Vitamin D Deficiency at Diagnosis Increases All-Cause and Prostate Cancer-specific Mortality in Jamaican Men.

BACKGROUND: 25 hydroxyvitamin D [25(OH)D] and serum calcium have been associated with incident prostate cancer (PCa). However, there is limited data on whether these metabolites predict survival in men of African descent, a population disproportionately affected by PCa. We studied the relationship of 25(OH)D at PCa diagnosis with all-cause and cancer-specific mortality among Jamaican men and examined whether serum calcium modified any associations. METHODS: Serum 25(OH)D from 152 Jamaican men with incident PCa within the Prostate Cancer Risk Evaluation (PROSCARE) study were re-evaluated approximately 11 years after enrollment. 25(OH)D analyses were stratified using the using Holick criteria. PCa-specific and all-cause mortality were examined in Kaplan-Meier survival curves and Cox regression models adjusted for age, body mass index (BMI), smoking and Gleason score. Restricted cubic splines evaluated nonlinear associations. Serum calcium was assessed as an effect modifier of the association between 25(OH)D and mortality. RESULTS: Of cases with available 25(OH)D, 64 men with PCa survived, 38 deaths were PCa specific and 36 died of other causes. At baseline, 9.9% of cases were vitamin D deficient and 61.2% were vitamin D sufficient. Compared to 25(OH)D sufficient men, those with 25(OH)D <20.0 ng/mL concentrations were associated with higher PCa-specific mortality (adjusted HR, 4.95; 95% CI, 1.68, 14.63, P = .004) and all-cause mortality (adjusted HR, 2.40; 95%CI, 1.33, 4. 32, P = .003). Serum calcium was not associated with survival and did not modify any associations with 25(OH)D. CONCLUSIONS: 25(OH)D deficiency at PCa diagnosis predicted decreased survival for overall and PCa-specific cancer in Caribbean men of African ancestry.

Associations of whole-blood fatty acids and dietary intakes with prostate cancer in Jamaica.

OBJECTIVE: To investigate the association of whole-blood fatty acids and reported intakes of fats with risk of prostate cancer (PCa). DESIGN: Case-control study of 209 men 40-80 years old with newly diagnosed, histologically confirmed prostate cancer and 226 cancer-free men attending the same urology clinics. Whole-blood fatty acid composition (mol%) was measured by gas chromatography and diet assessed by food frequency questionnaire. RESULTS: High whole-blood oleic acid composition (tertile 3 vs. tertile 1: OR, 0.37; CI, 0.14-0.0.98) and moderate palmitic acid proportions (tertile 2: OR, 0.29; CI, 0.12-0.70) (tertile 3: OR, 0.53; CI, 0.19-1.54) were inversely related to risk of PCa, whereas men with high linolenic acid proportions were at increased likelihood of PCa (tertile 3 vs. tertile 1: OR, 2.06; 1.29-3.27). Blood myristic, stearic and palmitoleic acids were not associated with PCa. Higher intakes of dietary MUFA were inversely related to prostate cancer (tertile 3 vs. tertile 1: OR, 0.39; CI 0.16-0.92). The principal source of dietary MUFA was avocado intake. Dietary intakes of other fats were not associated with PCa. CONCLUSIONS: Whole-blood and dietary MUFA reduced the risk of prostate cancer. The association may be related to avocado intakes. High blood linolenic acid was directly related to prostate cancer. These associations warrant further investigation.

Disseminated trichosporonosis in a burn patient: meningitis and cerebral abscess due to Trichosporon asahii.

A 44-year-old diabetic female presented to a hospital in Jamaica with thermal burns. Trichosporon asahii was isolated from facial wounds, sputum, and a meningeal swab. Dissemination of the fungus was demonstrated in stained histological sections of the meninges and a brain abscess at autopsy. Pure growth of the fungus from patient samples submitted and an environmental isolate obtained from a wash basin in the hospital supported the diagnosis.

Body size and risk of prostate cancer in Jamaican men.

