Recurrent prostate carcinoma presenting as omental large cell carcinoma with neuroendocrine differentiation and resulting in bowel obstruction.

Neuroendocrine differentiation in the neoplastic prostate varies from foci of adenocarcinoma showing immunoreactivity to the pure small cell carcinoma, which correlates with poor prognosis. Widely metastatic disease in unusual sites is reported for small cell carcinoma, and rarely is the serum prostate-specific antigen level elevated. We report a case of recurrent prostate adenocarcinoma presenting as bowel obstruction due to widespread metastatic disease in the omentum and peritoneum. The histopathology of the omental metastasis was that of a large cell neuroendocrine carcinoma, without evidence of an adenocarcinoma. The absence of a clinically evident second primary tumor, the concomitant elevated serum prostate-specific antigen level, and the positive tissue immunoreactivities to prostatic markers all supported the prostatic origin of the omental tumor. Review of the importance of prostatic neuroendocrine differentiation and its unusual metastatic patterns is presented.

Squamous cell carcinoma at the prostatectomy site: squamous differentiation of recurrent prostate carcinoma.

Adenosquamous carcinoma of the prostate is rare. Even rarer is the subsequent squamous metastasis or recurrence in which only the malignant squamous component is observed in some sites, with the adenocarcinoma present in other sites. We describe a case of squamous cell carcinoma presenting at the prostatic bed 6 years after radical retropubic prostatectomy was performed for adenocarcinoma. Even though the primary tumor showed adenocarcinoma with foci of squamous differentiation, there was no morphologic evidence of adenocarcinoma in the current tissue examined. The suspected origin of the squamous tumor from a recurrence of the prostate tumor is discussed.

Birth of a western lowland gorilla (Gorilla gorilla gorilla) following in vitro fertilization and embryo transfer.

A 21-year-old multiparous female exhibiting 31-41 day menstrual cycles was given hFSH (225 IU/day, Metrodin 75, from cycle day 3 through 9 (menses = day 1) and hCG (10,000 IU, Profasi, on day 10 to stimulate follicular development. At 35 h after hCG, under isoflurane (AErrane) anesthesia, follicles were aspirated by controlled suction under transvaginal ultrasound guidance. Metaphase II oocytes (n = 11) were placed in modified human tubal fluid (mHTF, 100 microliters) medium under oil at 37 degrees C in humidified 5% CO2. Frozen semen, collected by voluntary ejaculation, was thawed (70 degrees C H2O bath, 6 sec), diluted slowly, centrifuged, and resuspended in mHTF, and 160,000 motile spermatozoa/ml were added at 6 h after oocyte recovery. At 21 h postinsemination (p.i.) eight oocytes were at the two-cell stage, five were cryopreserved, and three were cultured to the six- to eight-cell stage in mHTF with granulosa cells before transcervical uterine transfer at 47 h p.i. using a Teflon catheter. Micronized progesterone (400 mg/d) was orally administered for 10 weeks posttransfer (p.t.). Ultrasound examination revealed a single fetus at 15 weeks p.t., and unassisted delivery of a live 1.37 kg female infant occurred at 29 weeks. Am. J. Primatol. 41:247-260, 1997.

The significance of elevated progesterone at the time of administration of human chorionic gonadotropin may be related to luteal support.

PURPOSE: Our purpose was to determine if the progesterone concentration on the day of HCG administration is associated with the establishment of pregnancy in IVF patients. METHODS: Concentrations of progesterone on the day of hCG were examined retrospectively in 293 patients with ovarian hyperstimulation induced by GnRH agonist with hMG and/or FSH. Patients were grouped based on progesterone concentration: < 0.9, 0.9 to < 1.2, 1.2 to < 1.5, and > or = 1.5 ng/ml. Oocytes recovered, fertilization rate, and pregnancy rate were compared among groups. RESULTS: Patients with a higher concentration of progesterone had increased concentrations of estradiol and greater numbers of oocytes retrieved. No differences were found for fertilization rate, polyploid fertilization, or pregnancy rate. It was noted that there was an association between the type of luteal support and the effect of high preovulatory progesterone on pregnancy rate. CONCLUSIONS: These data suggest that oocytes and embryos derived from patients with high preovulatory progesterone are not of a reduced quality. The association of high progesterone concentrations with a reduced rate of pregnancy varied with the type of luteal support.

