Pituitary abscess presenting two years after the diagnosis of a pituitary lesion in a patient with panhypopituitarism.

Pituitary abscess is a rare condition. Here, we present the case of a young male patient who was initially found to have a pituitary lesion following the diagnosis of panhypopituitarism. Two years later, he presented with severe headache and was subsequently diagnosed intraoperatively with pituitary abscess. At a follow-up of 6 years after surgery, the patient was continuing to do very well. We discuss the differential diagnosis and demonstrate the evolution of the pituitary lesion on magnetic resonance imaging at four different time points: at the time of the detection of the initial lesion; two years later at the time of the diagnosis of the pituitary abscess; at 7 weeks post operatively; and finally after six years from the pituitary surgery.

Differential gene expression in human lung adenocarcinomas and squamous cell carcinomas.

PURPOSE: Differential cDNA library screening was performed on 7 human lung adenocarcinomas and 7 human lung squamous cell carcinomas and their corresponding adjacent normal tissues using a human lung cDNA library constructed from the normal bronchoalveolar cells of a 72-year-old male smoker. EXPERIMENTAL DESIGN: Of the 2758 clones that were differentially expressed between normal and tumor tissues in the preliminary cDNA library screening analysis, 1163 clones were confirmed by dot blot, revealing a confirmation rate of >40%. DNA of confirmed clones was sequenced and was subjected to GenBank Blast searches. RNA expression levels were then individually analyzed by semiquantitative reverse transcription-PCR. RESULTS: Ninety-two genes/sequences were differentially expressed in adenocarcinomas and/or squamous cell carcinomas compared with their corresponding normal tissues. Several genes were underexpressed by at least 50% in both tumor types such as c-fos, decorin, alpha-2-macroglobulin, platelet endothelial cell adhesion molecule 1, EGR1, and fibronectin. Ribosomal protein S3 was underexpressed only in squamous cell carcinomas, whereas expression of hepatocyte growth factor activator inhibitor type 2, ubiquitin-conjugating enzyme UBC9, and clone 333E23 on chromosome Xq21.1 were altered only in adenocarcinomas. Several genes discovered recently of which the functions are unknown, such as KIAA0728 and KIAA0425, were also differentially expressed in both adenocarcinomas and squamous cell carcinomas of the lung. CONCLUSIONS: Many of these known and novel genes may be involved in human lung tumorigenesis; therefore, additional characterization is warranted and will be beneficial to the understanding of this deadly disease.

Utility of free prostate specific antigen serum level and its related parameters in the diagnosis of prostate cancer.

We evaluated the role of free prostate specific antigen (f-PSA) serum level and its related parameters in detecting prostate cancer. This retrospective study was conducted between January 2006 and March 2008. Transrectal ultrasound guided prostate biopsy was performed for 107 patients who had total PSA (t-PSA) level of either >4 ng/mL with or without palpable nodule or ≤4 ng/mL with palpable nodule on digital rectal examination. The performance measurements for f-PSA, percent free PSA (%f-PSA) and free PSA density (f-PSAD) were determined and compared with those for t-PSA and total PSA density (t-PSAD). Descriptive statistics for all variables of interest were calculated, and receiver operating characteristic curves were generated. Nine patients (8.4%) had normal histology, 69 patients (64.4%) had benign disease and 29 patients (27.1%) had prostate cancer. The performance of f-PSA in PCa detection was better than other evaluated parameters. The largest area under the curve for patients in the gray area (t-PSA range 4.1-10 ng/mL) was for f-PSA, with a value of 0.64 and a sensitivity and specificity of 44% and 87%, respectively. For %f-PSA, these values were 0.59, 63% and 62%, respectively. For patients with a t-PSA level of 10.1-20 ng/mL, they were 0.68, 67%, and 81%, respectively, for f-PSA, and 0.64, 67%, and 76%, respectively, for %f-PSA. In conclusion, f-PSA serum levels performed better than free to total PSA ratio and t-PSA for prostate cancer screening. It is of clinical value which could affect the biopsy decision avoiding unnecessary interventions.

Craniopharyngioma in a patient with acromegaly due to a pituitary macroadenoma.

We present the first reported case of a craniopharyngioma as a second primary tumor in a patient with acromegaly due to a growth hormone (GH)-secreting pituitary adenoma. The patient was lost for follow-up for 18 years after trans-sphenoidal pituitary surgery for a GH-secreting pituitary adenoma. She presented with headaches and decreased visual acuity, and showed unsuppressed GH in an oral glucose load test with high IGF-1 levels. Brain MRI showed a suprasellar cystic mass and the patient underwent surgery for cyst drainage resulting in postoperative improvement in her vision. Biopsy of the mass confirmed the diagnosis of a craniopharyngioma. We stress the need for close follow-up of patients with acromegaly with adequate control of GH and IGF-1 levels.