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PubMed2005

Oral malignant neoplasia: a survey of 428 cases in two Zimbabwean hospitals.

A review of oral malignant neoplasms biopsies accessioned in the pathology services of Harare Central Hospital and Parirenyatwa Hospital, Harare, Zimbabwe, during the 10year period January 1982 to December 1991 was carried out. Clinical records of 428 patients with histologically diagnosed oral malignant neoplasms by ICD-O type and site (COO.O-CO6.9) were retrieved and analyzed for gender, age, history of tobacco and alcohol usage, neoplastic type and histologic differentiation of squamous cell carcinoma (8000/3). Oral malignant neoplasms constituted 24.8% (n = 428) of the 1723 biopsies accessioned in the department during this period. There was a male to female ratio of 1.9:1, with lesions being most common in the 41-60 year age group. Squamous cell carcinoma, (8070/3) 73.1%, was the predominant oral malignancy most common in the 61-70 year age group with 21.1% on the mandibular gingivae (CO3.1), 20.5% on the tongue (CO1.9-CO2.9), 18.5% on the floor of the mouth (CO4.9) and 10.5% each on the maxillary gingivae (CO3.O) and buccal mucosa (CO6.O). The hard palate (CO5.9) had 9% of the lesions. Lip malignancy (COO-COO.9 and C44.0), inclusive of mucosa of lip, vermilion and skin, constituted 3.3% and minor salivary gland (CO6.9) malignancy (M-8940/3) 4.9%. The remaining oral malignancies, 11%, included Burkitt's lymphoma (M-9687/3) 4.7%; Kaposi's sarcoma (M-9140/3) 3.7%; osteosarcoma (M-9180/3) 2.6% and malignant melanoma (M-8720/3) 1.9%. Fourty five percent of the patients admitted tobacco and alcohol consumption, of whom 95% were males. Oral malignant neoplasms were more common in males than females and occurred in a relatively young age group. Well-differentiated squamous cell carcinoma (M-8070/31) was the most common oral malignant neoplasm and was most frequently found on the mandibular gingivae (CO3.1), tongue (CO1.9-CO2.9) and floor of the mouth (CO4.9). The lip (COO-COO.9) was least affected with a high palatal (CO5.9) involvement.

Adolescent↗

PubMed2004

Should pheochromocytoma size influence surgical approach? A comparison of 90 malignant and 60 benign pheochromocytomas.

BACKGROUND: Diagnostic tests cannot reliably distinguish malignant from benign pheochromocytomas. Laparoscopic adrenalectomy for pheochromocytomas >6 cm is controversial because of a perceived increased risk of malignancy that is based on anecdotal reports and small series. The aim of this study was to determine if pheochromocytoma size should affect the choice of surgical approach. METHODS: Malignant pheochromocytomas in the Surveillance Epidemiology and End Results (SEER) database (1988-2000) were compared to benign pheochromocytomas in our institutional database (1993-2003). The sensitivity, specificity and likelihood ratio for tumor size to predict malignancy were calculated for both groups. RESULTS: Ninety malignant and 60 benign pheochromocytomas were compared. Overall, malignant pheochromocytomas were larger than benign pheochromocytomas (7.6 +/- 4.2 cm vs 5.3 +/- 2.3 cm). However, tumor size was not significantly different between malignant pheochromocytomas without local invasion or metastases and benign pheochromocytomas (6.1 +/- 3.1 cm vs 5.3 +/- 2.3 cm). In pheochromocytomas with local disease only, maximum likelihood ratio to predict malignancy was at a tumor size of greater than 8 cm (2.84). CONCLUSIONS: Although risk of malignancy increases with size for all pheochromocytomas, size does not reliably predict malignancy in pheochromocytomas with local disease only. Regardless of tumor size, laparoscopic adrenalectomy for pheochromocytoma should be converted to open adrenalectomy for difficult dissection, invasion, adhesions, or surgeon inexperience.

Adolescent↗

PubMed2004

Cutaneous metastases from genitourinary malignancies.

