Pictorial review: Unusual tumours involving the prostate: radiological-pathological findings.

The appearance of several unusual tumours in the prostate has resulted in questions being raised concerning their histogenesis; moreover, some of these tumours have prognoses that are quite unlike those of prostatic adenocarcinoma. Unusual neoplasms involving the prostate have been described in recent years, including mucinous cystadenocarcinoma, neuroendocrine cancer, lymphoma, spindle cell neoplasm, squamous cell carcinoma and transitional cell carcinoma. Radiological findings can overlap, and play limited roles in the diagnoses of these entities. However, knowledge of the radiological findings in these conditions can be helpful in making differential diagnoses. Images of prostate lesions using several imaging modalities, including transrectal ultrasound, MRI and CT, as well as available pathological images of such lesions, are presented in this article.

Hypoechoic rim of chronically inflamed prostate, as seen at TRUS: histopathologic findings.

OBJECTIVE: The purpose of this study is to correlate the findings of peripheral hypoechoic rim, seen at transrectal ultrasonography (TRUS) in chronic prostatitis patients, with the histopathologic findings. MATERIALS AND METHODS: Seven patients with pathologically proven chronic prostatitis were involved in this study. The conspicuity of the peripheral hypoechoic prostatic rim, seen at TRUS, was prominent and subtle, and to determine its histopathologic nature, the microscopic findings were reviewed. RESULTS: In five of seven cases (71%), TRUS demonstrated a prominent peripheral hypoechoic rim. Microscopic examination revealed that inflammatory cell infiltration of prostatic glandular tissue was severe in three cases (42.9%), moderate in two (28.6%), and minimal in two (28.6%). In all seven cases, the common histopathologic findings of peripheral hypoechoic rim on TRUS were loose stromal tissues, few prostatic glands, and sparse infiltration by inflammatory cells. CONCLUSION: The peripheral hypoechoic rim accompanying prostatic inflammation and revealed by TRUS reflects a sparsity of prostate glandular tissue and is thought to be an area in which inflammatory cell infiltration is minimal.

Intramedullary spinal cord ganglioglioma: a report of five cases.

We report five cases of ganglioglioma in various locations. The tumours were removed with gross total resection in most cases without any further neurological deterioration. Without any additional treatment, no evidence of recurrence or regrowth of tumours was observed in the mean follow-up period of 4.1 years. We suggest that intramedullary spinal cord gangliogliomas be resected totally due to the high risk of recurrence and regrowth rate of the tumours with subtotal resection in the long term considering especially that these tumours affect predominantly young patients.

Meningioma manifesting intracerebral haemorrhage: a possible mechanism of haemorrhage.

We present a possible mechanism of intracerebral peritumoural haemorrhage in meningioma based on the clinical data of three of our cases. A meningioma manifesting intracerebral haemorrhage is uncommon and some sporadic case reports have been presented, but without any proven mechanisms. We are presenting three cases of convexity meningioma manifesting spontaneous intracerebral haemorrhage with apoplectiform onset. All three patients had no evidence of bleeding tendency or other predisposing factors for haemorrhage. Preoperative radiological studies showed a solid mass attached to the dura with intracerebral peritumoural haematoma. Total removal of the tumour and haematoma could be achieved in every case. Histological investigation revealed extensive tumour infarction in two cases and fibrosis related to pre-existing ischaemia in the other case. The diagnoses were atypical meningioma in two cases and transitional type in one case. We suggest that extensive tumour infarction might be a cause of spontaneous intracerebral peritumoural haemorrhage in our series of patients.

Correlation of changes in natural killer cell activity and glutathione S-transferase placental form positive hepatocytes in diethylnitrosamine-induced rat hepatocarcinogenesis.

To evaluate the induction of preneoplastic hepatic foci in relation to natural killer cell (NK) activity, we sequentially analyzed glutathione S-transferase placental form positive (GST-P+) hepatocytes and NK activity during diethylnitrosamine (DEN) and phenobarbital (PB)-induced hepatocarcinogenesis in Sprague-Dawley rats. Previous studies have shown that NK activity can modulate the carcinogenic process induced by chemical carcinogens. Newborn females were initially given a single intraperitoneal injection of 15 mg DEN/kg and three weeks later, they were treated with 500 ppm phenobarbital (PB). From week 3, PB was administered in drinking water for 9 weeks. Interim and terminal sacrifices were performed at weeks 12, 15 and 30. GST-P+ hepatocytes increased with age in DEN-treated rats, especially in the population of more than two GST-P+ hepatocytes. The NK activity of DEN-treated rats did not significantly differ from that of control rats until week 12, but it progressively decreased from week 15 to 30. These results indicate that changes of NK activity inversely correlated with the induction of preneoplastic hepatic foci. This strong correlation of decreased NK activity with enhanced induction of GST-P+ foci suggests that NK activity is important in the early progression of hepatocarcinogenesis in rats.