We investigated the associations between body size and risk of prostate cancer in a hospital-based case-control study in Jamaica. Height, weight, waist, and hip circumference were measured at enrollment, and data collected on medical and lifestyle factors for newly diagnosed cases (n = 243) and controls (n = 275). Compared with men in the normal range of waist-hip ratio (WHR), men with WHR > or =0.95 were at greater risk of total prostate cancer (OR,1.72; CI, 1.01-3.00) and high-grade cancer (OR, 2.02; CI, 1.03-3.96). With additional control for BMI, the association with WHR remained significant for total prostate cancer (OR, 1.90; CI, 1.01-3.53) and high-grade disease (OR, 2.94; CI, 1.34-6.38). There was no association between waist circumference and cancer without control for BMI but after controlling for BMI, waist circumference >90 cm (OR, 2.45; CI, 1.01-5.94) and >102 cm (OR, 5.57; CI, 1.43-18.63) showed a dose-response relationship with high-grade disease. Height and BMI were not associated with risk of prostate cancer. Abdominal obesity may be associated with risk of high-grade prostate cancer. Risk may be greater in those with higher abdominal obesity relative to overall size. The results further highlight the importance of investigating relationships by characteristics of the tumor.

A 6-year analysis of the clinicopathological profile of patients with prostate cancer at the University Hospital of the West Indies, Jamaica.

OBJECTIVE To document the clinicopathological characteristics of prostate cancer in a public hospital-based population in Jamaica, over a 6-year period, and examine any trends in these characteristics over time, as prostate cancer is the leading cause of cancer in Jamaican men, but there are few published reports documenting the clinicopathological profile of this disease in the Jamaican population. PATIENTS AND METHODS All patients consecutively diagnosed with prostate cancer by transrectal ultrasonography-guided biopsy at the University Hospital of the West Indies, from January 2000 to December 2005, were identified at time of diagnosis, and relevant clinical and pathological data collected from the accompanying histopathology request forms. RESULTS There were 529 cases of prostate cancer diagnosed over the 6 years. The mean (sd) age was 70.66 (8.74) years, with 137 patients aged 70-74 years. A serum prostate-specific antigen (PSA) level was obtained for 490 (92.6%) patients. Of these, an accurate PSA value was available for 456 (86.2%) patients and a 'minimum level' recorded for the remaining 34, all of whom had a PSA level of >100 ng/mL. Of the patients with available PSA information, only 91 (18.5%) had a level of < or =10.0 ng/mL. By contrast, 155 (31.6%) patients had levels of >100 ng/mL. The median (range, interquartile range) serum PSA level for those patients with accurate values was 30.7 (1-14 260, 11.7-109) ng/mL. Histologically, moderately and poorly differentiated cancers accounted for 198 (37.5%) and 160 (30.2%) cases, respectively. Correlation of the variables under investigation confirmed that there was a statistically significant positive and moderate correlation between serum PSA level and Gleason score (Spearman r 0.49; P < 0.001). Statistical analysis of all other variables, including the number of cases of prostate cancer diagnosed annually, showed no significant differences. CONCLUSION Compared with many countries, including some in the Caribbean, prostate cancer in Jamaican men is diagnosed when they are older and these patients have significantly higher PSA levels at diagnosis, suggesting more advanced disease. Despite increasing public awareness of prostate cancer, it appears that there has been no significant change in the profile of patients with prostate cancer, at the time of diagnosis, over the last 6 years, findings consistent with the absence of an organized screening programme for prostate cancer in Jamaica.

Primary tumors of the heart: experience at the University Hospital of the West Indies.

BACKGROUND: An analysis of primary cardiac tumors in the English-speaking Caribbean has never been previously conducted. This paper is an attempt to fill this void. METHODS: A retrospective review of autopsy and surgical pathology records of the Department of Pathology at the University Hospital of the West Indies was carried out in search of all primary cardiac tumors. RESULTS: Altogether, 15 patients with primary cardiac tumors were identified. Twelve patients had myxomas, 2 of which were newborn infants. There were 2 cases of fibroma and 1 of rhabdomyoma, also in children. No malignant tumors were identified. Of the 10 adult patients all of whom had myxoma, there were 5 men and 5 women whose ages ranged from 33 to 83 years with a mean of 52 years. Echocardiography was used in making the diagnosis of cardiac tumor in all but one of these cases. All adult patients were symptomatic, with shortness of breath, often accompanied by congestive cardiac failure, being the most common symptom. One patient presented with embolic phenomena. CONCLUSION: This analysis of the clinicopathologic features of primary cardiac neoplasms represents the first of its kind in the English-speaking Caribbean. While the total number of cases was small, there appears to be a disproportionate number of pediatric tumors representing a third of the total. Furthermore, the distribution of tumor types within the pediatric population was dissimilar to that usually seen with only one rhabdomyoma.

