Epidemiology of psoriasis: case-control study in the province of Trentino (preliminary reports).

In the province of Trento a case-control study on the main environmental risk factors for psoriasis has been performed. No correlation has been demonstrated between the investigated factors and psoriasis, with the exception of familial predisposition.

The role of aspiration cytology in the management of ureteral obstruction in patients with known cancer.

In patients with known cancer, especially in cases of genitourinary cancer, thickening of the ureteral wall secondary to irradiation, chemotherapy, or surgery may make the diagnosis of metastasis, recurrence or persistence of malignancy very difficult. Since it is impossible to determine by radiologic imaging methods, whether the stricture is benign or malignant in nature, exploratory laparotomy with direct tissue biopsy remains the only procedure for an accurate diagnosis of the cause of the obstruction. As such surgery carries a significant level of morbidity, nonaggressive diagnostic techniques should be considered. The authors investigated the usefulness of aspiration biopsy cytology under fluoroscopic guidance in establishing the true nature of ureteral stenosis in 15 patients with known primary malignancy, who had previously been treated with surgery, radiotherapy, or chemotherapy. The etiology of the primary malignancies were uterine cervix (six), bladder (two), prostate (two), uterine corpus (two), pancreas (one), stomach (one), and rectum (one). Thirteen patients had metastatic ureteral involvement. There were no false-positive or false negative cytologic findings, therefore diagnostic accuracy was 100%. In the authors' experience the success of aspiration biopsy cytology depends on the skill and experience of the physician performing the procedure. The results of this study and review of the literature demonstrate that aspiration biopsy cytology is an accurate, minimally invasive means for correct cytologic diagnosis of ureteral strictures which can complicate cancer, without resorting to more aggressive diagnostic procedures.

Penile cancer. Aspiration biopsy cytology for staging.

Appropriate management and prognosis of patients with penile carcinoma depends on an accurate knowledge of the regional node status. The usefulness of clinical and radiologic examinations in detecting the nodal spread of the disease is limited by the high rates of false-positive and false-negative results. On the other hand, routine or prophylactic lymphadenectomy is associated with 30% to 50% of the major morbidity and 3% of the mortality rate, so that caution is advisable for its use in patients with disease-free nodes. Even bilateral sentinel lymph node biopsy, as proposed by Cabanas, does not warrant an adequate selection of patients candidates to surgical treatment. The role of aspiration biopsy cytology in the management of penile carcinoma was evaluated in a study of 29 cases from the authors' institutions. Aspiration under fluoroscopic or computed tomographic guidance was performed using a 22-23-gauge Chiba needle. The accuracy of aspiration biopsy cytology in identifying the true stage of the disease was 100%. On histologic control, only one node contained malignant cells that were not detected by aspiration biopsy cytology, but this finding did not alter the stage of the patient. Positive cytology is conclusive of Stage III disease and, in this case, a curative lymphadenectomy may be attempted. Negative aspirations do not warrant the absence of metastatic nodal involvement as can be seen in two patients in this series. In such cases, however, a policy of "wait and watch" may be adopted, with repeated aspiration biopsies or surgical biopsy of the sentinel node area.

Primary angiosarcoma of the gingiva. Case report with immunohistochemical study.

A case of angiosarcoma involving primarily the gingiva in an 86-year-old woman is reported. The neoplasm was strongly positive for factor VIII-related antigen, negative for cytokeratins, and positive for vimentin, confirming the vascular nature of the tumor. The patient died from heart failure 1 month after surgical excision of the lesion without clinical evidence of metastasis.

The value of aspiration cytology in the definitive staging of bladder carcinoma.

Aspiration cytology is a simple, accurate and minimally invasive procedure in staging urological neoplasms. Percutaneous fluoroscopy-guided fine needle aspiration biopsy of 99 lymph nodes was performed in 30 patients with bladder carcinoma and 62 lymph node chains were evaluated. Aspiration biopsy is more accurate and specific than lymphography in the pre-operative staging of the neoplasm and represents a useful diagnostic procedure for the staging of bladder carcinoma.

Urine cytology in the detection of renal adenocarcinoma.

