Severe Maternal Pre- and Postpartum Intra-Abdominal Bleeding due to Deciduosis.

The term "deciduosis" is used to describe the severe pregnancy-associated occurrence of ectopic decidua with a usually asymptomatic course. We report on two cases of massive maternal intra-abdominal bleeding due to such symptomatic changes. The complications arose at different time points for the two cases: prepartum (26th week of pregnancy) or, respectively, - reported here for the first time - seven days postpartum. As well as differential diagnostic aspects we describe the management of the disease and its possible effects on subsequent pregnancies.

Recurrent neck abscess due to a bronchogenic cyst in an adult.

BACKGROUND: Neck abscesses can originate from congenital cervical cysts. Cervical cysts of bronchogenic origin are rare and often asymptomatic. Common symptoms of bronchogenic cysts are stridor, dyspnoea and dysphagia. The reported patient represents the second published case of a bronchogenic cyst causing a neck abscess in an adult. CASE REPORT: We report a case of a cervical bronchogenic cyst presenting as a recurrent supraclavicular abscess in a middle-aged woman. During extirpation, a fistula was demonstrated to the right upper lobe of the lung, suspected because the cyst inflated synchronously with respiration. DISCUSSION: The symptoms of bronchogenic cysts are due to the effects of compression or fistulas. In the majority of these cysts, a thorough investigation involving history, examination and radiological imaging does not clearly demonstrate a fistula. Therefore, extirpation is both diagnostic and therapeutic. CONCLUSION: A bronchogenic cyst is a very rare cause of a recurrent deep neck abscess. Total extirpation is the treatment of choice.

[First results of PET / CT-guided secondary lymph node surgery on patients with a PSA relapse after radical prostatectomy]. / Erste Ergebnisse der PET / CT-gesteuerten sekundären Lymphknotenchirurgie bei Patienten mit PSA-Anstieg nach radikaler Prostatektomie.

PURPOSE: CT and MRT are not applicable for the early detection of lymph node (LN) recurrence in prostate cancer. The PET / CT ((11)C-, (18)F-choline) technique can detect lesions >or= 5 mm and allows their topographic localisation. We have analysed positive (11)C-choline PET / CT LN findings in the case of a PSA increase after radical prostatectomy (RPE) histologicaly and documented the developing of PSA. MATERIALS AND METHODS: 8 patients with PSA relapse after RPE and lymphadenedtomy (LA) were diagnosed as having LNM by means of (11)C-choline PET / CT. Using PET / CT, metastasis suspicious and nearby LN were openly dissected. Histological and PET / CT results were compared and the postoperative PSA-development was examined. RESULTS: Of the metastasis suspicious LN (11) 9 were histologically reconfirmed. All additionally removed LN (12) were correct negative. LNM were mostly (7 of 9) located in the iliaca interna area and pararectal. 6 of 7 patients with histological metastasis detection showed a PSA response. 3 of 6 patients with single metastasis had complete PSA remission (< 0.01 ng / ml, maximum follow-up: 28 months) without adjuvant therapy. CONCLUSIONS: (11)C-choline PET / CT could detect LNM with high specificity in our collective. These often lie beyond standard LA area, where they were primarily only resected by use of extended or sentinel LA. Because 3 patients with single LNM reached a complete PSA remission (< 0.01 ng / ml) without adjuvant therapy, the selected collective seems to benefit from secondary LN surgery. Whether or not individual patients can be cured by this surgery has to be demonstrated in a longitudinal study. However, an optimal imaging and experience in LN surgery have to be assured.

[Dermal chondroid melanoma]. / Dermales chondroides Melanom.

This case describes the history of disease of a 53-year old man, who has been treated for a putative recurrent nailbed granuloma of the right big toe since 1996. In 2000 an enlarged inguinal lymph node was excised. The light microscopic examination showed a metastasis of a malignant melanoma. In 2003 we received a tumor of the right big toe for histopathological examination. The histological and immunohistochemical results proved a dermal chondroid melanoma. This extremely rare variant of malignant melanoma occurs particularly in subungual location and is possibly related to a previous trauma. We discuss the spectrum of differential diagnoses and the importance of immunohistochemistry.

