Levels of nitric oxide, gamma interferon and interleukin-12 in AIDS patients with toxoplasmic encephalitis

The production of nitric oxide (NO) by macrophages is important for the killing of intracellular pathogens, such as Toxoplasma gondii. Gamma interferon (IFN-gamma) and lipopolysaccharide stimulate NO production. The aim of this study was to investigate the importance of NO, IFN-gamma and interleukin-12 (IL-12) in the host immune response in AIDS patients suffering from toxoplasmic encephalitis (TE). It was demonstrated that the production of NO, detected as nitrite/nitrate in the sera and in the cerebrospinal fluid (CSF) of 32 AIDS patients with TE, was normal. In addition, levels of IFN-gamma in the sera and in the CSF of patients with TE were not increased. In contrast, serum levels of IL-12 in these patients were significantly increased (6.5 +/- 7.1 pg/ml; P = 0.0368), compared to the control patients (1.7 +/- 3.5 pg/ml). Furthermore, increased but not significant levels of IL-12 were also observed in the CSF of patients with TE (2.2 +/- 4.7 pg/ml; controls: 0.5 +/- 1.9 pg/ml). The results of this study indicate that reactivation or recurrence of T. gondii infection in HIV-1-infected patients is probably due to a down-regulation of IFN-gamma along with a resulting non-optimal NO activity.

Prognostic factors of outcome after radical cystectomy for bladder cancer: a retrospective study of a homogeneous patient cohort

PURPOSE

Pathological predictors of outcome for patients undergoing radical cystectomy for bladder cancer are needed as few data are available in the literature. We retrospectively analyzed a homogeneous and contemporary series of patients treated with radical surgery as monotherapy for bladder cancer to identify the independent predictors of survival.

MATERIALS AND METHODS

We evaluated 369 of 535 patients with bladder cancer treated with radical cystectomy, pelvic node dissection and urinary diversion by the same staff at a single institution between February 1982 and February 1994. Patients treated with radiation therapy and/or chemotherapy, and those who did not undergo formal pelvic node dissection were excluded from study. The end point of univariate and multivariate analyses was the overall 5-year survival.

RESULTS

Univariate analysis revealed that tumor stage, nodal involvement, ureteral obstruction, and vascular, lymphatic and perineural invasion were prognostic predictors of survival (p <0.05). However, only tumor stage (p <0.0000) and nodal involvement (p <0.0000) were independent prognostic variables of survival on multivariate analysis.

CONCLUSIONS

Tumor stage and nodal involvement are the only independent predictors of survival to be used to select the optimal therapy after radical cystectomy, stratify patients in controlled trials and evaluate new prognostic factors.

Multicenter trial of the quantitative BTA TRAK assay in the detection of bladder cancer

BACKGROUND

Human complement factor H-related protein (hCFHrp) is produced by several bladder cancer cell lines and may be useful as a cancer marker. The aim of this study was to compare urinary hCFHrp and cytology for the detection of bladder cancer found by cystoscopy in patients with suggestive signs, symptoms, or preliminary test results.

METHODS

The BTA TRAK assay, a quantitative enzyme immunoassay for the bladder tumor-associated antigen in urine, was compared with exfoliative cytology in 220 patients (155 men, 65 women; mean age, 64.2 years) presenting with signs, symptoms, or preliminary diagnostic results suggestive of this disease. Cystoscopy was the standard of detection.

RESULTS

In the 100 patients found to have bladder cancer, the overall sensitivities of the BTA TRAK assay (at a previously determined decision threshold of 14 kilounits/L) and cytology were 66% (66 of 100) and 33% (33 of 100), respectively (P <0.001). The BTA TRAK assay proved to be statistically more sensitive than cytology for tumor grades I and II and for stage Ta and T1 tumors. In contrast, the overall specificity of the BTA TRAK assay in the 120 patients without cystoscopically confirmed bladder cancer was 69% (83 of 120) and that of cytology was 99% (119 of 120; P <0.001). The specificity of the BTA TRAK assay was higher in patients without benign or malignant genitourinary disease other than bladder cancer (76%; n = 89) than in patients with these conditions. When the BTA TRAK assay and cytology were used together such that a positive result in either test was scored as positive and the results compared with those of the BTA TRAK assay alone, increases in overall sensitivity and equivalent specificity were observed.

