Evaluation of testicular tumour calcification with digital orchiography.

OBJECTIVES: To analyse the calcification of testicular tumours in the orchiectomy specimens detected by digital orchiography obtained in a full-field digital mammography (FFDM) unit. METHODS: Orchiectomy specimens of 37 consecutive patients were imaged by FFDM. Detected foci of calcification were stratified as: type 1, dense microcalcification; type 2, faint microcalcification; type 3, macrocalcification. Histopathology identified the tumour types, the presence of intratubular germ cell neoplasia (IGCN) and associated calcifications. Orchiography results correlated with the histopathology. RESULTS: On orchiography, 32/37of the specimens (86 %) had co-existing foci of calcification. Histopathology results revealed foci of calcification in 23/37 (62 %) of orchiectomy specimens. Of the 20 IGCN cases, 80 % presented with calcifications on orchiography. Fifty-six percent (14/25) of type 1, 70 % (12/17) of type 2, and 30 % (2/6) of type 3 foci of calcification were observed in IGCN-positive cases. CONCLUSION: This study classifies the morphology of testicular tumour calcification in three main groups by digital orchiography. In half of the testicular cancers, histopathologically proven IGCN is also found in addition to the index tumour. Type 2 foci of microcalcification detected by orchiography may be related to IGCN and may prompt further clinical assessment. KEY POINTS: • Orchiography can detect and classify calcification in 86 % of testicular cancers. • Intratubular germ cell neoplasia (IGCN) co-exists in 54 % of testicular cancers. • Type 2 foci of microcalcification detected by orchiography may be related to IGCN. • Orchiography may play a possible future role in the diagnosis of testicular IGCN.

Serum big endothelin-1 levels in female patients with breast cancer.

Endothelin-1[ET-1] acts as a growth factor in various malignancies. Big endothelin-1 (big ET-1) is the precursor of ET-1. The aim of this study was to determine the importance of serum big ET-1 levels as a novel marker of disease in female patients with breast cancer of various clinical stages. The study consisted of 75 female patients with breast cancer who were diagnosed and treated at the Gazi University Department of Medical Oncology and 20 controls. The patients were classified as follows: group A [n=26], patients with newly diagnosed primary breast cancer but without metastasis; group B [n=33], patients with metastatic breast cancer who had undergone treatment for their diseases and in whom metastasis was detected during follow-up; group C [n=16], off-therapy patients whose cancer had been in remission for at least 5 years; and group D [n=20] healthy controls. Serum big ET-1 level were measured with an enzyme immunoassay kit. The median serum big ET-1 levels of the 75 patients with breast cancer [10.96+/-1.36 ng/ml] were statistically significantly higher than those of controls [8.97+/-1.55 ng/ml]. The median serum big ET-1 levels of the patients with primary breast cancer patients [group A] were statistically significantly different from those in the controls, the off-therapy patients and the patients with metastatic disease [11.56+/-0.78 ng/ml, 8.97+/-1.55 ng/ml, 9.76+/-1.52 ng/ml, and 10.83+/-1.18 ng/ml respectively, P=.001]. There was no statistically significant difference in the serum big ET-1 levels of patients in group A in terms of tumor stage, hormone receptor status or lymph node status. Serum big ET-1 levels were statistically significantly higher in patients with metastatic disease than in controls or off-therapy patients (P=.001). The serum big ET-1 levels of off-therapy patients whose disease was in remission were not statistically significantly different from those in controls (P>.05). Serum big ET-1 levels seemed to represent the activation of ET-1 in female patients with breast cancer. Serum big ET- 1 levels can be an indicator of the breast cancer. Further studies are needed to demonstrate the prognostic importance of serum big ET-1 in patients with breast cancer.

Serum neopterin levels in patients with breast cancer.

