Twelve cases of central nervous system lymphoma diagnosed by stereotaxic brain biopsy are reviewed to determine the most effective method to establish the diagnosis given the small amount of tissue obtained by this technique. The stereotaxic biopsy material was examined cytologically, histologically, and immunocytochemically. The diagnosis was established by a smear made at the time of biopsy in eight cases. Histologic sections were diagnostic of lymphoma in 11 of 12 cases. Accurate classification according to the Working Formulation was possible in six cases, with diagnosis of diffuse small non-cleaved non-Burkitt's in three, large cell immunoblastic in two, and mixed small and large cell type in one. Five additional cases were diagnosed as high-grade lymphoma but could not be further subclassified because of the small biopsy size or formalin fixation. Immunocytochemical stains for lymphoid markers on paraffin-embedded material confirmed the diagnosis in ten cases, and, in one of these, the demonstration of monoclonality on air-dried cytospins identified an atypical polymorphous lymphocytic population as neoplastic.
Abstract Background: We compared the prognostic efficacy between the Japanese General Rules of Prostatic Cancer (JGRPC) and the Gleason grading system (GGS) by applying them to a single set of patients and assessing the survival outcome. Methods: One hundred and seventy‐six patients with previously untreated prostate cancer were studied. One experienced Japanese pathologist graded the slides with JGRPC. Another experienced American pathologist graded the same slides with the Gleason grading system. The JGRPC grades were correlated with the Gleason scores (GS) grouped into three (GS 2–4, 5–7 and 8–10) or four (GS 2–4, 5–6, 7 and 8–10) tiers. Results: The highest cancer death rates were seen in the higher grade groups in both systems. Comparison of JGRPC grade and three‐tiered grouping of the GS showed identical grades in 81 of 176 cases (46.0%). The overall kappa value of agreement was only 0.151. The 96 cases of JGRPC moderately differentiated carcinoma group contained two nearly equal‐sized groups by the Gleason grading system, those with GS 5–7 (47cases) and GS 8–10 (49 cases). There was a significant difference in survival rate between the GS 5–7 and GS 8–10 groups. No significant differences were noted in the reverse analysis of survival by JGRPC groups within patients with the same GS three‐tiered groups. Similar trends were seen when JGRPC was compared with the four‐tiered grouping of the GS. Conclusion: Both JGRPC and the Gleason grading system are useful in estimating the prognosis of prostate cancer, but only a mild correlation was found between the two systems. The Gleason grading system may provide more prognostic information than JGRPC in the moderately differentiated group.
The purpose of this study was to determine the accuracy of Gleason scores in prostate needle biopsy diagnosis and to investigate factors affecting the accuracy of the tumor grade. A single pathologist reviewed 116 sets of prostate cancer biopsies and radical prostatectomy specimens. The following factors were examined to determine their effect on the accuracy of the biopsy Gleason scores: (i) relative tumor differentiation; (ii) pathological stage; (iii) amount of tissue in the biopsy specimen; (iv) amount of cancer tissue in the biopsy specimen; (v) tumor heterogeneity; (vi) clinical findings (prostate specific antigen value and digital rectal examination); and (vii) interobserver variability. In 53 cases the Gleason score of biopsy specimens was identical to the score of prostatectomy specimens (45.7%). Fifty-four cases (46.6%) of biopsy specimens were undergraded. The most common discrepancy was diagnosis of well-differentiated carcinoma in the biopsy but diagnosis of moderately differentiated tumor in the corresponding prostatectomy specimen. This discrepancy occurred when the amount of tumor in the biopsy was 3 mm or less. Biopsy and prostatectomy results showed less agreement when the original biopsy tumor grade rendered by nine different pathologists was used, suggesting that interobserver variability can adversely affect the accuracy of tumor grade. Clarifying the histologic criteria for distinguishing each grade, especially between Gleason grades 2 and 3, is important for accurate grading.