Diffuse large cell lymphoma of B-cell type associated with reactive hemophagocytosis.

Some lymphomas, virtually all phenotypically of the T-cell type, have been associated with the phenomenon of hemophagocytosis. Only two B-cell lymphomas, one T-cell-rich and the other an angiocentric lymphoma, have been observed to exhibit this phenomenon. A case is reported of a diffuse large cell lymphoma of the B-cell type associated with reactive hemophagocytosis. Cytokines or other humoral factors produced by the lymphoma are a possible cause, and their effect is probably systemic. There is some evidence suggesting correlation of hemophagocytosis with tumor aggressiveness.

Colonic histiocytic neoplasm mimicking malignant histiocytosis and presenting as intussusception.

It is now apparent that distinction between the so-called malignant histiocytosis and lymphoma can be made using panels of established immunohistochemical markers and/or genotypic analysis. Many, if not all, of the previously diagnosed cases of malignant histiocytosis have been shown to be of lymphoid, rather than histiocytic, lineage. We report a rare case of colonic histiocytic neoplasm accompanied by a lymphoreticular dissemination that mimicked that of malignant histiocytosis. In addition, barium studies and computed axial tomography confirmed an intussusception that subsequently developed. The histiocytic nature of the neoplastic cells was supported by immunohistochemical, ultrastructural, and cytochemical studies. To our knowledge our case may represent the fifth documented case of a histiocytic malignancy reported in the literature. The relationship among the various cases will be discussed as well as the significance of the focal S-100 immunoreactivity observed in the present case.

Composite adenocarcinoma and carcinoid tumor of urinary bladder.

We present a unique case of primary mixed adenocarcinoma of the urinary bladder consisting of signet-ring cells, glands, and mucinous lakes intimately associated with carcinoid elements. Neuroendocrine differentiation was substantiated with immunohistochemical and ultrastructural studies. The literature on primary carcinoid tumor of the bladder is reviewed.

A novel monoclonal antibody to cytokeratin 18 with reactivity toward lung squamous cell carcinomas and adenocarcinomas of various sites.

Antibodies to cytokeratins (CKs) have found extensive application in the differential diagnosis of epithelial tumors. The chain-specific anti-CK reagents appear to be of practical value for further subtyping of carcinomas. The authors have produced a novel anti-CK 18 monoclonal antibody (ACK-156) using a modified immunization procedure that included sequential injections of human epidermal keratin, cyclophosphamide, and enriched cytoskeletal extracts from a human lung carcinoma cell line. This protocol effectively amplified clones with reactivity toward CK epitopes not present in epidermal keratin. Monospecificity of the antibody was confirmed by immunoblot analysis using both total cell lysates and cytoskeletal extracts as antigens. Immunoperoxidase staining of adenocarcinomas from a variety of sites, including lung, was strongly positive. Squamous cell carcinomas of lung were also strongly stained whereas squamous cell carcinomas of head and neck origin were stained focally or not at all. In contrast, several commercially available anti-CK 18 monoclonal antibodies did not distinguish squamous cell carcinomas of lung from those of head and neck origin. Immunoblot analysis of tumor lysates corroborated the tissue staining results and revealed that the commercially available antibodies that were tested recognize at least one other low molecular weight peptide in addition to the CK 18 peptide recognized by ACK-156.

Methods of monitoring menstrual function in field studies: efficacy of methods.

