Correspondence re: D. McDonagh, R.T. Vollmer, and J.D. Shelburne. Intercellular junctions and tumor behavior in lung cancer. Mod Pathol 4:436, 1991.
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
R T Vollmer
Publications and source records attributed to R T Vollmer.
Serum release of the creatine kinase tissue-specific isoforms MM3 and MB2 is simultaneous during myocardial reperfusion.
The release sequence of the creatine kinase MM and MB tissue-specific subforms after myocardial reperfusion was elucidated by computer-fitting serial enzyme data from 6 humans in whom coronary flow in the infarct-related artery was angiographically documented as initially zero, opening to normal after angioplasty. The model equation used demonstrated acceptable performance according to standard criteria including visual examination and statistical parameters. The model successfully described the sequential conversion of the MM3 and MB2 tissue isoforms to their respective MM2 and MM1, and MB1 isoforms. Release of MM3 and MB2 was simultaneous, differing in calculated release times by 0.2 to 10%, median 3%. Since MB2 release is not retarded after myocardial reperfusion compared to the more clinically established CK-MM3 isoform, assays for sensitive and rapid measurement of MB2 should be the focus for the non-invasive assessment of myocardial reperfusion due to its higher cardiospecificity.
Aged↗
Malignant melanoma in black Americans. A trend toward improved survival.
A search of patients seen at the Duke University Melanoma Clinic (Durham, NC) identified 79 black patients. Five- and 10-year survival was 35% and 26%, respectively. Patients presenting in the recent decade had less advanced disease, resulting in an improved 5-year survival of 49%. Five-year survival for white patients was 74%. Black patients had more negative prognostic indicators when compared with white patients. In a multivariate analysis, however, race was not a prognostic indicator, suggesting melanoma is not inherently more aggressive in black patients. The trend during the past decade has been for black patients to present with less advanced disease, with improved survival. This may be related to better appreciation of the disease by patients and physicians alike. Continued emphasis on education and early diagnosis may result in further improvement for black patients with melanoma.
Actuarial Analysis↗
Extramedullary hematopoiesis in the prostate.
A case of bone marrow myelofibrosis with extramedullary hematopoiesis in the prostate gland is described. This 75-year-old man had an 8-year history of myelofibrosis, massive hepatosplenomegaly, and progressive anemia and a 5-year history of bladder outlet obstruction symptomatology. Transurethral resection of prostate was performed, and light microscopic examination of the prostatic chips revealed a diffuse distribution of atypical megakaryocytes, immature granulocytes, and normoblasts in the prostatic stroma. The prostatic glandular epithelium was uninvolved. Immunostaining for hemoglobin in erythroid precursors and a chloroacetate esterase stain for granulocytic precursors were useful in confirming the diagnosis and in defining the extent of prostatic involvement. Extramedullary hematopoiesis is a rare process in the prostate gland, but it should be included in the differential diagnosis of cellular prostatic stromal lesions, particularly when atypical giant cells are observed.
Aged↗
Histologic grade, DNA ploidy, and intraglandular tumor extent as indicators of tumor progression of clinical stage B prostatic carcinoma. A direct comparison.
Histologic grade, DNA ploidy, and percentage tumor area were assessed in prostatectomy specimens from 73 patients with clinical stage B adenocarcinoma of the prostate and analyzed for their value as predictors of tumor progression. Further, the relationship between percentage tumor area and DNA ploidy was studied. Percentage tumor area was the indicator most strongly associated with the likelihood of tumor extension beyond the capsule of the prostate and of tumor progression as assessed in a logistic regression model. Grade was slightly superior to percentage area in predicting time to progression in a Cox model analysis. Increasing percentage tumor area was associated with an increased likelihood of aneuploidy. Little additional predictive ability was obtained with the concurrent use of two indicators in multivariate analysis, suggesting a high degree of interrelatedness of percentage tumor area, histologic grade, and DNA ploidy. DNA ploidy was not an independent predictive factor, and from a practical standpoint histologic grade and percentage tumor area were more important predictors of tumor progression than DNA ploidy.
Adenocarcinoma↗
Intercellular junctions and tumor behavior in lung cancer.