OBJECTIVES: To review the world literature for reports of cutaneous metastases from primary genitourinary malignancies and compare them with our experience during a 10-year period. Cutaneous metastases from primary visceral malignancies are uncommon manifestations of advanced disease. Among patients with urologic malignancies, the incidence and appearance of cutaneous metastases are not well established and recognition is poor among practicing urologists. METHODS: A Medline search and manual bibliographic review was performed to identify peer-reviewed reports pertaining to cutaneous metastases from all visceral malignancies. A comparative review of all pertinent cases arising from primary urologic malignancies was performed. A comprehensive search of our institution's tumor registry was performed to identify all analytic cases of urologic malignancy diagnosed, treated, and followed up between 1990 and 2000. Clinical and pathologic data were collated. RESULTS: We identified 2,369 reported cases of cutaneous metastases arising from 81,618 primary solid visceral malignancies, for an overall incidence of 2.9%. Dermatologic spread from primary urologic malignancies of the kidney, bladder, prostate, or testes was noted in 116 (1.3%) of 10,417. The incidence of cutaneous metastases from the kidney, bladder, prostate, and testes was 3.4%, 0.84%, 0.36%, and 0.4%, respectively. Overall, 436 cases of cutaneous metastases from urologic organs were identified in the English-language literature. We identified nine additional cases of pathologically confirmed cutaneous metastatic urologic tumors at our institution in the past 10 years. The most common presentation was an infiltrated plaque or nodules. Most cases displayed clinical features that mimicked common skin disorders. The median disease-specific survival was less than 6 months from the presentation of cutaneous metastasis. CONCLUSIONS: Cutaneous metastases from urologic tumors are uncommon and occur in 1% of patients with advanced disease. Urologic skin metastases are most common from renal tumors, followed by those of the bladder and then prostate. Their clinical appearance may mimic other common dermatologic disorders affecting patients with advanced malignancies. Definitive diagnosis requires an index of suspicion and skin biopsy. Cutaneous metastases from urologic malignancies are associated with a poor prognosis.

Aged↗

PubMed2005

Laparoscopic findings during adnexal surgery in women with a history of nongynecologic malignancy.

OBJECTIVES: To describe the results of laparoscopic management of adnexal masses in women with a history of nongynecologic malignancy. METHODS: We conducted a retrospective review of 262 patients with history of prior nongynecologic malignancy who underwent laparoscopy for management of an adnexal mass between 1/1992 and 6/2004. RESULTS: Median patient age at laparoscopy was 55 years (range, 20-91 years), and median BMI was 25 kg/m2 (range, 14-41 kg/m2). Of the 262 patients, 145 (55.3%) had prior abdominal/pelvic surgery. Prior cancer history included breast (202, 77.1%), lymphoma/leukemia (16, 6.1%), colorectal (8, 3.0%), lung (7, 2.7%), multiple myeloma (5, 1.9%), head/neck (5, 1.9%), genitourinary (5, 1.9%), upper gastrointestinal (4, 1.5%), and other (10, 3.8%). Median ovarian mass diameter measured on radiologic imaging was 3.8 cm (range, 0.2-13.5 cm); median CA-125 was 17.0 U/mL (range, 1-7000 U/mL). In all, 49 (18.7%) patients had malignancy identified at laparoscopy, with 30/49 (61.2%) diagnosed with metastatic malignancy to the ovary and 19/49 (38.8%) having a new primary ovarian malignancy. Median tumor diameter and CA-125 were significantly higher in women found to have a malignancy (4.7 vs. 3.7 cm, and 35 vs. 14 U/mL, respectively). Overall, conversion to laparotomy occurred in 34 (12.9%) cases. Twenty-one of 49 (42.9%) patients with malignancy were converted to laparotomy compared with 13/213 (6.1%) when benign disease was noted (P < 0.001). CONCLUSIONS: Approximately 1 in 5 patients with a history of nongynecologic malignancy who were selected for laparoscopic management of an adnexal mass was found to have malignancy, with 60% being metastatic from other primaries. The majority of cases were managed laparoscopically even if malignancy was identified.

