RESUMO
Subungual melanoma is uncommon, and delays in diagnosis and misdiagnosis occur frequently. We describe a 61-year-old black male who presented with a non-healing area in his left thumb nailbed with many of the features of subungual melanoma. However, the patient also had a pathologic fracture of the distal phalanx, leading to some initial confusion about the diagnosis. Despite aggressive multimodality therapy, the disease rapidly progressed, resulting in the patient's death. Pathologic fracture due to subungual melanoma may indicate a particularly poor prognosis.
Assuntos
Fraturas Espontâneas/etiologia , Melanoma/complicações , Doenças da Unha/complicações , Polegar/lesões , Neoplasias Ósseas/secundário , Terapia Combinada , Evolução Fatal , Humanos , Metástase Linfática , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Prognóstico , Neoplasias Cutâneas/secundárioRESUMO
Primary angiosarcoma of the breast is a rare and often misdiagnosed disease. The most common clinical presentation is a painless mass in the affected breast, but the often varied presentation and the high incidence of histologic misdiagnosis make early detection rare. The tumor size and the histologic type correlate with the prognosis. The treatment for angiosarcoma of the breast is early and complete surgical excision of the mass with adequate margins. Axillary dissection is not indicated because the predilection for nodal metastasis is rare. The definitive role of adjuvant therapy remains undetermined. Chemotherapy and radiotherapy may play an important role in survival; however, the data are inconclusive. A high index of suspicion for angiosarcoma is a crucial tool in its proper diagnosis and treatment. It should always be noted that a vascular lesion that is associated with any breast mass is an angiosarcoma until proven otherwise.
Assuntos
Neoplasias da Mama/diagnóstico , Hemangiossarcoma/diagnóstico , Adulto , Angiolipoma/diagnóstico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Lobular/patologia , Terapia Combinada , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Seguimentos , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias Primárias Múltiplas/patologiaRESUMO
Between 1981 and 1989, 83 male patients with stages Ta, Tis and T1 transitional cell carcinoma were treated with bacillus Calmette-Guerin (BCG). Of 17 patients with carcinoma in situ of the prostatic urothelium 13 had identifiable prostatic ducts and periurethral ductal transitional cell carcinoma was identified in 7. At a median followup of 64 months (range 29 to 90) 12 of 17 patients (70%) had a complete response in the prostatic urethra. Among the 10 patients with mucosal carcinoma without ductal involvement 8 responded as did 4 of the 7 with mucosal and ductal involvement. A total of 9 patients had persistent tumor or recurrence in the bladder or prostate. Two men had recurrence in the prostatic urethra and, due to age and co-morbidity, both were treated by transurethral resection and fulguration. Cystectomy was performed in the remaining 7 patients. Three of 31 patients (10%) whose prostate urethral biopsies were negative before BCG therapy had a positive biopsy afterwards. After treatment with BCG, the actuarial curves for cancer specific, progression-free and overall survivals showed no statistical difference between male patients with an initially positive or initially negative prostatic urethral biopsy. BCG is a reliable agent for initial therapy of superficial prostatic transitional cell carcinoma. Careful followup can identify persistent tumor, recurrences or progression that identifies patients for whom cystectomy is appropriate.
Assuntos
Vacina BCG/uso terapêutico , Carcinoma de Células de Transição/terapia , Neoplasias da Próstata/terapia , Neoplasias Uretrais/terapia , Administração Intravesical , Cistectomia , Seguimentos , Humanos , Imunoterapia/métodos , Masculino , Recidiva Local de NeoplasiaRESUMO
We have previously reported (1987) that a positive biopsy from a clinically normal prostate eighteen months or more after interstitial Iodine 125 or external beam irradiation predicted disease progression. In the present study, all biopsies were reexamined by the same pathologist (LEL) and correlated with long-term patient status. Of twenty-six positive biopsy specimens, twenty-two were reconfirmed as positive and four were reassigned to a negative diagnosis (false positive = 15%). Seventy-two of seventy-seven negative specimens were available for reexamination and seventy were reconfirmed as negative while two were reassigned to a positive diagnosis (false negative = 2%). A statistically higher incidence of local and/or distant failure for patients with positive biopsy specimens compared with patients with negative biopsy specimens was again confirmed (p = < 0.001). However, there is a group of patients with a positive biopsy (17%) who remain clinically free of disease at greater than ten years of follow-up. Therefore, a positive biopsy is not an absolute indication of imminent failure. Our results demonstrate the technical difficulty and potential error in interpreting prostate biopsies after radiation therapy. Therapeutic decisions should be based not only on biopsy histology but must also weigh the patient's initial tumor stage and grade, current clinical examination, PSA level, age, and health.