We examined the ultrastructure of 76 lung cancers and counted the number of intercellular junctions per area of tissue section. The total number of desmosomes, intermediate junctions, and tight junctions ranged from zero to 300 per 0.157 cm2 of tissue section area, and each type of carcinoma showed a considerable range in concentration of intercellular junctions. Multivariate analysis showed that the number of junctions was significantly tied to the probability of the patient's having extensive stage and to survival time, even after accounting for the routine light microscopic diagnosis of small cell versus non-small cell carcinoma. These results suggest that a tumor's ability to spread and metastasize is inversely related to its number of intercellular junctions, and this conclusion appears to apply to both small cell and non-small cell carcinomas.
Adenocarcinoma↗
Intraglandular tumor extent and prognosis in prostatic carcinoma: application of a grid method to prostatectomy specimens.
The extent of tumor in prostatectomy specimens was determined by a grid method in 117 patients with prostatic adenocarcinoma. A plastic strip or ruler with squares of 3.0 mm was used, and the ratio of squares overlying carcinoma to the total number of squares overlying prostate tissue was calculated. This grid ratio, which represents an estimate of the percentage of the prostate involved by tumor, was a significant prognosticator closely tied to the likelihood of tumor progression and to survival time, as assessed by logistic regression analysis and a proportional hazard model. The grid ratio was better than histologic grade in predicting tumor progression and patient survival; also, the ratio was more objective than histologic grade as judged by interobserver agreement values. Only slight improvement in prognostication was obtained with concurrent use of both extent and grade. The grid ratio method was slightly better in predicting tumor progression and patient survival than a second method of assessing the percentage of prostatic tissue involved by tumor, the pathologist's percentage estimate. These results indicate that it is important to quantitate tumor extent within prostatectomy specimens; such quantitation need not require step-sectioning of the entire prostate and an expensive and time-consuming method such as computerized morphometrics but rather may be performed by a simple estimate of the percentage of the prostate involved by tumor. Reporting of histologic grade and tumor extent in the prostate gland is recommended as both appear to be important in identifying those patients at risk for a poor outcome after prostatectomy for prostatic carcinoma.
Adenocarcinoma↗
Malignant melanoma arising during pregnancy. A study of 100 patients.
Melanoma is often diagnosed in young adults, a significant proportion of whom are women of child-bearing age. The prognosis of women diagnosed with melanoma during a pregnancy continues to be debated. One hundred patients, ages 19 to 40 years, have been identified who were pregnant at the time of diagnosis of their melanoma. All were treated with local excision. Sixteen per cent underwent elective lymph node dissections. Immunotherapy was administered to 83% of patients. Mean follow-up was 6.8 years from the date of diagnosis. The patients were compared to an age-matched group of 86 women who were not pregnant at the time of diagnosis. Overall mortality during the follow-up period was 25% in the pregnant group and 23% in the control group. Among the pregnant group, there was an increased incidence of lymph node metastases during the follow-up period (39% versus 26%, p = 0.053). Among stage I patients, there was a significantly shorter DFI for the pregnant group (p = 0.039), with 50% of pregnant patients and 67% of control patients free of disease at 10 years. Similarly, among stage 1 patients, the time to development of lymph node metastases was shorter in the pregnant group (p = 0.021). Multivariate analysis demonstrated that pregnancy at diagnosis was significantly associated with the development of metastatic disease (p = 0.008), when controlling for tumor site, thickness, and Clark level. Patients who developed melanoma during pregnancy did not, however, have a significant decrease in survival.
Adult↗
Neuroendocrine carcinoma of the oral cavity.
We report the clinical and pathologic features of a small cell neuroendocrine carcinoma arising in the oral cavity of a 63-year-old man. The tumor stained positively with neuron-specific enolase and had dense core granules ultrastructurally. Chemotherapy ordinarily given for pulmonary small cell carcinoma induced a clinical remission. When the tumor recurred 8 mo later, focal squamous differentiation was present within the neuroendocrine carcinoma. The patient died 2.5 yr after presentation.
Carcinoma, Small Cell↗
Anorectal melanoma: clinical characteristics and results of surgical management in twenty-four patients.