Adnexa Uteri↗

PubMed1996

Altered actin polymerization dynamics in various malignant cell types: evidence for differential sensitivity to cytochalasin B.

Using the DNase I inhibition assay, fluorimetric measurements, and immunoblot analysis, we studied quantitatively changes in the actin polymerization dynamics in primary cultures of normal and malignant human lymphocytes, normal human endometrial cells, and in various leukemic and endometrial adenocarcinoma cell lines. The G/total-actin ratio of malignant cells was found to be 1.37 to 1.81-fold higher compared to normal cells, indicating that malignant cells express reduced amounts of polymerized actin. The above findings were corroborated by fluorescence measurements of the amounts of rhodamine-phalloidin-labeled F-actin in normal and neoplastic cells, which showed significantly lower F-actin content in malignant cell preparations. Moreover, the total actin content, as quantitated by the DNase I inhibition assay and by immunoblot analysis, was found to be significantly decreased in the primary cultures of malignant human lymphocytes and endometrial cells when compared to the total actin levels in corresponding normal cells. Proliferation and viability measurements of normal and neoplastic cells in culture, treated equally with cytochalasin B (CB), revealed an increased susceptibility of malignant cells to this anticytoskeletal agent. This was not due to increased CB incorporation in neoplastic cells, as indicated by 3H-CB uptake experiments. In addition, fluorescence microscopy, in the presence of graded concentrations of CB, showed destabilization of microfilaments in the poorly differentiated endometrial adenocarcinoma HEC-50 cells, compared to the well-differentiated Ishikawa cells. In conclusion, all investigated malignant cells are characterized by: (a) higher G/total-actin ratio; (b) decreased F- and total-actin content; and (c) lower resistance to CB treatment. These quantitatively determined parameters may represent potential biochemical indicators reflecting malignant transformation. Moreover, it seems worthwhile to explore whether or not the differential sensitivity of malignant cells to anticytoskeletal drugs may provide a valuable approach to the manipulation of malignant cells.

Actins↗

PubMed1997

Papanicolaou smears by the Bethesda system in endometrial malignancy: utility and prognostic importance.

OBJECTIVE: To evaluate the prognostic significance of the Bethesda system's cytologic categories in patients with endometrial malignancy. METHODS: Patients with biopsy or hysterectomy-proven endometrial malignancy and a Papanicolaou smear result reported using the Bethesda system within 1 year of diagnosis were identified through retrospective review of our computerized database. RESULTS: After introduction of the Bethesda system in our laboratory on November 1, 1992, until January 1, 1997, 112 eligible patients were identified (108 with carcinomas and four with carcinosarcomas). Patients with cytologic diagnoses of malignancy (n = 17) were significantly more likely to have International Federation of Gynecology and Obstetrics (FIGO) grade 3 tumors and high-risk histology (serous, clear cell, and adenosquamous carcinoma and carcinosarcoma) than those with atypical glandular cells of uncertain significance (n = 33) or those with cytology not suspicious for malignancy (n = 63). Patients with malignant smears were also significantly more likely to have cervical extension, malignant peritoneal cytology, and FIGO stage II, III, or IV than those with atypical glandular cells of uncertain significance or those with cytology not suspicious for malignancy. CONCLUSION: Papanicolaou smears obtained within 1 year of histologic diagnosis of endometrial malignancy and interpreted using the Bethesda system were suspicious for (atypical glandular cells of uncertain significance) or diagnostic of malignancy in nearly half of all cases (29 and 15%, respectively). Patients having malignant glandular cells were more likely to have poor prognostic pathologic findings.

Adult↗

PubMed1982

The value of malignancy evaluation in patients with dermatomyositis.

