Vitamin D Deficiency at Diagnosis Increases All-Cause and Prostate Cancer-specific Mortality in Jamaican Men.

BACKGROUND: 25 hydroxyvitamin D [25(OH)D] and serum calcium have been associated with incident prostate cancer (PCa). However, there is limited data on whether these metabolites predict survival in men of African descent, a population disproportionately affected by PCa. We studied the relationship of 25(OH)D at PCa diagnosis with all-cause and cancer-specific mortality among Jamaican men and examined whether serum calcium modified any associations. METHODS: Serum 25(OH)D from 152 Jamaican men with incident PCa within the Prostate Cancer Risk Evaluation (PROSCARE) study were re-evaluated approximately 11 years after enrollment. 25(OH)D analyses were stratified using the using Holick criteria. PCa-specific and all-cause mortality were examined in Kaplan-Meier survival curves and Cox regression models adjusted for age, body mass index (BMI), smoking and Gleason score. Restricted cubic splines evaluated nonlinear associations. Serum calcium was assessed as an effect modifier of the association between 25(OH)D and mortality. RESULTS: Of cases with available 25(OH)D, 64 men with PCa survived, 38 deaths were PCa specific and 36 died of other causes. At baseline, 9.9% of cases were vitamin D deficient and 61.2% were vitamin D sufficient. Compared to 25(OH)D sufficient men, those with 25(OH)D <20.0 ng/mL concentrations were associated with higher PCa-specific mortality (adjusted HR, 4.95; 95% CI, 1.68, 14.63, P = .004) and all-cause mortality (adjusted HR, 2.40; 95%CI, 1.33, 4. 32, P = .003). Serum calcium was not associated with survival and did not modify any associations with 25(OH)D. CONCLUSIONS: 25(OH)D deficiency at PCa diagnosis predicted decreased survival for overall and PCa-specific cancer in Caribbean men of African ancestry.

Both serum 25-hydroxyvitamin D and calcium levels may increase the risk of incident prostate cancer in Caribbean men of African ancestry.

Circulating 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with both higher and lower risk of prostate cancer (PCa), whereas elevated levels of circulating calcium has been related to higher risks. However, there are few studies that account for effects of both calcium and 25(OH)D concentrations on incident PCa in a black population. We examined these relationships in a case-control study of men 40-80 years old with newly diagnosed, histologically confirmed PCa in Jamaica, a tropical country. Mean serum calcium concentrations was higher among cases (2.32 ± 0.19 mmol/L) than controls, (2.27 ± 0.30 mmol/L) (P = 0.023) however, there were no differences in 25(OH)D by cancer status (cases, 33.67 ± 12.71 ng/mL; controls (32.25 ± 12.59 ng/mL). Serum calcium was not correlated with 25(OH)D (partial correlation: r, 0.06; P = 0.287). Multivariable-adjusted models showed a positive linear relationship between PCa and serum calcium (OR, 1.12; CI, 1.00-1.25 per 0.1 nmol/L). Serum 25(OH)D concentration also showed a positive association with PCa (OR, 1.23; CI, 1.01-1.49 per 10 ng/mL). The odds of PCa in men with serum 25(OH)D tertile 2 was OR, 2.18; CI, 1.04-4.43 and OR, 2.47 CI, 1.20-4.90 for tertile 3 (P(trend) = 0.013). Dietary intakes of calcium showed no relationship with PCa. Despite the strong relationship between serum calcium and vitamin D the mechanism by which each affects prostate cancer risk in men of African ancestry needs additional investigation.

Associations of whole-blood fatty acids and dietary intakes with prostate cancer in Jamaica.

OBJECTIVE: To investigate the association of whole-blood fatty acids and reported intakes of fats with risk of prostate cancer (PCa). DESIGN: Case-control study of 209 men 40-80 years old with newly diagnosed, histologically confirmed prostate cancer and 226 cancer-free men attending the same urology clinics. Whole-blood fatty acid composition (mol%) was measured by gas chromatography and diet assessed by food frequency questionnaire. RESULTS: High whole-blood oleic acid composition (tertile 3 vs. tertile 1: OR, 0.37; CI, 0.14-0.0.98) and moderate palmitic acid proportions (tertile 2: OR, 0.29; CI, 0.12-0.70) (tertile 3: OR, 0.53; CI, 0.19-1.54) were inversely related to risk of PCa, whereas men with high linolenic acid proportions were at increased likelihood of PCa (tertile 3 vs. tertile 1: OR, 2.06; 1.29-3.27). Blood myristic, stearic and palmitoleic acids were not associated with PCa. Higher intakes of dietary MUFA were inversely related to prostate cancer (tertile 3 vs. tertile 1: OR, 0.39; CI 0.16-0.92). The principal source of dietary MUFA was avocado intake. Dietary intakes of other fats were not associated with PCa. CONCLUSIONS: Whole-blood and dietary MUFA reduced the risk of prostate cancer. The association may be related to avocado intakes. High blood linolenic acid was directly related to prostate cancer. These associations warrant further investigation.