Assuntos
Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Próstata/patologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Análise Atuarial , Biópsia , Reações Falso-Negativas , Reações Falso-Positivas , Seguimentos , Humanos , Masculino , PrognósticoRESUMO
We report the cytogenetic evaluation of 20 cultured cell strains derived from primary prostatic adenocarcinomas obtained from radical prostatectomies. The majority of the strains contained cells with only normal male karyotypes (46,XY), but cytogenetically abnormal clonal populations were found in five strains. Two of those strains contained aberrations involving the Y chromosome, one with a -Y and one with a +Y. Three strains (one of which also had the XYY karyotype) exhibited cells with double-minute chromosomes and four strains contained near tetraploid cells.
Assuntos
Adenocarcinoma/genética , Neoplasias da Próstata/genética , Aberrações dos Cromossomos Sexuais , Cromossomo Y , Adenocarcinoma/patologia , Bandeamento Cromossômico , Humanos , Cariotipagem , Masculino , Neoplasias da Próstata/patologia , Células Tumorais CultivadasRESUMO
Twenty patients with failed back surgery syndrome were analyzed prospectively with MR imaging. In addition, 10 of these patients were analyzed with high-dose contrast-enhanced CT or gadopentetate dimeglumine-enhanced MR imaging. Imaging results were compared with surgical and pathologic findings in all cases. In the 10-patient subset, abnormal epidural soft-tissue specimens were also assessed with light and electron microscopy for vascular density, size of the extracellular space, and collagen orientation and thickness. The average vascular density of epidural fibrosis on light microscopy was found to be 1.19%; the average size of the extracellular space on electron microscopy was 4.29%. Scar 4 months of age or less had a larger extracellular space than did older scar; high- (grade 4 or 5) intensity scar had a larger extracellular space than did less intense scar on long TR/short TE images. Scar 1 year old or less enhanced more intensely on CT than did older scar. The MR signal intensity and CT enhancement characteristics of epidural scar were also found to differ according to epidural location. The percentage of scar that was hyperintense on long TR/TE images was as follows: anterior, 82%; lateral recess, 70%; lateral, 47%; and posterior, 20%. However, no relationship was found between the degree of CT enhancement of scar and vascular density. Gap junction status and extracellular space size, therefore, are more important than vascular density in predicting the degree of enhancement. The accuracy of contrast-enhanced CT and unenhanced MR in separating scar from herniated nucleus pulposus is 80%. This accuracy is related to the partial overlap in imaging characteristics of scar and recurrent herniated nucleus pulposus.
Assuntos
Cicatriz/patologia , Deslocamento do Disco Intervertebral/patologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adulto , Idoso , Cicatriz/diagnóstico por imagem , Colágeno/ultraestrutura , Diagnóstico Diferencial , Gadolínio DTPA , Humanos , Aumento da Imagem , Injeções Intravenosas , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Microscopia Eletrônica , Pessoa de Meia-Idade , Compostos Organometálicos , Ácido Pentético , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Canal Medular/patologia , Canal Medular/ultraestruturaRESUMO
One hundred sixty-nine transrectal fine-needle aspirations of the prostate gland were performed in 166 patients over a two-year period. The results were compared with simultaneous core needle biopsy performed in all but 4 patients. Forty-seven (28%) aspirations were either unsatisfactory or inconclusive. Of the remaining 122 (72%) patients in whom a cytologic diagnosis could be made, core biopsy was available in 120. Aspiration cytology was 87 percent sensitive and 96 percent specific with an overall agreement of 93 percent with core biopsy. No major complications occurred. We conclude that fine-needle aspiration of the prostate is accurate, safe, and cost-effective, and greater application of this technique is encouraged.
Assuntos
Biópsia por Agulha/métodos , Neoplasias da Próstata/patologia , Humanos , Masculino , Valor Preditivo dos TestesRESUMO
Primary cell cultures were established from tissue specimens obtained from patients undergoing transurethral resection of the prostate. Cytogenetic analysis of these cultures revealed a normal male chromosomal complement from one and a 45,X karyotype from another patient with benign prostatic hyperplasia. In addition, a normal male chromosomal complement was observed from a moderately differentiated prostatic carcinoma, and a grossly abnormal karyotype was observed from a poorly differentiated adenocarcinoma of the prostate. This latter specimen contained a modal chromosome number of 84 with several consistent marker chromosomes including homogeneous staining regions and double minutes, and no normal chromosomes 3, 5, 10, 15 or Y. Primary prostatic cell cultures exhibit epithelial-specific keratin intermediate filament proteins, and, in conjunction with cytogenetic analysis, provide a model for the study of human prostate cancer.
