Seminal vesicle involvement by in situ and invasive transitional cell carcinoma of the bladder

We report six cases of seminal vesicle involvement by transitional cell carcinoma of the bladder among 187 consecutive cystoprostatectomy specimens. Two of these six cases showed mucosal spread without stromal invasion (type A); the remaining four cases presented a direct extension (type B) from muscle-invasive carcinomas of the bladder. Type A involvement of the seminal vesicle was associated with a long history of superficial bladder cancer with similar mucosal spread to the prostatic ducts, acini, and ejaculatory ducts. One type A case showed extensive pagetoid spread of transitional cell carcinoma to the urethral meatus and collecting ducts of the kidney. Because the clinical significance of mucosal spread or direct invasion of seminal vesicles is not clear, pathologists and urologists need to be aware of these phenomena. More cases should be analyzed to determine further clinicopathologic implications.

Non-Hodgkin's lymphoma in bone. Pathologic and radiologic features with clinical correlates

Thirty-seven lymphomas of bone were studied, including 33 diffuse large cell lymphomas, three undifferentiated (small noncleaved cell) lymphomas, and one well-differentiated (small) lymphocytic lymphoma. The large cell lymphomas were subclassified as large cleaved, large noncleaved, multilobated cell, and immunoblastic sarcoma (large cell lymphoma, immunoblastic type). Eleven of 26 large cell lymphoma patients with adequate follow-up were long-term survivors (free of disease for more than 5 years). Nineteen of the 33 large cell lymphomas were localized to one bone. The stage and histologic pattern significantly correlated with long-term survival among large cell lymphomas. Seventy-three percent of patients with localized lymphoma were long-term survivors, in contrast to 9% of those with disseminated disease. Sixty-seven percent of patients with large cleaved and multilobated cell lymphoma were long-term survivors, but only 21% of those with large noncleaved cell and immunoblastic sarcoma were. The tumors had a blastic, lytic, or mixed radiographic appearance and had either sclerotic, lytic, or permeative borders; none of the radiologic findings were diagnostically useful.

Small-cell osteosarcoma

Small-cell osteosarcoma, a subtype of osteogenic sarcoma, consists of sheets of round cells that produce an osteoid matrix. It may be confused with Ewing sarcoma if the osteoid matrix is not included in the biopsy. The distinctive radiographic features of an osteoblastic tumor and a pattern of permeative destruction will confirm the histologic diagnosis or indicate the true nature if tumor osteoid is not included in the histological sections. We add 13 patients to the 32 previously reported in the literature. Fourteen (31%) of the 45 are living and well, though three have been followed for only 2 months (Tables 1 and 2). The treatments have been so varied that a statistically significant evaluation cannot be developed. The radiographic features are not distinctive, but the diagnosis may be suggested when a tumor has osteoblastic features in the metaphysis and extends well down into the shaft with a pattern of permeative destruction. The radiographic features are especially important when limited biopsies reveal only sheets of round cells, thus suggesting Ewing sarcoma. The presence of an osteoid-producing tumor as evidenced by osteoblastic new bone formation will lead to the correct diagnosis.

Small cell carcinoma of the kidney. A clinicopathologic, immunohistochemical, and ultrastructural study

Three cases of primary small cell carcinoma of the kidney with light microscopic, immunohistochemical, and electron microscopic findings are reported. Two patients died of disseminated disease 8 months and 1 year, respectively, after the diagnosis and the third was free of tumor after 18 months. Immunohistochemical studies revealed keratin immunostaining of tumor cells in two cases and staining for neuron-specific enolase in the third. The third case also showed a few dense neurosecretory granules at the ultrastructural level. Although no strong conclusions regarding histogenesis can be drawn, this study indicates that small cell carcinoma of the kidney exists and does not necessarily exhibit a neuroendocrine differentiation. Small cell carcinoma of the kidney must be considered in the differential diagnosis of malignant renal tumor, especially in cases in which a large necrotic tumor is present. Based on the few cases presented in this study and on the one previously reported case, small cell carcinoma of the kidney appears to be an aggressive tumor.

