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A Lopez-Beltran

Publications and source records attributed to A Lopez-Beltran.

At least 37 records · Page 2Linked to original sources
PubMed1998

Carcinosarcoma and sarcomatoid carcinoma of the bladder: clinicopathological study of 41 cases.

PURPOSE: Carcinosarcoma of the bladder is a rare neoplasm characterized by an intimate admixture of carcinoma and malignant soft tissue neoplasm. The clinical usefulness of separating carcinosarcoma (carcinoma with sarcomatous component) from sarcomatoid carcinoma (carcinoma with spindle cell carcinomatous component) is uncertain, and it comprises the subject of this report. MATERIALS AND METHODS: We reviewed the clinical and pathological records of 10 men and 5 women a mean of 66 years old with carcinosarcoma, and 21 men and 5 women a mean of 66.5 years old with sarcomatoid carcinoma of the bladder, as documented in the files of the Mayo Clinic between 1936 and 1995. RESULTS: Of the 15 patients in the carcinosarcoma group 9 had urothelial carcinoma, small cell carcinoma, 3 had squamous cell carcinoma and 2 had more than 1 type. The sarcomatous component included chondrosarcoma in 3 cases, leiomyosarcoma in 3, malignant fibrous histiocytoma in 3, osteosarcoma in 2, fibrosarcoma in 1, rhabdomyosarcoma in 1 and more than 1 type in 2. All disease was high stage at presentation. Treatment included cystectomy in 11 patients with (4) and without (7) radiation therapy, and transurethral resection in 4 with (1) and without (3) radiation therapy. Mean followup available in 14 cases was 34 months (range 1 to 144). A total of 11 patients died of cancer at 1 to 48 months (mean 17.2) and 2 survived for 8 to 131 months. Of the 26 patients in the sarcomatoid carcinoma group 18 had urothelial carcinoma, 1 had squamous carcinoma, 2 had urothelial carcinoma combined with squamous cell carcinoma and 5 had spindle cells only with no recognizable epithelium. All but 1 case was high stage at diagnosis. Treatment included transurethral resection in 17 patients with (7) and without (10) radiation therapy, including 1 who also received chemotherapy, and only cystectomy in 5, including 2 who also underwent radiation therapy and 1 who also received chemotherapy. Mean followup available in 21 cases was 49 months (range 1 to 420). A total of 17 patients died of cancer at 1 to 73 months (mean 9.8), 1 was alive at 140 months and 3 died of unrelated causes. CONCLUSIONS: Carcinosarcoma and sarcomatoid carcinoma of the bladder are highly aggressive malignancies with a similar outcome regardless of histological findings and treatment. Pathological stage is the best predictor of survival.

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PubMed1997

Ultrastructure of prostatic intraepithelial neoplasia.

BACKGROUND: Prostatic intraepithelial neoplasia (PIN) is the most likely precursor of prostatic adenocarcinoma. However, the ultrastructural features of PIN have not been defined in properly fixed tissues. METHODS: In this study, we examined a total of 84 acini from 11 cases of high-grade PIN and matched benign epithelium and adenocarcinoma from patients undergoing radical prostatectomy. Specimens from each case were immediately fixed in glutaraldehyde after surgical removal and processed routinely to ensure optimal preservation. RESULTS: High-grade PIN displayed ultrastructural features that were intermediate between those of benign epithelium and adenocarcinoma. These included the presence of cells with a variable number of cytoplasmic secretory vacuoles, luminal apocrine blebs, large nuclei with coarsely clumped chromatin, enlarged nucleoli, prominent apical microvilli, intact or discontinuous basal cell layer, and intact basement membrane. CONCLUSIONS: Our results indicate that PIN shares many ultrastructural characteristics with adenocarcinoma, supporting its role as a premalignant lesion.

Adenocarcinoma↗
PubMed1997

Intestinal metaplasia is not a strong risk factor for bladder cancer: study of 53 cases with long-term follow-up.