Efficacy of methods for monitoring female reproductive potential under field study conditions was evaluated. Women (n = 10) were recruited to participate for two menstrual cycles on the bases, in part, of not seeking fertility assistance, working full-time but not in the medical field, and having less than one year of college education. Luteinizing hormone (LH), estrone-3-glucuronide, and pregnanediol-3-glucuronide were measured in daily morning urine and normalized to creatinine concentrations. These urinary measures were parallel to serum LH, estradiol, and progesterone profiles. Based on these urinary measures, 6 of 19 cycles were judged to be atypical. Transvaginal ultrasonography provided insights into ovarian activity during the atypical cycles. Of 13 LH surges detected by radioimmunoassay, 7 were not detected by a semiquantitative dipstick (OvuSTICK), perhaps due to that method's sensitivity to loss of LH immunoactivity caused by sample freezing. While intervals from salivary and vaginal mucous electrical resistance signals to the LH surge during typical cycles were similar to those reported previously, they were not predictive of ovulatory status during atypical cycles. Fifty-three percent of the cycles were misclassified on the basis of the basal body temperature rise. Cervical mucous color, amount, and consistency were not predictive of ovulation under these study conditions. The results from these 19 menstrual cycles provide information about the efficacy of various methods for characterizing menstrual function under field study conditions. In this regard, urinary endocrine measures are the most informative or practical.

Methods of monitoring menstrual function in field studies: attitudes of working women.

This study was designed to determine the attitudes and compliance of working women toward methods being evaluated for use in the assessment of the effects of toxicants on reproductive potential. Women such as the highly motivated fertility patients and nurses, who are typically familiar with the methods and procedures of fertility assessment and the value of medical research, have been used to validate such methods in a clinical setting. However, the attitudes of a general working female population toward these methods are unknown. Nine participants were selected on the bases, in part, of not seeking fertility assistance, working full-time but not in the medical field, and having less than one year of college education. Attitudes were also evaluated for 193 non-participating women to whom the procedures had been verbally described. Participants measured basal body temperature and salivary and vaginal mucous electrical resistance, evaluated cervical mucus manually (CME), and collected the first morning urine for two menstrual cycles. Blood, saliva, and transvaginal ultrasonograms (US) were obtained at a fertility clinic 6 to 9 days per cycle. Participants brought urine to the laboratory every 3 days. All participants performed all methods. Participants were paid $400; nonparticipants were not compensated. Only 3% of the respondents objected to the proposed methods: principally to CME, US, and giving blood samples. No respondent perceived the study as unimportant.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital arteriovenous malformation rupturing into a true jejunal diverticulum.

Massive hemorrhage from the gastrointestinal tract of an elderly patient due to a hitherto unreported cause is described. A congenital arteriovenous malformation located in the submucosa of a true jejunal diverticulum ruptured into the lumen. Both selective angiographic demonstration and histologic documentation of the bleeding point are presented. The simultaneous presence of these two entities is probably not a coincidence and is discussed.

Mucinous hamartoma of the biliary dust system causing obstructive jaundice.

A unique case of obstructive jaundice due to a previously undescribed mucus-secreting hamartoma compressing the common bile duct is reported. The obstructing lesion was part of a diffuse hamartoma that originated within the walls of the intrahepatic bile ducts. Gross and microscopic findings are presented.

Carcinoma in a true diverticulum of the gallbladder.

Extensive search of the literature reveals the extreme rarity of true diverticulum of the gallbladder. Its frequency varies from 0.0008% of all resected gallbladders at the Mayo Clinic to 0.06% of a series of congenital anomalies of the gallbladder collected from the world literature. We are presenting a case of a true diverticulum of the gallbladder with sonographic demonstration and focal malignant alterations, neither one of which has been reported previously. The difference between true and false diverticula of the gallbladder is discussed.

Rat antikeratin monoclonal antibodies are specific for stratified squamous epithelia.

Seven monoclonal antibodies of rat origin were generated against human epidermal keratins and were assayed by immunoblot and by immunoperoxidase staining of frozen sections from various human epithelial tissues. By immunoblotting, the antibodies recognized two different subsets of high molecular weight cytokeratin polypeptides. Unlike the majority of the reported mouse monoclonal antibodies obtained to similar immunogens, these rat monoclonal antibodies showed an unexpected degree of specificity, i.e., they stained only stratified squamous epithelia and not simple epithelia nor urothelia. The potential of using rats and the appropriate immunogen to generate more tissue-specific anticytokeratin monoclonal antibodies is discussed.

Local peritoneal factors: their role in infertility associated with endometriosis.