The aim of this study was to determine the importance of serum neopterin level in female patients with breast cancer of various clinical stages. The study consisted of 75 female patients with breast cancer who were diagnosed and treated at the Gazi University Department of Medical Oncology. The patients were classified into three representative groups and a control group: group A (n = 26), patients with newly diagnosed primary breast cancer and without metastasis; group B (n = 33), patients with metastatic breast cancer who had undergone treatment for their diseases and on whom metastasis was detected during their follow-up; group C (n = 16), off-therapy patient whose cancer had been in remission for at least 5 years; group D (n = 20) healthy controls. The median serum neopterin levels of the 75 patients with breast cancer 11.0 (range, 0-23.6) nmol/L were significantly higher than those of controls (8.3 (range, 1.2-12.0) nmol/L). In group B patients, neopterin levels (12.6 (range, 0-23.6) nmol/L) were statistically significantly higher than those of controls, primary breast cancer patients, and off-therapy patients (P < .05). In group B, patients with visceral metastases had higher neopterin levels than did those with bone or local metastases; however, that difference was not statistically significant. The median serum neopterin levels of the primary breast cancer patients in group A (8.8 (range, 0-20) nmol/l) were not statistically significantly different from those in controls and off-therapy patients. Serum neopterin levels were significantly elevated in patients with metastatic breast cancer. Neopterin seems to be an indicator of metastatic cancer rather than a marker for local cancer. In patients with metastatic breast cancer, determining the serum neopterin levels may be useful in estimating survival; however, additional long-term follow-up will be needed.

Signet-ring cell carcinoma of the gallbladder: a case report.

Gallbladder cancers are recognised common tumours of the gastrointestinal system. Histologically, almost all of them are adenocarcinomas. Previously, only two cases of signet-ring cell carcinoma of the gallbladder have been published, and little is known about the disease. Here, we present the case of a 76-year-old man with signet cell carcinoma of the gallbladder. Despite radical surgery, followed by 5-fluorouracil infusion chemotherapy, our patient died within 3 months. Advanced information may help to improve the prognosis of this tumour.

Prostate small cell carcinoma and skin metastases: a rare entity.

OBJECTIVES: To report a rare case of small cell carcinoma of the prostate with unusual skin metastasis. CLINICAL PRESENTATION AND INTERVENTIONS: A 60-year-old was evaluated for difficulty in urinating. Abdominal computed tomography scans revealed a prostatic mass invading the surrounding tissues and multiple perirectal, periprostatic, para-aortic and pericaval lymph nodes. Needle biopsy specimens showed both small cell carcinoma and adenocarcinoma. He was treated with combination chemotherapy: cisplatin and etoposide and bilateral orchiectomy. After six cycles of the chemotherapy, disease progressed and the patient did not respond to salvage therapy; hence, palliative care was instituted. During the follow-up, papillary lesions were observed in the scrotal skin; biopsy showed metastatic small cell carcinoma. CONCLUSION: Small cell carcinoma of the prostate is an aggressive disease with a highly metastatic potential; but skin metastases are very uncommon. It has poor prognosis despite therapy. Management resembles that of small cell carcinoma of the lung.

Early diagnosis of cancer in renal transplant patients: a single center experience.

Renal transplantation confers increased survival with improvement of immune suppressive drugs, but certain types of neoplasm can arise as secondary complications. It is thus well known that recipients have significantly increased risk of developing de novo malignancy when compared with the age-matched general population. Cancer is the 4th most common cause of death in transplant patients after cardiovascular disease, infections and liver failure. Our transplantation team has performed 1,582 kidney transplantations since 1975. Fifty-nine of the patients developed malignancies in the posttransplantation period. The most common was Kaposi's sarcoma (19 patients, 32.2 %), followed by lymphomas (16 patients, 27.1 %) and skin carcinomas (13 patients, 22.0 %). Many factors can contribute to high susceptibility in these patients; age at transplantation, certain types of viral infections like Epstein-Barr virus, human herpes virus-8, human papilloma virus or chronic usage of immune suppressive agents, type of immune suppressive drugs, and ethnic characteristics. Transplant recipients generally have advanced stage cancers at the time of diagnosis with a poor prognosis. Since some neoplasms are common early detection of cancer is important to decrease cancer related mortality and morbidity. This article considers risk factors and recommendations for early diagnosis of cancer in renal transplant patients.