Twenty-four patients with primary anorectal melanoma diagnosed since 1974 have been studied retrospectively. There was a predominance of women (2.4:1): Mean age was 64 years. The most common initial symptom was rectal bleeding, typically misdiagnosed as hemorrhoids. Seventeen patients had stage I cancer when first seen, four had stage II, and three had distant disease. Progressive disease most commonly started as a large pelvic mass, diffuse bilateral pulmonary nodules, or diffuse liver metastases. Twenty patients (83%) died of the disease; none survived more than 6 years. Among the patients who died of the disease, median survival was 1.9 years. Median survival for patients with stage I disease (29 months) was longer than that for patients with stage II disease (11 months; p less than 0.05) or stage III disease (9 months). Twelve patients were treated initially with abdominoperineal resection (APR), and three additional patients underwent APR to manage recurrent local or regional disease that developed later in the clinical course. Among evaluable patients with stage I disease initially managed with APR, 50% developed recurrent local-regional disease (mean disease-free interval, 23 months), compared with 100% of those who underwent more limited surgery (mean disease-free interval, 16 months). Even after APR, however, distant metastases were common, and there was no prolongation of survival for patients treated with APR. Primary melanoma of the anorectum has a high metastatic potential and carries a grave prognosis. APR appears to have some effect in controlling local and regional disease, but prolongation of survival will depend on both earlier diagnosis and development of more successful therapeutic approaches.
Anus Neoplasms↗
Relative increase in creatine kinase MB isoenzyme during reperfusion after myocardial infarction is method dependent.
We compared relative increases in creatine kinase (EC 2.7.3.2) MB isoenzyme (CK-MB) after reperfusion in myocardial infarction for four popular methods: electrophoresis, immunoinhibition, the "Magic Lite" (Ciba-Corning) system, and the Stratus (Dade). In a method comparison study, we confirmed that all four methods correlated (r greater than 0.95). Electrophoresis demonstrated the greatest scatter about the regression line, immunoinhibition the least. For CK-MB quantities near each method's "positive cutoff" indicating myocardial infarction, results by all methods agreed in 95% of samples. To characterize relative increases in CK-MB, we computer-fitted data obtained from each method for serial specimens collected from six acute myocardial infarction patients during myocardial reperfusion. Although for each individual patient the four methods appeared to exhibit parallelism, the methods differed significantly in terms describing their appearance rate, peak-time & fall-off, and time-to-peak activity. Consistent with these data, we found that the relative CK-MB increases at various times after reperfusion, compared with baseline concentrations, are method-dependent. Therefore, when using CK-MB for indicating coronary patency, one must develop specific limits for each method utilized.
Adult↗
Interferon alfa-2a in the treatment of cutaneous T cell lymphoma.
Twenty-two patients with Stages Ia to IVa cutaneous T cell lymphoma were entered into a controlled trial of interferon alfa-2a (Roferon-A). Patients initially received either 3 million IU interferon alfa-2a, or their dosage was escalated to 36 million IU intramuscularly daily for a 10-week induction period. At the end of induction, 14/22 (64%) of patients had an objective antitumor response: three patients had a complete response, ten patients had a partial response (greater than or equal to 50% resolution of clinical disease), and one patient had a minor response. Responders included those with Stages Ia to IVa cutaneous T cell lymphoma, and remissions have lasted at least 4 to 27.5 months. Three patients progressed from a partial to complete response with further treatment, for an overall complete response rate of 27%. Acute flu-like side effects were generally minor and transient. Malaise/fatigue, depression, anorexia, and weight loss were common chronic dose-related side effects and the most frequent reasons for dose reduction or discontinuation of drug. Leukopenia was the most common laboratory side effect and was also dose-related. Recombinant human leukocyte interferon alfa-2a is an effective and well-tolerated single-agent therapy for early and advanced cutaneous T cell lymphoma.
Adult↗
Comparative study of systemic interferon alfa-nl and isotretinoin in the treatment of resistant condylomata acuminata.
