Risk factors for cutaneous malignant melanoma in a northern Italian population

The relationship between cutaneous malignant melanoma (CMM) and the colour of skin, hair and eyes, the extent of sun exposure and reaction to it, education, and the occurrence of skin neoplasms in patients and their families was evaluated in a case-control study of 103 cases of CMM and 205 control subjects hospitalized for acute conditions other than malignant or hormonal disease. A significantly higher risk was associated with fair skin as compared to dark/medium skin (RR = 4.0; 95% CI: 1.5-10.5) and positive family history for CMM (RR = 8.1; 95% CI: 1.0-200.9). CMM seemed to occur more frequently, but not significantly so, in individuals with brown or blond hair, higher education and clinically diagnosed dysplastic naevi. Outdoor occupation and heavy sun exposure in the last 20 years seemed to increase the risk of CMM in sun-exposed sites but to be negatively associated with CMM in normally unexposed sites.

Aspiration cytology of cutaneous metastatic melanoma and epidermoid carcinoma of the penis

Aspiration biopsy cytology is an accurate, safe, innocuous alternative to excisional biopsy in diagnosing the nature of concomitant superficial nodules or lymphadenopathy in patients with known cutaneous malignancy. In patients with penile cancer, aspiration biopsy cytology may avoid the morbidity (30-50%) and mortality (3%) of groin dissection staging. A positive aspirate is conclusive of Stage III tumor and, in patients with occult nodal metastases, may lead to early curative lymphadenectomy. In the present study of 28 patients with known cutaneous malignant melanoma, the aspiration biopsy cytology of 31 superficial nodules resulted in a cytologic diagnosis of metastasis in 29 nodules from 26 patients. In the management of patients with known melanoma, the positive cytology of superficial nodules is conclusive of metastatic disease and requires an accurate radiologic study to establish or exclude disseminated disease. Surgical removal of a metastatic superficial nodule is indicated when the lesion is considered localized disease and the patient, having been accurately examined, is determined to be apparently free of disease in other sites and organs. When systemic diffuse melanoma is found, the excision of metastatic superficial nodules is unnecessary. Positive aspiration cytology may avoid risk from ill-judged surgical procedures and indicate appropriate palliative treatment of the disease.

Primary angiosarcoma of the gingiva. Case report with immunohistochemical study

A case of angiosarcoma involving primarily the gingiva in an 86-year-old woman is reported. The neoplasm was strongly positive for factor VIII-related antigen, negative for cytokeratins, and positive for vimentin, confirming the vascular nature of the tumor. The patient died from heart failure 1 month after surgical excision of the lesion without clinical evidence of metastasis.

Penile cancer. Aspiration biopsy cytology for staging

Appropriate management and prognosis of patients with penile carcinoma depends on an accurate knowledge of the regional node status. The usefulness of clinical and radiologic examinations in detecting the nodal spread of the disease is limited by the high rates of false-positive and false-negative results. On the other hand, routine or prophylactic lymphadenectomy is associated with 30% to 50% of the major morbidity and 3% of the mortality rate, so that caution is advisable for its use in patients with disease-free nodes. Even bilateral sentinel lymph node biopsy, as proposed by Cabanas, does not warrant an adequate selection of patients candidates to surgical treatment. The role of aspiration biopsy cytology in the management of penile carcinoma was evaluated in a study of 29 cases from the authors' institutions. Aspiration under fluoroscopic or computed tomographic guidance was performed using a 22-23-gauge Chiba needle. The accuracy of aspiration biopsy cytology in identifying the true stage of the disease was 100%. On histologic control, only one node contained malignant cells that were not detected by aspiration biopsy cytology, but this finding did not alter the stage of the patient. Positive cytology is conclusive of Stage III disease and, in this case, a curative lymphadenectomy may be attempted. Negative aspirations do not warrant the absence of metastatic nodal involvement as can be seen in two patients in this series. In such cases, however, a policy of "wait and watch" may be adopted, with repeated aspiration biopsies or surgical biopsy of the sentinel node area.

