Epithelioid Angiomyolipoma: A Case Report

Epithelioid angiomyolipoma is a recently recognized tumor entity. We report a case of epithelioid angiomyolipoma of the kidney that occurred in a 70-year-old female. The patient presented with massive abdominal hemorrhage and shock. There was no history of tuberous sclerosis complex. The tumor consisted of smooth muscle, adipocytes, small-to-medium-sized hyalinized blood vessels and numerous pleomorphic epithelioid cells with clear to eosinophilic cytoplasm. Mitosis was exceptional and no glandular pattern was recognizable. Immunohistochemically the epithelioid cells were strongly positive for HMB45 and CD68, focally positive for S-100, actin and vimentin, and negative for epithelial markers including epithelial membrane antigen and cytokeratins. Previous reports in the English literature suggest that epithelioid angiomyolipoma may have malignant potential. In our case, at six months from surgery the patient is alive and well without evidence of relapse or metastasis.

Course and severity of postpartum metritis cases following antibiotic and PGF2α administration in postpartum metritis cows infected with BoHV-4

Forty cows between day 1 and day 21 post-calving were examined for the presence of postpartum metritis in a dairy herd that had recently experienced an increase in metritis and that had previously tested positive against bovine herpes virus 4 (BoHV-4) by various methods. Antibodies against BoHV-4 were detected in sera from 15 of 22 cows. For the virological study, uterine swab samples of 22 cows with metritis were used and tested for BoHV-4 using polymerase chain reaction (PCR), virus isolation (VI), and immunofluorescence techniques. Twenty-two point seven per cent (5/22) of the vaginal discharge samples obtained from cows with metritis were found positive for BoHV-4 DNA by PCR. All of these samples were also positive in VI and/or immune fluorescence assay (IF). Swab samples were also tested for bacteria. Empirical therapy with a broad spectrum antibiotic (oxytetracycline) was administrated, pending culture and antibiotic sensitivity result. All cows with puerperal metritis or clinical metritis (CM) were treated with intra-uterine (i.u.) administration of oxytetracycline and with intramuscular (i.m.) injections of dinoprost tromethamine (PGF(2)α) for three consecutive days. Concurrently, with the administration of oxytetracycline and PGF(2)α, cows with a rectal temperature >39.5°C received an additional treatment with oxytetracycline (i.m) for three consecutive days. According to the antibiotic test result, on day 3 after the last oxytetracycline and PGF(2)α administrations, all cows were treated with a combination of amoxicillin and clavulanic acid (i.u.) for three consecutive days. All cows with metritis and that were positive for BoHV-4 recovered clinically after the administration of antibiotic and PGF(2)α. In conclusion, postpartum metritis cases in cows infected BoHV-4 recovered clinically following early diagnosis and prolonged treatments with a combination of antibiotics and PGF(2)α.

[Prostatic calculi: silent stones]

INTRODUCTION AND OBJECTIVES

Prostate stones are frequently encountered during transurethral resection of the prostate in urology practice. We aimed to demonstrate the physical and chemical properties of prostate stones. We also aimed to determine possible relationship between inflammation of prostate gland and prostate stones.

METHODS

The consecutive patients (excluding subjects with PSA>or=4ng/ml and urolithiasis), who underwent TURP operation and who were observed to have prostatic calculi during TURP, were included in the study. The prostatic stones obtained from each patient during TURP were analysed for chemical composition and observed under electron microscopy (SEM) for structure and surface morphology. The pathological specimens were assessed by the uropathologist for the final diagnosis and existence and degree of inflammation.

RESULTS

Five patients were included in the study. From each patient at least three (range 3-8) samples of stones (diameter varying from 1mm up to 5mm) were obtained. The stones were made of mixed composition of calcium phosphate and calcium carbonate. The stones were found to have lobular surface made up of small spheres under SEM. Histopathological examination of the TURP specimens revealed being prostatic hyperplasia accompanied with inflammation of mild to severe degree.

CONCLUSIONS

Prostatic stones are concentrically precipitated calcium stones within the prostatic ductuli with granular grape like morphology. Histopathological inflammation seems to be associated with these prostatic calculi.