Disseminated trichosporonosis in a burn patient: meningitis and cerebral abscess due to Trichosporon asahii.

A 44-year-old diabetic female presented to a hospital in Jamaica with thermal burns. Trichosporon asahii was isolated from facial wounds, sputum, and a meningeal swab. Dissemination of the fungus was demonstrated in stained histological sections of the meninges and a brain abscess at autopsy. Pure growth of the fungus from patient samples submitted and an environmental isolate obtained from a wash basin in the hospital supported the diagnosis.

Body size and risk of prostate cancer in Jamaican men.

We investigated the associations between body size and risk of prostate cancer in a hospital-based case-control study in Jamaica. Height, weight, waist, and hip circumference were measured at enrollment, and data collected on medical and lifestyle factors for newly diagnosed cases (n = 243) and controls (n = 275). Compared with men in the normal range of waist-hip ratio (WHR), men with WHR > or =0.95 were at greater risk of total prostate cancer (OR,1.72; CI, 1.01-3.00) and high-grade cancer (OR, 2.02; CI, 1.03-3.96). With additional control for BMI, the association with WHR remained significant for total prostate cancer (OR, 1.90; CI, 1.01-3.53) and high-grade disease (OR, 2.94; CI, 1.34-6.38). There was no association between waist circumference and cancer without control for BMI but after controlling for BMI, waist circumference >90 cm (OR, 2.45; CI, 1.01-5.94) and >102 cm (OR, 5.57; CI, 1.43-18.63) showed a dose-response relationship with high-grade disease. Height and BMI were not associated with risk of prostate cancer. Abdominal obesity may be associated with risk of high-grade prostate cancer. Risk may be greater in those with higher abdominal obesity relative to overall size. The results further highlight the importance of investigating relationships by characteristics of the tumor.

A 6-year analysis of the clinicopathological profile of patients with prostate cancer at the University Hospital of the West Indies, Jamaica.

OBJECTIVE To document the clinicopathological characteristics of prostate cancer in a public hospital-based population in Jamaica, over a 6-year period, and examine any trends in these characteristics over time, as prostate cancer is the leading cause of cancer in Jamaican men, but there are few published reports documenting the clinicopathological profile of this disease in the Jamaican population. PATIENTS AND METHODS All patients consecutively diagnosed with prostate cancer by transrectal ultrasonography-guided biopsy at the University Hospital of the West Indies, from January 2000 to December 2005, were identified at time of diagnosis, and relevant clinical and pathological data collected from the accompanying histopathology request forms. RESULTS There were 529 cases of prostate cancer diagnosed over the 6 years. The mean (sd) age was 70.66 (8.74) years, with 137 patients aged 70-74 years. A serum prostate-specific antigen (PSA) level was obtained for 490 (92.6%) patients. Of these, an accurate PSA value was available for 456 (86.2%) patients and a 'minimum level' recorded for the remaining 34, all of whom had a PSA level of >100 ng/mL. Of the patients with available PSA information, only 91 (18.5%) had a level of < or =10.0 ng/mL. By contrast, 155 (31.6%) patients had levels of >100 ng/mL. The median (range, interquartile range) serum PSA level for those patients with accurate values was 30.7 (1-14 260, 11.7-109) ng/mL. Histologically, moderately and poorly differentiated cancers accounted for 198 (37.5%) and 160 (30.2%) cases, respectively. Correlation of the variables under investigation confirmed that there was a statistically significant positive and moderate correlation between serum PSA level and Gleason score (Spearman r 0.49; P < 0.001). Statistical analysis of all other variables, including the number of cases of prostate cancer diagnosed annually, showed no significant differences. CONCLUSION Compared with many countries, including some in the Caribbean, prostate cancer in Jamaican men is diagnosed when they are older and these patients have significantly higher PSA levels at diagnosis, suggesting more advanced disease. Despite increasing public awareness of prostate cancer, it appears that there has been no significant change in the profile of patients with prostate cancer, at the time of diagnosis, over the last 6 years, findings consistent with the absence of an organized screening programme for prostate cancer in Jamaica.