This study evaluated the effectiveness of systemic interferon alfa-nl versus isotretinoin in the treatment of condylomata acuminata. Patients were randomly assigned interferon alfa-nl, 5 million units, subcutaneously daily for 2 weeks then twice weekly for 4 weeks, or isotretinoin, 1 mg/kg by mouth daily for 6 weeks. Seventeen otherwise healthy men with histologically confirmed condylomata acuminata refractory to standard treatment completed 6 study weeks. Five of nine men (56%) treated with interferon alfa-nl had an objective clinical response (greater than or equal to 50% clearance of baseline disease), with one patient clearing completely. None of the patients treated with isotretinoin alone had an objective response (p = 0.009). Those whose clearing was incomplete with interferon alone were then assigned to interferon therapy three times weekly in combination with daily isotretinoin for 6 weeks, and those receiving isotretinoin were switched to interferon three times weekly for 6 weeks. There was continued clearing in all patients in the combination treatment group but in only three of seven in the sequential treatment group. Side effects were common and generally predictable for each drug but were generally not exacerbated when interferon and isotretinoin were used in combination. Parenteral interferon alfa-nl is an effective alternative treatment modality for patients with refractory condylomata acuminata.
Adult↗
Characteristics of creatine kinase-MB and MB isoforms in serum after reperfusion in acute myocardial infarction.
Characteristics of CK-MB, the MB1 and MB2 isoforms, and the MB2/MB1 ratio are described in six acute myocardial infarction (AMI) patients in whom the infarct-related artery was identified and, after intervention, normal coronary flow was re-established. After myocardial reperfusion, washout of CK-MB and the MB2 isoform occurred in parallel, with CK-MB peaking between 5.75 and 10.0 h, and MB2 peaking between 4.50 and 8.00 h. In five of the six patients, MB1 peaked between 8.75 and 15.5 h; the MB2/MB1 ratio demonstrated the earliest peak from 0.75 to 2.25 h. When we compared this study group to an additional 10 AMI patients who had achieved myocardial reperfusion earlier, we found a significant difference (P less than 0.005) for all tests, except MB1 isoform activity, as early as 50 min after reperfusion. This same comparison, by logistic-regression analysis, showed that the MB2/MB1 ratio discriminated between the groups 50 min after reperfusion (P less than 0.05); MB2 showed near-significance at 100 min (P less than 0.057); and CK-MB achieved significance after 200 min (P less than 0.05). CK-MB, the MB2 isoform, and especially the MB2/MB1 ratio show potential for the early, noninvasive detection of myocardial reperfusion.
Aged↗
Malignant melanoma. A multivariate analysis of prognostic factors.
Explore the source record for details and available documents.
Follow-Up Studies↗
The ratio of prostate chips with cancer: a new measure of tumor extent and its relationship to grade and prognosis.
The ratio of chips with cancer to the total number of chips was studied in 118 patients with prostate cancer who underwent transurethral prostatectomy. We found that this ratio is a prognosticator closely associated to the stage of tumor (local or extensive) and to the chance of death from prostate cancer. Stage, the ratio of positive chips and the Gleason histologic score are all closely tied one to another, and it is unclear from this initial study whether these variables provide independent or additive prognostic information. Nevertheless, the ratio of positive chips shows far better interobserver agreement than does the Gleason score, and in patients with the most common predominant score of three, it can separate most of those with localized disease from most of those with extensive disease. Thus the ratio shows promise as a reliable predictor of stage of disease and of long-term failure, and hence it may help in the choice of patients for curative surgery.
Adenocarcinoma↗
Sinus histiocytosis with massive lymphadenopathy. Case report and review of a multisystemic disease with cutaneous infiltrates.
A report of a patient with the rare syndrome of sinus histiocytosis with massive lymphadenopathy is presented here. This patient is unusual in several respects, including his longevity after diagnosis, the presence of a benign monoclonal gammopathy, and the characterization of his cutaneous infiltrates by immunofluorescent monoclonal antibody markers. A review of the literature on sinus histiocytosis with massive lymphadenopathy, with particular emphasis on cutaneous manifestations, is given.
Aged↗
Autosomal dominant multiple cylindromas associated with solitary lung cylindroma.
The occurrence of multiple cutaneous cylindromas constitutes an uncommon autosomal dominant cutaneous disorder whose associations usually are limited to other cutaneous tumors. We report here the first case of a patient with multiple cutaneous cylindromas, who concurrently had a benign lung cylindroma with histologic features identical to her skin lesions. She also had a family history of early death from cardiac disease.
Carcinoma, Adenoid Cystic↗