered, bilobed red mass on the left hepatic lobe; one lobe projected outwards the other was embedded in the liver. Histologically the mass was splenic tissue. This case of intrahepatic splenic tissue differing from the three human cases reported previously in that there was a common capsule beneath which splenic pulp directly abuts on hepatic tissue. This suggests that this case is more probably one of hyperplasia of congenitally ectopic splenic tissue following splenectomy rather than limited splenosis after implantation onto the serosal surface of splenic tissue released by trauma. Splenic ectopia should be considered in the differential diagnosis of hepatic lesions detected post-splenectomy and the liver should be considered as a possible site of residual splenic tissue if splenic function returns following splenectomy.

Molecular screening of multifocal transitional cell carcinoma of the bladder using p53 mutations as biomarkers.

Thirteen of 28 patients (46%) with grade 2-3 multifocal transitional cell carcinoma (TCC) of the bladder were found to have p53 mutations using DNA sequence analysis. These were subsequently utilized as tumor-specific biomarkers. Analysis of 17 episodes of recurrence from five of the patients revealed that all but one carried the identical mutation to the primary tumor. Thirty urine samples were collected, at initial diagnosis and during follow-up screening, from eight patients with mutations over a period of 24 months. Sequence analysis of PCR products generated from DNA extracted from the urine sediments was carried out. The p53 mutation seen in the primary tumors was detectable in 24 of 30 urine samples. The remaining six cases coincided with a negative cystoscopic examination. Interestingly, 6 of the 24 urine samples in which mutations were detectable also coincided with negative cystoscopy. The results are consistent with: (a) monoclonality of multifocal TCC; (b) the spread of TCC through a seeding mechanism; and (c) the long-term persistence of tumor cell clones (up to 97 months) within the bladder, even in the absence of obvious tumor growth.

Selective sampling of yellow prostate chips: a specific method for detecting prostatic adenocarcinoma.

Yellow chips were sought in 206 transurethral resection specimens of prostate. 18 (9%) contained yellow chips, and 46 (22%) prostatic adenocarcinomas were present. Yellow chips showed a specificity of 100% (95% confidence interval, CI 98-100%), a sensitivity of 39% (95% CI 25-55%), and a positive predictive value of 100% (95% CI 82-100%) for prostatic adenocarcinoma. Yellow chips were more easily recognized in poorly fixed specimens. On comparing prostatic adenocarcinomas with or without yellow chips, there was no significant difference in Gleason score or percentage of chips infiltrated by tumour. Complete sampling of prostate chips may be unnecessary, if yellow chips are present and selectively sampled. Naked-eye detection of prostatic adenocarcinoma may be increased by examining the tissue before fixation.

Case report: splenic-gonadal fusion--the ultrasound appearances.

We report the ultrasound appearances, with pathological correlation, of splenic-gonadal fusion in a patient who presented with an asymptomatic scrotal swelling. Ultrasound examination showed an echo-poor 2 cm diameter lesion in the upper pole of the left testicle. Histologically the lesion was normal spleen. Splenic-gonadal fusion should be considered in the differential diagnosis of scrotal swellings.

Clonal evolution of marker chromosomes in a case of myelofibrosis with myeloid metaplasia and myeloblastic transformation.

The diverse spectrum of acquired chromosome abnormalities in a female patient with myelofibrosis and myeloid metaplasia is described. A sequence of karyotypic evolution involving a ring chromosome is postulated. The terminal clinical picture was unusual in that there was obstructive renal failure from extramedullary myeloblastic transformation and infiltration of the bladder, and this was also present in other sites. Initially neutrophils showed low alkaline phosphatases activity but latterly two distinct populations in which cells had either high activity or none.

Evaluation of a teaching hospital necropsy service.

The information returned to the hospital clinician after a necropsy was investigated in a series of 1000 patients. It was found that specific clinical queries were answered in 83% of cases, that the necropsy corrected the major clinical diagnosis in 36% of cases, and that 29% of cases were used for undergraduate or postgraduate teaching. The results demonstrate the continuing value of the necropsy as an investigative and educative procedure.

Prognostic significance of inappropriate production of pregnancy proteins by breast cancers.

50 cases of cancer of the breast (diagnosed between 1962 and 1966) were studied retrospectively. An enzyme-bridge immunoperoxidase technique was used to demonstrate that so-called pregnancy-specific proteins were detectable in the cytoplasm of the tumour cells. Of the proteins studied, pregnancy-specific beta1-glycoprotein was present in 76% of cases, placental lactogen in 82%, and chorionic gonadotrophin in 60%. Those women with cancers negative for pregnancy-specific beta1-glycoprotein and placental lactogen had significantly longer survival-time compared with those whose cancers stained for these proteins. Pregnancy-specific beta1-glycoprotein appears to be the best indicator of prognosis. A prospective study is needed to determine whether those patients requiring adjuvant chemotherapy after mastectomy can be identified by staining tumour tissue for pregnancy-specific beta1-glycoprotein by the enzyme-bridge technique.