[Early diagnosis of cutaneous melanoma and its precursors. Importance of the clinical characteristics of thin melanoma]

The diagnosis and removal of precursor and early lesions is the only method to improve the prognosis and survival rate in malignant melanomas of the skin since the aetiology of the disease is unknown and treatment ineffective when the neoplasm is diagnosed at an advanced stage. A campaign for the prevention and early diagnosis of melanoma is based on the health education of the entire population with the distribution of illustrative material that by teaching people to examine their skin will show up suspicious pigmentary lesions that can be examined and removed by the dermatologist. Thin melanoma is always curable when removed and constitutes the basic tumour to be described to the public as it is easily identified and has constant, typical features. Among the precursors the most interesting lesions is the sporadic or familial dysplastic nevus despite the controversy over its pathogenic significance and morphological aspect. The other pigmentary neoplasias (congenital and acquired nevus) only must to be removed when they present changes resembling thin melanoma.

The value of aspiration cytology in the definitive staging of bladder carcinoma

Aspiration cytology is a simple, accurate and minimally invasive procedure in staging urological neoplasms. Percutaneous fluoroscopy-guided fine needle aspiration biopsy of 99 lymph nodes was performed in 30 patients with bladder carcinoma and 62 lymph node chains were evaluated. Aspiration biopsy is more accurate and specific than lymphography in the pre-operative staging of the neoplasm and represents a useful diagnostic procedure for the staging of bladder carcinoma.

Malignant schwannoma of the submandibular gland. A case report

The first case of malignant schwannoma of the submandibular gland in a 23-year-old man with neurofibromatosis is reported. Light microscopy showed typical features of neurogenic sarcoma and an immunocytochemical study confirmed the schwannian differentiation of the neoplasm. The patient is still well without evidence of metastases or local recurrence of the tumor 80 months after the excision of the neoplasm.

Spindle-cell squamous carcinoma of head and neck region: a clinicopathologic and immunohistochemical study of eight cases

Spindle cell squamous carcinoma is a highly malignant neoplasm, characterized by a biphasic appearance, due to the presence of a diffuse proliferative pattern of pleomorphic spindle cells with extremely rare foci of conventional squamous cell carcinoma. Epithelial markers in eight cases of spindle-cell squamous carcinoma of the head and neck region were studied by immunocytochemistry. Epithelial membrane antigen and cytokeratin resulted strongly positive in the spindle cells of the sarcoma-like areas demonstrating the epithelial nature of the neoplasm. In 6 of our patients who later died from widespread metastases, the neoplasm had poor prognosis with a mean survival rate of 14.7 months.

Adenomatoid tumor of the epididymis: immunohistochemical study of 8 cases

The immunohistochemical characteristics of 8 adenomatoid tumors of the epididymis are reported. Using the peroxidase antiperoxidase technique and the avidin-biotin complex method, antibodies against carcinoembryonic antigen, factor-VIII-related antigen and keratin were tested. In agreement with previous findings strong cytoplasmic staining for keratin was seen in all the tumors, whereas the factor-VIII-related antigen and carcinoembryonic antigen were absent. These results suggest a mesothelial origin of the adenomatoid tumor.

Urine cytology in the detection of renal adenocarcinoma

Whereas urine cytology has proved to be of considerable diagnostic value for nonpapillary urothelial carcinoma, carcinoma in situ, and high-grade urothelial tumors, controversy has arisen over the accuracy of cytology in the diagnosis of renal neoplasms. To establish the reliability of urine cytology as a detection technique, 436 urine specimens from 59 patients with histologically proven renal adenocarcinoma were examined. Malignant cells in urinary sediment were found in 121 (27.75%) specimens from 31 (52.54%) patients. Seven of 20 (35%) patients with Stage I tumor showed neoplastic cells in 16 (16.5%) of 97 urinary samples. Positive cytologic features were found in 36.9% of 84 urinary specimens from 7 (50%) of 14 patients with tumors smaller than 5 cm. Using only imaging methods, the renal neoplasm was diagnosed in 58 (98.3%) cases. Urine cytology is, therefore, of little value in the diagnostic evaluation of known renal masses and in the detection of early-stage disease. In the current series there was not a single case with positive cytologic findings in which radiology did not reveal the tumor. The cytologic examination of the urinary sediment is unreliable in the diagnosis of radiologically unresolved cases of renal neoplasms. In 15 patients (44%) who had cancer cells in the urine the neoplasm had not invaded the renal pelvis. In 36% of patients with negative urine cytologic findings the renal pelvis was involved by renal adenocarcinoma. In the current study the desquamation of neoplastic cells in the urinary stream did not depend on tumor invasion of the renal pelvis. Based on the assumption that the primary objective of a screening procedure is to achieve an adequate sensitivity for early detection of disease, the results led the authors to conclude that the use of urine cytology as a possible screening test of renal adenocarcinoma is futile. Factors in the current study that diminished the practical value of cytologic examination of urinary sediment included the large number of specimens without malignant cells and the insensitivity of the procedure in diagnosing early renal adenocarcinoma of limited extent. Although this is the largest series reported, the number of cases considered was limited and further detailed studies are mandatory to definitively clarify the value of urine cytology in detecting renal adenocarcinoma.

