Primary small cell undifferentiated carcinoma of the rectum associated with ulcerative colitis.

Primary small cell undifferentiated carcinomas (SCUCs) are unusual tumors of the colon and rectum. Histologically, these lesions represent a spectrum of neuroendocrine differentiation, with oat cell carcinoma being the most primitive subtype and carcinoid tumors being the most differentiated. This observation is supported by immunohistochemical and ultrastructural findings. We report a case of SCUC of the rectum in a patient with ulcerative colitis. To date, there have been only two reported cases of primary SCUC associated with ulcerative colitis. Recent theories of tumorigenesis attribute most colorectal cancers to a single, pluripotential mucosal stem cell, regardless of the tumor's histologic type.

Cytohistologic correlation of urothelial lesions secondary to photodynamic therapy.

Qualitative cytologic evaluations of urinary bladder washings were performed on a selected population following photodynamic therapy for recurrent transitional cell carcinoma of the bladder. The seven patients were monitored trimonthly by cystoscopy, multiple biopsies and cytopreparations. Cancers reappeared in two of the five patients who initially responded to therapy. In the remaining two patients, the recurrent neoplasms were therapeutically refractory. Cytology detected recurrent cancer prior to biopsy confirmation and/or cytoscopic identification. Exfoliative cytology was correlated with the histopathology of the concurrent biopsies; a possible source for a false-positive cytodiagnosis was the cellular atypia of reepithelialized bladder mucosa. Dysplasia was not identified cytologically or histologically.

Multiple adenocarcinomas of the colon and rectum. An analysis of incidences and current trends.

Three hundred forty-five colorectal cancers were identified in 320 patients over a nine-year period. Twenty-one patients (7 percent) had synchronous cancers. Metachronous cancers were identified in five patients (2 percent). Thirteen of the synchronous cancers were foci of invasive adenocarcinoma in polyps with elements of benign neoplastic tissue. There was a trend for younger patients to have multiple colon cancers. Fifteen percent of the synchronous colon cancer patients were less than 50 years of age. The mean age of patients who presented with metachronous cancer was 54, and 11 years was the average time interval between the diagnosis of the initial and the metachronous tumor. Colonoscopy proved to be more reliable than barium-enema examinations in identifying synchronous cancers. It is concluded from this review that before elective resections, colonoscopy should be used to effectively screen patients for synchronous cancers, and following curative resection, the residual colon should be periodically examined for the remainder of the patient's life.

Pulmonary cytology in the posttherapeutic monitoring of patients with bronchogenic carcinoma.

A study of 113 patients with histologically confirmed bronchogenic carcinoma and survival for at least 18 months was performed. Posttherapeutic cytologic specimens were submitted for only 52.2% (59/113), and for only 8.5% (5/59) of the individuals was specimen procurement related to clinic visits. Yet, when utilized as a diagnostic procedure for the hospitalized patient, a positive cytodiagnosis was made on 55.6% (15/27) of the patients with recurrent carcinoma, in 61.1% (11/18) with persistent disease and in all 5 patients with a metachronous primary bronchogenic carcinoma. Cytologic diagnoses of cancer compared favorably with concurrent histologic interpretations of biopsies and radiologic observations of chest films.

Pulmonary cytologic examination in the identification of the second primary carcinoma of the lung.

Multiple primary carcinomas of the lung were histologically confirmed in 23 male patients. Five were synchronous neoplasms. Seventeen of the second pulmonary cancers originated in the contralateral lung. The major cell type was epidermoid (17/23), and in 11 patients the tumor was similar in histologic features to the first lesion. Examination of pulmonary secretions as a diagnostic aid in the identification of the second malignant neoplasm was employed for 73.9% (17/23) of the patients. With a single exception, these were obtained at the second diagnostic hospitalization rather than as an outpatient monitoring procedure. Only nine patients had a series of cytologic preparations consisting of three consecutive early morning sputa, bronchial washings/brushings, and a postbronchoscopy sputum. A cytodiagnosis of cancer was established in 82.4% (14/17) of the cases and preceded histologic verification in ten. Radiologic evidence of a second primary was noted in only 56.5% (13/23) of the patients. Pulmonary cytologic examination as a monitoring procedure was not employed in the outpatient follow-up for 64 patients surviving pulmonary cancer for 18 months or longer. Posttherapeutic studies were obtained on 39.1% (25/64) of the hospitalized patients. Thirty-two percent (8/25) were collected concurrently with tissue biopsies for the confirmation of recurrence or metastasis. Patients with primary pulmonary cancers resected for cure should be monitored on a regular basis to include the cytologic examination of three consecutive early morning sputa and a chest radiograph.

Prostatic acid phosphatase immunoperoxidase staining of cytologically positive effusions associated with adenocarcinomas of the prostate and neoplasms of undetermined origin.

