Fourier-transform infrared spectroscopic study of characteristic molecular structure in cancer cells of esophagus: an exploratory study.

OBJECTIVE: To investigate the structural changes at the molecular level and to assess the usefulness of Fourier-transform infrared (FTIR) spectroscopy in the diagnosis of esophageal cancer. METHODS: A pilot study was established of 10 consecutive patients with adenocarcinoma of the esophagus. Tissue samples from the diseased and normal sites of the resected specimens were analyzed and compared using FTIR spectroscopy and histopathology. RESULTS: Specific changes were observed in the FTIR spectral features of esophageal cancer and thus spectral criteria were established for the detection of malignancy in esophagus tissues by FTIR spectroscopy. The spectral changes in cancer were the results of characteristic structural alterations at the molecular level in the esophageal cancer specimens. These alternations included an increase in the nuclei-to-cytoplasm ratio, an increase in the relative amount of DNA while a decrease in the relative amount of RNA, an enhancement in the phosphorylation of proteins, a decrease in the glycogen level, a loss of hydrogen bonding of the COH groups in the amino acid residues of proteins, a tighter intermolecular packing and a stronger intermolecular interaction among the DNA molecules, an increase in the distribution of protein segments with the conformation of beta-sheet and unordered turns and a tighter packing of the alpha-helical segments in overall tissue proteins, a decrease in the overall CH(3)-to-CH(2) ratio and an accumulation of triglycerides. CONCLUSIONS: FTIR is an automated method that has shown promise in differentiating cancer in the esophagus and may play a role in surveillance programs in premalignant conditions.

Pulmonary alveolar proteinosis and end-stage pulmonary fibrosis: a rare association.

We present the high resolution CT features of marked pulmonary fibrosis in a patient known to have pulmonary alveolar proteinosis (PAP) confirmed on open lung biopsy. Significant fibrosis in PAP is an extremely rare occurrence with only a few case reports. Our case demonstrated a predominantly central distribution, which has not been described previously.

Benign Hürthle cell adenoma with papillary architecture: a benign lesion mimicking oncocytic papillary carcinoma.

We studied the significance of encapsulated Hürthle cell thyroid nodules with papillary structures lacking the nuclear features of papillary thyroid carcinoma (PTC); 19 cases fulfilling these criteria were encountered The patients' ages ranged from 22 to 40 years (32+/-6), and the F:M ratio was 3:1 The tumors measured from 0.5-5 cm (2+/-1.1). The diameter of the tumor cell nuclei ranged from 5.6 to 7.2 microns. Many nodules had nuclei displaying a fine chromatin pattern somewhat resembling those of PTC, but these were present in <20% of the tumor cells. Immunohistochemically, there was reactivity for MIB-1 in the papillary structures, negativity to focally weak reactivity for HBME and galectin-3, and negativity to moderate diffuse reactivity for CK19. Clinical follow-up from 1 to 19 years revealed no evidence of metastases in any of the cases. It is unlikely that the papillary structures in the study cases represent degenerative changes in view of the proliferative activity we have demonstrated in them. In view of (1) the encapsulation and the uniformity of the constituent cells, (2) the negative or weak immunoreactivity for galectin-3 and HBME and negative to moderate immunoreactivity for CK19, and (3) the absence or paucity of nuclear criteria for the diagnosis of PTC and the absence of lymph node metastasis in all study cases, we believe that these lesions represent the papillary variant of oncocytic follicular adenoma (Hürthle cell adenoma). Recognition of this entity is important to avoid an overdiagnosis of oncocytic PTC.

Histopathological and immunohistochemical study of papillary urothelial neoplasms of low malignant potential and grade associated with extensive invasive low-grade urothelial carcinoma.

OBJECTIVE: To report five cases of papillary urothelial neoplasm of low malignant potential (UNLMP) and papillary urothelial carcinoma of low grade (UCLG) associated with extensive muscle invasion, and to investigate the clinical and histopathological presentation and their immunohistochemical properties. MATERIALS AND METHODS: Consecutive cystectomy and correlating transurethral resection (TUR) of urinary bladder tumour specimens were reviewed to identify cases of UCLG having extensive invasion into the urinary bladder wall. All specimens were stained immunohistochemically, as were those from 10 control cases having reactive urothelium or superficial UNLMP. The clinical charts were reviewed. RESULTS: Of a total of 95 cystectomy cases there were four of UNLMP or UCLG with extensive invasion. An additional case was added from our consultation file. All five cases had biopsies misdiagnosed as benign lesions or prostatic adenocarcinoma. The superficial invasive components consisted of UCLG conforming to the previously described entities of nested transitional cell carcinoma (TCC), microcystic or deceptively benign-appearing TCC. Immunostaining for cytokeratin 20, MIB-1 and p53 was similar to reactive epithelia, whereas E-cadherin immunoreactivity was slightly different, with focal negativity compared with extensive immunoreactivity in invasive vs noninvasive UCLG. Four patients developed distant metastases; three died within a follow-up of 3 years. CONCLUSIONS: UNLMP and UCLG that widely and deeply invade the bladder accounted for 4% of urothelial carcinoma (UC) in cystectomy specimens and commonly pose diagnostic problems in superficial TUR specimens. From this study with few cases the diagnosis of this entity in superficial biopsies is aided by an awareness of it and by identifying 'benign appearing' nests of urothelial cells which are deeply seated in the stroma. Immunostaining is unlikely to be very useful.