Adenocarcinoma of the urethra in women. A clinicopathologic study

Twenty-two cases of adenocarcinoma of the urethra in women were studied. Nine were classified histologically as clear cell adenocarcinoma and 13 were classified as columnar/mucinous adenocarcinoma. Thirteen patients (59%) were black. The average patient age was 61 years (range, 27 to 76 years). Follow-up ranged from 6 to 194 months, (average, 40 months). At presentation, most patients (82%) had extension of tumor into adjacent structures or metastases to regional lymph nodes. Eighty-six percent received radiation therapy and 41% underwent an anterior exenteration or cystectomy. Eight of 22 patients (36%) had no evidence of disease 21 to 194 months after diagnosis (average, 83 months). Fourteen (64%) were dead of disease 6 to 23 months after diagnosis (average, 15 months). In general, the extent of tumor correlated best with survival time. Forty-four percent of patients with clear cell adenocarcinoma were dead of disease within 24 months of diagnosis, in contrast to 77% of those with columnar/mucinous adenocarcinoma, suggesting that patients with clear cell adenocarcinoma may have a better prognosis than those with columnar/mucinous adenocarcinoma. However, the difference in survival probability between the two groups was not found to be statistically significant. Recognition of the two histologic types of urethral adenocarcinoma is important to prevent misdiagnosis of such tumors as metastases (or direct extension) of nonurethral neoplasms having a similar histologic appearance. A possible predilection of the disease for black women has not been previously described.

Muscularis mucosa of urinary bladder. Importance for staging and treatment

We report the results of a histologic evaluation of muscle (muscularis mucosa) in the lamina propria of the urinary bladder performed on 100 consecutive cystectomy specimens. Muscle fibers were found in the lamina propria lying parallel to the mucosa and forming a distinct muscularis mucosa in three cases; they were interrupted or discontinuous in 20 cases, and dispersed or scattered, forming thin bundles, in 71 cases. In six cases, there were no muscle fibers in the lamina propria. In addition, we noticed that the lamina propria contains large vessels that run along the length of the lamina propria in a continuous or interrupted fashion. When muscle fibers are present, they are associated with these vessels. Since prognosis and management of muscle invasive carcinomas (stage B) is different from that of lamina propria-invasive tumors (stage A), pathologists and urologists should be aware of the presence of a muscularis mucosa in the urinary bladder.

Osteosarcoma chemotherapy effect: a prognostic factor

Chemotherapy has become a routine part of the treatment of osteosarcoma. However, the precise role of preoperative chemotherapy remains in question. Between 1979 and 1982, a group of 40 patients were treated by multimodality therapy consisting of preoperative chemotherapy (intra-arterial cis-platinum and systemic adriamycin), surgery, and postoperative chemotherapy. Survival in this group is 64%, while continuous disease-free survival is 58%. Although age, sex, tumor size, site, and classification were found to be prognostic factors, histologic evidence of response to preoperative chemotherapy, measured as percent tumor necrosis, was found to be the most significant prognostic factor. When continuous disease-free survival was calculated as a function of tumor necrosis it was 91% in patients with greater than or equal to 90% tumor necrosis, while it was 14% in patients with less than 90% tumor necrosis. At initial presentation, 7% of patients were judged limb-salvage candidates. But due to the local effects of preoperative chemotherapy, 60% ultimately underwent limb-salvage surgery. Preoperative arteriograms were a reliable means of monitoring response to chemotherapy and served as an indicator of residual viable tumor. Using arteriogram directed planes of section, postchemotherapy, specimens were "mapped" and analyzed for chemotherapy effect. When present, residual viable tumor was preferentially found at the interface of tumor and normal anatomic structures; "sanctuary sites." It is necessary that standard methods for analyzing postchemotherapy specimens be developed; a technique is described.

