RESUMEN
BACKGROUND: The importance of tumor size measurements as predictors of disease recurrence after radical prostatectomy in patients with prostate carcinoma remains somewhat controversial, and many pathologists do not report these measurements routinely. The authors studied the correlation between the visual estimate of the percentage of carcinoma in prostatic tissue from radical prostatectomy specimens and prostate carcinoma recurrence rates in a series of 595 patients who underwent radical prostatectomy. METHODS: A total of 595 men with clinically localized prostate carcinoma were treated by the same surgeon (W.J.C.) from 1993 through 1997. The percentage of carcinoma in radical prostatectomy specimens from these patients was assessed microscopically through visual estimate. The authors used Kaplan-Meier product limit estimates, log-rank statistics, and the Cox proportional hazards model to evaluate the percentage of carcinoma in the pathologic specimens as predictors of recurrence free survival. RESULTS: Of the 595 patients, 46 (8%) had evidence of tumor recurrence. The mean percentage of carcinoma in the prostatectomy specimen was 11.3% in the group of patients who did not have disease recurrence and 23.8% in the group of patients who did experience disease recurrence. The percentage of carcinoma, preoperative prostate specific antigen levels, tumor differentiation (histologic Gleason grade), and pathologic stage all were significant predictors of disease recurrence according to the Kaplan-Meier method (all log-rank P values < 0.0001). Using the Cox proportional hazards model, controlling for all of these variables, only pathologic tumor stage, Gleason score, and percentage of carcinoma proved to be independent predictors of disease recurrence. In the final model, which included pathologic stage, Gleason score, and percentage of carcinoma, for each 5% increase in the percentage of carcinoma in the surgical specimen, there was an 11% incremental increase in the chance of tumor recurrence. CONCLUSIONS: The visual estimate of the percentage of carcinoma in prostatic tissue specimens from patients who undergo radical prostatectomy is a practical, simple, and inexpensive method that provides important prognostic information after radical prostatectomy.
Asunto(s)
Carcinoma/patología , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias de la Próstata/patología , Adulto , Anciano , Análisis de Varianza , Carcinoma/cirugía , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Prostatectomía , Neoplasias de la Próstata/cirugíaRESUMEN
We report a case of crystal-storing histiocytosis associated with large cell lymphoma in a patient with a history of monocytoid B-cell lymphoma 10 years previously. The cervical lymph node biopsy showed a diffuse proliferation of large lymphocytes with vesicular nuclear chromatin and distinct nucleoli. These lymphocytes were associated with numerous immunoglobulin lambda light-chain crystal-storing histiocytes, which morphologically resembled rhabdomyoblasts. Occasional lymphoid cells also showed large immunoglobulin crystals. This case establishes the association of crystal-storing histiocytes with lymphomas of mucosa-associated lymphoid tissue and emphasizes the need for immunophenotyping to distinguish these unusual cases from other tumors, particularly adult rhabdomyomas.
Asunto(s)
Transformación Celular Neoplásica/patología , Histiocitos/patología , Linfoma de Células B/patología , Linfoma de Células B Grandes Difuso/patología , Anciano , Biomarcadores de Tumor/análisis , Cristalización , Femenino , Histiocitos/química , Humanos , Inmunoglobulinas/análisis , Inmunohistoquímica , Ganglios Linfáticos/patología , Linfoma de Células B/química , Linfoma de Células B Grandes Difuso/química , Cuello , Neoplasias Primarias Secundarias , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/cirugíaRESUMEN
One of the major diagnostic challenges in prostate needle biopsy interpretation is definitive establishment of a malignant diagnosis based on a minimal or limited amount of carcinoma in needle biopsy tissue. Major and minor diagnostic criteria should be used for interpretation of small foci of carcinoma. The constellation of findings and a combination of the major and minor diagnostic criteria permit a definitive diagnosis of focal adenocarcinoma. The differential diagnosis of minimal prostatic adenocarcinoma in needle biopsy tissue is broad and includes many benign lesions. The benign entities most likelty to be misdiagnosed as minimal prostatic adenocarcinoma are atypical adenomatous hyperplasia (adenosis) and atrophy. High-grade prostatic intraepithelial neoplasia and a descriptive diagnosis of focal glandular atypia or atypical small acinar proliferation also should be considered before diagnosing minimal adenocarcinoma. The most valuable adjunctive study for the diagnosis of minimal adenocarcinoma is immunohistochemistry using antibody 34 beta E12, reactive against basal cell-specific high-molecular-weight cytokeratins. Most cases can be diagnosed based on H&E-stained sections without this immunostain. Most minimal carcinomas in prostate needle biopsy tissue are of intermediate histologic grade, and most are indicative of pathologically significant carcinoma in the whole prostate gland.