Both serum 25-hydroxyvitamin D and calcium levels may increase the risk of incident prostate cancer in Caribbean men of African ancestry.

Circulating 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with both higher and lower risk of prostate cancer (PCa), whereas elevated levels of circulating calcium has been related to higher risks. However, there are few studies that account for effects of both calcium and 25(OH)D concentrations on incident PCa in a black population. We examined these relationships in a case-control study of men 40-80 years old with newly diagnosed, histologically confirmed PCa in Jamaica, a tropical country. Mean serum calcium concentrations was higher among cases (2.32 ± 0.19 mmol/L) than controls, (2.27 ± 0.30 mmol/L) (P = 0.023) however, there were no differences in 25(OH)D by cancer status (cases, 33.67 ± 12.71 ng/mL; controls (32.25 ± 12.59 ng/mL). Serum calcium was not correlated with 25(OH)D (partial correlation: r, 0.06; P = 0.287). Multivariable-adjusted models showed a positive linear relationship between PCa and serum calcium (OR, 1.12; CI, 1.00-1.25 per 0.1 nmol/L). Serum 25(OH)D concentration also showed a positive association with PCa (OR, 1.23; CI, 1.01-1.49 per 10 ng/mL). The odds of PCa in men with serum 25(OH)D tertile 2 was OR, 2.18; CI, 1.04-4.43 and OR, 2.47 CI, 1.20-4.90 for tertile 3 (P(trend) = 0.013). Dietary intakes of calcium showed no relationship with PCa. Despite the strong relationship between serum calcium and vitamin D the mechanism by which each affects prostate cancer risk in men of African ancestry needs additional investigation.

Leiomyosarcoma of the uterus with a florid intravascular component ("intravenous leiomyosarcomatosis").

A leiomyosarcoma of the uterus in a 54-year-old woman exhibited striking involvement of large vessels of the myometrium and broad ligament on both gross and microscopic examination. The pattern of vascular involvement resembled that seen in intravenous leiomyomatosis. Imaging studies showed recurrent tumor within the inferior vena cava 3 months after hysterectomy. To our knowledge, this is the first reported such case in the literature, for which we propose the designation intravenous leiomyosarcomatosis of the uterus.

Use of the Gleason system in international comparisons of prostatic adenocarcinomas in blacks.

BACKGROUND: Comparisons of prostate cancer in blacks living in different countries can shed light on factors responsible for high rates of the disease among blacks in America. Since the prognostic value of the Gleason grading system is well established, we assessed agreement between pathologists in countries where black populations of the African Diaspora reside. METHODS: Three genitourinary pathologists at hospitals in Nigeria, Jamaica, and the US independently assessed sextant biopsies from 12 patients. Gleason sum and percentage involvement were recorded, and a percent-weighted average calculated. Agreement under different groupings was evaluated using the kappa statistic generalized to three raters. RESULTS: Agreement was significant for individual sums (kappa = 0.3317, P = 0.0173), sums grouped as well (2-4), moderately (5-6), and poorly differentiated (7-10) (kappa = 0.2437, P < 0.0001) and other groupings. Agreement between at least two raters was 91.7-100%; complete agreement was 41.7-66.7%. CONCLUSIONS: The Gleason system is feasible and practical for international studies of prostate cancer among blacks from contrasting environments.

The pathology of thyroid neoplasms at the University Hospital of the West Indies: a 10-year analysis

Thyroid neoplasms were diagnosed in 93 patients (79 women and 14 men) between January 1986 and December 1995. 52 tumors were benign and 41 were malignant. An unusual finding was that there were 16 cases each of follicular and papillary carcinomas: that is, more patients with follicular carcinomas than expected. The significance is discussed.