Primary chemotherapy for clinical stage II nonseminomatous germ cell tumors of the testis: a follow-up of 50 patients

Fifty patients with clinical stage II nonseminomatous germ cell tumor of the testis (NSGCTT) were treated with primary chemotherapy followed by a retroperitoneal lymph node dissection (RPLND) in selected patients. The study population included 34 patients with retroperitoneal masses and elevated levels of serum biomarkers (alpha-fetoprotein [AFP] and beta-human chorionic gonadotropin [BHCG] ), five with needle aspiration biopsy-proven retroperitoneal metastases but normal levels of biomarkers, and 11 in whom there were rising levels of serum biomarkers but no radiographic evidence of retroperitoneal metastases. Forty-eight patients (96%) achieved a complete response (CR), with a mean disease-free survival of 132 weeks (range, 55 to 273 weeks). Two patients developed recurrent disease. One died and one achieved a second CR with further therapy (48 + weeks). Postchemotherapy RPLND was required in 11 patients (22%). Patients with embryonal carcinoma had a lower frequency of RPLND (8%) than patients with teratomatous elements in their primary tumor [36%, P = .014]. To reduce the frequency of double therapy (surgery +/- chemotherapy), we propose individualized therapy. Patients presenting with clinical stage II embryonal carcinoma of the testis should receive primary chemotherapy. Patients with clinical stage II NSGCTT and teratomatous elements in their primary tumor continue to require an RPLND. Those patients with intermediate volume disease (greater than 2 cm less than or equal to 5 cm in maximum diameter) may be treated with an RPLND only. Patients with higher volume teratomatous elements (greater than 5 cm less than or equal to 10 cm in maximum diameter) are likely to require the combination of chemotherapy and surgery.

Small cell carcinoma of the prostate. Part I. A clinicopathologic study of 20 cases

Clinical information and histological slides of 20 cases of small cell carcinoma of the prostate seen at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston over a 23-year period were reviewed. Patient's ages ranged from 30 to 89 years (median, 67 years). In nine cases, pure adenocarcinoma of the prostate preceded recognition of the small cell component by 7 months to 8 years (median, 18 months); five of these were initially at Stage A. There was a small cell component at presentation in 11 cases (10, Stage D). Small cell carcinoma was merging with the adenocarcinoma in 11 cases and represented 30% to 90% of total tumor volume. Eleven of 20 patients died of their disease. Those presenting initially with a pure adenocarcinoma survived between 7 months and 9 years (median, 24 months). After the recognition of the small cell carcinoma component, regardless of a prior history of adenocarcinoma, death followed within 1.5 years (median, 5 months). This study suggests a biologic difference in behavior in prostatic carcinoma containing a small cell carcinoma component. The small cell component may manifest early or late in the disease.

Small cell carcinoma of the prostate. II. Immunohistochemical and electron microscopic studies of 18 cases

To evaluate the histogenesis of small cell carcinoma of the prostate, 18 cases of this tumor (9 pure small cell and 9 combined adeno- and small cell carcinoma) were studied using immunohistochemical methods. Seven of the small cell components also were assessed by electron microscopic examination. Using neuron-specific enolase (NSE), prostatic acid phosphatase (PAP), and prostate-specific antigen (PSA) on tissue sections, three distinctive immunostaining patterns of small cell carcinoma components were identified: staining positive for NSE and negative for PSA and PAP (10 cases), staining positive for PSA and PAP and negative for NSE (3 cases), and negative reaction for all three antigens (5 cases). Electron microscopic study demonstrated neurosecretory granules in two cases. Based on the immunostaining and electron microscopic findings, small cell carcinomas of the prostate appear to be a heterogeneous group of tumors. Some of them are neuroendocrine carcinomas whereas others are poorly differentiated adenocarcinomas or, possibly, reserve cell carcinomas. Differences in immunostaining patterns or presence and absence of adenocarcinoma component do not reflect any differences in the uniformly poor prognosis of small cell carcinomas, in which median survivals is 7.7 months. The authors believe that, because of such heterogeneity, small cell carcinomas of the prostate arise from multipotential prostatic epithelium and that an origin from specific neuroendocrine cells need not be implicated.