Whereas urine cytology has proved to be of considerable diagnostic value for nonpapillary urothelial carcinoma, carcinoma in situ, and high-grade urothelial tumors, controversy has arisen over the accuracy of cytology in the diagnosis of renal neoplasms. To establish the reliability of urine cytology as a detection technique, 436 urine specimens from 59 patients with histologically proven renal adenocarcinoma were examined. Malignant cells in urinary sediment were found in 121 (27.75%) specimens from 31 (52.54%) patients. Seven of 20 (35%) patients with Stage I tumor showed neoplastic cells in 16 (16.5%) of 97 urinary samples. Positive cytologic features were found in 36.9% of 84 urinary specimens from 7 (50%) of 14 patients with tumors smaller than 5 cm. Using only imaging methods, the renal neoplasm was diagnosed in 58 (98.3%) cases. Urine cytology is, therefore, of little value in the diagnostic evaluation of known renal masses and in the detection of early-stage disease. In the current series there was not a single case with positive cytologic findings in which radiology did not reveal the tumor. The cytologic examination of the urinary sediment is unreliable in the diagnosis of radiologically unresolved cases of renal neoplasms. In 15 patients (44%) who had cancer cells in the urine the neoplasm had not invaded the renal pelvis. In 36% of patients with negative urine cytologic findings the renal pelvis was involved by renal adenocarcinoma. In the current study the desquamation of neoplastic cells in the urinary stream did not depend on tumor invasion of the renal pelvis. Based on the assumption that the primary objective of a screening procedure is to achieve an adequate sensitivity for early detection of disease, the results led the authors to conclude that the use of urine cytology as a possible screening test of renal adenocarcinoma is futile. Factors in the current study that diminished the practical value of cytologic examination of urinary sediment included the large number of specimens without malignant cells and the insensitivity of the procedure in diagnosing early renal adenocarcinoma of limited extent. Although this is the largest series reported, the number of cases considered was limited and further detailed studies are mandatory to definitively clarify the value of urine cytology in detecting renal adenocarcinoma.

Aspiration cytology in the staging of urologic cancer.

Knowledge of the status of the pelvic lymph nodes is vital for accurate staging and adequate treatment of patients with urologic cancer. Noninvasive techniques for assessing the lymphatic spread of urologic neoplasms have proved to be of limited value. Bipedal lymphangiography and percutaneous fine needle aspiration cytology under fluoroscopic guidance were performed for staging purposes in 71 patients with clinically localized bladder, prostatic and penile cancer from 257 nodal chains. The overall diagnostic accuracy was 93% and the correct aspiration of 186 lymph nodes was surgically confirmed. There were 11 (6%) false-negative biopsy results and no false-positive diagnoses. Aspiration cytology is a safe, well tolerated, accurate, and rapid method of determining the presence of metastatic disease in lymphangiographically visualized pelvic nodes. In the management of prostatic carcinoma, positive cytologic results are diagnostic of nodal metastatic involvement and spare the patients unnecessary surgical staging. Negative cytologic findings may be considered diagnostic of localized disease in the patients with well differentiated prostatic carcinoma (2-4 Gleason's sum). Since most surgeons are reluctant to perform a staging lymphadenectomy in the management of invasive bladder carcinoma, aspiration cytology can provide accurate staging, thus permitting an appropriate treatment plan. In patients with carcinoma of the penis, a positive aspirate permits an early and even curative lymphadenectomy in cases with clinically negative but pathologically positive nodes.

Aspiration cytology of simultaneous bilateral adrenal metastases from renal cell carcinoma. A case report and review of the literature.

We report the computerized tomography and ultrasound-guided aspiration cytology results in the first case of renal cell carcinoma with bilateral adrenal involvement. The adrenal metastases were evident clinically 6 years after radical nephrectomy and were treated successfully by an operation. Aspiration cytology under computerized tomographic and sonographic guidance is an excellent procedure to evaluate enlarged adrenal glands in patients with renal cell carcinoma or other malignant neoplasms.

The role of etretinate (Tegison; Tigason) in the management of keratoacanthoma.

Four patients with keratoacanthomas 2 to 3 cm in size were treated with etretinate. All the patients demonstrated early response and complete regression of the lesions. Follow-up (of 24 months in one case) did not reveal any recurrence.

Comparative study of lymphography and aspiration cytology in the staging of prostatic carcinoma. Report of 35 cases with histological control and review of the literature.