Numerical chromosomal aberrations in papillary renal cortical tumors: relationship with histopathologic features.

Previous studies have indicated that a combined trisomy of chromosomes 7 and 17 is a constant finding in papillary renal cortical adenomas and that papillary renal cell carcinomas are marked by additional trisomies such as trisomy 12, 16, and 20. The aim of our study was to compare this cytogenetic classification of papillary renal cortical tumors with conventional histopathologic classification. We performed interphase cytogenetics with enumeration probes for chromosomes 7, 12, 16, 17, and 20 on 41 papillary tumors found in 21 nephrectomy and 10 autopsy kidneys. A total of 38 tumors harbored gains of chromosomes 7 or 17, and most of these showed a trisomic signal distribution. The three tumors with normal copy numbers for chromosomes 7 and 17 were a papillary grade-2 carcinoma, a small adenoma (both with distinctive oxyphilic cytoplasm), and a papillary carcinoma with focally clear cells. Gains for chromosomes 12, 16, or 20 were found in 21 tumors and were significantly associated with the presence of histologic criteria of malignancy ( P<0.0001). Histopathologic and cytogenetic features of malignancy were found in eight tumors smaller than 10 mm. There is a good agreement of cytogenetic and histopathologic criteria of malignancy in papillary renal cell tumors. Interphase cytogenetics might give useful additional information in cases of doubt or when only small biopsy specimens are available.

Significance of high-grade prostatic intraepithelial neoplasia in needle biopsy specimens.

OBJECTIVES: To examine the significance of high-grade prostatic intraepithelial neoplasia (HGPIN) in biopsy specimens. METHODS: We performed sextant biopsies on a series of 83 cystoprostatectomy specimens removed for bladder cancer. For each case the number of foci and volume of both HGPIN and prostate cancer were assessed in the prostatectomy specimens and compared with the number of biopsy specimens involved by HGPIN. RESULTS: We identified HGPIN in 82 (99%) of 83 prostatic glands, whereas prostate cancer was found in 41 cases (49%). Corresponding sextant biopsies harbored both HGPIN and prostate cancer in 6 cases (7%), whereas only HGPIN was diagnosed in 29 sextant biopsies (35%). There was a positive correlation between the number of biopsy specimens containing HGPIN and the volume and multifocality of HGPIN in the corresponding prostatic glands. Prostates with HGPIN on sextant biopsy contained prostate cancer significantly more often when compared to cases with no HGPIN on sextant biopsy. Frequency of concurrent prostate cancer was higher in cases with two or more biopsy specimens containing HGPIN than in cases with only one such biopsy specimen, but case numbers of these categories were too small to render this difference statistically significant. CONCLUSIONS: The presence of HGPIN in sextant biopsies is a significant predictor of concurrent prostate cancer. Multifocality of HGPIN is a useful parameter in assessing the extent of HGPIN in the corresponding prostates. Its value in predicting a significantly increased risk of concurrent prostate cancer needs to be further investigated in larger case studies.

Renal actinomycosis mimicking renal carcinoma.

The case of a 52-year-old man is reported who presented with night sweats and slight debilitation. Upon CT scan a left-sided renal mass with centrally liquefied areas was detected. The patient underwent nephrectomy for suspected renal cancer with central necrosis. Histologically, the diagnosis of renal actinomycosis was established based on the detection of sulphur granules. Actinomyces israelii is an anaerobic gram-positive bacterium that may cause localized tumour-like infections mainly in the craniocervical region and exceptionally retroperitoneally. Renal actinomycosis is a rare differential diagnosis of renal masses. As nephrectomy may prove hazardous in these cases, the diagnosis should be attempted pre-operatively by ultrasound-guided aspiration and consecutive antibiotic treatment. In selected cases surgery could be avoided at all.

A validated strategy for side specific prediction of organ confined prostate cancer: a tool to select for nerve sparing radical prostatectomy.

