Association of an oversized adrenal cortical adenoma with expression of pheochromocytoma-like neurosecretory features.

Abnormal stimulation of adrenal function may be either direct, affecting similarly cortical and medullary secretion, or indirect affecting primarily the medulla. Indirect activation of clinically detectable adrenomedullary function may develop as a physical consequence of a non-functional adrenal tumor exerting pressure on the medulla by its size, location and direction of growth. Our case of an oversized and overweight adrenal tumor associated with expression of late-onset pheochromocytoma-like clinical symptoms may be explained by the physical indirect rather than the biological direct activation of adrenomedullary function like hyperplasia or cancer.

Minimal injury mastectomy in the surgical treatment of stage I and II breast cancer patients. A 20-year experience.

The main purpose of the present study is to enhance what we coined minimal injury mastectomy (MIM) as a reliable, efficient and acceptable procedure in the surgical treatment of breast cancer besides other therapeutic options currently used in the setting of adjuvant treatment (e.g. radiation therapy, chemotherapy or hormonal manipulations). We analysed retrospectively data of 142 patients with stage I and II breast cancer. Fifty-five of them had stage I, and the remaining 87 patients had stage II disease. Patients were submitted to minimal injury mastectomy, which is a broad segmental mastectomy, with limited or no axillary lymphadenectomy, thus minimizing locoregional trauma. Radiotherapy was given on a selective basis. Postoperative follow-up period ranged from one to 19.5 years (mean 103.5 months). Cosmetic results, shoulder function, texture of the breast and patient psychology were excellent in all the patients. In 55 stage I patients, six local recurrences occurred (12.72%), a mean 49.9 months after MIM, with ultimate local control of all patients and a remarkable survival after treatment of recurrences. In 87 stage II patients, six local (6.8%) and 16 systemic recurrences (18.7%) occurred, the latter after a mean period of 54.4 months postoperatively. It is concluded that with the minimal injury mastectomy, locoregional injury is minimized, preserving the regional immunological functions and by preventing lymphedema of the remaining breast, systemic resistance mechanisms are maintained and other adverse factors are avoided.

Tamoxifen-induced endometrial polyp. A case report and review of the literature.

A case of an endometrial polyp which developed in a 74-year-old woman treated with tamoxifen for 15 years after breast cancer surgery was the stimulus for this brief and concise review of the endometrial changes caused by anti-estrogen treatment in post-menopausal women with breast cancer. Tamoxifen therapy has been associated with the development of endometrial polyps, hyperplasia and adenocarcinoma possibly mediated through its agonistic estrogenic properties. Hysteroscopy follow-up should be performed in this group of patients and hysteroscopy should be done before the beginning of therapy and repeated once a year during the treatment.

Cystadenolymphoma of the parotid gland an immunohistochemical study of the epithelial component of twenty cases.

Carcinoembryonic antigen, epithelial membrane antigen, Keratin, Desmin, Vimentin, CD30, lysozyme, alpha 1-antitrypsin, alpha 1-antichymotrypsin, S-100 protein, somatostatin and glucagon were looked for using immunohistochemical methods in the epithelial component of 20 parotid gland cystadenolymphomas and 20 normal parotid glands. Carcino-embryonic antigen, ephithelial membrane antigen, S-100 protein, and somatostatin were found in the epithelial cells of most of the cystadenolymphomas. In normal parotid tissue, carcinoembryonic antigen, epithelial membrane antigen, Keratin, alpha 1-antitrypsin, alpha 1-antichymotrypsin, and S-100 protein were found in all three types of ductal cells, somatostatin only in intercalated and striated ductal cells, and lysozyme only in acinar and intercalated ductal cells. Desmin and CD30 were found in the epithelial component of seven of the 20 tumors versus none of the 20 normal parotid glands. Glucagon and Vimentin were negative both in tumor epithelial cells and in normal parotid ductal cells. Our results support the theory that cystadenolymphomas arise from epithelial cells. The presence of lysozyme in the epithelial tumor cells and in the intercalated ductal cells of normal parotid tissue suggest that cystadenolymphomas may arise from the intercalated ducts. The presence of S-100 and somatostatin may indicate that the tumor derives from neuroendocrine structures, but further studies are needed to clarify this point.

Expression of a cell surface antigen recognized by the monoclonal antibody AUA1 in bladder carcinoma: an immunohistochemical study.

The expression of a cell surface antigen recognized by the epithelium-specific, tumor-associated monoclonal antibody (Moab) AUA1 has been studied in 22 cases of normal urothelium, 7 cases of dysplastic urothelium and 86 cases of transitional cell carcinoma. Tissue specimens were stained with the conventional hematoxylin-eosin technique as well as with the indirect immunoperoxidase technique using Moab AUA1. Results showed that: (a) Moab AUA1 reacts mainly with cells of high or intermediate grade transitional cell carcinoma and with a restricted number of normal urothelial cells, and (b) antigenic heterogeneity exists between tumors of the same grade and within the same tumor.

