Iodoamino acid content and distribution in normal and abnormal human thyroids.

Iodoamino acid content and distribution were measured in adenomas, nodular goiters, thyroiditis and carcinomas and compared to thyroids from patients who died suddenly and normal thyroid tissues originally adjacent to diseased tissue. Tissues were hydrolyzed with Pronase, derivatized and analyzed by gas chromatography as had previously been reported for rat thyroids. Considerable overlap in values was found among adenomas, nodular goiters and papillary and follicular carcinomas as compared to values in normal thyroid tissue, but low values were also found in several diseased tissues. MIT/DIT and T3/T4 ratios were essentially constant in most tissues, even when T4 values were low. MIT/DIT ratios were, however, high and iodothyronines undetectable in all Hurthle cell neoplasms, clearly differentiating them from other thyroid conditions.

Current Status of Classification and Staging of Prostate Cancer.

The international TNM classification system for prostatic cancer has been recently revised and is most helpful for comparisons between various groups of patients. Today in the United States, the evaluation of certain factors related to clinical and pathologic staging are being further altered. These include primary grade of tumor and the extent and techniques of tumor staging. New tests for acid phosphatase and alkaline phosphatase isozymes are being concurrently evaluated. Advances in the past six years have contributed to further redefinition and subgrouping of previous conventional staging or prognostic assessment of prostatic cancer. Localized (Stage B, C), occult (Stage A), or generalized (Stage D) tumors are being subdivided. Although grade of the primary tumor has been thought to be important only recently has a consensus been achieved by the National Prostatic Cancer Project for a system of assessment that uses cellular patterns and nuclear changes. Aspiration cytology may be a useful adjuvant. The role and type of pelvic lymph node assessment, whether operative, radiographic, or by thin needle percutaneous aspiration, is undergoing additional study. In dealing with the so-called occult (Stage A) lesions, a further subdivision, Stage A,/A2 has been employed. Similar changes in so-called B1 /B2 , C1 /C2 , and D1 /D2 also exist. These are valid attempts to further define extent of disease and overall true tumor burden. Nevertheless, it is still the privilege of the physician to determine the necessity and extent of the use of such classification. Today, the decision to provide therapeutic care based only on a clinical stage must be made with the knowledge of these variations of classification and staging as well as of other developments.

Prognostic factors in bladder cancer. A pathologic, immunohistochemical, and DNA flow-cytometric study.

Pathologic grade and stage, immunohistochemical analysis of eight cell and tumor markers, and DNA ploidy were studied in 36 cases of bladder cancer to determine the features of value in assessment of patients' survival. Tumors of high grade and advanced stage correlated with DNA aneuploidy, whereas low grade and early stage correlated with DNA diploidy when simultaneously evaluated with survival. In addition, blood group isoantigen A correlated with DNA ploidy in deceased patients, whereas blood group isoantigen H and oncogene-related protein p21 correlated with DNA ploidy in surviving patients. Despite the relatively small number of cases studied, these results suggest that pathologic grade and stage and immunohistochemical analysis of blood group isoantigens A and H and oncogene-related protein p21 hold additional value in the prediction of bladder cancer survival when evaluated simultaneously with DNA ploidy.

Functioning malignant nonchromaffin paraganglioma of retroperitoneum with metastases.

A case is reported of a functioning, malignant nonchromaffin paraganglioma (chemodectoma) of the retroperitoneum with metastases in a seventeen-year-old boy. The literature is reviewed and the treatment modalities are discussed.

Malignant phyllodes tumor of prostate.

A case of malignant phyllodes tumor of the prostate, with clinical course of recurrence and pulmonary metastasis is described in a thirty-eight-year-old man. Histologically the tumor was characterized by a fibrosarcoma-like pattern with adjacent changes of fibroadenoma and phyllodes type of prostatic atypical hyperplasia. The pathology, histogenesis, differential diagnosis, and the role of immunohistochemistry in the diagnosis and demonstration of its components is reviewed.

Comparative evaluation of National Prostatic Cancer Treatment Group and Gleason systems for pathologic grading of primary prostatic cancer.

