RESUMEN
Identification of amyloidosis on a prostate biopsy specimen raises suspicion for systemic amyloidosis. For patients at risk of prostate adenocarcinoma, a transrectal MRI ultrasound fusion (MRI-TRUS) guided biopsy of the prostate is often needed for further investigation. Our patient is a 70 year old male presenting from his primary care provider with an elevated PSA. The patient underwent MRI-TRUS fusion biopsy of the prostate, which demonstrated AL (lambda)-type amyloidosis, confirmed by mass spectrometry in addition to prostatic adenocarcinoma. He was subsequently diagnosed with primary amyloidosis of the prostate without evidence of other amyloid deposition sites.
RESUMEN
Drug resistance and poor virological responses are associated with well-characterized mutations in the viral reading frames that encode the proteins that are targeted by currently available antiretroviral drugs. An integrated system was developed that includes target gene amplification, DNA sequencing chemistry (TRUGENE HIV-1 Genotyping Kit), and hardware and interpretative software (the OpenGene DNA Sequencing System) for detection of mutations in the human immunodeficiency virus type 1 (HIV-1) protease and reverse transcriptase sequences. The integrated system incorporates reverse transcription-PCR from extracted HIV-1 RNA, a coupled amplification and sequencing step (CLIP), polyacrylamide gel electrophoresis, semiautomated analysis of data, and generation of an interpretative report. To assess the accuracy and robustness of the assay system, 270 coded plasma specimens derived from nine patients were sent to six laboratories for blinded analysis. All specimens contained HIV-1 subtype B viruses. Results of 270 independent assays were compared to "gold standard" consensus sequences of the virus populations determined by sequence analysis of 16 to 20 clones of viral DNA amplicons derived from two independent PCRs using primers not used in the kit. The accuracy of the integrated system for nucleotide base identification was 98.7%, and the accuracy for codon identification at 54 sites associated with drug resistance was 97.6%. In a separate analysis of plasma spiked with infectious molecular clones, the assay reproducibly detected all 72 different drug resistance mutations that were evaluated. There were no significant differences in accuracy between laboratories, between technologists, between kit lots, or between days. This integrated assay system for the detection of HIV-1 drug resistance mutations has a high degree of accuracy and reproducibility in several laboratories.