Expression of proliferating cell nuclear antigen (PCNA) and nucleolar organizer regions (NORs) in multiple myeloma.

We have studied 72 cases of multiple myeloma (MM) bone marrow trephine biopsies using the monoclonal antibody PC-10 and the colloid silver nitrate method for identification of proliferating cell nuclear antigen (PCNA) and nucleolar organizer regions (NORs), respectively. PC-10 and AgNOR scores were statistically significantly different between low versus intermediate and low versus high grade of malignancy (P < 0.001), whereas their difference was not significant between intermediate and high grade. A strong correlation was identified between these two proliferation-associated indices in each histological grade. There is evidence that the proliferative state of myelomas belonging to the intermediate grade is approximately the same as that observed in high grade (blastic) ones.

Clear cell sarcoma (malignant melanoma of soft parts). Presentation of two additional cases.

Clear cell sarcoma or malignant melanoma of soft parts is a rare tumor with a predilection for the extremities. Although characterized by a slow clinical course, prognosis is poor because of a high incidence of local recurrences and distant metastases. In this report, two additional cases which originated in the toes are presented.

A comparative assessment of proliferating cell nuclear antigen, c-myc p62, and nucleolar organizer region staining in non-Hodgkin's lymphomas: a histochemical and immunohistochemical study of 200 cases.

Proliferating cell nuclear antigen (PCNA) and c-myc p62 oncoprotein are two nuclear proteins expressed in proliferating and transformed cells. They can be recognized immunohistochemically in paraffin sections by the monoclonal antibodies PC-10 and c-myc 1-9E10, respectively. On the other hand, nucleolar organizer regions (NORs) are loops of DNA that carry the r-RNA genes and can be visualized in paraffin sections as black dots (AgNORs) using a silver impregnation method. It has been suggested that the mean number of AgNORs may reflect the cellular kinetics of a tumor. We independently examined 200 cases of non-Hodgkin's lymphomas using the monoclonal antibodies PC-10 and c-myc 1-9E10, as well as the AgNOR method. Our study shows a very significant correlation between PCNA, c-myc expression, and AgNOR count on the one hand and histologic grade on the other (P < .001), although a significant overlap among the three grades exists. PC-10, c-myc 1-9E10, and AgNOR scores are all shown to be linearly related, even though significant discrepancies were observed, and the correlation is stronger between PCNA and AgNORs (PCNA v c-myc p62, r = .551; PCNA v AgNORs, r = .746; c-myc p62 v AgNORs, r = .529; P < .001). A remarkable finding is that the intermediate group of lymphomas is heterogeneous as far as the proliferative rate is concerned: diffuse large cell cleaved/non-cleaved lymphomas (category G of the Working Formulation) are characterized by a significantly higher proliferative index, as evidenced by the elevated PCNA, c-myc p62, and AgNOR scores, in comparison with the other types of intermediate-grade lymphomas (P < .001). However, the proliferative rate is lower than that of the high-grade lymphomas (PCNA, P < .05; c-myc p62, P < .001; AgNORs, P < .005). No significant difference exists between B-cell and T-cell lymphomas except for the higher expression of c-myc p62 in intermediate-grade B-cell lymphomas, obviously due to the higher proliferative rate of diffuse large cell lymphomas. Based on our findings, it appears that the combination of PCNA, c-myc p62, and AgNORs provides an accurate estimate of the proliferative rate of non-Hodgkin's lymphomas in paraffin sections. Clinical studies may show whether this information has prognostic value independent of histologic classification. In addition, our results suggest that category G (diffuse large cell) lymphomas may belong to a malignancy grade higher than the intermediate grade, a suggestion consistent with their more aggressive biologic behavior.

Intravesical administration of tumor-associated monoclonal antibody AUA1 in transitional cell carcinoma of the bladder: a study of biodistribution.