Multivariable analysis was used to investigate the relationship between risk of disease progression or death in patients who were treated with adjuvant therapy after definitive treatment for prostatic adenocarcinoma and the components of the National Prostatic Cancer Treatment Group (NPCTG) and Gleason systems for pathologic grading of prostatic cancer. Data were available for 203 patients who were treated on NPCTG Protocols 900 and 1,000, which involve surgical and radiation therapy as definitive treatment. Since less than 10 per cent of these patients have died, analysis of survival was not attempted. The study focus was progression-free survival, which is the minimum of time to progression or death. The analysis demonstrates that a new measure, the NPCTG score (the sum of the glandular and nuclear grades) is superior to the previously reported NPCTG grade (the maximum of the two grades). In addition, the Gleason score is somewhat superior to the new NPCTG score. All of this, however, applies only to the primary tumor and not the nature of any present or future metastatic lesions.

Light and ultrastructural studies of renal oncocytic adenoma.

An asymptomatic renal oncocytoma was found in the upper left quadrant of an eighty-five-year-old woman during a routine physical examination. Ultrastructurally, the tumor was composed entirely of epithelial cells filled with normal and abnormal mitochondria. Selective renal angiography showed two renal arteries supplying a lobulated, highly vascular mass. The mass contained irregular and tortuous vessels without any arteriovenous shunting.

A functional parathyroid gland adenoma of transitional oxyphil cells. A light and ultrastructural study.

This report describes light and ultrastructural features of a functional parathyroid gland adenoma, principally composed of transitional oxyphil cells, in a 64-yr-old hypertensive black woman. She was hospitalized for repeated episodes of headaches, lethargy, and dizzy spells. Her serum calcium level was 2.92 mmol/l and immunoassay for parathormone was 390 pg/ml. On neck exploration, the left lower parathyroid gland was found enlarged and therefore removed in toto. The serum calcium and phosphate levels returned to normal following parathyroidectomy. Microscopically, the diagnosis of functional oxyphil adenoma was made. On ultrastructural examination, the tumour was composed principally of transitional cells, occasional typical, and degenerating oxyphil cells. The predominant transitional cells were rich in mitochondria and contained multiple active Golgi complexes, stacked profiles of rough endoplasmic reticulum, and a few secretory granules. On the other hand, typical oxyphil cells were tightly packed with mitochondria at the expense of other organelles. It appeared that neoplastic oxyphil cells were chief cells transformed in response to some unknown oncogenic stimulus.

Prostate cancer grading: the NPCP system.

The use of the NPCP grading system does not contradict the principle that an accurate prediction of tumor volume, presence, and extent of metastases, therapeutic response, and clinical behavior of prostate cancer cannot be entirely based on the grade of the disease at the time of initial diagnosis. The morphology of prostate cancer, like any other cancer, is probably no more than one of a group of parameters that are decisive for the prediction of the biology and clinical course of the disease. Nevertheless, the present data support the premise that the NPCP system of grading prostate cancer, among others, is a very helpful indicator of the extent and behavior of prostate malignancy. Table 6 illustrates the correlation between grades and stages of prostatic carcinoma that can be drawn from the preceding data.

Scanning electron microscopic study of prostatic cancer.

Scanning electron microscopy is applied to the study of 3-dimensional surface and organization of a normal prostate gland and of samples of prostatic disease, including five cases of benign hyperplasia and 15 cases of prostatic adenocarcinoma of different degrees of differentiation. The study provided further evidence regarding the nature and origin of prostatic cancer at a cytologic level and indicated alternate pathways to the neoplastic spread within the prostate gland.

Carcinomas arising in fibroadenomas: a report of two cases and a review of the literature.

Carcinomas arising in fibroadenomas are rare. Two such cases are being presented; one is of the ductal variety and the other, lobular. Both cases clearly demonstrate the overall configuration of fibroadenomas with foci of in situ and infiltrating carcinoma, the surrounding breast tissue being devoid of malignant changes. The diagnosis was clinically unsuspected in both cases and in only one of them was it suspected at the time of gross pathological examination. The intent of this presentation is to increase general awareness as to the existence of carcinomas arising in fibroadenomas and also to actively discourage the practice of rendering gross pathological diagnoses of fibroadenomas at table diagnosis, however innocuous these neoplasms may appear to be, without microscopic examination by frozen sections.

Characterization of a Wilms' tumor model.