OBJECTIVES: Intestinal metaplasia often coexists with adenocarcinoma of the urinary bladder, suggesting to some investigators that it is premalignant. However, the natural history and long-term outcome of intestinal metaplasia in isolation are unknown. We report 53 cases of intestinal metaplasia of the urinary bladder followed for more than 10 years. METHODS: We reviewed the Mayo Clinic surgical pathology files between 1926 and 1996 and all patients with exstrophic bladder recorded in the files of the Hospital for Sick Children (Toronto, Ontario, Canada) and Dallas Children's Hospital (Dallas, Texas) between 1953 and 1987, and identified all patients with intestinal metaplasia of the bladder. RESULTS: A total of 53 cases were identified from both series, and none of the patients developed adenocarcinoma of the bladder. The Mayo Clinic series consisted of 24 patients. Nineteen of the 24 (79.1%) were alive without evidence of cancer (median follow-up 14 years, range 0.9 to 53), and 5 patients died of intercurrent disease (at 0.9, 4, 8, 11, and 53 years after diagnosis) without evidence of bladder cancer. The Dallas Children's Hospital and the Hospital for Sick Children series consisted of 29 patients. Twenty-seven of the 29 (93.1%) were alive without evidence of cancer (median follow-up 13 years, range 3 to 23.9). Two patients died of trauma (at 10.9 and 12 years after diagnosis) and at autopsy had no evidence of bladder cancer. CONCLUSIONS: Intestinal metaplasia of the urinary bladder is not a strong risk factor for adenocarcinoma or urothelial cancer.

Adenocarcinoma↗
PubMed1997

Human papillomavirus and bladder cancer.

Human papillomavirus (HPV) deoxyribonucleic acid (DNA) has been originally detected in urothelial carcinomas of the bladder in immunocompromized patients. Studies from the general population showed a variable incidence of high risk HPV DNA which ranged from 2.5% to 81%, with HPV 16 DNA occurring more frequently. HPV DNA was detected in both papillary and invasive cancers, although in our experience the overall incidence was low. Most HPV positive cases were of high grade and stage with significant reduced survival or increased recurrence rate after transurethral resection. These results indicate an additional prognostic value of viral infection in bladder cancer. In addition, molecular studies suggest that the HPV related oncoproteins E6 and E7 play a role in bladder carcinogenesis via inactivation and/or degradation of p53 and pRb suppressor gene-associated proteins. The purpose of this review is to provide a brief summary of what is known about HPV and bladder cancer, and to address issues germane to the translation of this information to patient management.

DNA, Viral↗
PubMed1997

Prostatic adenocarcinoma with atrophic features: malignancy mimicking a benign process.

Acinar atrophy and postatrophic hyperplasia in the prostate are commonly confused with adenocarcinoma. The converse situation may also present a diagnostic dilemma. We recently encountered a number of cases of adenocarcinoma with features that mimicked atrophy, raising the serious concern for the underdiagnosis of malignancy. To investigate the frequency of prostatic adenocarcinoma with atrophic features and the histologic criteria that allow its distinction from benign processes, we reviewed the histopathologic findings in 202 consecutive totally embedded whole-mount radical prostatectomy specimens with adenocarcinoma, 100 consecutive routine needle biopsy specimens, and five additional selected needle biopsy specimens. None of the patients had received androgen deprivation therapy before specimen acquisition. Prostatic adenocarcinoma with atrophic features was defined as a proliferation of malignant acini that architecturally resembled atrophy or postatrophic hyperplasia but retained the diagnostic cytologic features of cancer. The acini were round, often dilated and distorted, and lined by flattened attenuated epithelium with scant cytoplasm. All cases had cytologic evidence of malignancy, including nuclear enlargement and prominent nucleoli; these findings could not be attributed to inflammation or treatment effect. Atrophic features were identified in cancer in six radical prostatectomy specimens (3%) and two routine needle biopsy specimens (2%). The proportion of cancer with atrophic features comprised a mean of 27% of each tumor in the prostatectomy specimens (range 10-60%) and 24% in the needle biopsies (range 10-90%). In the prostatectomy cases, the Gleason score of the cancers was 7 (in five cases) and 5 (in one case); in the biopsy specimens the Gleason score was 6 (in five cases) and 7 (in two cases). In addition, atrophic cancer in the prostatectomy cases had luminal eosinophilic proteinaceous secretions (six cases), blue mucin (five cases), crystalloids (two cases), apocrine blebs (three cases), collagenous micronodules (one case), and high-grade prostatic intraepithelial neoplasia within two high-power fields (three cases); the histologic features were similar in the needle biopsy specimens. We conclude that prostatic adenocarcinoma with atrophic features is an unusual finding that is easily confused with benign acinar atrophy. It is recognized by a combination of architectural and cytologic findings and usually coexists with typical Gleason score 5-7 acinar adenocarcinoma. This pattern is important to recognize to avoid the underdiagnosis of malignancy.