Changes in natural killer cell activity and prostaglandin E2 levels during the progression of diethylnitrosamine-induced hepatocarcinogenesis in Fischer 344 rats.

The sequential changes of natural killer cell (NK) activity and prostaglandin E2 (PGE2) during hepatocarcinogenesis induced by diethylnitrosamine (DEN) in male Fischer 344 rats were investigated. DEN at a concentration of 40 ppm was administered in drinking water for 10 weeks. At weeks 5, 10, 20 and 30, rats were autopsied and the development of glutathione S-transferase placental form positive foci (GST-P+ foci) at weeks 5 and 10 and hepatocellular tumors at weeks 20 and 30 were examined. The labeling index of bromodeoxyuridine (BrdU) an indicator of DNA synthesis, was also sequentially checked. GST-P+ foci were found to increase with age. Hepatocellular nodules increased until week 20, but by week 30 when the incidence of hepatocellular carcinoma was 100%, the incidence of nodules had decreased. BrdU positive cells also increased with age, and by week 30 when the incidence of hepatocellular carcinoma was 100%, the number of BrdU-positive cells had decreased. NK cell activity increased until week 10, but at week 20, was less than in the untreated control group. The level of PGE2 increased until week 5, but at week 10, levels were not significantly different from those seen in the untreated control group. On the basis of these results, we concluded that NK activity is closely related to the progression of hepatocarcinogenesis, but PGE2 levels show no significant change.

Extensive colonic stricture due to pelvic actinomycosis.

A 36-year-old woman presented with a palpable tender mass at the left lower quadrant of the abdomen. She had suffered from constipation for five years and had a previous history of intrauterine device-use for one year. Preoperative barium enema and abdominopelvic CT showed a compatible finding of rectosigmoid colon cancer or left ovary cancer. She underwent segmental resection of the sigmoid colon along with the removal of left distal ureter, left ovary and salpinx. Pathologic examination revealed actinomycotic abscesses containing sulfur granules. Thereafter, she took parenteral ampicillin (50mg/kg/day) for one month and oral amoxicillin (250mg, tid) for 2 months consecutively. The patient has no specific problems for 6 months after surgical resection and long-term antibiotic therapy. This report may be the first of intrauterine device-associated pelvic actinomycosis involving both sigmoid colon and rectum extensively.

Hepatocellular carcinoma associated hemolytic uremic syndrome unrelated to chemotherapy.

A 67-year-old man, diagnosed as hepatocellular carcinoma by percutaneous needle aspiration biopsy of liver mass, presented microangiopathic hemolytic anemia, thrombocytopenia and renal failure from the early phase of the illness. We could establish the diagnosis of cancer-associated hemolytic uremic syndrome which was unrelated to chemotherapy clinically. This is a rare case reported in adult hepatoma patients.

Prognostic significance of proliferating cell nuclear antigen-positive growth fraction in gastric adenomas.

The proliferative activity of gastric adenomas from 18 patients (42 endoscopic procedures) was compared with follow-up results. These cases were gastric adenomas proven by follow-up with repeated endoscopic procedures for more than 2 years, or were confirmed as gastric adenocarcinoma thereafter by histopathologic examination. Among the eighteen cases, nine showed carcinoma in the subsequent biopsies (group 1) and the remaining nine did not result in carcinoma (group 2). The proliferating cell nuclear antigen (PCNA) positivity rates of the two groups were significantly different (P < 0.01). The average PCNA positivity in group 1 was 33.1%, while it was 10.0% in group 2. The risk of developing carcinoma increased as the PCNA positivity increased: 0% in the low PCNA positivity group, 41% in the mid-positivity group and 89% in the high positivity group. We concluded that growth fraction could be taken into account as one of the most important prognostic factors for gastric adenoma, and accordingly repeated endoscopic biopsies with close follow-up should be carried out especially in the high PCNA positivity group.

Chromogranin-A expression in gastric and colon cancer tissues.