In order to detect peritoneal abnormalities that could account for infertility associated with endometriosis, 122 infertile individuals were studied at the time of laparoscopy for diagnostic purposes or for in vitro fertilization. Four groups were defined: group 1, laparoscopy without endometriosis; group 2, laparoscopy with endometriosis; group 3, in vitro fertilization without endometriosis; and group 4, in vitro fertilization with endometriosis. Mean peritoneal fluid volume was greater, although not significantly so, in group 4 (29.0 +/- 6.6 ml, mean +/- SEM) than in group 3 (18.2 +/- 2 ml). The concentration and total number of pelvic macrophages were similar for groups 1 and 2. The total number of pelvic macrophages was increased in group 4 (16.9 +/- 4.2 x 10(6)) versus group 3 (10.0 +/- 1.8 x 10(6)) (p = 0.08). The mean sperm phagocytosis in vitro did not differ among the four groups studied. Interleukin 1 activity within the peritoneal fluid and the in vitro interleukin 1 production rate did not differ between individuals with and without endometriosis. Peritoneal fluid and macrophage supernatants from individuals with endometriosis were not embryotoxic when studied in an in vitro mouse embryo system.

Follicular stimulation for in vitro fertilization using pituitary suppression and human menopausal gonadotropins.

Multiple follicular stimulation is a prerequisite to the efficient use of in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). For some individuals, however, this stimulation may be difficult using standard superovulation protocols because of dominant follicle formation, suboptimal estradiol response, or premature luteinizing hormone surge. A group of such individuals with several previous failed attempts at superovulation were studied. Follicular stimulation was accomplished using a long-acting agonist of gonadotropin-releasing hormone (GnRH) for pituitary suppression followed by human menopausal gonadotropin (hMG) for follicular stimulation. Fourteen cycles (12 IVF, 2 GIFT) were completed in 12 individuals. There were no cycle cancellations. Mean number of prior cycle cancellations per patient was 3.1 +/- 0.4. Mean number of mature oocytes recovered was 3.9 +/- 0.5. Two pregnancies resulted. Pituitary suppression with a long-acting agonist of GnRH followed by hMG appears to be an effective adjunct to current superovulation regimens.

Acute effects of exercise on plasma catecholamines in sedentary and athletic women with normal and abnormal menses.

Norepinephrine plays a role in the regulation of luteinizing hormone secretion and may therefore be involved in the etiology of exercise-induced menstrual dysfunction. This study evaluated both intraexercise and postexercise responses of epinephrine, norepinephrine, and dopamine in sedentary women and women runners with normal and abnormal menstruation. Five eumenorrheic nonrunners and five eumenorrheic, four oligomenorrheic, and five amenorrheic runners were evaluated on 2 consecutive days. On day 1, the women cycled on a bicycle ergometer against an increasing work load until exhaustion, and on day 2, the women underwent a submaximal exercise regimen. Serial blood draws were taken at specified time intervals during intraexercise and postexercise periods on both days. The data collected during exercise for all groups showed that epinephrine and norepinephrine had a sixfold to sevenfold rise on day 1 and had a threefold rise on day 2. Dopamine increased twofold during both exercise protocols. On day 1 norepinephrine displayed a significantly higher percentage change from baseline to peak levels for oligomenorrheic and amenorrheic runners than for eumenorrheic runners and sedentary women. This latter finding is consistent with the hypothesis that periodic marked elevations in norepinephrine levels during maximal exercise may interfere with pulsatile luteinizing hormone release and hence may play a role in the occurrence of menstrual dysfunction in women runners.

Adnexal torsion as a complication of superovulation for ovum retrieval.

Adnexal torsion has not been reported previously following hMG/hCG for superovulation induction during an IVF cycle. It is clear that the enlarged ovary from the superstimulation cycle and coital activity contributed to the torsion in this case. Portable ultrasonography helped in making the diagnosis and may be an aid for diagnosis in future cases. Medications used for ovulation induction should be used cautiously and judiciously with close monitoring. Clinicians involved with this type of therapy are obligated to keep a constant watch for such infrequent but devastating complications.