Assuntos
Aberrações Cromossômicas , Próstata/ultraestrutura , Neoplasias da Próstata/genética , Humanos , Masculino , Hiperplasia Prostática/genética , Neoplasias da Próstata/patologia , Células Tumorais CultivadasRESUMO
The response to definitive radiation therapy of localized carcinoma of the prostate by 125iodine implantation or external beam radiotherapy was monitored by examining specimens from biopsies performed after treatment. We analyzed 126 biopsy specimens obtained 18 months or more after treatment: 71 were obtained from 109 patients treated by 125iodine and 55 from 197 patients treated by external beam radiotherapy. Thereafter, the disease status of these patients was examined at minimum 3-year intervals. No significant statistical difference was found between the negative specimen rates of the 2 treatment modalities: 46 of 71 (65 per cent) after 125iodine implantation and 39 of 55 (71 per cent) after external beam radiotherapy were negative. To analyze the predictive value of biopsy results 103 patients whose prostatic examination results were normal at biopsy or who showed regression of tumor size and tumor induration after radiation were evaluated. The biopsy results from all patients were combined for analysis. Of 77 patients with negative biopsy specimens 16 (21 per cent) have had recurrent disease, compared to 17 of 26 (65 per cent) with positive biopsy specimens (p equals 0.00005). Of the 77 patients with negative biopsy specimens 7 (9 per cent) had local disease recurrence, compared to 12 of 26 (46 per cent) with a positive biopsy specimen (p equals 0.0001). The value of a positive specimen to predict failure remained significant with patients stratified by pre-treatment clinical stage and grade of the disease. Our results show that patients with positive specimens from the prostate who had been judged clinically by rectal examination to have responded to radiation therapy had a significantly increased incidence of local and distant failure compared to patients who had negative biopsy specimens.
Assuntos
Adenocarcinoma/radioterapia , Braquiterapia , Radioisótopos do Iodo/uso terapêutico , Próstata/patologia , Neoplasias da Próstata/radioterapia , Radioterapia de Alta Energia , Análise Atuarial , Adenocarcinoma/patologia , Biópsia , Humanos , Masculino , Neoplasias da Próstata/patologia , Fatores de TempoAssuntos
Carcinoma de Células Renais/diagnóstico , Hemangioma/diagnóstico , Neoplasias Renais/diagnóstico , Lipoma/diagnóstico , Adulto , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Masculino , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Pasteur strain bacillus Calmette-Guerin was used to treat superficial transitional cell carcinoma of the bladder in 28 patients. Patients selected for treatment had an incomplete resection, positive selected site biopsies and/or post-resection positive cytology findings. Complete response required negative histology and cytology findings at cystoscopic followup 4 to 8 weeks after completion of treatment. Of the patients 20 (71 per cent) demonstrated a complete response, including all 6 with carcinoma in situ. Results converted to negative in 16 of 17 patients with positive urine cytology findings and 4 with positive prostatic urethral biopsies. Of the responders 8 had received prior treatment with thiotepa. The treatment regimen of 120 mg. Pasteur strain bacillus Calmette-Guerin weekly for 6 weeks was well tolerated. It was necessary to limit the number of treatments to 5 because of local irritative effects in only 3 patients. No chronic bladder disability has been noted during followup of 3 to 30 months. This experience supports the efficacy of bacillus Calmette-Guerin as a cost-effective, well tolerated treatment modality for patients with superficial transitional cell carcinoma of the bladder.