PURPOSE: Nerve sparing radical prostatectomy for prostate cancer should be restricted to patients who harbor tumors without capsular penetration. To our knowledge the selection criteria for nerve sparing radical prostatectomy are not clearly defined. We investigated a panel of preoperative tumor characteristics with respect to their ability to predict organ confined tumor growth for each lobe of the prostate to indicate unilateral or bilateral nerve sparing radical prostatectomy. MATERIALS AND METHODS: Nine preoperative tumor characteristics in 278 patients with clinically localized prostate cancer were included in retrospective univariate and multivariate tree structured regression analysis. The association of clinical stage, serum prostate specific antigen (PSA), PSA density, and results of transrectal ultrasound and systematic sextant biopsy, including a quantitative assessment of cancer in the biopsies with organ confined tumor growth, was statistically evaluated. Except for serum PSA and PSA density preoperative characteristics were considered separately for each prostate lobe. Multivariate analysis results were validated prospectively in 353 patients. RESULTS: On univariate analysis the number of positive biopsies was the most useful single parameter with a positive predictive value of 83% in 274 lobes and a negative predictive value of 55%, followed by mm. of tumor in the biopsy. Of all characteristics included in multivariate analysis only the number of biopsies with high grade cancer, the number of positive biopsies and serum PSA were independent for predicting organ confined cancer. When PSA was less than 10 ng./ml. and not more than 1 biopsy with high grade cancer was identified in a lobe, organ confined tumor growth was present in 86.1% of cases. On prospective validation the same criteria led to an 88.5% incidence of organ confined prostate cancer. Pooling the 2 most favorable groups led to 391 prostate lobes (70.8% of those investigated) with a positive predictive value of 82.1% (95% confidence interval 77.9% to 85.8%). Using the multivariate approach more prostate lobes were assigned to a favorable risk group than on univariate analysis. Clinical stage and simple Gleason grade did not contribute independent information for predicting organ confined disease. CONCLUSIONS: Quantifying cancer and high grade cancer by systematic biopsy and serum PSA concentration are useful preoperative characteristics for predicting organ confined prostate cancer. Side specific analysis of these parameters is a flexible and reliable tool for selecting patients for nerve sparing radical prostatectomy.

Numerical aberrations of chromosome 8 and allelic loss at 8p in non-muscle-invasive urothelial carcinomas of the urinary bladder.

OBJECTIVES: Cytogenetic and molecular studies indicate that the development and progression of bladder cancer involves multiple and complex genetic events. We screened 39 primary T(a )and T(1) transitional cell carcinomas of the urinary bladder for numerical changes of chromosome 8 and for the presence of relative allelic loss at 8p. The results were compared with the histopathologic stage and grade and with tumour recurrence. METHODS: Thirty-nine paraffin-embedded transurethral resection specimens containing bladder cancer were examined by interphase cytogenetics with a probe specific for chromosome 8. DNA from tumour cells and normal tissue was prepared after microdissection. Allelic loss was assessed by PCR-based microsatellite analysis. RESULTS: Numerical aberrations of chromosome 8 were present in 20 of the 39 cases (51.3%) and were significantly associated with a higher tumour grade and stage. Ten cases (25.6%) displayed allelic losses at 8p. Sixteen patients (41%) suffered from tumour recurrence, but Kaplan-Meier analysis and the log-rank test did not show any statistically significant correlation between tumour grade, stage, numerical aberrations of chromosome 8, allelic losses of 8p and freedom from disease recurrence. CONCLUSIONS: In this group of patients with non-muscle-invasive bladder cancers, numerical and structural aberrations at chromosome 8 are associated with a higher tumour grade and stage, but not with tumour recurrence.

Stage migration in clinically localized prostate cancer.

OBJECTIVES: To determine whether migration of pathological tumor stages in patients with clinically localized prostate cancer exists and whether this is due to an increasing frequency of treating patients with clinically insignificant cancer. METHODS: 1,063 radical retropubic prostatectomies were performed in patients with clinically localized prostate cancer in one institution within 7.5 years (from 1992 until June 1999). All specimens were prospectively processed according to the Stanford protocol. These were then analyzed regarding the migration of pathological tumor stages and cancer volumes. RESULTS: Within the observation period, the annual rate of radical retropubic prostatectomies increased by 225% from 69 to 224 cases. The authors noted a decline of advanced tumor stages (from 65 to 40%) and an increase in pathological T2 tumors (from 30 to 55%). The rate of small cancers (<0.5 cm(3)) remained stable between 2 and 5% over the last 5 years. CONCLUSION: The data confirm trends which were observed in large US centers with increasing detection and treatment of localized prostate cancer without unnecessary treatment of clinically insignificant cancers.