Accurate staging of prostatic carcinoma is essential in determining the prognosis and establishing the most adequate therapy of the disease. Lymphography is the most widely used method in staging prostatic carcinoma but shows false-positive rates varying up to 58% and false-negative rates varying from 11 to 66%. Aspiration biopsy was proposed to enhance the reliability of lymphography. In our study we performed transcutaneous aspiration biopsy of the pelvic nodal chains in 35 patients with clinically localized prostatic carcinoma using a long-beveled side-holed modified Chiba needle. 124 nodal chains were punctured and malignant cells were found in 26 aspiration biopsies of 15 patients. In determining the true stage of the disease, aspiration cytology and lymphography showed accuracy of 91 versus 57%; sensitivity of 83 versus 67% and specificity of 100 versus 47%, respectively. Positive cytologic findings are conclusive for stage D disease, while negative cytology may be accepted as definitive only when the neoplasm is well differentiated or the Gleason sum is 2-3-4. Combined use of lymphography and aspiration cytology permits surgical staging to be limited to those patients with undifferentiated neoplasm, intermediate or high Gleason sum (5-10) and negative cytology.

Aromatic retinoid in the chemoprevention of the progression of nevoid basal-cell carcinoma syndrome.

The management of nevoid basal-cell carcinomas in this syndrome is sometimes very difficult, because of the high number of tumors and of their particular localizations. The authors reviewed the literature and here report their experience in the treatment of nevoid basal-cell carcinoma syndrome with aromatic retinoid etretinate (RO 10-9359; Tigason).

[The role of transcutaneous fine-needle aspiration biopsy of the regional lymph nodes in the management of cancer of the penis]. / Il ruolo della biopsia aspirativa transcutanea con ago sottile dei linfonodi regionali nel trattamento del carcinoma del pene.

Knowledge of the status of the regional lymph-nodes is essential for establishing the stage and the optimal treatment of carcinoma of the penis. Lymphadenectomy cannot be performed routinely because of its morbidity (30-50%) and mortality. Various noninvasive procedures such as lymphography, T.A.C. and echography have been proposed but are of limited diagnostic value because of the unacceptable frequency of the false positive and false negative findings. The transcutaneous fine-needle aspiration biopsy of the draining nodes visualized by lymphography is an innocuous, non invasive, excellent procedure, alternative to staging surgery in determining or excluding the presence of the nodal metastases. The positive cytology is conclusive of stage III and implies early, sometime, curative lymphadenectom. If the aspirate is abundant and largely representative the negative findings may also be considered to indicate the reactive nature of the lymphadenopathy.

Value and role of percutaneous regional node aspiration cytology in the management of penile carcinoma.

The determination of the status of regional draining lymph nodes is crucial in the prognosis and treatment of penile carcinoma. Tumor staging is inaccurate without histologic examination of the nodes, but the high attendant morbidity rate of lymphadenectomy mandates careful case selection rather than routine prophylactic dissection. Since the penile and pedal lymphography opacifies all lymph nodes involved by penile carcinoma, fine needle aspiration cytology of regional nodes is an innocuous, accurate, easy, and inexpensive diagnostic procedure and alternative to surgical staging in determining the nodal extension of neoplasm. Positive cytology enables rapid, early and even curative lymphadenectomy in patients with clinically negative but microscopically positive nodes. Since radiopaque contrast medium opacifies the nodes for 6-9 months, repeated fine needle aspiration cytology may be used for accurate, careful and regular follow-up examination of patients with penile carcinoma.

'True' sarcomatoid carcinoma of the renal pelvis. First case report with immunocytochemical study.

A case of sarcomatoid carcinoma of the renal pelvis is reported. The neoplasm showed polypoid configuration and was composed exclusively of plump, spindle and pleomorphic cells. Light microscopy did not reveal any epithelial differentiation of the neoplastic cells. Immunoperoxidase staining for keratins and for epithelial membrane antigen was strongly positive in the spindle elements and showed the epithelial nature of the proliferation. The present case suggests that pleomorphic tumors, when occurring in visceral organs, should be carefully sampled and immunocytochemical markers for epithelial and sarcomatous differentiation studied, before diagnosis of carcinosarcoma or sarcoma may be accepted.