Assuntos
Produtos Biológicos/administração & dosagem , Carcinoma de Células de Transição/terapia , Mycobacterium bovis , Neoplasias da Bexiga Urinária/terapia , Idoso , Biópsia , Carcinoma in Situ/patologia , Carcinoma in Situ/terapia , Carcinoma de Células de Transição/patologia , Ensaios Clínicos como Assunto , Terapia Combinada , Cistoscopia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Cuidados Pós-Operatórios/métodos , Fatores de Tempo , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/patologiaRESUMO
BALB/c mice were hyperimmunized against a membrane preparation derived from a pool of transurethral resection specimens which included three benign prostatic hyperplasia and one prostate adenocarcinoma tissue samples. The activated lymphocytes were fused with the NS-1 mouse myeloma cell line, and supernatants from immunogen-reactive hybridomas were screened for antibody binding activity using a solid-phase radioimmunoassay against the Calu-1 human lung adenocarcinoma cell line and several membrane preparations derived from various normal human tissues. Hybridoma cultures secreting antibodies which did not appear cross-reactive were doubly cloned by limiting dilution and screened against a large panel of membrane preparations derived from normal prostate, benign prostatic hyperplasia, and prostate adenocarcinoma tissues as well as samples obtained from a variety of normal human tissues. The monoclonal antibodies were also evaluated against 24 normal, virally transformed, and malignant human cell lines. Two monoclonal antibodies were isolated which demonstrated a restricted binding activity to prostate antigens and were not widely cross-reactive with nonprostate normal tissues or cell lines. These antibodies were designated TURP-27 (IgG3, k) and TURP-73 (IgG2a, k). Both of these monoclonal antibodies were reactive against formalin-fixed, paraffin-embedded tissues in the immunoperoxidase assay and were subsequently tested against a variety of normal, hyperplastic, and malignant human tissues. These studies indicated that TURP-27 may be directed against a new prostate organ-associated marker and that TURP-73 is directed against an antigen expressed on prostate and a limited number of other tissues.
Assuntos
Anticorpos Monoclonais/imunologia , Próstata/imunologia , Hiperplasia Prostática/imunologia , Neoplasias da Próstata/imunologia , Especificidade de Anticorpos , Mama/imunologia , Linhagem Celular , Membrana Celular/imunologia , Colo/imunologia , Reações Cruzadas , Humanos , Técnicas Imunoenzimáticas , Rim/imunologia , Masculino , RadioimunoensaioRESUMO
Interstitial implantation with the 125iodine isotope has been used as definitive treatment in 115 patients with localized carcinoma of the prostate. The disease was staged surgically by bilateral pelvic lymphadenectomy in all of the patients. Followup has been for a minimum of 1 year and 64 patients have been followed for a minimum of 5 years. There has been no operative mortality in this series. Mean patient age at implantation was 63 years. Potency has been maintained in 31 of 46 patients (78 per cent) followed for a minimum of 5 years and 15 of 26 (58 per cent) followed for a minimum of 7 years. At 5 years the actuarial survival free of disease by surgical stage was 100, 81, 49 and 41 per cent for patients with stages A2, B, C and D1 disease, respectively. All 7 patients with stage B1 nodules followed to 5 years are free of disease. The actuarial survival free of disease by grade at 5 years was 95 per cent for patients with well, 65 per cent with moderately and 34 per cent with poorly differentiated tumors. Local failure was defined as palpable evidence of prostatic enlargement or irregularity with biopsy confirmation of neoplasm. Patients with positive biopsy plus normal or stable prostatic examinations were not considered local failures, although such patients are at high risk for failure in the future. The actuarial probability of local failure at 5 years was 0, 13, 27 and 44 per cent for patients with surgical stages A2, B, C and D1 disease, respectively, and 5, 23 and 43 per cent for those with well, moderately and poorly differentiated tumors, respectively. Based on our experience, interstitial implantation with 125iodine isotope is reserved for patients with well or moderately differentiated stage B lesions. The ultimate success of this treatment modality awaits 10 and 15 years of followup.
Assuntos
Braquiterapia , Carcinoma/radioterapia , Radioisótopos do Iodo/uso terapêutico , Neoplasias da Próstata/radioterapia , Análise Atuarial , Carcinoma/mortalidade , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade , Neoplasias da Próstata/mortalidade , Fatores de TempoRESUMO
The immunoperoxidase technique was used to study the localization and distribution of antigens reactive with two monoclonal antibodies, D83.21 and P6.2, produced against cultured prostate tumor cells, in formalin-fixed, paraffin-embedded histological sections of human tissues. Monoclonal D83.21 reacted with 11 of 19 (58%) primary prostate carcinomas and 1 of 6 (17%) metastatic tumors, whereas monoclonal P6.2 reacted with 14 of 19 (68%) primary and 4 of 6 (67%) metastatic prostate tumors. Neither antibody reacted with five primary prostate tumors and one metastatic prostate tumor. In some tumor cells, the antigens recognized by these monoclonals were localized in either the cytoplasm or cell membrane, while in other tumor cells, both diffuse cytoplasmic and membrane or focal staining patterns were observed. In addition to the variable staining patterns, antigenic heterogeneity was also noted within most prostate tumors examined. Two types of staining variability were observed: (a) tumor cells in one area of the tissue section stained positive, but in another area they did not react with the antibody; and (b) both stained and unstained tumor cells were adjacent to each other. These results would suggest that a panel of monoclonals will be required to detect the different subpopulations of prostate tumor cells. Neither antibody reacted with 6 normal or 12 benign prostate tissues, nor any of a variety of other normal human tissues except for staining of the proximal tubules of normal kidneys. The antigen detected by P6.2 demonstrated a wider tissue distribution being found on bladder, breast, lung, and pancreatic tumors, whereas the antigen recognized by D83.21 was restricted to prostate and bladder carcinomas. These antibodies may have clinical applicability for the identification of prostate tumor cells in biopsy specimens and for immunohistopathological classification of prostate carcinomas.