Detection rate of histologically insignificant prostate cancer with systematic sextant biopsies and fine needle aspiration cytology.

PURPOSE: We evaluate the detection rate of insignificant prostate cancer and the rate of significant prostate cancer overlooked in the results of systematic sextant biopsy and fine needle aspiration biopsy of the prostate of asymptomatic men with serum prostate specific antigen concentrations less than 4.0 ng./ml. MATERIALS AND METHODS: We analyzed specimens from 133 consecutive patients with a mean age of 60 years undergoing cystoprostatectomy for bladder cancer. Six systematic biopsy specimens and 2 fine needle aspiration cytology samples were taken from the prostate immediately after cystoprostatectomy. The specimens were step sectioned and examined for prostate cancer. Insignificant prostate cancer was defined as any cancer with an aggregate volume 0.5 cm.3 or less. RESULTS: Incidental prostate cancer was found in 58 of the 133 patients (44%). Tumor volume was 0.5 cm.3 or less in 47 cases. Sextant biopsy detected 7 cancers, including 4 of 47 (9%) that were insignificant and 3 of 11 (27%) that were significant. Fine needle aspiration cytology also detected 7 cancers, including 3 (6%) and 4 (36%) that were insignificant and significant, respectively. CONCLUSIONS: Systematic sextant biopsy and fine needle aspiration cytology each diagnose prostate cancer in about 5% of asymptomatic men who have normal digital rectal examination and serum prostate specific antigen less than 4.0 ng./ml. However, many of the cancers thus detected are insignificant and most of the significant cancers are missed. Therefore, routine screening of such patients with sextant biopsy or aspiration cytology does not appear to be justified.

Derivation of a new hematopoietic cell line with endothelial features from a patient with transformed myeloproliferative syndrome: a case report.

BACKGROUND: During embryonal development primitive hematopoiesis can be observed first in the yolk sac, in which both hematopoietic and endothelial cells are derived from a common precursor, the hemangioblast. Whether cells with this dual differentiation potential persist during postnatal life is unknown. METHODS: A cell line was derived from a patient with secondary acute leukemia. Because of its ability to grow in soft agar and in SCID mice, this cell line was analyzed for expression of differentiation antigens by fluorescence-activated cell sorter analysis, immunocytochemistry, fluorescent in situ hybridization (FISH) analysis with simultaneous cell surface staining, and polymerase chain reaction (PCR). RESULTS: A new cell line was established from a patient with essential thrombocytosis that transformed into acute leukemia. The patient's initial clinical presentation included skin and lymph node infiltrations that were taken for an angiosarcoma due to positivity for CD34, CD31, and von Willebrand factor on immunohistology. In addition to hematopoietic markers, leukemic cells expressed endothelial antigens such as CD62E, CD105, and bound Ulex europäeus lectin-1. Immunocytochemistry revealed positive staining for vascular endothelial growth factor receptor type 2 (KDR), Tie-2/Tek, the angiopoietin receptor, and vascular endothelial cadherin. These results were confirmed by PCR analysis. Simultaneous staining for CD62E and FISH analysis showed that cells with endothelial characteristics belonged to the leukemia. FISH analysis of histologic sections of the lymph node infiltration confirmed this manifestation as part of the leukemic process. The derived cell line, UKE-1, forms colonies in soft agar and is tumorigenic in SCID mice. CONCLUSIONS: This new cell line, UKE-1, appears to combine hematopoietic and endothelial features, indicating the close ontogenic relation of both lineages.

Analysis of molecular isoforms of PSA and their ratios in men with PSA-relapse after radical prostatectomy.