A simple technique for calculation of the volume of prostatic adenocarcinomas in radical prostatectomy specimens.

Tumor volume has been suggested as an important prognostic factor of prostatic adenocarcinoma (PAC) treated with radical prostatectomy (RP). The calculation of tumor volume is complicated by the difficulty in appreciation of tumor nodules at gross examination, multifocality, and variation in the shape of tumor nodules. We propose a simple technique for the calculation of tumor volume. One hundred consecutive specimens of RP were studied with special attention to the shape of tumor nodules. Most small PAC, transitional zone (TZ) PAC, peripheral zone (PZ) PAC without associated benign prostatic hyperplasia (BPH), and PZPAC with Gleason's score (GS) > 3 + 4 had an ovoid shape. Most large sized nodules of PZPAC with GS < 4 + 3 tended to mold according to the boundaries of the TZ that were themselves often compressed by hyperplastic nodules. Therefore, these large tumor nodules were crescentically shaped and had tapering pole(s). We deduced from that tendency that the ratio of height of the tumor nodule = D1 x the height/greatest horizontal diameter of the prostate (D1 = the greatest diameters of the largest section of tumor nodule). Using the mathematical formula for volume of an ellipsoid structure, we propose the following formula to calculate the volume of each tumor nodule = 0.8 x K x D1(2)x D2 (D2 = greatest diameter orthogonal to D1, and K = coefficient for correction of tumor volume due to the compression of hyperplastic nodules). K is empirically estimated as 2/3 for PZPAC in mid prostate and 1/2 for tumor nodules at the apex and base. The total tumor volume is the sum of all tumor nodule volumes. By measuring the two greatest orthogonal diameters, D, and D2, of the largest horizontal section of a tumor nodule, we were able to calculate the corresponding volume and consequently the total tumor volume of the prostate. Analysis of the calculated total tumor volume showed a good correlation with the current technique of measurement on each section of the prostate, particularly for tumors ranging from 1.5 to 3.0 cm3.

Esophageal leiomyomatosis.

BACKGROUND: Esophageal leiomyomatosis is rare with an incidence that is essentially unknown with only a few reported cases. Characteristically there is proliferation of smooth muscle cells in the esophageal wall causing localized circumferential thickening. Esophageal leiomyomas are usually very slow growing and often asymptomatic. Symptomatic tumors are usually greater than five centimeters in diameter. The accepted treatment for esophageal leiomyomatosis has been surgical removal, which frequently requires esophagectomy with reconstruction. CASE REPORT: We report a case of a 29-year-old woman with esophageal leiomyomatosis whose presentation was not typical and magnetic resonance imaging proved diagnostic. This patient was effectively with enucleation of the tumor. CONCLUSIONS: Recommended treatment for this condition has been total esophagectomy with reconstruction, but we report a case treated with enucleation of the tumor.

Location and extent of positive resection margins and ductal carcinoma in situ in lumpectomy specimens of ductal breast carcinoma examined with a microscopic three-dimensional view.

The location of positive margins in lumpectomy specimens for ductal carcinoma could be predicted due to the common pattern of the geographic relationship between the intraductal and invasive carcinomas. To test this hypothesis, 62 lumpectomy specimens for ductal carcinoma of the breast were submitted for this study. The specimens were microscopically examined by serially sectioning them into giant sections in a plane parallel to the chest wall (frontal plane). The margins were identified as proximal (closest to the nipple), distal (opposite to proximal), and peripheral (nonproximal or distal). We found that the location of positive or close margins was proximal in 6 cases, peripheral in 13 cases, and none were found to be distal. Ductal carcinoma in situ (DCIS) was found to be located in the area adjacent to the invasive carcinoma. The invasive carcinoma was located at the periphery of the intraductal carcinoma. All six specimens with invasive carcinoma without DCIS had free margins. Nine of 16 specimens (56%) with extensive intraductal carcinoma (EIC) component and 7 of 40 (18%) with DCIS but negative EIC contained positive or close margins involved by DCIS. One case with multifocal invasive carcinoma measuring 3.5 cm in diameter and with DCIS but EIC negative had margins involved by both DCIS and invasive carcinoma. In conclusion, in ductal carcinoma, invasive carcinoma arose at the peripheral areas of the DCIS. DCIS tends to spread toward the nipple and the peripheral margins of the resected specimens. Incomplete excision of the ductal carcinoma and the wide positive margins are most likely caused by the failure to estimate the extent and location of DCIS.

Identification of isolated and early prostatic adenocarcinoma in radical prostatectomy specimens with correlation to biopsy cores: clinical and pathogenetic significance.