Primary osteosarcoma of the uterine corpus. Report of a case and critical review of the literature

Uterine osteosarcoma represents an extremely rare pure heterologous sarcoma of the uterus. In the present case osteosarcoma occurred primarily in the uterine cavity of a 56-year-old woman. The tumor was anaplastic and the presence of different proliferative patterns caused differential diagnostic problems with various malignant tumor types. The osteoid features of extracellular matrix were demonstrated by electron microscopy. Clinical and pathological features of previously reported cases of uterine osteosarcoma are critically reviewed.

Aspiration cytology in the staging of urologic cancer

Knowledge of the status of the pelvic lymph nodes is vital for accurate staging and adequate treatment of patients with urologic cancer. Noninvasive techniques for assessing the lymphatic spread of urologic neoplasms have proved to be of limited value. Bipedal lymphangiography and percutaneous fine needle aspiration cytology under fluoroscopic guidance were performed for staging purposes in 71 patients with clinically localized bladder, prostatic and penile cancer from 257 nodal chains. The overall diagnostic accuracy was 93% and the correct aspiration of 186 lymph nodes was surgically confirmed. There were 11 (6%) false-negative biopsy results and no false-positive diagnoses. Aspiration cytology is a safe, well tolerated, accurate, and rapid method of determining the presence of metastatic disease in lymphangiographically visualized pelvic nodes. In the management of prostatic carcinoma, positive cytologic results are diagnostic of nodal metastatic involvement and spare the patients unnecessary surgical staging. Negative cytologic findings may be considered diagnostic of localized disease in the patients with well differentiated prostatic carcinoma (2-4 Gleason's sum). Since most surgeons are reluctant to perform a staging lymphadenectomy in the management of invasive bladder carcinoma, aspiration cytology can provide accurate staging, thus permitting an appropriate treatment plan. In patients with carcinoma of the penis, a positive aspirate permits an early and even curative lymphadenectomy in cases with clinically negative but pathologically positive nodes.

Aspiration cytology of simultaneous bilateral adrenal metastases from renal cell carcinoma. A case report and review of the literature

We report the computerized tomography and ultrasound-guided aspiration cytology results in the first case of renal cell carcinoma with bilateral adrenal involvement. The adrenal metastases were evident clinically 6 years after radical nephrectomy and were treated successfully by an operation. Aspiration cytology under computerized tomographic and sonographic guidance is an excellent procedure to evaluate enlarged adrenal glands in patients with renal cell carcinoma or other malignant neoplasms.

Fine needle aspiration biopsy in the evaluation of lymphoreticular tumors of the thorax

The role of fine needle aspiration (FNA) biopsy in the evaluation of lymphoreticular disorders involving the lung and mediastinum was evaluated in a study of 16 cases from the authors' institutions. The cytologic material from these cases was reviewed, and the original cytologic interpretations were compared to the tissue diagnoses, with the overall accuracy of the cytologic interpretation evaluated. There were no false-positive diagnoses of malignancy in this series. A definite diagnosis of malignant lymphoma was most readily made in those cases in which the lymphoma was of the large-cell type. Small-cell and mixed large-cell and small-cell lymphoid proliferations were less able to be definitively interpreted, with pseudolymphoma presenting particular difficulty. The results support the conclusion that FNA biopsy can be useful in evaluating these lesions but also emphasize the fact that accurate diagnosis requires correlation of cytologic, clinical and laboratory data.