Primary tumors of the heart: experience at the University Hospital of the West Indies.

BACKGROUND: An analysis of primary cardiac tumors in the English-speaking Caribbean has never been previously conducted. This paper is an attempt to fill this void. METHODS: A retrospective review of autopsy and surgical pathology records of the Department of Pathology at the University Hospital of the West Indies was carried out in search of all primary cardiac tumors. RESULTS: Altogether, 15 patients with primary cardiac tumors were identified. Twelve patients had myxomas, 2 of which were newborn infants. There were 2 cases of fibroma and 1 of rhabdomyoma, also in children. No malignant tumors were identified. Of the 10 adult patients all of whom had myxoma, there were 5 men and 5 women whose ages ranged from 33 to 83 years with a mean of 52 years. Echocardiography was used in making the diagnosis of cardiac tumor in all but one of these cases. All adult patients were symptomatic, with shortness of breath, often accompanied by congestive cardiac failure, being the most common symptom. One patient presented with embolic phenomena. CONCLUSION: This analysis of the clinicopathologic features of primary cardiac neoplasms represents the first of its kind in the English-speaking Caribbean. While the total number of cases was small, there appears to be a disproportionate number of pediatric tumors representing a third of the total. Furthermore, the distribution of tumor types within the pediatric population was dissimilar to that usually seen with only one rhabdomyoma.

Use of the Gleason system in international comparisons of prostatic adenocarcinomas in blacks.

BACKGROUND: Comparisons of prostate cancer in blacks living in different countries can shed light on factors responsible for high rates of the disease among blacks in America. Since the prognostic value of the Gleason grading system is well established, we assessed agreement between pathologists in countries where black populations of the African Diaspora reside. METHODS: Three genitourinary pathologists at hospitals in Nigeria, Jamaica, and the US independently assessed sextant biopsies from 12 patients. Gleason sum and percentage involvement were recorded, and a percent-weighted average calculated. Agreement under different groupings was evaluated using the kappa statistic generalized to three raters. RESULTS: Agreement was significant for individual sums (kappa = 0.3317, P = 0.0173), sums grouped as well (2-4), moderately (5-6), and poorly differentiated (7-10) (kappa = 0.2437, P < 0.0001) and other groupings. Agreement between at least two raters was 91.7-100%; complete agreement was 41.7-66.7%. CONCLUSIONS: The Gleason system is feasible and practical for international studies of prostate cancer among blacks from contrasting environments.

Leiomyosarcoma of the uterus with a florid intravascular component ("intravenous leiomyosarcomatosis").

A leiomyosarcoma of the uterus in a 54-year-old woman exhibited striking involvement of large vessels of the myometrium and broad ligament on both gross and microscopic examination. The pattern of vascular involvement resembled that seen in intravenous leiomyomatosis. Imaging studies showed recurrent tumor within the inferior vena cava 3 months after hysterectomy. To our knowledge, this is the first reported such case in the literature, for which we propose the designation intravenous leiomyosarcomatosis of the uterus.

Prostate cancer at the University Hospital of the West Indies in Jamaica: a clinico-pathological profile at the time of needle biopsy diagnosis

A prospective study of the clinico-pathological feaures of prostate cancer at the time of needle biopsy diagnosis was conducted in the Department of Pathology at the University Hospital of the West Indies over a one-year period. Ninety cases were diagnosed during this time. The mean age of patients at diagnosis was 72 years and the mean Gleason score of the biopsy, 7.3. Serum prostate-specific antigen levels were markedly elevated in the majority of patients, with a mean value of at least 159.8 ng/ml in the 76 patients for whom this information was available. The significance of these findings and that of other histopathological features examined are discussed, particularly in relation to recognized prognostic factors. It is concluded that the diagnosis of prostate cancer in Jamaica appears to be considerably later than that seen elsewhere. This information should support for those who advocate the introduction of a vigorous screening process for prostate cancer in Jamaica. (AU)