Adenocarcinoma↗
PubMed1996

Molecular biology of prostatic intraepithelial neoplasia.

High-grade PIN is the most likely precursor of prostatic adenocarcinoma, according to virtually all available evidence to date. The clinical importance of recognizing PIN is based on its strong association with prostatic carcinoma. PIN has a high predictive value as a marker for adenocarcinoma. Its identification in biopsy specimens of the prostate warrants further search for concurrent invasive carcinoma. PIN is associated with progressive abnormalities of phenotype and genotype intermediate between normal prostatic epithelium and cancer, indicating impairment of cell differentiation and regulatory control with advancing stages of prostatic carcinogenesis. There is progressive gain or loss of a wide variety of biomarkers, including morphometric markers, differentiation markers, stromal markers, growth factors and associated receptors, oncogenes, tumor suppressor genes, and chromosomes. Abnormalities in expression of most biomarkers are amplified in the progression from high-grade PIN to localized cancer, metastatic cancer, and hormone-refractory cancer. Oncogenesis of prostatic carcinoma probably occurs through the selection of several genetic changes, each modifying the expression or function of genes controlling cell growth and differentiation. Further studies are needed to evaluate the function and prognostic value of oncogene expression in the normal, preneoplastic, and neoplastic prostate.

Adenocarcinoma↗
PubMed1996

Sarcomatoid transitional cell carcinoma of the renal pelvis. A report of five cases with clinical, pathological, immunohistochemical and DNA ploidy analysis.

Sarcomatoid transitional cell carcinoma of the renal pelvis is a rare neoplasm with only 7 well illustrated examples reported. These tumours can assume a partial or complete spindle cell pattern of growth, leading to the erroneous classification as sarcomas. We describe the clinic-pathologic features of five additional examples of sarcomatoid carcinoma of the renal pelvis observed in three males and two females. The age ranged from 65-to-82 years-old (mean 71.6). All these patients were treated by nephrectomy and died of disease between 6 and 20 months (mean 11.2) after the onset of symptoms. An immunohistochemical study demonstrated coexpression of keratins, epithelial membrane antigen and vimentin. The image DNA ploidy of all the tumours showed an aneuploid pattern.

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PubMed1996

Human papillomavirus DNA as a factor determining the survival of bladder cancer patients.

The natural history of transitional cell carcinoma (TCC) of the urinary bladder is somewhat variable, with a significant number of tumour recurrences that occasionally evolve towards an infiltrating disease. The aim of this study was to investigate the presence of human papillomavirus (HPV) DNA in 76 TCC specimens, and then correlate such findings with the overall patient survival. However, other classical prognostic clinical and pathological variables such as pathological grade and stage, koilocytosis, age and sex were also tested. HPV DNA was investigated by means of the highly sensitive polymerase chain reaction (PCR). DNA primers specific for HPV types 6, 11, 16 and 18 were used. Our results showed that 7 (9.21%) out of 76 such cases were reactive for HPV 16 DNA; one of them also reacted with HPV 6 DNA. The statistical analysis was done by the Kaplan-Meier method, Wilcoxon's generalised test for studying the differences in survival curves and Cox's regression analysis for independent prognostic factors. A significant P-value was found for pathological grade (P < 0.0001) and stage (P < 0.0001), HPV 16 DNA (P = 0.0418) and koliocytosis (P = 0.0140). Thus, pathological grade was the only independent factor in the bladder cancer survival. These observations may prove useful in prognostic stratification of patients with TCC of the bladder.