Ectopic Liver Tissue on the Gallbladder: An Incidental Mass in Laparoscopy.

Ectopic liver is a rare developmental abnormality. It is often asymptomatic and could be determined during the surgery. AIthough it could be detected in different areas of the body either below or above of the diaphragm, ectopic liver is usually found on the wall of the gallbladder. The importance of the ectopic liver came from the elevated risk of development of hepatocellulary carcinoma from ectopic tissue. Ectopic liver tissue could also mimic malign masses in radiographic studies. Ultrasound-guided percutaneous biopsies could be helpful for preoperative diagnosis. Recently, widespread usage of laparoscopic techniques caused an increase on the description of ectopic liver tissues located on the gallbladder. Due to the potential risk of developing malignancy the resection of the mass should be the preferred approach for an incidentally or intraoperatively diagnosed ectopic liver tissue.

Primary squamous cell carcinoma of the stomach: a case report.

Squamous cell carcinoma (SCC) originating from the stomach is a relatively rare entity. There are theories regarding the development of this rare tumor, but its exact pathogenesis remains obscure. Fewer than 100 cases of primary SCC of the stomach have been presented in the literature. Due to the advanced stage at the time of diagnosis in most of these cases, the prognosis is generally poor. In the case presented here, dissemination of the tumor to the transverse colon, gallbladder and omentum was present at diagnosis. Despite the tumor's advanced stage, complete remission was achieved after six courses of adjuvant chemotherapy with 5-flourouracil and cisplatin. No recurrence has been detected during follow-up. The patient has been healthy with no sign of the disease for three years.

The great mimicker: zona zoster at the mastectomy site causing contralateral intramammary lymph node enlargement.

Zona zoster is rarely observed in patients with malignancy; when present, it follows a dermatomal fashion. Involvement of widely separated regions is very rare. Hereby, zona zoster causing enlarged intramammary lymph nodes (IMLN) in the opposite breast is reported for the first time in literature. The masses were hypoechoic on US with no hilum and hypervascular on color Doppler US. MRI showed hypointense masses with type 3 time-intensity curve and adjacent vessel sign. The complete regression of the nodes after the antiviral therapy confirmed the diagnosis. In breast cancer patients, IMLN enlargements may mimic breast cancer metastasis, and zona zoster infection of the mastectomy site may present with contralateral IMLN enlargement due to altered lymphatic drainage. When breast US is not sufficient for the differential diagnosis, breast MRI may warrant proper diagnosis, and prevent unnecessary biopsies. Antiviral treatment with followup would be sufficient for management.

Management of neuroendocrine carcinomas of the breast: A rare entity.

Neuroendocrine (NE) carcinoma of the breast is extremely rare and constitutes less than 0.1% of all breast tumors. Only a few studies are currently available in the literature and a standard approach to treating this tumor has yet to be established. The aim of this study was to apply pathological treatment modalities in clinical practice and to select the most appropriate treatment accordingly. Six female patients were diagnosed with primary NE carcinoma of the breast. The patients underwent modified radical mastectomy with axillary dissection. Pathological specimens were stained with hematoxylin and eosin and an immunohistochemical panel of antibodies [neuron-specific enolase (NSE), chromogranin, synoptophysin, estrogen and progesterone receptor, c-erbB2 and Ki-67]. The results showed that tumor size ranged from 2 to 4.5 cm in diameter. Lymph node metastasis was detected in 4 (67%) patients. Estrogen and progesterone receptor expression was found in 5 (83%) patients. None of the patients expressed c-erbB2. Chromogranin was found to be positive in 5 (83%) patients. Synoptophysin expression was detected in 5 (83%) patients. NSE was stained in 4 (67%) patients. An intraductal component was found in 5 (83%) patients. Lymphovascular invasion was found in 5 (83%) patients. Adjuvant chemotherapy was administered to patients with a Ki-67 index of ≥10%. Radiotherapy was administered to 4 (67%) patients, and 4 (67%) patients received hormonal therapy. The mean follow-up time was 31.1 months (range 12-52). All 6 patients survived, although following chemotherapy and tamoxifen, the disease progressed in 1 patient who received second-line hormonal therapy. In conclusion, NE carcinoma of the breast is a distinct entity. Management of this rare tumor may include surgery and radiotherapy depending on the size of the tumor and lymph node status. However, the exact role of chemotherapy and hormonal therapy has yet to be established. Adjuvant chemotherapy is recommended for patients with a Ki-67 index of ≥10%, and hormonal treatment appears to be feasible in patients who are positive for estrogen and/or progesterone receptor.