Sarcomatoid renal cell carcinoma: clinicopathologic. A study of 42 cases

Forty-two cases of sarcomatoid renal cell carcinoma were reviewed clinicopathologically. Twenty-four patients were men, and 18 women; average age was 56.2 years (range, 30-81 years). Eight, 9, 13, and 12 cases were Stages I, II, III, and IV, respectively. Three morphologic patterns of sarcomatoid components were identified: malignant fibrous histiocytomatous (26 cases), fibrosarcomatous (6 cases), and unclassified sarcomatoid (10 cases). Mitotic count, degree of pleomorphism, cellularity, and amount of tumor matrix in the sarcomatoid areas, and similar morphologic parameters in the carcinomatous component all failed to correlate with prognosis, as did tumor size and renal vein involvement by tumor. Clinicopathologic stage was a most significant prognostic factor, with a survival of 49.7 months for Stage I and 6.8 months for combined Stages II, III, and IV. Tumor necrosis in the sarcomatoid area and proportion of sarcomatoid components were also poor prognostic factors. When these factors were compared to the stage, necrosis was an independent variable, however, proportion of sarcomatoid components was a poor prognostic indicator only for Stages I and II.

Sarcomatoid renal cell carcinoma: clinicopathologic. A study of 42 cases

Forty-two cases of sarcomatoid renal cell carcinoma were reviewed clinicopathologically. Twenty-four patients were men, and 18 women; average age was 56.2 years (range, 30-81 years). Eight, 9, 13, and 12 cases were Stages I, II, III, and IV, respectively. Three morphologic patterns of sarcomatoid components were identified: malignant fibrous histiocytomatous (26 cases), fibrosarcomatous (6 cases), and unclassified sarcomatoid (10 cases). Mitotic count, degree of pleomorphism, cellularity, and amount of tumor matrix in the sarcomatoid areas, and similar morphologic parameters in the carcinomatous component all failed to correlate with prognosis, as did tumor size and renal vein involvement by tumor. Clinicopathologic stage was a most significant prognostic factor, with a survival of 49.7 months for Stage I and 6.8 months for combined Stages II, III, and IV. Tumor necrosis in the sarcomatoid area and proportion of sarcomatoid components were also poor prognostic factors. When these factors were compared to the stage, necrosis was an independent variable, however, proportion of sarcomatoid components was a poor prognostic indicator only for Stages I and II.

Advantage of Fontana-Masson stain in capsule-deficient cryptococcal infection

We describe light and electron microscopic findings in three cases of pulmonary infection caused by capsule-deficient Cryptococcus neoformans (CDCN) and emphasize the value of the Fontana-Masson silver (FMS) stain in diagnosing cryptococcosis. Capsule-deficient C neoformans infections, including coccidioidomycosis, histoplasmosis, typical cryptococcosis, blastomycosis, candidiasis, and pneumocystosis were used as controls. Several stains including mucicarmine, alcian blue, and FMS were done on tissue sections from all of the above mentioned infections. It was found that while the FMS stain was positive only in the organisms of CDCN and typical C neoformans, the mucicarmine was positive only in typical C neoformans. The negativity of the mucicarmine in the organisms of CDCN reflected the absence of capsular material as demonstrated by ultrastructural study. Therefore, when fungal cultures are not available or are negative, and tissue mucicarmine is negative, the FMS stain is a valuable alternative for use on tissue sections. It may be used, along with routine fungal stains, when a yeast-forming fungal infection is suspected.

Complete responses in metastatic transitional cell carcinoma of the prostate with cisplatin regimens

We describe 3 patients with metastatic transitional cell carcinoma of the prostate who achieved a complete response with regimens containing cisplatin. Two patients received cyclophosphamide and weekly cisplatin, and 1 was given cyclophosphamide, doxorubicin and cisplatin. All 3 patients had extensive pulmonary metastasis at initiation of chemotherapy. One patient, who also had massive local disease, suffered an isolated brain metastasis 9 months after completion of chemotherapy but he remains in systemic remission 5 months later. Another patient had bilateral brain metastases 3 months after achieving complete remission with chemotherapy, followed 4 months later by systemic relapse. The third patient, who also had bone and bone marrow metastasis, is free of disease 20 months after completion of chemotherapy. In contrast, none of 14 patients with transitional cell carcinoma of the bladder and other sites treated with the same regimens obtained a complete response. Advanced transitional cell carcinoma of the prostate must be recognized promptly, since it is nonresponsive to hormonal manipulation and complete responses have been achieved with cisplatin chemotherapy programs as used in our patients.