UNLABELLED: We studied the expression of chromogranin A (CgA) in human gastric (n = 17) and colorectal (n = 18) adenocarcinomas by nucleic acid hybridization and immunohistochemical analyses using a specific monoclonal antibody (MAb) to human chromogranin A (CgA). Some corresponding adjacent non-malignant mucosal tissues were also examined. RESULTS: (1) Northern blotting: of 3 normal gastric mucosas examined, 2 (67%) had an easily detected signal for expression of CgA. Only one of 14 gastric carcinomas (7%) and one of 18 colorectal carcinomas (6%) had easily detected RNA signals. (2) Immunohistochemical staining: all non-malignant samples of gastric and colonic mucosa contained CgA-positive neuroendocrine (NE) cells. Two of 17 (12%) gastric adenocarcinomas, and 3 of 18 (17%) of colorectal adenocarcinomas contained CgA-positive tumor cells. Interestingly, the positive cases detected by immunohistochemistry included both cases detected by Northern blotting. Of the 5 cases detected by immunohistochemistry, 2 gastric cancers and 1 rectal carcinoma contained many diffusely scattered positive cells, occurring singly or in small clusters, while 2 colorectal carcinomas contained only occasional single CgA-positive tumor cells. In one of the positive gastric cases, a well-differentiated adenocarcinoma arising in a tubular adenoma, both the adenomatous and the carcinomatous elements contained positively staining cells. Our specific assays for CgA indicate that (1) a NE cell component, either diffusely scattered or occasional, occurs in about 15% of gastric and colorectal tumors; (2) there is no correlation between the presence of NE cells and degree of tumor differentiation; and (3) because only a minority of the tumor cells in positive cases stain for CgA, immunohistochemistry is a more sensitive method than Northern blotting.

Localized form of colitis cystica profunda--a case of occurrence in the descending colon.

An unusual localization of localized colitis cystica profunda in a 31-year-old man is described. The patient presented as anal bleeding and a protruding mass at the descending colon; the mass was polypoid and was made up of papillary epithelial hyperplasia with downward herniation of glands into the submucosa. Only one similar case involving a descending colon has been reported in the world literature.

Inflammatory pseudotumor of the lung in a child with mycoplasma pneumonia.

A case of inflammatory pseudotumor of the lung occurring in a six-year-old boy is reported with clinicopathologic findings, including its ultrastructure. The patient had had frequent upper respiratory tract infections, and one and half year before the discovery of the lung mass, he suffered from pneumonia of the right lung, which was serologically proven to be a mycoplasma pneumoniae infection. Exploratory thoracotomy revealed a large mediastinal mass that was removed together with the right middle and lower lobes of the lung. The mass arose from the lung with an endobronchial element. Microscopically, the mass was composed of a variety of inflammatory and mesenchymal cells, including plasma cells, histiocytes, lymphocytes, and fibroblast-like spindle cells. Ultrastructurally, the spindle-shaped mesenchymal cells were either fibroblasts or myofibroblasts. At the time of diagnosis of the inflammatory pseudotumor of the lung, the serum titer of antimycoplasma antibody rose again, and the lung parenchyma adjacent to the mass showed interstitial pneumonia with features of bronchiolitis obliterans. The present case suggests that the inflammatory pseudotumor of the lung could be a postinflammatory lesion associated with mycoplasma pneumoniae infection.

Foregut choristoma of the ileum, (adenomyoma)--a case report.

An ileal adenomyoma in a 7-year-old boy who presented with jejunoileal intussusception is described and the term "foregut choristoma" is proposed for this and related conditions, such as ectopic pancreas or heterotopic Brunner's glands in the gastrointestinal tract. The polypoid mass in the ileum of this patient was composed of cystically dilated glandular structures lined by a tall columnar epithelium resembling hepatobiliary or pancreatic ductal epithelium, hypertrophic and irregular smooth muscle bundles surrounding the glandular elements, and small amount of fibrous stroma. Reported cases of this disorder in the gastrointestinal tract are generally confined to the antrum of the stomach.

An unusual ventricular loop associated with right juxtaposition of the atrial appendages.

We report two autopsied cases of an unusual ventricular loop in hearts with right-sided juxtaposition of the atrial appendages. Case 1 showed usual atrial arrangement, a concordant atrioventricular connexion with a disharmonious ventricular loop showing left-hand topology and double outlet right ventricle with normally related arterial trunks. The atrioventricular connexions were crossing, with the inlet to the left-sided morphologically right ventricle being posterior to that of left ventricle. Mitral hypoplasia and coarctation of the aorta were the associated lesions. The second case showed usual atrial arrangement, a discordant atrioventricular connexion with an imperforate left atrioventricular orifice and double outlet right ventricle with the aorta in the right-sided position. A large right atrium was connected to right-sided morphologically left ventricle. A prominent dimple in the left atrial floor was firmly attached to the hypoplastic right ventricle which was left-sided and anterior. A small but discrete inlet portion of the right ventricle could be traced towards the anteriorly located left atrial dimple. Thus, despite the presence of a discordant atrioventricular connexion with the usual atrial arrangement, there was righ-hand ventricular topology. In each case the inlet component of the ventricular septum was displaced, being to the right in case 1 and anteriorly in case 2. We suggest that the embryologic mechanism producing disharmony between the atrioventricular connexion and the segmental combinations be interpreted on the basis of posterior ventricular looping, since they are best explained on the basis of a hypothetical heart with posteriorly located outflow tracts.