BACKGROUND: The aim of this study was the longitudinal comparison of % f-PSA in patients before radical prostatectomy and after PSA relapse. Is % f-PSA a consistent tumor specific parameter or does this ratio change during untreated tumor progression? MATERIALS AND METHODS: In this study 41 out of 420 patients with untreated increasing PSA-progression (> 0.5 ng/ml) were analysed. Patients with neoadjuvant or adjuvant hormonal therapy were excluded. T-PSA were f-PSA were analyzed by Immulite DPC (Diagnostic Products Coop., CA) and Abbott Axsym (Abbott Park, Il, USA). RESULTS: Pre-operative % f-PSA ratio was 10.6% (range 4.6-22%; Std. dev.: 4.9); T-PSA concentration was 26.4 ng/ml (range 5.5-10.2 ng/ml Std. dev.: 20.3). In men with PSA relapse after radical prostatectomy % f-PSA ratio was 14.73% (range 2.2-4.5% Std. dev.: 9.7). Repeated post-operative % f-PSA measurements resulted in 12.94% f-PSA (range 2.7-3.8% Std. dev.: 9.9%) with a regression of R = 0.57. All men with pre-operative elevated % f-PSA (> 15%) had post-operative elevated % f-PSA. CONCLUSIONS: The data indicates that post-operative % f-PSA is a constant tumor specific parameter in men with untreated PSA relapse after radical prostatectomy. Post-operative % f-PSA was higher compared with pre-operative % f-PSA concentrations. No correlation with Gleason score or pathological stage was found.

Numerical chromosomal anomalies in latent adenocarcinomas of the prostate.

BACKGROUND: Even the high incidence of clinically diagnosed prostate cancer is exceeded by the frequency of tumors detected at autopsy. However, there is some debate concerning the malignant potential of these so-called "latent prostate cancers." In this study, prostate cancers detected at autopsy were investigated for the presence of numerical aberrations of chromosomes 7, 10, 17, X, and Y. METHODS: Prostates from 57 autopsies, performed on male patients aged 45 years or older, were histologically investigated for the presence of cancer. Interphase cytogenetics, an in situ hybridization method with chromosome-specific probes, was performed on paraffin sections. RESULTS: Of the 57 specimens investigated, 23 contained foci of prostate cancer. Three prostates contained more than one tumor focus. Interphase cytogenetics could be performed successfully in 19 specimens. Of the 22 tumor foci investigated, 14 were disomic and 8 were nondisomic for the five chromosomes tested. Ploidy correlated significantly with the presence of a Gleason score of 7 or higher (P = 0.0109), but not with a tumor volume larger than 0.5 cm3, or with patient age over 75 years. CONCLUSIONS: Some latent prostate cancers display a nondisomic chromosomal status and a low histologic differentiation in spite of a small tumor volume, suggesting a more aggressive potential in a subset of these tumors.

Allelic losses at 8p, 10q, 11p, 13q, 16q, 17p, and 18q in prostatic carcinomas: The impact of zonal location, Gleason grade, and tumour multifocality.

Molecular genetic investigations have made it clear that the development and progression of prostate cancer is associated with losses of genetic material in certain chromosomal arms. However, there are only few data about the question of whether the zonal location, a higher Gleason grade, or multifocality of the tumour have any influence on the pattern of allelic losses. In the present study, 48 tumour foci from 32 radical prostatectomy specimens were investigated for allelic losses at chromosomes 8p, 10q, 11p, 13q, 16q, 17p, and 18q with a set of 20 microsatellite markers. The results were analysed for the zonal location of the tumour foci and the presence of a Gleason grade 4 differentiation. Overall, focal allelic losses at 8p, 10q, 11p, 13q, 16q, 17p, and 18q were observed in 62.5%, 17.2%,. 3.2%, 18.8%, 40%, 9.7%, and 22.6% of the 32 cases, respectively. Comparing the frequencies of allelic losses with the zonal location or the Gleason grade, no highly significant correlations were found at any chromosomal locus investigated. However, the observation of different patterns of allelic losses in 12 of 14 cases containing more than one tumour focus indicates a high rate of genetic heterogeneity. We conclude that allelic losses at the chromosomal loci investigated are not strongly associated with a specific zonal location or a higher Gleason grade of prostatic carcinoma. Genetic heterogeneity of multiple tumour foci within one gland might contribute to the difficulties in predicting the prognosis for this common malignancy.