Dermatomyositis (DM) has been linked to internal malignancy in adult patients. However, the value of an extensive malignancy evaluation in patients with DM is controversial. Fifty-seven patients who had DM with malignancies, in whom data were available regarding the discovery of malignancy, have been analyzed. Fifty-three of these were reported previously. There were sixty-seven malignancies in the fifty-seven patients. The malignancy preceded (26 cases), followed (23 cases), or occurred with the DM (18 cases). A "blind" (nondirected) malignancy search was not of value in any of the cases analyzed. Rather, the tumors were discovered in forty cases by history (preceding tumor, or abnormal symptoms), in fourteen cases by physical examination, or in twelve cases by abnormal laboratory findings (chest x-ray, urinalysis, stoll guaiac, etc). One case was not discovered until autopsy (adenocarcinoma of the broad ligament). Analysis of tumor sites further negates the value of a malignancy work-up, because most (greater than 90%) tumors occur in areas not amenable to a "routine malignancy search." In several instances patients had an extensive search, without having complete physical examinations. Malignancy evaluations should be directed by abnormal history, physical findings, or routine laboratory testing.

Adult↗

PubMed1999

Complete removal of nonpalpable breast malignancies with a stereotactic percutaneous vacuum-assisted biopsy instrument.

BACKGROUND: Several devices have been developed for sampling nonpalpable mammographic breast lesions. Complete removal of malignancies with a stereotactic percutaneous directional vacuum-assisted biopsy instrument has been reported. STUDY DESIGN: We reviewed our experience with the percutaneous vacuum-assisted biopsy instrument to identify instances of complete excision of cancers: no residual carcinoma found at surgical excision for malignancies diagnosed by the percutaneous vacuum-assisted biopsy instrument. The radiologic and pathologic characteristics of malignancies completely removed by the percutaneous vacuum-assisted biopsy instrument were compared with those of malignancies with residual carcinoma found at surgical excision. RESULTS: Fifty-two malignancies were diagnosed by the percutaneous vacuum-assisted biopsy instrument: 16 infiltrating ductal carcinomas, 5 infiltrating lobular carcinomas, and 31 ductal carcinomas in situ. No residual carcinoma was found at surgical excision in 9 (17%) of the 52 malignancies. Patients with complete removal of the malignant lesion were younger than patients with incomplete removal (52 versus 58 years; p = 0.069). Completely removed malignancies were smaller on mammography (4 versus 17 mm; p = 0.213), and more specimens were removed (19 versus 15; p = 0.074). All nine completely removed malignancies presented with calcifications without a mass (p = 0.112), and all nine were ductal carcinoma in situ (p = 0.019). CONCLUSIONS: Complete removal of nonpalpable breast malignancies is possible with the stereotactic percutaneous directional vacuum-assisted biopsy device. Complete removal is more likely with removal of a large number of specimens from small areas of mammographic calcifications due to ductal carcinoma in situ.

Biopsy↗

PubMed2005

Telomere repeat amplification protocol (TRAP) in situ reveals telomerase activity in three cell types in effusions: malignant cells, proliferative mesothelial cells, and lymphocytes.

Telomerase Repeat Amplification Protocol (TRAP) in situ was performed on cytospin preparations from 65 effusions from the serous cavities (45 pleural and 19 ascitic fluids and one pericardial fluid) submitted for routine diagnosis and the results were correlated to cytological morphology. Three types of cells with nuclear fluorescence were identified: malignant cells, hyperplastic mesothelial cell and lymphocytes. Of 38 cytologically malignant effusions, 12 showed strong reactivity in all malignant cells, three strong reactivity in part of the malignant population, whereas 12 showed moderate reactivity in the whole and five in part of the malignant population, respectively. In five malignant effusions weak reactivity was found in all (one case) and in scattered (four cases) malignant cells. Two effusions contained telomerase-negative malignant cells. Two pleural and two ascitic fluids contained proliferative mesothelial cells with weak or, in one case, moderate reactivity. Lymphocytes usually showed weak telomerase activity. Telomerase was expressed in almost all malignant tumours metastatic to serous cavities. Heterogeneity in tumour populations was demonstrated, which may have diagnostic implications, especially in cytology. Weak or moderate reactivity was found in lymphocytes and in some mesothelial proliferations and may explain the low specificity for malignancy sometimes obtained with the TRAP extract method. The weak reactivity found in lymphocytes may reduce the specificity when the extract method is used but causes no diagnostic problem with the TRAP in situ method.