Oat cell carcinoma of the urinary tract. An immunohistochemical and electron microscopic study

Four oat cell carcinomas of the urinary tract (three of the bladder and one of the ureteropelvic junction) were studied using immunohistochemical and electron microscopic methods to evaluate the possible histogenesis of these tumors. Ultrastructurally, the oat cell component of the tumors had neurosecretory-type granules and positive immunoreaction for neuron-specific enolase, indicating the endocrine nature of the tumors. Three tumors were mixed with a non-oat cell component: adenocarcinoma and/or transitional carcinoma or carcinoid tumor. There are no previous reports of mixed oat cell and adenocarcinoma or carcinoid tumor of the urinary tract. This report is also the first of an oat cell carcinoma originating in the pelvic ureteric junction.

Pseudosarcomatous fibromyxoid tumor of the urinary bladder

The light-microscopic, immunohistochemical, and ultrastructural features of two examples of a pseudosarcomatous fibromyxoid tumor of the urinary bladder are reported. Both patients were women, 56 and 52 years old. Gross hematuria was the chief complaint and occurred for two days and two weeks, respectively, before presentation. Cystoscopy revealed a 2 X 1 X 1 cm mass located at the dome in case 1 and a 4 X 3 X 3 cm mass at the left posterior lateral wall in case 2. Microscopically, the lesions were composed of spindle, plump, or stellated fibroblast-like cells embedded in myxoid stroma with little collagen; mitotic figures were about 2 per 10 high-power fields, and both cases showed encroachment of the superficial muscle bundles. Because of bizarre spindle cell proliferation, occasional mitoses, and invasion to the underlying muscle, these lesions were initially diagnosed as embryonal rhabdomyosarcoma. However, follow-up examination disclosed the benign nature of these lesions. There was no previous instrumentation or surgery on the genitourinary tract. Immunohistochemical and ultrastructural studies revealed the fibroblastic-myofibroblastic nature of these lesions. These cases illustrate that clinicopathologic correlation is essential to define certain pseudosarcomatous lesions.

Giant cell tumors of bone: treatment with radiation therapy

Records of 15 patients with giant cell tumor of bone treated with radiation therapy over a 35-year period were reviewed; ten patients for whom follow-up information was available constituted the study group. One patient was treated by means of orthovoltage equipment only, a second, by both orthovoltage and megavoltage equipment (cobalt 60). The remaining eight were all treated with megavoltage to doses of 40-52 Gy in 24-30 fractions. Seven patients are alive without disease, with an average survival of 192 months (range, 48-360 months). Three patients died of uncontrolled local and distant disease (average survival, 52 months; range, 23-99 months): one with metastasis in the lungs at time of treatment and two after treatment. Although incidence of lung metastasis appears high, it may be due to patient selection because chemotherapy had failed in all three. Complications from irradiation in one surviving patient required surgical closure of a dural fistula 19 years after treatment. No radiation-induced sarcomatous transformations of controlled tumors were noted. These data suggest that giant cell tumor of bone can be well controlled by radiation therapy. Megavoltage irradiation should be considered in treating local disease not easily controlled by surgery in the axial skeleton. Complications are minimal, and normal function can be preserved in the treated areas.