The evolution of prostate pathology diagnosis at the UHWI: trends over a ten-year period

OBJECTIVE: During the last decade, serum prostate-specific antigen (PSA) used as a screening tool for prostate carcinoma, and the 18-guage prostate biopsy gun, which allows for relative ease of prostate gland sampling, became available at the University Hospital of the West Indies. The aim of this study was to investigate what impact these diagnostic tools have had on the histopathogy services and in the diagnosis of prostate cancer. METHODS: A retrospective search of all prostate tissue specimens received in the Department of Pathology over the ten-year period 1991 to 2000 was conducted and their histology reports examined. Parameters recorded included the type of specimen received and the diagnosis issued by the pathologist. RESULTS: Our results demonstrated a small but gradual increase in the total number of prostate specimens accessioned until 1997, followed by a marked and sustained rise. This pattern reflected almost exclusively a similar trend in the number of biopsy specimens reviewed. During the period under review, there was a marginal decrease in the number of chips accessioned but a slight increase in the number of open prostatectomies. Radical prostatectomies were frequently performed. A total number of 106 cases of carcinoma of the prostate was diagnosed from biopsy specimens (35 percent of the biopsies received) during the first 5 years of the study, compared with 362 in the latter period (48 percent of biopsies received). CONCLUSION: The availability of the serum PSA test and the prostate biopsy gun had a significant impact on the number of specimens received in the histopathology laboratory and in the diagnosis of prostate cancer in particular. (AU)

Soft tissue sarcomas: a ten-year analysis

Malignant soft tissue tumours are uncommon and the diagnosis is often difficult to make. This study of fifty-nine cases represents a pathological perspective of our experience with these tumors over a 10-year period. Malignant fibrous histiocytoma was the most frequent diagnosis made (36 percent) and the Majority of these occurred in the lower limbs. In 11 (19 percent) cases, the sarcomas could not be further classified along histogenetic lines. We consider some of the reasons for this and discuss these findings in the light of an increasing trend towards the use of smaller samples for diagnosis. (AU)

Nodular Fasciitis

A 10-year review of the files of the Department of Pathology revealed 11 cases of nodular fasciitis. The clinicopathologic features of these cases are presented together witha discussion of the pathology of this lesion. The purpose of this study is to enhance both physicans' and pathologist awareness of this entity.(Au)

Medical students' evaluation of their patholgy clerkship experience

As part of a recent trend among faculties in educational institutions to review and upgrade their courses and teaching methods, the Department of Pathology introduced a questionnaire for assesment of the pathology clerkship experience by the medical students. This was to be completed at the end of their rotation. An elevation of the results of an entire class indicates that, for the most part, the responses were positive with 82 per cent considering the experience to be of great benefit and 17 per cent of reasonable benefit. The responses were generally more favorable to Anatomical Pathology and Haematology than to Chemical Pathology. The study identified areas where modifications in teaching could be considered, and ways to improve the questionnaire, making it more useful for future assesments. (AU)

Complete non-puerperial uterine inversion as a result of a uterine sarcoma

Complete non-puerperial uterine inversion is rare and when present is usually associated with a prolapsed submucous fibroid. The inversion in this case was associated with a uterine sarcoma in an 88 year old diabetic patient, gravida 13, who presented with a four month history of intermittent vaginal bleeding. She was successfully managed with a total abdominal hysterectomy and some of the difficulties with diagnosis and management are highlighted.(Au)

Complete non-puerperial uterine inversion as a result of a uterine sarcoma

Complete non-puerperial uterine inversion is rare and when present is usually associated with a prolapsed submucous fibroid. The inversion in this case was associated with a uterine sarcoma in an 88 year old diabetic patient, gravida 13, who presented with a four month history of intermittent vaginal bleeding. She was successfully managed with a total abdominal hysterectomy and some of the difficulties with diagnosis and management are highlighted.

Female adnexal tumour of probable wolffian origin

We report a case of female adnexal tumour of probable wolffian origin, a rare tumour of the broad ligament, and discuss aspects of its origin, differential diagnosis and behaviour.(AU)

Right ventricular cardiomyopathy: a rare and underdiagnosed cause of sudden death in young adults

We present an example of right ventricular cardiomyopathy, a very uncommon condition which caused sudden death in an adolescent boy. This case report is used to highlight the pathological features of this rare and poorly understood condition, which is often undiagnosed (AU)