Ascitic Fluid↗

PubMed1999

Selective usage of D-type cyclins in lymphoid malignancies.

Three D-type cyclins, cyclin D1, D2 and D3, belong to the G1 cyclin, which regulates the G1/S transition of the cell cycle, and feature highly homologous amino acid sequences. The cyclin D1 gene was found to be transcriptionally activated in B-lymphoid malignancies with t(11;14), but available information is limited regarding expression of cyclin D2 and D3 in hematopoietic malignancies. We examined the expressions of three D-type cyclins to investigate how these homologous genes are differentially used. Northern blot hybridization with densitometric analyses was performed to examine 64 cell lines and 159 patients with various hematopoietic malignancies. Among lymphoid malignancies, cyclin D1 overexpression was exclusively detected in B cell malignancies accompanied by a genetic event consisting of 11q13 chromosomal translocation, consisting of 13 of 19 (68%) patients with mantle cell lymphoma, two of 11 (18%) with B-chronic lymphocytic leukemia, and one of six (17%) with multiple myeloma. The cyclin D2 expression was significantly higher in T cell malignancies than in B cell malignancies (P = 0.003 for cell lines and P < 0.0001 for patient samples, respectively). In the T cell malignancies, cyclin D2 overexpression was predominantly recognized in those with mature phenotype. Furthermore, cyclin D2 expression was upregulated by phytohemagglutinin (PHA) stimulation of normal T-lymphocytes, suggesting that this simply represents the proliferation status of mature T cells. Although cyclin D3 was ubiquitously expressed, its expression was reduced in lymphoid malignancies with cyclin D1 or D2 overexpression. In myeloid leukemias, although three D-type type cyclins were differentially expressed, no preference for particular D-type cyclins was found. This selective usage of D-type cyclins in lymphoid malignancies suggests an existence of a regulatory mechanism among three D-type cyclins.

Cell Lineage↗

PubMed2003

Unusual intraparenchymal growth patterns of malignant pleural mesothelioma.

AIMS: Malignant pleural mesothelioma is known to mimic morphologically a number of diverse reactive and neoplastic conditions. We describe three unusual intraparenchymal growth patterns of malignant mesothelioma seen in a series of 200 malignant pleural mesotheliomas. The diagnostic pitfalls associated with these findings are described and their potential medico-legal implications are highlighted. METHODS AND RESULTS: The study group comprised 200 malignant pleural mesotheliomas. In each case diagnosis was morphologically confirmed with ancillary immunohistochemistry using a broad panel of both mesothelial and epithelial markers. The patterns of intraparenchymal growth were documented and grouped as: direct subpleural; lymphangitic; and other. The 200 malignant pleural mesotheliomas comprised 118 epithelioid, 57 biphasic and 25 sarcomatoid, subtyped according to the WHO classification. Direct subpleural invasion was seen in 42 cases, lymphangitic spread in 27 cases. Other less well-defined intraparenchymal patterns included three sarcomatoid subtype malignant mesotheliomas exhibiting an intra-alveolar growth pattern mimicking epithelioid haemangioendothelioma. One epithelioid subtype malignant mesothelioma contained an intraparenchymal tumour nodule microscopically comprising lepidic spread of neoplastic cells over maintained alveolar structures mimicking bronchioloalveolar carcinoma. One epithelioid subtype malignant mesothelioma morphologically had areas in which alveoli were distended by discohesive epithelioid neoplastic cells with no interstitial invasion. The appearances mimicked desquamative interstitial pneumonia. Immunohistochemistry played an important role in the definitive diagnosis of each unusual parenchymal tumour deposit. In 126 malignant mesotheliomas no invasion of the subjacent lung parenchyma was identified. CONCLUSIONS: An awareness of the unusual parenchymal growth pattern in malignant mesothelioma is important to prevent misdiagnosis of other entities. In the medico-legal setting, the presence of epithelioid haemangioendothelioma or bronchioloalveolar carcinoma (in the absence of asbestosis) may be deemed to impact upon the patient's anticipated life expectancy and thereby would decrease the compensation settlement.