Asunto(s)
Adenocarcinoma/patología , Biopsia con Aguja , Neoplasias de la Próstata/patología , Adenocarcinoma/metabolismo , Atrofia/patología , Diagnóstico Diferencial , Humanos , Hiperplasia/patología , Inmunohistoquímica , Queratinas/metabolismo , Masculino , Neoplasias de la Próstata/metabolismoRESUMEN
Prostate cancer screening and early detection efforts have resulted in the identification of smaller volume carcinomas of the prostate. We evaluated the diagnostic features of minimal (< 1 mm) carcinoma in sextant needle biopsy specimens of the prostate and in follow-up analyzed the features of the corresponding carcinomas in the whole gland. We reviewed specimens from 50 consecutive patients who had minimal carcinoma in needle biopsy tissue and who had undergone radical prostatectomy. Histologic grade, tumor size, pathologic stage, and margin status of the 50 carcinomas in the whole gland in which the carcinoma size was minimal in the sextant needle biopsy specimen were compared with those of 50 carcinomas in the whole gland in which carcinoma size was greater than 1 mm in the needle biopsy specimen. The most common morphologic features of these minimal carcinomas were nucleomegaly (96%), infiltrative growth pattern (88%), intraluminal secretions (78%), prominent nucleoli (64%), associated high-grade prostatic intraepithelial neoplasia (40%), amphophilic cytoplasm (36%), hyperchromatic nuclei (30%), and intraluminal crystalloids (22%). Perineural invasion (2%), collagenous micronodules (2%) and mitotic figures (2%) were uncommon. The mean tumor volume in the whole gland of carcinomas corresponding to minimal carcinoma in a needle biopsy specimen was significantly smaller (P=.029) at 1.1 mL than it was in carcinomas with tumor greater than 1 mm in the needle biopsy specimen at 1.6 mL, but other pathologic features of carcinoma in the whole gland were not significantly different. In conclusion, a constellation of morphologic attributes is important for establishment of a diagnosis of minimal carcinoma of the prostate in needle biopsy specimen. Most (82%) of the corresponding prostate cancers in the whole gland were pathologically significant.
Asunto(s)
Carcinoma/patología , Neoplasias de la Próstata/patología , Anciano , Biopsia con Aguja , Carcinoma/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prostatectomía , Neoplasias de la Próstata/cirugíaRESUMEN
GVHD is a major complication in allogeneic bone marrow transplantation (BMT). MHC class I mismatching increases GVHD, but in MHC-matched BMT minor histocompatibility antigens (mH) presented by MHC class I result in significant GVHD. To examine the modification of GVHD in the absence of cell surface MHC class I molecules, beta2-microglobulin-deficient mice (beta2m(-/-)) were used as allogeneic BMT recipients in MHC- and mH-mismatched transplants. Beta2m(-/-) mice accepted MHC class I-expressing BM grafts and developed significant GVHD. MHC (H-2)-mismatched recipients developed acute lethal GVHD. In contrast, animals transplanted across mH barriers developed indolent chronic disease that was eventually fatal. Engrafted splenic T cells in all beta2m(-/-) recipients were predominantly CD3+alphabetaTCR+CD4+ cells (15-20% of all splenocytes). In contrast, CD8+ cells engrafted in very small numbers (1-5%) irrespective of the degree of MHC mismatching. T cells proliferated against recipient strain antigens and recognized recipient strain targets in cytolytic assays. Cytolysis was blocked by anti-MHC class II but not anti-CD8 or anti-MHC class I monoclonal antibodies (MoAbs). Cytolytic CD4+ T cells induced and maintained GVHD in mH-mismatched beta2m(-/-) mice, supporting endogenous mH presentation solely by MHC class II. Conversely, haematopoietic beta2m(-/-) cells were unable to engraft in normal MHC-matched recipients, presumably due to natural killer (NK)-mediated rejection of class I-negative cells. Donor-derived lymphokine-activated killer cells (LAK) were unable to overcome graft rejection (GR) and support engraftment.