Signet-ring cell carcinoma of the colon with leptomeningeal involvement.

Primary signet-ring cell carcinoma of the colon is rare. Most patients with this type of cancer have a poor prognosis. We describe a patient with signet-ring cell carcinoma of the colon, for whom leptomeningeal metastasis presented a variety of clinical symptoms.

Prognostic significance of the C-erbB-2 expression in turkish non-small cell lung cancer patients.

BACKGROUND: The prognostic value of c-erbB-2 expression in patients with non-small cell lung cancer (NSCLC) remains controversial. The prevalence of c-erbB-2 expression in NSCLC and relation to disease prognosis were therefore investigated. METHODS: Eighty-nine patients with NSCLC diagnosed at Baskent University, Adana Hospital, Medical Oncology Department, between 2000-2005 were investigated. Expression of c-erbB-2 was evaluated by immunohistochemistry in paraffin-embedded sections. Characteristics of patients, histology and stage of the disease were obtained from clinical records. RESULTS: C-erbB-2 expression was detected in 18 patients (20.2%). Median survival of the patients with c-erbB-2 negative was 13 months, as compared to 6 months for c-erbB-2 positive cases (p=0.02), the relative risk of death being 1.96 times higher. No correlation was found between c-erbB-2 positivity and stage of the disease or histology of the tumor (p> 0.05). CONCLUSIONS: C-erbB-2 positivity may indicate shorter survival and can be regarded as an unfavorable prognostic factor in NSCLC. Immunohistochemistry seems to be a readily applicable, inexpensive methodology for determining c-erbB-2 expression in NSCLCs.

Management of elderly patients with advanced non-small cell lung cancer in Turkey.

OBJECTIVE: Non-small cell lung cancer is a disease that affects the elderly. However, most patients older than 70 years are less likely to receive standard therapy than their younger counterparts and the aim of the present study was to determine age-dependent variation in efficacy. SUBJECTS AND METHODS: Between 2004-2008, 40 consecutive patients older than 70 years received treatment for advanced non-small cell lung cancer. All were evaluated for response and toxicity. Chemotherapy was either with cisplatin or carboplatin and double or single agents (vinorelbine, gemcitabine). Docetaxel was used as a second line therapy in selected cases. Patients were grouped according to age: group 1 (70-74 years), group 2 (>or= 75 years). RESULTS: Except for 4 cases, all received chemotherapy, and 61 % were given a cisplatin-containing regimen. Second-line therapy was given to 42.5% and grades 3-4 neutropenia was seen in 17 (42.5%). Only one patient died due to neutropenic fever. Nephrotoxicity was observed in 2 (5%) and one underwent hemodialysis. Overall survival was 10 months, with median survival periods for groups 1 and 2 of 13 and 10 months, respectively (p> 0.05). No differences were found regarding type of chemotherapy administered or adverse events between the 2 groups. CONCLUSION: Patients older than 75 years appear to deserve the same standard therapy for non-small cell lung cancer as that given to younger cases.

The effect of HER2 expression on cisplatin-based chemotherapy in advanced non-small cell lung cancer patients.