Forty-five patients known or suspected to have transitional cell carcinoma of the urinary bladder underwent intravesical administration of either AUA1 tumor-associated monoclonal antibody or 11.4.1. nonspecific monoclonal antibody. Antibodies were radiolabeled with iodine-131, diluted in 50 ml normal saline and remained in the bladder for up to 1 h. During cystoscopy or transurethral resection of the tumor, tissue samples were taken from normal and malignant areas and were counted for radioactivity in a gamma counter. Blood samples were also measured for radioactivity. Mean uptake of AUA1 at 2, 20, 40 and 60 h after administration (expressed as 10(3) x percentage of injected dose/gram of tissue) was: 1.77 +/- 3.2, 1.28 +/- 1.67, 0.72 +/- 0.94 and 0, respectively in the tumor and 0.79 +/- 0.83, 0.14 +/- 0.34, 0.033 +/- 0.06 and 0 in normal tissue. Mean uptake of 11.4.1 at 2 and 20 h was: 0.47 +/- 0.42 and 0.018 +/- 0.015, respectively, in tumor and 0.2 +/- 0.19 and 0.013 +/- 0.002 in normal samples. No remarkable radioactivity was found in blood samples. Conventional and immunoperoxidase staining were also performed. Mean uptake of AUA1 by the tumor increased as the degree of tumor differentiation decreased. Our findings indicate that intravesical administration of AUA1 results in selective immunolocalization of AUA1 in intermediate and high-grade transitional cell carcinoma. This may allow the development of a new method for bladder carcinoma treatment or prophylaxis against recurrence.

Carcinoma of the inguinal region arising from endometriosis of the round ligament. Report of a case.

The case is reported of a patient with a mixed epithelial tumor, composed mainly of a clear cell and endometrioid carcinoma, arising from a focus of preexisting endometriosis of the round ligament. The tumor was presented as a painful inguinal hernia.

A case of gonadoblastoma in a normal woman with tubal pregnancy.

Gonadoblastoma is a rare tumor arising usually in a dysgenetic gonad. The commonest karyotypes seen in patients with this neoplasm are 46XY and 46XY/45XO mosaicism. The occurrence of gonadoblastoma in pregnant or normal (46XX karyotype) women is extremely rare. A case of gonadoblastoma in a pregnant eukaryotic (46XX) woman is reported.

Combination of hyperthermia and methotrexate in the treatment of transplanted Walker sarcoma.

The purpose of this experimental study was to evaluate the possible synergistic effect of hyperthermia (HPT) and methotrexate (MTX) in Wistar rats transplanted with Walker sarcoma. HPT was induced by microwaves of 432 MHZ frequency transmitted through a source of 2 x 5.5 cm2 surface. The temperature in the tumor was maintained at 43 degrees C which was controlled by an intratumor thermocouple connected with an electronic thermometer. Three experiments were performed. First, in 5 rats HPT only was applied and one rat was used as control. Second, HPT and MTX in combination were given to 6 rats. Third, MTX alone was given to 6 rats. In the first experiment all 5 rats had 50% reduction of their tumors compared to control. In the second experiment complete disappearance of the tumor was noticed and in the third experiment the tumor increased in size. Histologically, in the responding tumors extensive necrosis was seen with thrombosed vessels. We conclude that HPT and MTX are synergistic in treating Walker sarcoma in Wistar rats.

Sex cord nests with annular tubules. The incidence of identifying them in normal ovaries.

Sections from 588 ovaries removed during various operations and reported as being within normal size limits were reviewed. In seven cases structures with the characteristic appearances of sex cord "tumours" with annular tubules (SCTAT) were found. We called the lesions sex cord nests with annular tubules (SCNAT). Their mean diameter was 0.17 mm. If ovaries were cut in serial sections the probabilities of identifying such lesions should increase very much.

Occult thyroid carcinoma in a Greek population.

Eleven occult carcinomas (1.8%) were found in 611 specimens from partial and radical thyroidectomies performed in Metaxa's Memorial Hospital of Piraeus and 3 (1.5%) in 200 autopsies from Athens City Forensic Department. Both surgical and autopsy specimens were thoroughly examined. Autopsies were selected to match for age and sex to the surgical material, from non hospitalized relatively healthy individuals. The prevalence found by us was lower than that reported from other European countries. The prevalence found in autopsies and surgicals was almost identical and it appears that thyroid lesions due to which the patients were operated are not related to the presence of the tumors.

Squamous cell carcinoma of the heel developing at site of previous frostbite.

Ten cases of squamous cell carcinoma of the heel previously affected by frostbite are reported. They had a similar natural history, location and histological appearance. All were treated by excision, and follow up over periods of 2-5 years has not revealed metastases.

Intralaboratory variations in the grading of breast carcinoma.

To assess the reliability of the World Health Organization's grading system for breast carcinomas, six observers independently graded 158 tumors. Five of the observers had been simultaneously trained in the same institution. The sixth was one of their tutors. There was agreement in the grading of only 23 cases, most of which were either well or poorly differentiated tumors. If the prognosis breast carcinoma is predicated by the who method, it should be restricted to the two extreme groups. It seems that there is no need to apply the who grading method because these groups could be easily distinguished by the overall impression of the examining pathologists.