RESUMO
Metastatic cancer presenting as an oral lesion is exceedingly uncommon. To the best of our knowledge this is the first reported instance of renal cell carcinoma presenting initially as an oral lesion.
Assuntos
Carcinoma de Células Renais/secundário , Neoplasias Renais/patologia , Neoplasias Bucais/secundário , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: A minimally invasive standard has yet to be developed for sentinel lymphadenectomy, and many patients undergo this procedure in the main operating room under general anesthesia. These patients often have microscopic metastases in sentinel nodes that could be missed by histopathologic examination. Techniques of reverse transcriptase polymerase chain reaction (RT-PCR) could detect these metastases if the nodes could be preserved intraoperatively. STUDY DESIGN: Fifty patients with melanoma > or = mm thick underwent sentinel lymphadenectomy under local anesthesia in an outpatient surgical unit. Sentinel nodes were identified using blue dye and technetium-99 sulfur colloid and a hand-held gamma probe. Each node was sectioned, with half sent for routine histopathologic study and half preserved in liquid nitrogen. We used RT-PCR to detect mRNA for tyrosinase and Melanoma Antigen Recognized by T cells-1 (MART-1). RESULTS: All patients were able to tolerate sentinel lymph node biopsy under local anesthesia. Sentinel lymph nodes were obtained in 100% of our patients, and usable mRNA was harvested from all but five. Ten patients had positive sentinel node(s) by standard histopathologic examination, and all of these nodes were also positive for MART-1 and tyrosinase. Three patients with negative results by histopathology had positive results by RT-PCR analysis. The average cost of these outpatient operations was 38% less than the same operations performed in the main operating room under general anesthesia. CONCLUSIONS: Sentinel lymphadenectomy under local anesthesia in an outpatient setting and intraoperative lymph node preservation in liquid nitrogen are both feasible. Both tyrosinase and MART-1 are promising markers in the detection of occult melanoma in lymph nodes.
Assuntos
Biomarcadores Tumorais/análise , Linfonodos/química , Melanoma/patologia , Monofenol Mono-Oxigenase/análise , Proteínas de Neoplasias/análise , Neoplasias Cutâneas/patologia , Actinas/análise , Procedimentos Cirúrgicos Ambulatórios/economia , Anestesia Local , Antígenos de Neoplasias/análise , Análise Custo-Benefício , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática/diagnóstico , Antígeno MART-1 , Masculino , Melanoma/economia , Melanoma/cirurgia , Estadiamento de Neoplasias , Reação em Cadeia da Polimerase , DNA Polimerase Dirigida por RNA , Neoplasias Cutâneas/economia , Neoplasias Cutâneas/cirurgiaRESUMO
PURPOSE: A new modality termed mechanical imaging has recently been developed. We determined whether mechanical imaging could be used to detect prostate cancer in radical prostatectomy specimens. MATERIALS AND METHODS: Stress patterns on the surface of excised prostates were evaluated using the data obtained from a planar piezoelectric resistive force sensor array. Seven radical prostatectomy and 2 cystoprostatectomy specimens were manually palpated and evaluated by the mechanical imager. The prostates were histopathologically analyzed for the presence of cancer. The results of the manual palpation, mechanical imaging and pathological analysis were correlated. RESULTS: Mechanical imaging correlated closely with nodules palpated in all specimens and in 1 it revealed a suspicious area undetected by palpation, which on subsequent histological analysis demonstrated carcinoma. CONCLUSIONS: Mechanical imaging can detect areas of heterogeneity in prostate tissue which correlate with cancer. Our findings provide the basis for the development of a transrectal mechanical imaging probe for prostate cancer detection.
Assuntos
Prostatectomia , Neoplasias da Próstata/patologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Projetos PilotoRESUMO
Teratoma with malignant transformation is defined as the emergence of a non-germ cell tumor from a teratoma. Although extremely rare in extraovarian sites, cases have been reported that involve primary extragonadal germ cell tumors with transformation to variants of sarcoma. We report a 54-year-old man who was found to have adenocarcinoma arising within a mature teratomatous retroperitoneal metastasis 15 years after treatment of a nonseminomatous testicular germ cell tumor. The tumor was successfully excised and he remains without evidence of disease.
Assuntos
Adenocarcinoma/patologia , Germinoma/secundário , Segunda Neoplasia Primária/patologia , Neoplasias Retroperitoneais/secundário , Neoplasias Testiculares/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: Primary adenocarcinoma of the bladder is a rare neoplasm whose histogenesis is poorly understood. Current data support the concept that adenocarcinoma of the bladder and urachus evolves from zones of intestinal metaplasia that become dysplastic and invasive. To address this hypothesis further we determined the immunoreactivity of benign and malignant epithelial tissue from the bladder and urachus with a monoclonal antibody that is reactive with colonic epithelium to evaluate the presence of a common reactive epitope. MATERIALS AND METHODS: The monoclonal antibody 7E12H12 (IgM isotype), developed against a colonic epithelial protein, was used in an immunoperoxidase assay to survey formalin fixed, paraffin embedded archival tissue specimens. A total of 26 specimens obtained by endoscopic biopsy or extirpative surgery, including benign and malignant bladder and urachal epithelial abnormalities, was chosen for retrospective evaluation. RESULTS: All adenocarcinoma reacted positively regardless of the histological variant, differentiation, or bladder or urachal origin. In contrast, transitional cell and squamous cell carcinomas were nonreactive. Also, the pattern of reactivity in tissues that contained benign epithelial proliferations suggested a stepwise transition with no reactivity in normal urothelium or Brunn's epithelial nests, rare staining of cystitis cystica, and uniformly positive reactivity in cystitis glandularis and frank colonic intestinal metaplasia of the bladder and urachus. CONCLUSIONS: The shared, aberrant phenotypic expression of a unique colonic epitope in benign epithelial metaplasia, and adenocarcinoma of the bladder and urachus suggests a common underlying pathway toward adenocarcinoma in cystic and urachal adenocarcinoma. The implications for diagnostic pathology are discussed.
Assuntos
Adenocarcinoma/imunologia , Epitopos/imunologia , Mucosa Intestinal/imunologia , Úraco/imunologia , Neoplasias da Bexiga Urinária/imunologia , Adenocarcinoma/patologia , Anticorpos Monoclonais/imunologia , Humanos , Imuno-Histoquímica , Estudos Retrospectivos , Úraco/patologia , Neoplasias da Bexiga Urinária/patologiaRESUMO
Desmoplasia, the formation of excessive connective tissue surrounding some neoplasms, is a well documented, but incompletely understood phenomenon. To characterize the fibrotic response in benign breast conditions and malignancy, we examined the steady state levels of mRNA coding for types I and III procollagen in mild fibrocystic changes, in fibroadenoma, and in infiltrating ductal carcinoma. The results indicate that in mild fibrocystic change there is a relative increase in type III procollagen mRNA. In contrast, fibroadenoma and carcinoma are characterized by increased levels of type I procollagen mRNA.