Age Factors↗
PubMed1995

Transitional cell carcinoma of the bladder: low incidence of human papillomavirus DNA detected by the polymerase chain reaction and in situ hybridization.

Viral studies on mammalian urothelium have shown an association between the bovine papillomavirus and cancer of the bladder in cattle. However, the evidence for human papillomavirus (HPV) involvement in urinary bladder in man is less clear. The aim of this study was to investigate the association between HPV DNA and transitional cell carcinoma of the bladder, using the highly sensitive polymerase chain reaction (PCR) and non-isotopic DNA in situ hybridization of formalin-fixed paraffin-embedded tissues from 76 patients. An HPV type specific set of primers was localized on the E6-gene for HPV 16/18 DNA. The second and third set of primers were specific for HPV 6/11 DNA. A biotinylated DNA probe which recognizes HPV 6/11, 16/18, and 31/33/35 was used for in situ hybridization. Of the 76 cases investigated, PCR analysis showed positive signals in seven (9.2%) of cases--six for HPV 16 DNA, and one for HPV 16 DNA and HPV 6 DNA. Four (5.2%) were also reactive for HPV 16/18 DNA using in situ hybridization. Most transitional cell carcinomas (71.4%) associated with HPV DNA were of high pathological grade/stage. One case had koilocytosis. Our results suggest that HPV DNA in transitional cell carcinoma is probably a rare occurrence, although the finding on the high risk HPV 16 DNA may indicate a role for it in this tumour's aetiology.

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PubMed1995

Inflammatory pseudotumor of the urinary bladder. A clinicopathological analysis of two cases.

We report 2 cases of inflammatory pseudotumor (IPS) of the urinary bladder observed in a man and a woman aged 63 and 66, respectively. Gross hematuria was the chief complaint. Immunohistochemical profile of IPS suggested a myofibroblastic proliferation. The DNA diploid pattern of IPS further supported the benign nature of the process. Immunohistochemistry seems to be the method of election in differentiating IPS from other spindle cell proliferations of the bladder.

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PubMed1994

Downregulation of Fc gamma receptor IIIA alpha (CD16-II) on natural killer cells induced by anti-CD16 mAb is independent of protein tyrosine kinases and protein kinase C.

Downregulation of functionally relevant surface molecules has been shown to be a powerful regulatory mechanism of Ag surface expression that seems to be of general significance in vivo. CD16-II (Fc gamma RIIIA alpha) is the transmembrane form of the low-affinity receptor for IgG which is expressed on monocytes and NK cells. Occupancy of CD16-II receptor on NK cells induces expression of activation antigens, synthesis of cytokines, and lysis of antibody-coated target cells. Furthermore, after activation the receptor is downregulated from the cell surface. This downregulation could play a physiological role in the NK activation process via CD16 by releasing the antibody-coated target cell and halting signal transduction. The participation of PKC and PTKs in the activation of NK cells via CD16 is clearly established. Thus, we have considered of interest to study the mechanism of CD16-II downregulation in NK cells and the role played by these kinases in the process. The results show that 1,10-phenantroline, a specific inhibitor of Zn(2+)-dependent metalloproteases, inhibits CD16 downregulation induced by CD16 crosslinking, thus suggesting that this process requires the activation of a Zn2+ dependent metalloprotease as it occurs in PMA mediated CD16 downregulation by shedding. Our results also demonstrate that CD16-II downregulation induced by CD16 crosslinking is independent of PKC and PTK activation. In contrast other NK cell activities induced by CD16 crosslinking, such as the induction of activation markers or the production of TNF-alpha, were dependent of PTK activation. The fact that PKC inhibitor staurosporine blocks PMA- but not CD16-induced downregulation suggests that CD16 downregulation can be achieved via two different pathways: one that is PKC dependent and one that is not. The characterization of the Zn(2+)-dependent metalloproteases and the analysis of the regulatory mechanisms involved in its activation will be of interest in order to clarify the physiological relevance of CD16-II release from NK cells as part of the NK activation process.