Primary testicular sarcomas are extremely rare. In contrast, germ cell tumors (GCTs) with sarcomatous components (SCs) that can have similar pathologic features are more frequently reported. We report a primary undifferentiated testicular sarcoma with cytogenetic analysis for amplification of 12p. A 36-year-old male initially presented with 9.4 cm right testicular tumor and no metastatic disease. He was lost to follow-up but re-presented 2 years later with tumor growth to 21 cm and multiple pulmonary and bone metastases. Histologically, the testicular tumor revealed an undifferentiated sarcoma. Fluorescence in situ hybridization (FISH) of paraffin-embedded tissue showed no amplification of 12p. Gain of isochromosome 12p (i(12p)) is a specific chromosomal anomaly present in most GCTs. The cytogenetic analysis indicated the possibility that the tumor was not of GCT origin. This is the first report of primary testicular undifferentiated sarcoma with cytogenetic analysis for i(12p). J Med Cases. 2016;7(1):7-12 doi: http://dx.doi.org/10.14740/jmc2356w
241 Background: Recently, several studies have reported that soy isoflavones and the ability to produce Equol, an active derivative of soy isoflavone, may play a role in the suppression of prostate cancer. An Equol-producing bacterium, Slackia sp. strain NATTS has been identified in stool cultures. To further investigate this relationship, we evaluated Japanese-Americans (JA) and whites (W) in Hawaii, with and without prostate cancer, with regards to dietary soy intake, serum isoflavone levels, and the presence of stool NATTS. Methods: The serum levels of Daidzein, Genistein, Glysitein, Dihydrodaidzein (DHD), Equol, o-desmethylangolensin (o-DMA) and total isoflavone was determined in 65 JA (34 patients with prostate cancer , 31 controls) and 68 W (34 patients with prostate cancer , 34 controls) subjects. The control group consisted of age matched cancer-free male subjects. To evaluate Equol producing ability, we assessed the presence of NATTS in stool samples. All subjects completed a lifetime dietary soy consumption survey. Results: The serum level of Genistein and o-DMA were significantly higher in JA (Genistein: W 21.5±54.0, JA 61.8±150.9, p=0.04; o-DMA: W 0, JA 2.0±7.9, p=0.04). Daizein level trended higher in JA (W 13.9±34.7, JA 33.3±84.0, p=0.09). Glysitein level was significantly higher in W (W 35.7±10.4, JA 30.7±15.5, p=0.03). No differences were noted in DHD and Equol levels between W and JA. Total isoflavone level trended higher in JA (W 76.3±104.9, JA 135.1±245.6, p=0.07). There were no differences in serum isoflavone level between prostate cancer patients and controls for both JA and W. Only 10 of 120 stool samples were positive for NATTS (8.6%), a rate much lower than seen in Japan. JA showed higher intake of soy than W. Conclusions: The high soy consumption and isoflavone levels in JA may be related to the observed lower incidence of prostate cancer relative to W in Hawaii. The near absence of equal producers in Hawaii JA may contribute to their higher incidence of prostate cancer compared to Japan based Japanese. These results suggest that both soy isoflavone levels and Equol production may be inversely associated with prostate cancer incidence.
A case is reported of venous angioma at the right basal ganglia simulating the encapsulated chronic intracerebral hematoma. A 29-year-old man was admitted to our hospital on July 14, 1988 with a two-month history of headache. Neurological examination revealed left homonymous lower quadrantic anopsia. CT scans showed a mosaic high density lesion at the right basal ganglia with extensive adjacent edema. MRI revealed that the high density lesion on CT scans was the combination of a reticulated core of mixed signal intensity with a surrounding rim of decreased signal intensity. The lesion was accompanied with extensive edema. Followed up CT scans showed the transformation of the lesion and ring-shaped enhancement. A right frontotemporal craniotomy was performed on August 9, 1988. After thorough dissection of the sylvian fissure and small corticotomy to the insula, a tough capsule was seen. There was blood in various stages of organization in the capsule. A histological examination gave a diagnosis of venous angioma in the membrane similar to the outer membrane of chronic subdural hematomas. Postoperatively, the patient showed slight left motor weakness, but it gradually improved and he was discharged on foot, on October 19, 1988. There have been a lot of reports about angiographically occult intracranial vascular malformation (AOIVM). But AOIVM at the basal ganglia is rare, and to our knowledge, only 8 cases have been reported. In our case, the presence of adjacent extensive edema, and ring-shaped enhancement on CT scans confused the preoperative diagnosis. Those findings might have been caused by encapsulation. By using CT scans and MRI, a complete and accurate diagnosis was impossible.(ABSTRACT TRUNCATED AT 250 WORDS)