MMP20 hemopexin domain mutation in amelogenesis imperfecta

Proteolytic enzymes serve important functions during dental enamel formation, and mutations in the kallikrein 4 (KLK4) and enamelysin (MMP20) genes cause autosomal-recessive amelogenesis imperfecta (ARAI). So far, only 1 KLK4 and 3 MMP20 mutations have been reported in ARAI kindreds. To determine whether ARAI in a family with a hypomaturation-type enamel defect is caused by mutations in the genes encoding enamel proteolytic enzymes, we performed mutational analysis on candidate genes. Mutational and haplotype analyses revealed an ARAI-causing point mutation (c.910G>A, p.A304T) in exon 6 of MMP20 that results in a single amino acid substitution in the hemopexin domain. Western blot analysis showed decreased expression of the mutant protein, but zymogram analysis demonstrated that this mutant was a functional protein. The proband and an affected brother were homozygous for the mutation, and both unaffected parents were carriers. The enamel of newly erupted teeth had normal thickness, but was chalky white and became darker with age.

The development of metachronous prostate cancer and chronic myeloid leukemia in a patient with metastatic rectal cancer

We report herein an unusual case of metachronous triple cancers (rectum, prostate and Philadelphia(+) [Ph(+)] chronic myeloid leukemia [CML]). A metastatic rectal cancer was diagnosed in a 76-year-old male patient, who was treated with transanal tumor resection and chemotherapy. Thirty months from the initial rectal cancer diagnosis, prostate cancer was diagnosed and the patient was administered maximal androgen blockade and received palliative radiotherapy to the lumbar spine because of painful bone metastases. Thirty months after the diagnosis of rectal cancer and 12 months after the diagnosis of prostate cancer the patient developed Ph(+) CML and imatinib treatment was started. After one-year period in remission, CML evolved into accelerated phase and the patient died of intracranial hemorrhage.

Technetium-99m hexamethylpropylene amine oxime lung scintigraphy findings in low-dose amiodarone therapy

Amiodarone (AD)-induced pulmonary toxicity is one of the major complications of long-term AD therapy. Technetium-99m-labeled D: ,L: -hexamethylpropylene amine oxime (Tc-99m HMPAO) scintigraphy has been used to assess lung injury. We designed this study to clarify lung uptake changes of Tc-99m HMPAO using low doses of AD (5 mg/kg/day) during long-term therapy in a rabbit model. Group 1 consisted of 7 rabbits fed with AD by gavage for 6 months. To investigate the effect of ketamine on Tc-99m HMPAO uptake, 5 rabbits were included in Group 2 as a control group. Tc-99m HMPAO scintigraphy was performed in both Group 1 and Group 2 at baseline and after 2, 4, 6, 8, and 12 weeks of AD intake. After 16, 20, and 24 weeks of drug intake, Tc-99m HMPAO scintigraphy was repeated only in group 1. One-min anterior images were acquired 30 min after the injection of 37 MBq of Tc-99m HMPAO. For semiquantitative evaluation, the mean count values were obtained and lung/background and liver/background ratios were calculated. Histopathologic evaluation was performed. No increase in lung and liver uptake of Tc-99m HMPAO was found 2, 4, 6, 8, and 12 weeks after drug intake. There was no significant increase in L/B and H/B ratios of Tc-99m HMPAO in Group 1 compared with Group 2. Both scintigraphic studies and histopathologic examinations showed nonspecific changes. Longitudinal studies investigating Tc-99m HMPAO lung uptake may be planned in patients carrying risk factors for AD-induced lung toxicity.

A Clinico-pathological study on the effect of vincristine on transmissible venereal tumour in dogs

Transmissible venereal tumour (TVT) is a coitally transmitted neoplasm of dogs and is common among sexually active dogs, where sexual behaviour is not under control. Several treatment options are available for the treatment of the tumour, with chemotherapy being the most commonly employed. In this study, we investigated the clinical and cytological changes after weekly vincristine sulphate administration in 38 cases of naturally occurring TVT. Tumours totally regressed in 31 dogs after two to seven doses (mean 3.54 +/- 1.01) of vincristine. One dog died after the fifth dose of vincristine, and in six dogs, an additional treatment with doxorubicin was needed. Masses were still present in four dogs and the histopathological examination revealed small nodules of granulation tissue in two dogs, while viable tumour cells were identified in the remaining two cases. No recurrences were observed in a follow-up period of 7-49 months (mean 13.64 +/- 9.66); in one dog, granulation tissue was detected in the surgery site after 2 months. Treatment success could easily be followed by the cytological changes. In conclusion, vincristine was found to be effective chemotherapeutic agent.