Adenocarcinoma, Bronchiolo-Alveolar↗

PubMed2003

Risk of malignancies in psoriasis patients treated with cyclosporine: a 5 y cohort study.

This prospective long-term cohort study investigated the incidence of malignancies in severe psoriasis patients treated with cyclosporine. A total of 1252 patients were followed prospectively for up to 5 y. Malignancies were recorded prospectively. Incidence rates for malignancies were compared with the general population using standardized incidence ratios. The effect of duration of exposure to cyclosporine and to previously administered anti-psoriatic treatments on the incidence of malignancies was investigated using Poisson regression models. The mean age of patients was 43 y and on average, patients received cyclosporine for 1.9 y. Malignancies were diagnosed in 47 patients (3.8%), 49% of them had skin malignancies. The standardized incidence ratio in the study cohort was 2.1 as compared with the general population. The higher incidence of malignancies was attributed to a 6-fold higher incidence of skin malignancies, most of which were squamous cell carcinoma. The incidence of nonskin malignancy overall was not significantly higher in this study than in the general population. Duration of exposure to cyclosporine, exposure to psoralen and ultraviolet A, exposure to methotrexate, and exposure to immunosuppressants showed a significant effect on the incidence of nonmelanoma skin malignancies. In conclusion, treatment of psoriasis with cyclosporine is associated with an increased risk of nonmelanoma skin cancer. Patients treated for more than 2 y with cyclosporine were shown to have a higher risk. In addition, exposure to psoralen and ultraviolet A and to other immunosuppressants was shown to contribute to the overall risk.

Adult↗

PubMed2001

Surveillance of pre-malignant disease of the pancreatico-biliary system.

Technical advancements in ultrasonography, contrast-enhanced computed tomography and magnetic resonance imaging, as well as the wider availability of these ultramodern imaging techniques, have resulted in the early detection and a better classification of various asymptomatic and symptomatic pancreatico-biliary lesions. Pre-malignant biliary and pancreatic lesions are rare disorders, and no clear data are available to define their malignant potential. Because of the lack of controlled epidemiological data, the time span for malignant transformation and its frequency cannot be defined in the majority of these lesions. Adenomyomatosis of the gallbladder and gallbladder polyps larger than 10 mm should be treated by cholecystectomy even in asymptomatic patients because of an increased risk of malignant transformation. Chronic cholangitis, primary sclerosing cholangitis and choledochal cysts are also pre-malignant conditions. The timing of surgery, once it is advised for a pre-malignant condition that is still benign, should, however, be individualized to the particular patient situation. In patients with chronic pancreatitis, surgery may be indicated for disease-related complications. In as much as chronic pancreatitis predisposes to a higher risk of pancreatic cancer, any suspicion of malignancy should warrant a surgical exploration. Intraductal papillary tumours and mucin-producing pancreatic tumours are other pre-malignant pancreatic lesions whose malignant potential cannot be precisely determined pre-operatively. They should be resected in situations where there is a high degree of suspicion even without a clear objective diagnosis. In conclusion, pre-malignant hepato-biliary and pancreatic lesions of uncertain pathology should undergo early resection in view of treatment limitations and the dismal prognosis of established cancers. While hepato-biliary and pancreatic surgery is nowadays performed in specialized centres, with a low post-operative morbidity and mortality, it is equally important to understand that observation alone with regular computed tomography or magnetic resonance imaging control can no longer be recommended in the management of these lesions.

Biliary Tract Neoplasms↗

PubMed2000

Tumor vessel: a valuable cholangioscopic clue of malignant biliary stricture.