Clear cell cribriform hyperplasia of prostate. Report of 10 cases

We report 10 patients with clear cell cribriform hyperplasia of the prostate. Their ages ranged from 62 to 87 years, with a mean of 72 years. The clinical diagnosis in all patients was benign nodular hyperplasia; all the patients are alive and have shown no evidence of recurrent disease. Follow-ups ranged from 1 month to 7 years (median: 12.5 months; mean: 24.6 months). Pathologically, this lesion has a cribriform arrangement of clear cells with a complex papillary growth simulating the cribriform pattern of prostatic carcinoma. In fact, in five of the 10 cases, the referring diagnosis was either carcinoma or possible carcinoma. Cytologically, however, there is no nuclear atypia, mitosis, or prominent nucleoli, and typically there is a double epithelial cell layer at the periphery of the involved acini. In summary, clear cell cribriform hyperplasia is a benign hyperplastic process with a complex papillary-cribriform structure and should not be confused with prostatic carcinoma. The key feature for the diagnosis is the preservation of nodular configuration with a bland cytology and double cell layer lining the involved acini.

Chondrosarcoma with additional mesenchymal component (dedifferentiated chondrosarcoma). II. An immunohistochemical and electron microscopic study

Light microscopic, immunocytochemical and ultrastructural studies were performed on chondrosarcomas which contained a second, noncartilagenous mesenchymal component. Attention was focused on the nonchondroid portion of each tumor in an attempt to elucidate the histogenesis of this mixed variant of chondrosarcoma. The immunoreactivity of 20 tumors was studied using antisera for S-100 protein, alpha-1-antitrypsin, alpha-1-antichymotrypsin, smooth muscle myosin, desmin, and myoglobin. Cells of the nonchondroid portion stained for alpha-1-antichymotrypsin in 12 of 20 cases, and these were predominantly tumors that had been classified as fibrosarcoma or malignant fibrous histiocytoma by conventional light microscopic study. Staining for S-100 protein was consistently negative, whereas the chondrosarcoma component stained in 14 cases. Six tumors stained for desmin, and four of the six were positive for myoglobin and two for smooth muscle myosin; in four, a rhabdomyosarcomatous component was identified in the hematoxylin and eosin-stained sections. Electron microscopic study was performed on ten tumors and there was a good correlation between the immunohistochemical and ultrastructural findings. Three of the ten were pure rhabdomyosarcomas while the others displayed a range of ultrastructural appearances that can be seen in fibrosarcomas and malignant fibrous histiocytomas. The findings from this study support the view that the tumors are formed by the synchronous differentiation of two separate clones of cells.

Chondrosarcoma with additional mesenchymal component (dedifferentiated chondrosarcoma). I. A clinicopathologic study of 26 cases

During a 37-year period, 26 patients were seen who had chondrosarcoma with additional mesenchymal components ("dedifferentiated low-grade chondrosarcoma"). Sixteen were men and 10 were women aged 30 to 85 years (median, 61 years). The tumors' chondroid areas were of borderline or low-grade malignancy. The additional mesenchymal component was histologically classified as malignant fibrous histiocytoma (16), rhabdomyosarcoma (4), low-grade fibrosarcoma (3), osteosarcoma (2), and undifferentiated sarcoma (1). Preferred locations were pelvis (10) and femur (8). Symptoms had been present for 1 year or less in most cases. Pain was the most common symptom. In 15 of 26, major amputation was the primary treatment. Twelve patients received chemotherapy, usually after developing metastatic disease, but only one achieved a partial response. Median disease-free interval after diagnosis was 4 months, median survival was 6 months, and 19 patients died within 1 year. Of 4 who survived longer than 18 months, 3 presented with a low-grade fibrosarcoma. Survival and development of metastasis appeared unrelated to cell type, initial treatment, or chemotherapy, except when the tumor's initial nonchondroid component was low-grade fibrosarcoma.

Chondrosarcoma with additional mesenchymal component (dedifferentiated chondrosarcoma). I. A clinicopathologic study of 26 cases