An immunoperoxidase staining technique was employed in an effort to demonstrate prostatic acid phosphatase in sections of the effusion cell blocks in a retrospective investigation of the incidence of malignant prostatic cells in body cavity effusions in 33 patients with histologically confirmed prostatic cancer. An attempt was also made to identify the prostate as a possible anatomic site of origin in 26 patients with an unknown primary but with cytologically positive fluids. Neoplastic cells were identified in the effusion specimens in 21.2% of the patients with confirmed prostatic cancer; the sources, however, were either primary or metastatic carcinomas of nonprostatic origin. None of the cytologic specimens in this study demonstrated a positive prostate-specific acid phosphatase staining reaction, as did the prostatic metastases to the lungs used as controls.

Cytologic negativity in the diagnosis of secondary pulmonary neoplasms.

This retrospective study consisted of 55 patients with histologically confirmed metastatic cancer to the lung. Cytologic specimens were collected within 45 days before death. These included bronchial secretions, pleural effusions, and fine needle aspirations obtained randomly, either singly or in various combinations. The cytodiagnosis of cancer was made in 58% (32/55) of the patients. Originally, 34% (11/32) of these had been false-negative cases. Morphologic features associated with cytologic negativity in 23 patients included apparent failure to invade the respiratory air compartment in 57% (13/23) of the cases; when applicable, failure to induce a pleural effusion with neoplastic invasion of pleural tissues in 75% (6/8); peripheral distribution of the metastatic nodules to the outer third of the pulmonary parenchyma in 26% (6/23); and tumor size of less than 1.5 cm in 57% (13/23).

Inhibition of tumor growth by magnesium depletion of rats.

In earlier studies tumor growth was inhibited in rats that first were made magnesium-deficient and subsequently implanted with tumors. The objective of this study was to determine if the reverse sequence is also effective. Namely, is tumor growth inhibited if tumors first are established and then a magnesium deficiency imposed? Rats with palpable mammary adenocarcinomas, or with sham implants were pair-fed either a control or magnesium-deficient diet for 32 days. Rats were then killed and tumors, plasma and several tissues analyzed. In tumors from magnesium-depleted rats, growth was inhibited 46%, magnesium concentration decreased 40% and necrosis was 50% greater. Magnesium depletion alone resulted in a 66% decrease in magnesium and a 29% increase in copper in plasma. Also, depletion caused a decrease in heart zinc and increase in kidney copper concentrations. As a result of tumor growth alone, concentrations of zinc in plasma decreased 40% and copper increased 37%. Rats with tumors also had decreased sodium and increased potassium levels in plasma. To our knowledge this is the first demonstration that the growth of an established tumor can be retarded solely by dietary magnesium depletion and thus may be significant for the nutritional management of tumor patients.

Inhibition of tumor growth by zinc depletion of rats.

Tumors grow less rapidly when implanted into zinc-deficient rats. The objective of this study was to determine if tumor growth is also inhibited when tumors first are established and then a zinc depletion initiated. Therefore, rats with palpable mammary adenocarcinomas or with sham implants were pair-fed either a control or zinc-deficient diet for 32 days. Rats were then killed and tumors, plasma and several tissues analyzed. In three separate experiments tumor growth was inhibited 32, 35 and 35%, respectively. The extent of tumor necrosis and tumor zinc concentration were not different between control and deficient groups. However, there was a significant positive correlation between tumor zinc concentration and percent viable tumor tissue in both groups. Although zinc depletion in tumor-bearing rats resulted in a 10% loss of carcass weight, there was little effect on liver, kidney and heart weights. As a result of depletion alone, zinc concentrations decreased only in plasma and kidney. As a result of tumor growth alone, concentrations of liver zinc increased and kidney copper decreased. In plasma of tumor-bearing rats, levels of zinc decreased 40% while copper and magnesium increased 50 and 13%, respectively. To our knowledge, this is the first demonstration that growth of established tumors can be retarded solely by dietary zinc depletion.

Malignancy-associated serosanguinous pleural effusions.

Cytologic preparations of 786 pleural effusions from 495 patients were reviewed, including 312 specimens from 172 cancer patients. Approximately 50% of the paraneoplastic effusions were sanguinous. Thoracic cancer was histologically confirmed in 145 patients, 64% of whom had cytologically positive pleural effusions; 71% of these specimens were also macroscopically bloody. Regardless of any histologic evidence of neoplastic invasion of the pleura, the presence of blood in the majority of the effusions was related most often to acute inflammatory reactions with vascular dilatation and proliferation within serosal tissues or the underlying pulmonary parenchyma.

Clinical assessment of three hemoglobin screening programs on a selected population.