The pathology of thyroid neoplasms at the University Hospital of the West Indies: a 10-year analysis

Thyroid neoplasms were diagnosed in 93 patients (79 women and 14 men) between January 1986 and December 1995. 52 tumors were benign and 41 were malignant. An unusual finding was that there were 16 cases each of follicular and papillary carcinomas: that is, more patients with follicular carcinomas than expected. The significance is discussed.(AU)

The pathology of thyroid neoplasms at the UWI: a 10-year analysis - abstract

Papillary carcinoma of the thyroid is recognized universally as the most common type of thyroid carcinoma. Inorder to confirm or refute a long-held impression that this was not the experience in Jamaica, a retrospective analysis was made of all thyroidectomy specimens received form patients operated on at the University Hospital of the West Indies (UHWI) over a 10-year period, January 1986 to December 1995. Of 433 thyroidectomy specimens, 323 (75 percent) represented goitres, 93 (21 percent) were neoplasms and 17 cases (4 percent) comprised miscellaneous diseases including Hashimoto's thyroiditis and Graves' disease. There were 52 adenomas, 41 carcinomas and equal number of papillary and follicular carcinomas (16 cases). Five tumours were poorly differentiated carcinomas and 4 were medullary carcinomas, 2 of which occurred in young patients and could represent patients with the MEN syndrome. These confirm that the proportion of individual types of thyroid carcinoma is not likely, however, to influence the overall good prognosis. The possibilty that Jamaica might be considered an iodine-deficient area needs to be further explored. (AU)

Prostate cancer at the University Hospital of the West Indies in Jamaica: a clinico-pathological profile at the time of needle biopsy diagnosis

A prospective study of the clinico-pathological feaures of prostate cancer at the time of needle biopsy diagnosis was conducted in the Department of Pathology at the University Hospital of the West Indies over a one-year period. Ninety cases were diagnosed during this time. The mean age of patients at diagnosis was 72 years and the mean Gleason score of the biopsy, 7.3. Serum prostate-specific antigen levels were markedly elevated in the majority of patients, with a mean value of at least 159.8 ng/ml in the 76 patients for whom this information was available. The significance of these findings and that of other histopathological features examined are discussed, particularly in relation to recognized prognostic factors. It is concluded that the diagnosis of prostate cancer in Jamaica appears to be considerably later than that seen elsewhere. This information should support for those who advocate the introduction of a vigorous screening process for prostate cancer in Jamaica. (AU)

Nodular Fasciitis

A 10-year review of the files of the Department of Pathology revealed 11 cases of nodular fasciitis. The clinicopathologic features of these cases are presented together witha discussion of the pathology of this lesion. The purpose of this study is to enhance both physicans' and pathologist awareness of this entity.(Au)

Tumours and tumor-like lesions of bone: the UHWI experience

A review of all primary tumours and tumour-like lesions of bone diagnosed in patients who attended the University Hospital of the West Indies over a 10-year period revealed 136 cases comprising 69 benign and 54 malignant tumours, and 13 cases of tumour-like lesions. The prevalence and clinical characteristics of the various lesions are discussed and compared with the findings in other series. The results of this analysis provide demographic data useful in the differential diagnosis of bone lesions locally.(AU)

Primary leiomyosarcoma of bone

Primary leiomyosarcoma of bone is rare. We present the clinicopathological features of a case, the first documented from the Caribbean, seen recently at our institution.

Co-existing leiomyoma and benign cystic teratoma of the ovary

A case of benign cystic teratoma and a leiomyoma in the same ovary is described. The leiomyoma was confirmed by immunohistochemical methods. The occurrence of leimyoma and a teratoma within the same ovary is very rare.

Primary leiomyosarcoma of bone

Primary leiomyosarcoma of bone is rare. We present the clinicopathological features of a case, the first documented from the Caribbean, seen recently at our institution. (AU)

Soft tissue sarcomas: a ten-year analysis

Malignant soft tissue tumours are uncommon and the diagnosis is often difficult to make. This study of fifty-nine cases represents a pathological perspective of our experience with these tumors over a 10-year period. Malignant fibrous histiocytoma was the most frequent diagnosis made (36 percent) and the Majority of these occurred in the lower limbs. In 11 (19 percent) cases, the sarcomas could not be further classified along histogenetic lines. We consider some of the reasons for this and discuss these findings in the light of an increasing trend towards the use of smaller samples for diagnosis. (AU)

Right ventricular cardiomyopathy: a rare and underdiagnosed cause of sudden death in young adults

We present an example of right ventricular cardiomyopathy, a very uncommon condition which caused sudden death in an adolescent boy. This case report is used to highlight the pathological features of this rare and poorly understood condition, which is often undiagnosed (AU)