BACKGROUND: An irregularly dilated and tortuous vessel, the so-called tumor vessel, is considered to be one of the cholangioscopic features that suggest biliary malignancy. This is a prospective analysis of the presence of a tumor vessel as a finding that discriminates between benign and malignant biliary strictures. METHODS: From August 1997 to August 1998, a total of 63 patients with biliary strictures diagnosed with endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography obtained during percutaneous transhepatic biliary drainage tube placement were included in this study. Strictures were characterized as benign or malignant based on the observation of tumor vessels. The results were compared with those of percutaneous transhepatic cholangiography-guided biopsy and final diagnosis. RESULTS: Forty-one patients were confirmed to have malignant strictures and 22 had benign biliary strictures. Cancer was confirmed by histopathologic evaluation of biopsies in 33 of 41 patients with malignancy (80.4%). Tumor vessel was seen in 25 of 41 patients with malignancy (61%). No patients with benign stricture had tumor vessels. Of the 8 patients with negative percutaneous transhepatic cholangioscopy-guided biopsies but with a final diagnosis of malignancy, 6 had tumor vessels. Combining the observation of tumor vessel and percutaneous transhepatic cholangiography-guided biopsy resulted in a diagnosis of malignancy in 39 of 41 patients (96%) and significantly increased the rate of preoperative diagnosis when compared with percutaneous transhepatic cholangiography-guided biopsy or presence of tumor vessel alone (p<0.05). CONCLUSION: The presence of tumor vessel may be a valuable cholangioscopic finding that indicates the presence of a malignant biliary stricture. The combination of tumor vessel observation and percutaneous transhepatic cholangiography-guided biopsy may improve the preoperative diagnosis of malignancy.

Adult↗

PubMed2002

Intraductal US is a useful adjunct to ERCP for distinguishing malignant from benign biliary strictures.

BACKGROUND: Distinguishing malignant from benign biliary strictures remains a challenge. This prospective study assessed intraductal US as an adjunct to endoscopic retrograde cholangiography and tissue sampling for diagnosis of malignant and benign biliary strictures. METHODS: Sixty-two patients were enrolled who had biliary strictures suspected to be malignant but with negative tissue sampling by endoscopic retrograde cholangiography, or suspected biliary strictures based on clinical manifestations and/or cross-sectional imaging. Intraductal US was performed with an over-the-wire 2.4-mm diameter 20 MHz catheter US probe. The diagnostic accuracy of endoscopic retrograde cholangiography plus tissue sampling with and without intraductal US was compared with surgical findings or clinical outcome at a 12-month follow-up (benign/malignant) in nonsurgical cases. Tissue sampling results were reported as malignant, suspicious for malignancy, atypical, or normal. Analysis was by intention-to-treat. RESULTS: Two patients (3%) were excluded from analysis because the stricture could not be traversed with the intraductal US probe. Of the 60 remaining patients (37 men, mean age 64 years, range 27-89 years), 31 had malignant strictures (12 cholangiocarcinoma, 8 pancreatic, 5 metastatic, 3 gallbladder, 3 papilla), and 29 had benign strictures. Sphincterotomy was not required in any case to facilitate intraductal US. Fourteen patients (23%) underwent subsequent surgery including 11 with a preoperative diagnosis of resectable tumor. Endoscopic retrograde cholangiography/tissue sampling (atypia considered equivalent to benign) correctly identified 15 of 31 malignant strictures (p = 0.001) and all 29 benign strictures (p = 0.16) (accuracy 73%, sensitivity 48%, specificity 100%). The addition of intraductal US correctly identified 28 of 31 malignant strictures and 27 of 29 benign strictures (accuracy 92%, sensitivity 90%, specificity 93%). Of 11 patients with tumors who came to surgery, intraductal US correctly staged 4 (36%), understaged 5 (45%), missing metastatic lymph nodes in all cases and vascular invasion in 1 patient, and overstaged 2 (18%), with a false-positive diagnosis of metastatic lymph nodes in 1 and tumor mass in 1 patient who had no cancer at surgery. CONCLUSION: Technically easy, intraductal US is a valuable adjunct to endoscopic retrograde cholangiography/tissue sampling that increases the ability to distinguish malignant from benign strictures. Intraductal US is unsuitable for assessing lymph nodes associated with malignant strictures.

Adult↗

PubMed1998

Melanocytic naevus or malignant melanoma? A large-scale epidemiological study of diagnostic accuracy.