INTRODUCTION: The prognostic value of HER2 expression in patients with advanced non-small cell lung cancer remains controversial. The relationship between HER2 expression, and platinum resistance and patient survival, was investigated. METHODS: Seventy-three consecutive patients (median age, 61 years) with stage IIIB and IV non-small cell lung cancer, admitted between February 2004 and December 2006, were included in this study. Sixty-one patients received gemcitabine, given as two 1250 mg/m2 doses on days 1 and 8 and, cisplatin, given as a 75 mg/m2 dose on day 8. Twelve patients received vinorelbine, given as two 25 mg/m2 doses on day 1 and 8, and cisplatin, given as a 75 mg/m2 dose on day 1. Both treatment paradigms were repeated on a 21-day cycle. Tumor response was evaluated by comparing tumor size on computerized tomography scans before and after three cycles of chemotherapy. HER2 status was examined by immunohistochemical analysis of paraffin-embedded specimens. RESULTS: HER2 was positive in 21 of 73 patients (28.8%). Of the 21 patients with HER2 positivity, 13 (61.9%) responded to chemotherapy with either a complete response, partial remission, or evidence of stable disease. Of 52 HER2-negative patients, 48 (92.3%) exhibited a response to chemotherapy. The difference in response to therapy between HER2-positive and -negative patients was statistically significant (p = 0.003). The median overall survival duration for all patients was 13 months. Median overall survival time was 14 months for HER2-negative patients and 10 months for HER2-positive patients (log-rank p = 0.007). CONCLUSION: Non-small cell lung cancer patients with high expression of HER2 exhibited resistance to cisplatin-based chemotherapies that are the standard treatment for this disease. Our results indicate that HER2 status may be a predictive and prognostic factor for cisplatin- based therapy response and disease survival.

Lack of influence of cyclooxygenese-2 expression in hepatocellular carcinomas on patient survival.

Recent studies suggest that cyclooxygenese-2 (COX-2) enzyme activation may play a role in hepatocarcinogenesis. However, the clinical significance of COX-2 expression in hepatocellular carcinoma (HCC) remains obscure. This study evaluated COX-2 expression in hepatitis B and hepatitis C virus related HCC and in HCC patients with an unknown etiology. Liver tissue samples of 31 patients with HCC (27 men and 4 women; age range, 48-75 years) were analyzed. COX-2 expression was evaluated by immunohistochemically in the tumor tissues. Patient data including age, sex, Child score, stage, grade of the tumor and survival were analyzed. Of these patients 19 were positive for hepatitis B virus (HBV), 6 were positive for hepatitis C virus (HCV) and 6 patients were negative for all viral markers and other etiologic factors. COX-2 staining were evaluated in 2 groups (group 1: COX-2 expression less than 25% (grades 1-2 COX-2 expression), and group 2: Cox-2 expression 25% or more (grades 3-5 COX-2 expression). COX-2 expression was shown in all HCC samples with positive or negative viral markers. No difference was found between degree of COX-2 expression and the etiology of HCC. COX-2 expression was not correlated with number of lesion or stage of the disease or grade of the tumor. COX-2 expression was not related with Child score of the patients. Median survival of all patients was 32 months. Median survival of patients did not differ according to patient's viral marker status. No difference was observed in median survival of patients in group 1 and 2. As a result, COX-2 system seem to be shared part in hepatocarcinogenesis regardless factors that initiate the disease. Although COX-2 expression appears to be independent of disease's characteristics', treatments that target this system appear to be feasible in the management of HCC.

Primary mediastinal yolk sac tumor in a 66-year-old woman.

OBJECTIVE: To report a rare case of nonseminomatous extragonadal germ cell tumor in a 66-year-old female with primary yolk sac tumor of the mediastinum. CLINICAL PRESENTATION AND INTERVENTION: A 66-year-old female was admitted to our hospital with a history of chest pain for 1 month. Computerized tomography of the thorax showed a left paracardiac mass adjacent to the aortic arch, left main pulmonary artery and pericardium. Total surgical excision could not be performed, but several biopsies which were taken through a thoracotomy revealed yolk sac tumor of the mediastinum. Systemic chemotherapy was started, but no response was observed and the patient died after one course of chemotherapy. CONCLUSION: Nonteratomatous mediastinal germ cell tumors are virtually nonexistent in women. To our knowledge, this is the oldest female patient with a primary mediastinal germ cell tumor. Chemotherapy was not effective especially in an old patient. We suggest surgery should be considered as primary treatment modality if diagnosis is made at an early stage.