Heat shock protein 70 expression in neonatal rats after hypoxic stress

OBJECTIVES

The tissue damage due to hypoxia in newborns is to some extent age-dependent; organs of premature babies are more vulnerable to hypoxic insult than full-term neonates. The aim of this immunohistochemical study was to investigate the role of heat shock protein 70 (HSP70), a stress-inducible protein, in developing the response to hypoxia in premature newborns.

METHODS

Postnatal day-7 rats (corresponding to a human fetus of 32-34 weeks' gestation) and day-12 rats (corresponding to a full-term newborn infant) (n = 7) were subjected to mild hypoxia at 33 degrees C. Control rats (n = 7) for each group breathed room air for 4 h. After 4 h of recovery, the animals were killed, and brains, hearts and kidneys were removed for immunohistochemical staining.

RESULTS

Immunohistochemically, HSP70 expression was found to be induced in the hippocampus and myocardium after exposure to hypoxia. The level of HSP70 expression in the hippocampus after hypoxic stress was significantly higher in the 12-day rats than in the 7-day rats (p = 0.03). However, HSP70 expression in the myocardium did not show any significant difference between the two groups. In addition, no significant induction of HSP70 expression was apparent in the kidney of rats exposed to hypoxia or in any organ of the control animals.

CONCLUSIONS

We conclude that diminished HSP70 expression in the hippocampus of premature newborns may play a critical role in developing the response to hypoxic stress. However, HSP70 expression in the heart and the kidney after exposure to hypoxia did not appear to be related to fetal maturity.

Expression of pS2 protein and its relation with the Ki-67 proliferative indices and tumor recurrence in superficial bladder carcinomas

OBJECTIVE

To investigate the expression and possible role of pS2 protein as a predictor of tumor recurrence in superficial transitional cell carcinoma of the bladder and to determine its relation with tumor stage, grade, size, number, recurrence and proliferative activity.

METHODS

Paraffin sections of transurethral resection material from 80 patients with superficial transitional cell bladder carcinoma were stained with pS2 and Ki-67 antibodies using the standard streptavidin biotin immunoperoxidase method. Cytoplasmic pS2 staining was scored on a scale of 1-3 and the Ki-67-labelling index was determined as a percentage of positively staining tumor cells.

RESULTS

An inverse relationship was found between pS2 expression and Ki-67 index (p<0.001). pS2 expression showed no relation with any clinicopathological prognostic parameters as well as the recurrence rate. The recurrence rate was only associated with increased tumor number (p = 0.05), while the time to first recurrence was significantly related to tumor size, proliferative activity and tumor grade (p = 0.04, p<0.001, and p = 0.03, respectively). On the other hand, higher tumor grade was correlated with increased tumor number, Ki-67 index and tumor stage (p = 0.016, p = 0.006, and p<0.001, respectively).

CONCLUSION

pS2 expression is associated with a low proliferative potential of superficial transitional cell carcinoma of the bladder, while it does not seem to be related to the recurrence rate of the tumor and other prognostic factors. Tumor size and proliferative activity may aid in the estimation of the time to the first recurrence.

Does angiogenesis predict recurrence in superficial transitional cell carcinoma of the bladder?

OBJECTIVES

To investigate the role of angiogenesis in predicting tumor recurrence and its correlation with established clinicopathologic prognostic factors in superficial transitional cell carcinoma of the bladder.

METHODS

The paraffin sections of 80 superficial papillary transitional cell bladder carcinoma specimens were stained with CD31 antibody to label the vascular endothelium using the standard streptavidin-biotin-immunoperoxidase method. The vascular surface density (VSD) equivalent to the vascular surface area per unit of tissue volume and number of vessels per square millimeter of stroma (NVES) were assessed by means of stereology, and these morphometric parameters of angiogenesis were statistically analyzed to interpret the relation to tumor recurrence in addition to tumor stage, grade, size, and number and the presence of carcinoma in situ.