Growth characteristics, survival time, sex differences and hormonal effects, and various biochemical parameters were evaluated in a transplantable Furth/Wistar rat Wilms' tumor model. Survival time was dependent on site of tumor transplant and ranged from a mean of 28 days for intrarenal implantation to 44 days intramusculary. Maximum tumor weight (130 g) was obtained via subcutaneous implant. Lung metastasis was evident in the majority of animals with the exception of those receiving the tumor implant intraperitoneally. The levels of erythropoietin and serum calcium and phosphatase were comparable to control values whereas hematocrit levels declined. Tumor tissue arginase or total protein remained unchanged during tumor growth. In these same tissues DNA, content and 5-alpha-reductase activity significantly and progressively increased with concomitant tumor growths. Measurements of lactic dehydrogenase, alkaline phosphatase, and their isoenzymes indicated patterns of liver involvement which were not macroscopically evident. After 31 days of subcutaneous tumor transplant, male and female rats had tumors of comparable weights. Orchiectomy or estradiol treatment significantly reduced tumor weight in males. In female rats testosterone treatment significantly increased tumor weights. DNA concentration in tumor tissue was unaffected by treatment. Similiarly, although 5-alpha-reductase activity was higher in tumors from males, and arginase higher in females, these enzymes were not affected by surgical or hormonal treatment.

Locally recurrent endometrioid adenocarcinoma of the prostate after radical prostatectomy.

Endometrioid carcinoma of the prostate is considered a variant of classical prostatic ductal carcinoma. Endometrioid carcinoma variant often has the unique clinical presentation of gross hematuria. The propensity of this tumor to spread within the urothelium makes local failure of curative therapy commonplace. We present 2 representative cases with a review of followup surveillance procedures and treatment options for the local recurrence once identified.

Cell and tumor markers' immunohistochemistry in transitional cell carcinoma of the bladder.

A wide range of cell and tumor markers including the blood group-related isoantigens A, B, O(H) and T-Ag, the cell markers DCA(F36/22) and epithelial membrane antigen (EMA), and the oncogene-related proteins RAP-5p21 and ORP-p21 were investigated by means of immunohistochemistry in selected biopsies from 36 bladder cancer patients with the aim of ascertaining which are of value in patients' survival. A heterogeneous distribution of positivity was found for each marker. In addition, EMA immunostaining correlated significantly (p < 0.05) with patient survival. We conclude that immunohistochemical detection of EMA may provide additional prognostic information in bladder cancer patients.

Morphological responses of benign human prostatic hypertrophic tissue to chemotherapeutic agents in an in vitro culture system.

The in vitro maintenance of hypertrophic tissue with fluid containing cytotoxic drugs showed more degenerative changes in prostatic epithelium and stroma of the tissue compared with concurrently cultured aliquots of control tissue. It is suggested that theses morphological changes can be related with functional activity of the tissue. The mechanism of such an action is at present unsettled, but an interference on known enzymatic systems regulating prostatic growth seems likely. This system provides an added technique for the evaluation of drugs considered for possible therapeutic testing in human prostatic cancer states.

Histologic grading of primary prostatic cancer: a new approach to an old problem.

A simple and objective system for grading prostatic carcinoma was evaluated in a retrospective analysis of 169 cases followed during a 16-year period. The system identified and separated 4 grades of increasing malignancy based on the combined evaluation of gland differentiation and nuclear anaplasia as separate but complementary factors. The system demonstrates significant correlation with mortality rates for each grade group. Retrospective evaluation of the extent of the disease at the time of initial diagnosis also indicates correlation between prostatic grades and clinical stages.

An unusual case of supraclavicular and colonic malakoplakia--a light and ultrastructural study.

A case of malakoplakia of the supraclavicular region and colon in a 41-year-old patient is presented. Clinical, histopathological, histochemical and ultrastructural features are described. The etiology and pathogenesis are discussed. Malakoplakia is a chronic inflammatory disorder probably due to an abnormal response to infection with Gram negative bacteria, most likely Escherichia coli or Klebsiella. The disease is characterised by the accumulation of macrophages intermixed with plasma cells and lymphocytes. The malakoplakic cells are laden with phagolysosomes which may provide a suitable biochemical environment for the deposition of calcium to form the pathognomonic Michaelis-Gutmann bodies. Ultrastructural examination enhances the accuracy of diagnosis since it highlights the presence of lysosomes, phagolysosomes, Michaelis-Gutmann bodies, and intact E. coli or their remnants.