Prostatic foamy gland carcinoma with aggressive behavior: clinicopathologic, immunohistochemical, and ultrastructural analysis.

Foamy gland carcinoma is a recently described histologic variant of prostatic adenocarcinoma characterized by abundant foamy cytoplasm and minimal cytologic atypia. The biologic behavior and biochemical nature of the foamy adenocarcinoma cells are unknown. Six cases of prostatic adenocarcinoma with marked foamy appearance were identified from radical prostatectomies. Clinicopathologic, histochemical, immunohistochemical, and ultrastructural analyses were conducted. The patients ranged in age from 50 to 73 years (mean age, 65 years) with preoperative serum prostate-specific antigen levels ranging from 2.7 to 37.5 ng/mL (mean, 15.2 ng/mL). All six cases were bilateral high-volume tumors. Five of six patients had high-grade tumors with extraprostatic extension. The foamy tumor cells were negative for mucin and lipid stains, but were positive for colloidal iron and Alcian blue stain. Ultrastructurally, the foamy cells displayed numerous intracytoplasmic vesicles and numerous polyribosomes. The authors conclude that the foamy appearance of these tumor cells is the result of the presence of numerous intracytoplasmic vesicles, and not the result of the presence of lipid or neutral mucin. This study illustrates that foamy gland carcinoma is a distinctive histologic variant of prostatic adenocarcinoma and is often associated with an aggressive behavior despite its deceivingly benign histologic appearance.

Absence of nasal mucosal atrophy with fluticasone aqueous nasal spray.

OBJECTIVE: To evaluate whether 1 year of continuous treatment with intranasal fluticasone propionate would lead to atrophy in the nasal mucosa compared with an active control, oral terfenadine. DESIGN: Prospective, randomized, multicenter, open-label, parallel-group study. SETTING: Two tertiary care academic institutions. PATIENTS: Seventy-five subjects older than 18 years with perennial allergic rhinitis. INTERVENTIONS: Patients received either fluticasone propionate aqueous nasal spray, 200 microg once daily, or terfenadine, 60 mg twice daily, for 1 year. Nasal biopsy specimens were obtained before and after 1 year of treatment and were evaluated for evidence of atrophy. MAIN OUTCOME MEASURES: Epithelial and collagen layer thickness of the nasal mucosa as assessed by light microscopy and the presence and degree of edema, and regularity of collagen fibrils as assessed by electron microscopy. Analyses were performed without knowledge of subject identity or treatment assignment. RESULTS: Neither fluticasone nor terfenadine treatment led to atrophy in the nasal mucosa by clinical or histologic observation. No significant changes from baseline were observed for any assessment of atrophy. In contrast to what would have been expected if atrophy were to occur, mean epithelial layer thickness in the fluticasone group significantly increased compared with terfenadine treatment (P = .03). CONCLUSIONS: Treatment with intranasal fluticasone for 1 year increases the thickness of the nasal epithelium as compared with a year's treatment with terfenadine and does not lead to atrophy in the nasal mucosa. The increased thickness in the fluticasone treatment may represent repair from epithelial damage caused by chronic allergic inflammation.

Retroperitoneal bronchogenic cyst presenting as an adrenal mass.

Subdiaphragmatic bronchogenic cysts are rare, and those located retroperitoneally are exceptional. A review of the English-language literature revealed only three reported cases. We describe an additional case of a retroperitoneal bronchogenic cyst that presented uniquely as a symptomatic adrenal mass and discuss the cases of subdiaphragmatic bronchogenic cysts reported in the English-language literature.