While the early detection of malignant melanoma is important and has been emphasized widely in the past few years, it is difficult to accomplish. The purpose of this study is to assess how well dermatologists recognize malignant melanomas in patients with naevi. Information from 9,121 patients visiting two dermatological clinics in Stockholm and diagnosed melanocytic naevi was linked with the Swedish Cancer Registry to identify individuals with records of malignant melanoma. One-hundred-and-thirteen cases of malignant melanoma were detected in the study population. Sixty patients were diagnosed malignant melanoma prior to the naevus diagnosis and most of them were under continuous follow-up. A further 35 patients were diagnosed malignant melanoma and naevus at the same time. The remaining 18 were given the diagnoses malignant melanoma after the naevus diagnosis and, of these, 6 cases were detected more than 6 years after examination and malignant melanoma was considered not present at the time of consultation. Three cases can be considered as missed (6%) and four others as partially missed or delayed. Thus, of 47 cases of probable recognizable malignant melanoma, there was insufficient management of 7 (15%). Six cases were detected during dermatological examination for other conditions and five through general examination of naevi. Although a few possibly detectable malignant melanomas were not discovered, the results of this study reflect a high clinical detection rate. In addition, a number of cases were discovered by chance during examinations for other dermatological conditions.

Adolescent↗

PubMed2002

Multiple primary malignancies in the head and neck: a clinical review of 121 patients.

A total of 121 multiple primary malignancies (quadruple, n = 2; triple, n = 11; and double, n = 108) were treated at the Department of Otorhinolaryngology, Kitasato University Hospital between July 1972 and December 1998. Of the 108 patients with double primary malignancies, 18 had synchronous double primary malignancies (SDPM), which were defined as occurrence of the index tumor and second malignancy within 6 months of each other, and 90 had metachronous double primary malignancies (MDPM), which were defined as occurrence of the index tumor and the second malignancy separated by a period of > 7 months. MDPM was subdivided into MDPM-F (head and neck malignancy occurred as the first tumor; n = 55) and MDPM-S (head and neck malignancy occurred as the second tumor; n = 35). Of the 55 patients with MDPM-F, 27 (49.11%) of the second malignancies were found in the digestive tract, 12 in the stomach (21.8%), 8 in the esophagus (14.5%) and 7 in lower digestive tract tumors (12.7%). The 3- and 5-year survival rates of MDPM-F were 79.2% and 62.3%, respectively. Differential diagnosis between multiple primary malignancy (MPM) and multicentric tumors is often difficult when the lesions involve the oral cavity, pharynx and esophagus. We suggest that it is beneficial to follow patients for as long as possible in order to facilitate diagnosis of tumor recurrence, metastasis and MPM.

Adult↗

PubMed1979

Differential response of malignant BALB/c mammary epithelial cells to the multiplication-stimulating activity of insulin.

Investigations were done to distinguish normal from malignant BALB/c mammary epithelial cells by growth differences. In a high concentration (15%) of serum, normal epithelial cells (from mice at midterm of first pregnancy) and malignant BALB/c mammary epithelial cells in primary culture divided at the same rate (doubling time = 24 hr) and exhibited an extremely short longevity (three doublings). Insulin did not affect growth rate or longevity. Growth rate of normal and malignant cellss was serum-dependent. At serum concentrations limiting for normal cell multiplication, malignant cells showed no proliferative advantage. Insulin complemented but did not replace limiting serum for multiplication of both normal and malignant cells. When allowed to become confluent before three doublings, normal and malignant cell exhibited a contact-mediated (or density-mediated) growth inhibition. Both normal and malignant cells were arrested in the G1 phase of the cell cycle at the same density. Near physiologic doses of insulin stimulated DNA synthesis and mitosis in malignant cells but not in normal cells. Approximately 6% of malignant cells were stimulated to divide in the presence of insulin. Maximum DNA synthesis occurred at 24 hours and maximum mitotic activity at 30 hours after addition of insulin. The data suggested that malignant mammary epithelial cells are more sensitive to insulin as an overgrowth-stimulating factor than are normal cells.

Animals↗