RESUMEN
PURPOSE: We investigated the role of performing 2 consecutive sets of transrectal ultrasound guided sextant biopsies of the prostate in a single office visit as the protocol for detecting prostate cancer in men presenting for the first time with an abnormal digital rectal examination and/or elevated serum prostate specific antigen (PSA). MATERIALS AND METHODS: A total of 137 consecutive men presenting for the first time with a clinically localized prostate nodule on digital rectal examination and/or elevated serum PSA based upon age specific reference ranges underwent 2 consecutive sets of sextant prostate biopsies under transrectal ultrasound guidance in a single office visit. The 2 sets of biopsies were processed and analyzed separately by pathologists. RESULTS: Adenocarcinoma of the prostate was diagnosed in 43 of the patients (31%) undergoing biopsy. Adenocarcinoma of the prostate was diagnosed in only the second set of biopsies in 13 cases (10%). High grade prostatic intraepithelial neoplasia without adenocarcinoma of the prostate was observed in 18 of the first set of biopsies (15%). High grade intraepithelial neoplasia without adenocarcinoma of the prostate was the only pathological diagnosis in the second set of biopsies in 3 cases. The second set of biopsies provided important new clinical information related to prostate cancer in 20 cases (28%) and increased the number of cancers detected by 30%. In addition, 14 patients with high grade intraepithelial neoplasia who would have required a second set of biopsies were found not to have adenocarcinoma of the prostate. Prostate cancer was detected in 43, 27 and 24% of men with prostate volumes less than 30, 30 to 50 and greater than 50 cc, respectively. The percentage of prostate cancers detected only in the second set of biopsies was not significantly related to prostate size. CONCLUSIONS: Two consecutive sets of transrectal ultrasound guided sextant biopsies of the prostate performed in a single office visit represent a cost-effective biopsy strategy for men presenting with an abnormal digital rectal examination and/or elevated serum PSA. The benefits include increasing the detection of adenocarcinoma of the prostate and providing the recommended second set of biopsies for high grade intraepithelial neoplasia without increased morbidity or cost.
Asunto(s)
Adenocarcinoma/patología , Biopsia con Aguja/métodos , Neoplasias de la Próstata/patología , Adenocarcinoma/diagnóstico por imagen , Anciano , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias de la Próstata/diagnóstico por imagen , UltrasonografíaRESUMEN
PURPOSE: To evaluate the expression of fibroblast growth factors (FGFs) and FGF receptors (FGFRs) in human prostate. MATERIALS AND METHODS: RNA was extracted from surgically excised human prostate glands and from primary cultures of human prostatic epithelial and stromal cells. Expression of FGFs and FGF receptors was evaluated by Northern blotting and reverse-transcriptase polymerase chain reaction (RT-PCR) techniques. RESULTS: FGF7 (KGF) is the major FGF mRNA expressed in the human prostate, with smaller amounts of FGF2 and extremely small amounts of FGF1. For all three FGFs, the prostatic stromal cells were the primary site of expression. Prostatic epithelial cells express primarily the FGFR-3 IIIc isoform, which preferentially binds FGF1 over FGF2, with smaller amounts of the FGFR-2 IIIb (FGF7 binding) isoform. Prostatic stromal cells express primarily the FGFR-3 IIIc isoform and smaller amounts of FGFR-1 IIIc and FGFR-2 IIIc isoforms, which bind both FGF1 and FGF2. CONCLUSION: The pattern of expression of FGFs and FGF receptors in the prostate is consistent with a paracrine stimulation of epithelial growth by stromal-derived FGFs and potential autocrine stimulation of stromal cell proliferation by stromal FGFs.
Asunto(s)
Factores de Crecimiento de Fibroblastos/biosíntesis , Próstata/metabolismo , Receptores de Factores de Crecimiento de Fibroblastos/biosíntesis , Factores de Crecimiento de Fibroblastos/genética , Humanos , Masculino , Próstata/química , ARN/análisis , Receptores de Factores de Crecimiento de Fibroblastos/genéticaRESUMEN
An 81-year-old man being treated with weekly low dose methotrexate (MTX) for psoriasis was admitted with a 2-month history of cough, shortness of breath and 7% eosinophilia in the peripheral blood. Chest roentgenogram revealed bilateral alveolar and interstitial infiltrates. Although the clinical presentation suggested MTX pneumonitis, a transbronchial lung biopsy established a diagnosis of pulmonary cryptococcosis. Pulmonary cryptococcosis should be included in the list of infectious processes that can mimic MTX pneumonitis.
Asunto(s)
Criptococosis/diagnóstico , Enfermedades Pulmonares/diagnóstico , Metotrexato/efectos adversos , Neumonía/inducido químicamente , Neumonía/diagnóstico , Anciano , Anciano de 80 o más Años , Criptococosis/microbiología , Cryptococcus neoformans/aislamiento & purificación , Diagnóstico Diferencial , Humanos , Enfermedades Pulmonares/microbiología , Masculino , Metotrexato/uso terapéutico , Psoriasis/tratamiento farmacológicoRESUMEN
An unusual slow-growing tumor was found in the superficial lobe of the right parotid gland. It was multilobulated and encapsulated and consisted of sheets of epithelial oncocytes and minor foci of myoepithelium and ducts. Psammoma bodies were abundant. An antibody directed against keratin protein was localized in all tumor cells and in ductal but not acinar elements of adjacent parotid tissue. Ultrastructurally, the neoplastic cells proved to be ductal epithelial and myoepithelial oncocytes.