Assuntos
Adenocarcinoma/imunologia , Antígenos de Neoplasias/análise , Neoplasias da Próstata/imunologia , Adenocarcinoma/patologia , Anticorpos Monoclonais , Complexo Antígeno-Anticorpo , Linhagem Celular , Humanos , Técnicas Imunoenzimáticas , Masculino , Metástase Neoplásica , Antígeno Prostático Específico , Neoplasias da Próstata/patologia , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/patologiaAssuntos
Retalhos Cirúrgicos , Uretra/cirurgia , Animais , Masculino , Microcirurgia , Pênis/cirurgia , RatosRESUMO
Monoclonal antibodies to human prostate adenocarcinoma membrane antigens were produced by fusion of P3X63/Ag8 mouse myeloma cells with spleen cells from BALB/c mice immunized against the prostate cancer cell line DU145. The hybrids were screened for antibody production using glutaraldehyde-fixed cells in a solid-phase radioimmunoassay. Antibody-binding specificity was also checked by quantitative adsorption, membrane immunofluorescence, and complement-dependent cytotoxicity assays. A hybridoma clone (83.21) was isolated that secreted antibodies which preferentially bound to several prostate and bladder cancer cell lines but did not bind to a variety of other normal and malignant human cell lines. This antibody also reacted with a cytomegalovirus-transformed human embryonic lung cell line but not to normal human embryonic lung cells. Quantitative adsorption studies demonstrated that the 83.21 monoclonal antibody was strongly reactive to membrane preparations from human prostate adenocarcinoma tissue and a liver metastasis of prostate carcinoma. Little or no binding activity was observed against two other prostate carcinomas, bening prostatic hyperplasia, normal prostate, or normal liver. Binding studies indicate that the 83.21 monoclonal antibody does not bind to alpha-fetoprotein, carcinoembryonic antigen, prostatic acid phosphatase, human leukocyte antigen, beta 2-microglobulin, HLA-Dr antigens, fibronectin, or prostate antigen. The data indicate that we have isolated a monoclonal antibody that binds to an antigen(s) expressed by several urogenital carcinoma cell lines as well as human prostate tumor tissue and that the antibody is not directed against well-known human tumor cell markers.
Assuntos
Anticorpos Monoclonais , Antígenos de Neoplasias/análise , Neoplasias da Próstata/imunologia , Neoplasias da Bexiga Urinária/imunologia , Animais , Complexo Antígeno-Anticorpo , Linhagem Celular , Transformação Celular Viral , Imunofluorescência , Humanos , Hibridomas/imunologia , Neoplasias Renais/imunologia , Linfócitos/imunologia , Masculino , Camundongos , Plasmocitoma/imunologiaRESUMO
There were 39 prostatic needle biopsies obtained from 33 patients with carcinoma of the prostate 1 to 3 years after definitive treatment with interstitial implantation using 125iodine radioactive sources. Of these biopsies 57 per cent obtained at 12 to 18 months and 73 per cent obtained at 19 to 36 months after implantation were negative for malignancy. All biopsies revealed histologic evidence of significant radiation injury. Neither the presence or absence of malignancy on biopsy nor the degree of radiation injury could be related to the initial stage and grade of the prostatic neoplasm.
Assuntos
Radioisótopos do Iodo/uso terapêutico , Neoplasias da Próstata/radioterapia , Idoso , Biópsia por Agulha , Braquiterapia/efeitos adversos , Humanos , Radioisótopos do Iodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Próstata/patologia , Neoplasias da Próstata/patologiaRESUMO
Mucus-secreting adenocarcinoma of the renal pelvis is an extremely rare tumor. It arises from multipotential transitional epithelium which is capable of undergoing metaplastic transformation when subjected to chronic irritation from calculi, hydronephrosis, or pyelonephritis. Women are affected slightly more often than men. Tumor invasion implies a poor prognosis. Long-term survival occurs but is infrequent. In the case reported, preoperative angiography yielded useful diagnostic information.