Alkaloids↗
PubMed1994

Prognostic factors in bladder cancer. A pathologic, immunohistochemical, and DNA flow-cytometric study.

Pathologic grade and stage, immunohistochemical analysis of eight cell and tumor markers, and DNA ploidy were studied in 36 cases of bladder cancer to determine the features of value in assessment of patients' survival. Tumors of high grade and advanced stage correlated with DNA aneuploidy, whereas low grade and early stage correlated with DNA diploidy when simultaneously evaluated with survival. In addition, blood group isoantigen A correlated with DNA ploidy in deceased patients, whereas blood group isoantigen H and oncogene-related protein p21 correlated with DNA ploidy in surviving patients. Despite the relatively small number of cases studied, these results suggest that pathologic grade and stage and immunohistochemical analysis of blood group isoantigens A and H and oncogene-related protein p21 hold additional value in the prediction of bladder cancer survival when evaluated simultaneously with DNA ploidy.

ABO Blood-Group System↗
PubMed1994

Adenocarcinoma of the urachus showing extensive calcification and stromal osseous metaplasia.

We report a case of adenocarcinoma of the urachus showing extensive calcification and stromal osseous metaplasia, arising in the bladder dome of a 51-years-old man. The patient underwent partial cystectomy, including in block excision of the entire urachus and umbilicus, and remains well, free from symptoms after a 22-month follow-up period. Main pathologic and clinical characteristics of urachal calcified tumors are reviewed. To our knowledge, this is the first report in the English literature on urachal carcinoma showing both extensive scattered calcification and massive stromal osseous metaplasia.

Adenocarcinoma↗
PubMed1993

Cell and tumor markers' immunohistochemistry in transitional cell carcinoma of the bladder.

A wide range of cell and tumor markers including the blood group-related isoantigens A, B, O(H) and T-Ag, the cell markers DCA(F36/22) and epithelial membrane antigen (EMA), and the oncogene-related proteins RAP-5p21 and ORP-p21 were investigated by means of immunohistochemistry in selected biopsies from 36 bladder cancer patients with the aim of ascertaining which are of value in patients' survival. A heterogeneous distribution of positivity was found for each marker. In addition, EMA immunostaining correlated significantly (p < 0.05) with patient survival. We conclude that immunohistochemical detection of EMA may provide additional prognostic information in bladder cancer patients.

Antigens, Differentiation↗
PubMed1992

Prognostic factors in survival of bladder cancer.

Clinical and pathologic data of 36 patients with transitional cell carcinoma of the bladder were investigated to determine the significance on patient survival of these factors: pathologic grade and stage; the immunohistochemistry of eight cell and tumor markers; nuclear DNA flow cytometric parameters; and patient smoking status. The bivariate and multivariate statistical analysis significantly correlated patient survival rates with the immunohistochemical expression of blood group, isoantigens A (P less than 0.05), O(H) (P = 0.001), the oncogene-related protein ORP-p21 (P less than 0.05), the pathologic grade and stage (P = 0.002), and the tumor DNA ploidy (P less than 0.05). Smoking status correlated aneuploidy (P less than 0.05) and tumor expression of ORP-p21 (P less than 0.05) with the patient survival rate. Despite the relatively small number of patients in this study, the results suggest that the clinicopathologic variables are significant factors in survival of bladder cancer.

ABO Blood-Group System↗
PubMed1991

Intracystic carcinoma of the breast. A clinicopathologic entity.

Two intracystic breast carcinomas with papillary pattern, one of which was argyrophilic, are reported, and their peculiar clinical features emphasized. The confusing terminology used in literature is also discussed. The fainly well-defined clinico-pathological features of these tumors allow them to be classed as a specific clinico-pathological variety of ductal breast carcinoma. The immunohistochemical study, which was negative to ALA, ACTH, GH, PRL and NSE, led us to consider the potential mucoid nature of the argyrophilic granules.

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