Asunto(s)
Rechazo de Injerto/inmunología , Enfermedad Injerto contra Huésped/inmunología , Antígenos de Histocompatibilidad Clase I/fisiología , Animales , Linfocitos T CD4-Positivos/inmunología , Citometría de Flujo , Trasplante de Células Madre Hematopoyéticas , Antígenos de Histocompatibilidad Clase I/inmunología , Prueba de Histocompatibilidad , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Bazo/citología , Bazo/inmunología , Linfocitos T Citotóxicos/inmunología , Microglobulina beta-2/deficiencia , Microglobulina beta-2/inmunologíaRESUMEN
Heart rates of northern elephant seals diving at sea and during apnoea on land were monitored to test whether a cardiac response to submergence is an important factor in their ability to make repetitive, long-duration dives. Seven juvenile northern elephant seals were captured at Año Nuevo, CA, instrumented and translocated to release sites around Monterey Bay. Heart rate and dive depth were recorded using custom-designed data loggers and analogue tape monitors during the seals' return to Año Nuevo. Heart rates during apnoea and eupnoea were recorded from four of the seals after they hauled out on the beach. Diving patterns were very similar to those of naturally migrating juveniles. The heart rate response to apnoea at sea and on land was a prompt bradycardia, but only at sea was there an anticipatory tachycardia before breathing commenced. Heart rate at sea declined by 64% from the surface rate of 107 +/- 3 beats min-1 (mean +/- S.D.), while heart rate on land declined by 31% from the eupnoeic rate of 65 +/- 8 beats min-1. Diving heart rate was inversely related to dive duration in a non-linear fashion best described by a continuous, curvilinear model, while heart rate during apnoea on land was independent of the duration of apnoea. Occasionally, instantaneous heart rate fell as low as 3 beats min-1 during diving. Although bradycardia occurs in response to apnoea both at sea and on land, only at sea is heart rate apparently regulated to minimise eupnoeic time and to ration oxygen stores to ensure adequate supplies for the heart and brain not only as the dive progresses normally but also when a dive is abnormally extended.
Asunto(s)
Buceo/fisiología , Frecuencia Cardíaca/fisiología , Descanso/fisiología , Phocidae/fisiología , Animales , Conducta Animal , Valores de Referencia , RespiraciónRESUMEN
Heart rate during overnight rest and while diving were recorded from five emperor penguins with a microprocessor-controlled submersible recorder. Heart rate, cardiac output and stroke volume were also measured in two resting emperor penguins using standard electrocardiography and thermodilution measurements. Swim velocities from eight birds were obtained with the submersible recorder. The resting average of the mean heart rates was 72 beats min-1. Diving heart rates were about 15% lower than resting rates. Cardiac outputs of 1.9-2.9 ml kg-1 s-1 and stroke volumes of 1.6-2.7 ml kg-1 were similar to values recorded from mammals of the same body mass. Swim velocities averaged 3 m s-1. The swim speeds and heart rates suggest that muscle O2 depletion must occur frequently: therefore, many dives require a significant energy contribution from anaerobic glycolysis.