Experience with modified Chiba needle in staging of genitourinary tumors

The features of a new needle used in the percutaneous pelvic node fine-needle aspiration biopsy in 56 patients with urologic neoplasms are described. The side openings on either side of the needle walls and the bevel angle lowered to 15 degrees provide excellent penetration and aspiration ability. Representative specimens were obtained from all patients, and the accuracy of aspiration biopsy results in determining true stage of disease was 94.64 per cent. These data provided sufficient evidence of the efficiency of our needle to recommend it for use in TNM classifications of urologic tumors.

The role of etretinate (Tegison; Tigason) in the management of keratoacanthoma

Four patients with keratoacanthomas 2 to 3 cm in size were treated with etretinate. All the patients demonstrated early response and complete regression of the lesions. Follow-up (of 24 months in one case) did not reveal any recurrence.

Urinary cytology of tuberculosis of the bladder

The cytologic findings in the urinary sediment of 13 patients with tuberculosis (TB) of the bladder were compared with the histologic findings. TB was cytologically recognized in 11 patients because of the presence of epithelioid and/or Langhans' giant cells. The morphologic deviations of the urothelial cells and the urothelium were classified according to the criteria of Koss. The type I atypical urothelial cells found in ten patients were correlated to the urothelial hyperplasia found at histology; the follow-up data documented the benign reversible nature of the urothelial hyperplasia as the focal expression of the reactive potential of urothelium to various forms of inflammatory processes. The presence of type II atypical urothelial cells reflected moderate and severe atypia of the urothelium at biopsy. In order to assess the reactive, reversible or precancerous nature of these forms of atypia associated with TB, an accurate follow-up is necessary. Since TB of the bladder may cause the presence of atypical cells in the urine, this lesion is of special interest in the differential diagnosis between inflammatory processes and carcinoma.

Role of percutaneous pelvic node aspiration cytology in the management of bladder carcinoma

Six of the 23 patients with bladder carcinoma who underwent percutaneous pelvic node aspiration biopsy cytology for staging purposes showed positive findings from nodal chains. Pelvic lymphadenectomy revealed no false-positive or false-negative cytologic results. The fine needle aspiration of opacified pelvic nodes under fluoroscopic control is of great diagnostic value, with a high accuracy in detecting nodal extension of bladder carcinoma and providing a rational basis for proper therapy. Positive aspiration results may be accepted as a basis for therapeutic decisions. Since the metastatic involvement of multiple nodes makes any therapeutic treatment as well as cystectomy completely useless, positive aspirations from more than two nodes may spare patients an unnecessary radical surgery.

Comparative study of lymphography and aspiration cytology in the staging of prostatic carcinoma. Report of 35 cases with histological control and review of the literature

Accurate staging of prostatic carcinoma is essential in determining the prognosis and establishing the most adequate therapy of the disease. Lymphography is the most widely used method in staging prostatic carcinoma but shows false-positive rates varying up to 58% and false-negative rates varying from 11 to 66%. Aspiration biopsy was proposed to enhance the reliability of lymphography. In our study we performed transcutaneous aspiration biopsy of the pelvic nodal chains in 35 patients with clinically localized prostatic carcinoma using a long-beveled side-holed modified Chiba needle. 124 nodal chains were punctured and malignant cells were found in 26 aspiration biopsies of 15 patients. In determining the true stage of the disease, aspiration cytology and lymphography showed accuracy of 91 versus 57%; sensitivity of 83 versus 67% and specificity of 100 versus 47%, respectively. Positive cytologic findings are conclusive for stage D disease, while negative cytology may be accepted as definitive only when the neoplasm is well differentiated or the Gleason sum is 2-3-4. Combined use of lymphography and aspiration cytology permits surgical staging to be limited to those patients with undifferentiated neoplasm, intermediate or high Gleason sum (5-10) and negative cytology.