Through three related programs, 9,675 individuals were screened for hemoglobinopathy. The studied population was predominantly black (58%) and male (91%). Identified were 333 variants (3.4%), 90.7% of them in blacks. Two hundred occurred in hospitalized patients. Laboratory results were entered in medical charts in all but three instances. Annotation of the abnormality by a physician in the progress notes, discharge summary, or final coded diagnosis was made in 14.4% of the reviewed records. This included 46.7% of 15 patients with clinically manifested disease related to the hemoglobinopathy.

A specific dietary zinc requirement for the growth of Walker 256/M1 tumor in the rat.

To determine the specific effect of zinc status on the growth of Walker 256/M1 carcinosarcomas young male rats were pair-fed either a control or zinc-deficient diet for 14 days, were implanted with tumors and killed 7 days later. Half of the deficient rats were repleted with zinc for the 7 days after tumor implantation. In deficient rats, tumor weights were decreased 70% (p less than 0.005), tumor necrosis was 3-fold greater (p less than 0.05) and tumor zinc concentrations were decreased 23 to 37% (p less than 0.005). A specific zinc effect was observed by a 2-fold increase in tumor weights in repleted rats (p less than 0.05) with marked decreases in tumor necrosis (p less than 0.05) and 29 to 84% increases in tumor zinc concentrations (p less than 0.005). Since there were no decreases in organ weights of zinc-deficient animals and no correlation between final tumor weights and postimplant changes in carcass weights, the results indicate a specific inhibitory effect of zinc deficiency independent of a nonspecific malnutrition.

Megakaryocytes in renal glomeruli.

Reported are 27 autopsies with significant increases in the numbers of megakaryocytes within the renal glomerular capillary network (P less than 0.001). These were selected from 118 cases in which peripheral vascular megakaryocytosis could be expected preterminally. Generally, the histologically observed increases in numbers of renal megakaryocytes corresponded to increases in the pulmonary microcirculation and in the bone marrow. An exception to the latter was noted in patients who had morphologic evidence of coagulopathy without sepsis.

Autogenous tunica vaginalis graft for Peyronie's disease: an experimental study and its clinical application.

Tunica vaginalis autografting was done after patches of tunica albuginea of the penis were excised in 5 dogs. Examination of these grafts 4 to 12 weeks later showed that they were well accepted. A selected group of 5 patients with Peyronie's disease underwent excision of Peyronie's plaques and autogenous tunica vaginalis grafting with satisfactory results in all cases.

The changing prevalence of secondary cardiac neoplasms as related to cancer therapy.

A 25-year-review of 1303 autopsies with metastatic non-reticuloendothelial and non-central nervous system malignancies revealed secondary cardiac neoplasms in 179 cases (14%). When the autopsies were divided into two groups by time period, a significant increased prevalence of secondary cardiac neoplasms was demonstrated during the later period (1966-1977). This noted increase was not influenced by chemotherapy but was apparently related to attempted curative surgical and/or radiation therapy.

Immunoglobulins and hyposensitization for allergy.

The premise that protracted stimulation of the human immune system might be involved in the induction of malignant immunocytopathies is scrutinized. Studies of the serum immunoglobulins of 313 patients who had been hyposensitized for allergy are compared with those of 138 nonallergic and 189 allergic individuals not subjected to this therapy. Critical historical data in all groups are also evaluated. The investigators concluded that, as far as the parameters studied, there were significant differences in the mean total immunoglobulin G levels in allergic hyposensitized persons compared with the non-allergic control group. It involved a depression of the serum IgG concentration and related to the length of the desensitization program and to whether it was continuous or interrupted. One evolving monoclonal immunocytopathy, etiology of which has not been established, was encountered during the period of study.

The impact of prophylactic measures on fatal pulmonary embolism.

Prompted by reviews showing no significant reduction in the overall incidence of fatal pulmonary embolism in recent years, we examined the incidence of this complication found on autopsy over the 15-year period between 1960 and 1974 in a Veterans Administration Hospital. During the first six years, when no specific prophylactic measures were practiced, 41 patients died of pulmonary embolism on the surgical service; whereas in the last nine years, when dextrans were used prophylactically in high-risk patients, 24 patients had fatal pulmonary embolisms. Of these 24 patients, 21 did not receive the recommended dosages of dextran. There were no significant differences in the average annual number of admissions and major operations, or in the rate of autopsy, between the two periods. We conclude that the prophylactic use of dextran in high-risk surgical patients is a practical, effective, and safe method to reduce the overall mortality from pulmonary embolism.

The cyto-histopathology of a pseudomesotheliomatous carcinoma of the lung.

A cyto-histopathologic study of a pseudomesotheliomatous carcinoma of the lung has been presented. The cytologic preparations of the early morning and post-bronchoscopy sputum specimens, bronchial washings and pleural fluid contained tumor cells similar to those exfoliated from a terminal bronchiolar carcinoma, of which this neoplasm is considered a variant.