RESULTS

VSD and NVES values showed no statistically significant difference between pTa and pT1 tumors or patients with and without recurrence. In contrast, VSD and NVES values were found to increase in higher grade tumors (P = 0.019). VSD values were also higher in patients with coexisting carcinoma in situ in pTa tumors (P <0.001). Tumor number and size and recurrence number and time to the first recurrence did not correlate with any vascular parameters.

CONCLUSIONS

Stereologic assessment of angiogenesis does not help to predict recurrence in superficial bladder cancer. Angiogenic parameters appeared to be well correlated with the conventional histologic grading system. Otherwise, the present study did not show any correlation of angiogenesis with any potential prognostic factors. This may be due to the diverse angiogenic pathways occurring in invasive and superficial tumors.

Ganglion cells in the human prostate

Prostate carcinoma infiltrating around ganglion cells is claimed to be diagnostic of extracapsular extension because ganglion cells are only found in periprostatic soft tissue. However, the presence of autonomic ganglion cells in the fibrous capsule of the prostate has been reported. In this study, we aimed to define the exact localization of the ganglion cells in radical prostatectomy specimens. Slides of 64 totally embedded radical prostatectomies were reviewed. The ganglion cells were noted as outside the gland if no relation could be defined with prostate capsule or prostatic glands. They were noted as in the capsule when ganglion cells were observed inside the capsule, which was easily and definitely discerned. Ganglion cells were noted as in the prostate when ganglion cells were observed beneath the capsule and in close proximity to the prostatic glands. Also, the ganglion cells were noted as in the capsule if they were observed inside the capsule but not adjacent to the prostatic glands, and as outside the prostate when the capsule could not be easily defined and distant from the prostatic glands. Ganglion cells were observed in the prostate in 12 cases (18.75%). There was no relationship of these ganglion cells with the tumor in the prostatectomy specimens. Ganglion cells were located in the capsule in 14 cases (21.9%). The ganglion cells were observed outside the prostate in the other 38 cases (59.4%). These results show that there may be ganglion cells in the prostate. Therefore, defining ganglion cell invasion by the tumor as extracapsular invasion may lead to staging error and cause erroneous management of the disease. Presence of carcinoma in ganglion cells should be recorded by defining whether these structures are within or outside the prostate gland. Prostate Cancer and Prostatic diseases (2000) 3, 34-36

Prognostic significance of angiogenesis and immunoreactivity of cathepsin D and type IV collagen in high-grade stage T1 primary bladder cancer

OBJECTIVES

To assess the prognostic significance of biologic parameters such as angiogenesis, expression of cathepsin D (a lysosomal protease), and degradation of type IV collagen (a basement membrane protein), we studied 20 patients with primary grade III Stage T1 transitional cell carcinoma of the bladder.

METHODS

Endothelial cells were labeled immunohistochemically using factor VIII-related antigen. The vascular surface density (VSD) and the microvessel number (NVES) were assessed by means of stereology. The tumor tissues were also analyzed by immunohistochemical methods for the expression of cathepsin D and the staining pattern of type IV collagen.

RESULTS

Eight patients (40%) having either recurrence or progressive disease showed greater NVES and VSD values (P = 0.002 and P = 0.01, respectively) than patients without. The significance of vascular parameters was found to be statistically independent from coexisting carcinoma in situ, bacille Calmette-Guerin (BCG) treatment, tumor size, and number. Additionally, these parameters did not show statistical significance between progressive and recurrent tumors. However, tumors with solid morphologic features had higher VSD values and a significantly greater rate of recurrence or progression (P = 0.01 and P = 0.07, respectively). Tissue from 17 (85%) of 20 tumors showed absent or patchy basement membrane staining for type IV collagen, and 12 (60%) showed strong immunoreactivity for cathepsin D antibody. There were no differences for either molecule with either BCG treatment or other parameters related to prognosis.

CONCLUSIONS

Angiogenesis may have an independent role in predicting prognosis in grade III Stage T1 bladder carcinoma. Grade III Stage pT1 tumors with solid morphologic features have higher angiogenetic activity and a worse prognosis. Cathepsin D and type IV collagen do not seem to play a role in predicting biologic behavior.