During a 37-year period, 26 patients were seen who had chondrosarcoma with additional mesenchymal components ("dedifferentiated low-grade chondrosarcoma"). Sixteen were men and 10 were women aged 30 to 85 years (median, 61 years). The tumors' chondroid areas were of borderline or low-grade malignancy. The additional mesenchymal component was histologically classified as malignant fibrous histiocytoma (16), rhabdomyosarcoma (4), low-grade fibrosarcoma (3), osteosarcoma (2), and undifferentiated sarcoma (1). Preferred locations were pelvis (10) and femur (8). Symptoms had been present for 1 year or less in most cases. Pain was the most common symptom. In 15 of 26, major amputation was the primary treatment. Twelve patients received chemotherapy, usually after developing metastatic disease, but only one achieved a partial response. Median disease-free interval after diagnosis was 4 months, median survival was 6 months, and 19 patients died within 1 year. Of 4 who survived longer than 18 months, 3 presented with a low-grade fibrosarcoma. Survival and development of metastasis appeared unrelated to cell type, initial treatment, or chemotherapy, except when the tumor's initial nonchondroid component was low-grade fibrosarcoma.

Intraluminal crystalloids in prostatic adenocarcinoma. Immunohistochemical, electron microscopic, and x-ray microanalytic studies

Histochemical, immunohistochemical, electron microscopic, and x-ray microanalytic studies were performed on crystalloids within glandular lumina of adenocarcinomas of the prostate. In a review of light microscopic sections of 343 prostatic adenocarcinomas, unequivocal crystalloids were identified in 35 cases (10.2%). Immunohistochemical and ultrastructural studies revealed distinct differences between these crystalloids and the Bence Jones crystals of multiple myeloma: anti-kappa and anti-lamda immunostaining was negative, and the characteristic lattice-like architecture of Bence Jones crystals was not seen. Differences from corpora amylacea also were demonstrated. X-ray microanalysis did not elucidate the nature of the prostatic crystalloids, and their biochemical composition and mode of formation remain uncertain. Detection of the crystalloids in light microscopic sections nevertheless can aid in the diagnosis of prostatic adenocarcinoma, particularly when the tissue is distorted by crushing artifact, or if the tumor is so well-differentiated that it can be confused with atypical hyperplasia or inflammatory atypia. When intraluminal crystalloids are detected in prostatic glands that appear histologically benign or atypical, study of additional levels or a repeat biopsy should be undertaken.

Osteoid-osteoma: intraoperative tetracycline-fluorescence demonstration of the nidus

Nine patients with a clinical and radiographic diagnosis of osteoid-osteoma received 750 to 4,000 milligrams of tetracycline preoperatively. Immediate examination of the surgically removed specimens under ultraviolet light demonstrated fluorescence of the nidus in all nine patients. Reactive and normal bone did not fluoresce. This simple technique permits quick, easy, economical, and sure verification that the nidus has been excised.

Desmoid fibromatosis: a clinicopathologic study of 25 children

We studied 25 patients under 15 years of age with desmoid fibromatosis (DF). There were 15 boys and 10 girls; 13 were under seven years of age and 12 were above. Histologically, DF was identical to DF in adult patients, except for a higher mitotic rate in children's tumors. The tumors were located on the head and neck (8), upper (7) or lower (6) extremities, or the trunk (4). Patients with head and neck DF received preoperative adriamycin and 5-(dimethyltriazeno) imidazole-4-carboxamide or a combination of vincristine, actinomycin D, and cyclophosphamide. In seven patients, tumor reduction began to occur during chemotherapy, while in one patient, there was no response at all. Five patients underwent conservative resections of their residual tumors, and in two patients, all tumor disappeared necessitating no additional surgery. Follow-up in these patients indicates that 6 have no evidence of disease, 1 is alive with recurrent disease, and 1 is lost to follow-up. Surgery was the primary modality of treatment for the trunk and extremity lesions. Twelve patients had no evidence of disease from 2 months to 25 years and 5 months, two died from complications of chemotherapy, and three were lost to follow-up. Our experience agrees with that of other investigators that DF is best managed surgically. However, preoperative chemotherapy should be strongly considered for patients with tumors occurring in the head and neck areas.

Retrovesical leiomyoma

Primary tumors arising in the retrovesical area are rare. We recently treated by primary excision a large retrovesical leiomyoma in a forty-five-year-old man. The smooth muscle nature of the tumor was confirmed by electron microscopy. Recognizing this entity is important, since treatment consists only of surgical removal, and the prognosis should be excellent.