Prostatic adenocarcinoma (PAC) is a multifocal disease. In this study, we identified isolated and small foci of PAC (ISPAC) in radical prostatectomy specimens, described the histopathologic features, investigated their zonal distribution in the prostate and their relationship with large tumor nodules, and correlated the findings with those of preceding biopsy cores. One hundred and thirty radical prostatectomy specimens performed for PAC or for urothelial carcinoma of the urinary bladder with incidental PAC were reviewed for identification of ISPAC. Prostates were serially sectioned in the horizontal plane and submitted in toto for microscopic examination. ISPAC were defined as foci of PAC measuring less than 3 mm in maximum diameter. There were 461 ISPAC identified in 114 cases. They were distributed in the transitional zone (TZ) (18 foci), the apex (73 foci), the anterior horn of the non-TZ (NTZ) (118 foci), the base (8 foci), and the remaining NTZ (244 foci). ISPAC usually consisted of groups of small acini with a GS ranging from 2 to 7 (3 + 4). GSs of ISPAC consisted of single grade or two consecutive grades equal to or lower than those of the main PAC. ISPAC were more often located in close proximity to large tumor nodules. The number of ISPAC increased with the tumor volume up to 3 cm3, then decreased as the PAC became more extensive (p value = 0.02, statistically significant). Prostates with NTZ PAC <1.5 cm3 and TZ PAC or prostates containing 4 or more than 4 ISPAC tended to be frequently associated with small foci of PAC in biopsy cores In this study, we identified ISPAC that likely represent foci of PAC in early development and account for the multicentricity and heterogeneity of PAC. ISPAC in the NTZ were common and may account for small foci of PAC or atypia in biopsy cores. Although these small foci of PAC or atypia in biopsy cores without accompanying higher GS PAC were often associated with significant PAC, they may also occasionally represent insignificant or vanishing PAC in subsequent radical prostatectomies.

Endometrioid carcinoma of the endometrium with an invasive component of minimal deviation carcinoma.

Minimal deviation endometrioid adenocarcinoma is a rare pathological variant of endometrioid adenocarcinoma. We describe a case representing another rare variant of endometrioid adenocarcinoma composed of both typical and minimal deviation endometrioid adenocarcinoma in a 45-year-old woman. Macroscopically, the cervix was of normal size but it had an indurated consistency. The myometrium was unremarkable. Microscopically, in addition to the typical endometrioid adenocarcinoma that involved 75% of the endometrium, there was a proliferation of mildly atypical endometrial type glands sparsely distributed in the fibrovascular tissue, typical of minimal deviation endometrioid adenocarcinoma. The latter component extended downward from the endomyometrial junction and involved focal areas of the uterine body and isthmus, diffusely invaded the entire cervix and focally the cervical resection margins. Focal transitional areas between typical and minimal deviation endometrioid adenocarcinoma were identified. Due to a relatively normal gross appearance and the microscopic deceptively benign looking appearance, minimal deviation endometrioid adenocarcinoma may pose problems of obtaining adequate sampling and evaluating the thickness of invasion of the endometrial carcinoma on gross, as well as microscopic, examination. HUM PATHOL 33:856-858.

Surgical staple metalloptysis after apical bullectomy: a reaction to bovine pericardium?

Palliation of symptomatic emphysema may include bullous resection to improve function of the remaining lung. Buttressing staple lines with bovine pericardium partially alleviates postoperative air leak, but can promote inflammation and infection. We report a patient expectorating staples and pericardium 5 years after bilateral apical bullectomy. Previous reporting of this complication in lung volume reduction operation also involved both pericardium and staples, and we propose that an ongoing local inflammatory reaction to these materials may facilitate delayed erosion into airways.

Differentiated thyroid carcinomas with vascular invasion: a comparative study of follicular, Hürthle cell and papillary thyroid carcinoma.

AIM: Non-medullary thyroid carcinomas arise from follicular cells. The purpose of this study is to correlate clinical and pathological properties of these tumours with the rate of distant metastasis from a series of thyroid tumours excised at one institution. METHODS: A total of 311 non-medullary thyroid tumours were identified and divided into: 29 follicular carcinoma (FC), 12 Hürthle cell carcinoma (HC), 13 Hürthle cell papillary thyroid carcinoma (HPTC) with vascular invasion (VI), 32 papillary thyroid carcinoma (PTC) with VI and 225 PTC without VI. The mean follow-up was 6.5 years with a range of 1-17 years. The tumours were histologically subdivided into minimal or wide invasion for FC and HC and focal or extensive invasion for PTC and HPTC, and stratified according to status of VI. RESULTS: The rate of distant metastasis was similar for FC, malignant Hürthle cell tumours and PTC with VI, and increased with extent of invasion. VI was seen in 12% of all PTC and 0% of HPTC in this study. PTC without VI were associated with a much lower potential of distant metastasis, were smaller in size and occurred in patients of younger age than PTC with VI. In addition, there was a tendency for increased potential for distant metastases with increased tumour size and patient age for all groups of tumours in the study. Patient age and tumour size appeared to play a smaller role than that of VI in predicting distant metastasis. CONCLUSIONS: Our study suggests that the rate of distant metastasis relates to VI, patient age and tumour size, regardless of Hürthle cell, FC or PTC differentiation. PTC of large size, and in patients older than 45 years, have a high propensity for vascular invasion.