CONCLUSION

Because of its relatively high sensitivity, the BTA TRAK assay could complement cytology as an adjunct to cystoscopy in the diagnosis and follow-up of most patients with bladder cancer.

Comparison of the BTA stat test with voided urine cytology and bladder wash cytology in the diagnosis and monitoring of bladder cancer

OBJECTIVE

To compare the BTA stat test (BTA stat), a new one-step immunochromatographic assay that can be performed in the urologist's office or in the laboratory, to voided urine cytology and bladder wash cytology (cytology) in the diagnosis and monitoring of cancer of the bladder (BC).

METHODS

BTA stat and cytology were performed in a double-blinded, prospective, clinical study on specimens from 240 subjects (68 females; mean age of subjects: 64 years) suspected of having BC.

RESULTS

In 107 subjects with final diagnoses of BC confirmed by cystoscopy or cystoscopy and biopsy, the overall sensitivities of BTA stat and cytology were 65 and 33%, respectively. For tumor grades I, II, and III, the sensitivities of BTA stat were 39, 67 and 83%, respectively. Those of cytology were 4, 20 and 69%. Nine subjects had a diagnosis of 'suspicious for bladder cancer'. The specificities of BTA stat and cytology in the 124 subjects without BC were 64 and 99%, respectively. In the subjects with a history of BC (n = 74), the specificities of BTA stat and cytology were 72 and 99%, respectively. The specificity of BTA stat was lower in subjects with benign or malignant genitourinary disease other than BC (46%) than in subjects without genitourinary disease (71%).

CONCLUSIONS

The BTA stat test is considerably more sensitive than cytology in the detection of BC and can replace cytology as an adjunct to cystoscopy in the diagnosis and follow-up of patients with BC. However, due to low specificity, BTA stat should not be used without first ruling out potential interferences such as infections, renal disease and cancer, or genitourinary trauma.

Thin-section CT follow-up of metastatic ovarian carcinoma correlation with levels of CA-125 marker and clinical history

Second-look laparotomy and CA-125 are the gold standard in follow-up of ovarian carcinoma. Since no definite role seems established for cross-sectional imaging in assessment of recurrence we employed thin-section computed tomography (CT), correlated with CA-125 levels and detailed knowledge of the clinical history as a follow-up protocol One hundred seventy-seven patients with ovarian carcinoma were selected because of: (a) pathologically proven remission after first-line chemotherapy, (b) follow-up by means of thin-section CT every 6 months for the fist 3 years and every 10 months subsequently, (c) monitoring CA-125 serum levels every 3 months for the first 3 years and every 6 months subsequently; (d) pathologic confirmation or clinical and laboratory follow-up after 12 months or longer for the CT findings. Fifty percent of the patients showed recurrence of disease. Our protocol yielded 93.2% true positive, dubious findings in 5.6% 1.0% false negatives, 97.7% true negative, and 2.3% false positive. With a tailored technique, CT was particularly sensitive in early diagnosis of peritoneal seeding, even in the absence of ascites or increases in the levels of CA-125. Repeated administration of contrast medium, water enemas, and repeated scanning of suspicious volumes with differing scanning parameters were the factors managed by the radiologist. We conclude that thin-section CT, correlated with CA-125 levels and careful review of the clinical history could represent a valid alternative to repeated explorative laparotomies in the follow-up of ovarian carcinomas.

[Pulmonary iatrogenic lesions in chemotherapy: computerized tomography findings]

PURPOSE

To analyze the lung damage caused by anticancer drug toxicity comparing the pathologic mechanisms, histopathologic response and CT features.

MATERIAL AND METHODS

Twenty-one patients (15 men and 6 women aged 21-75 years, mean: 41) were selected from the cancer patients treated with chemotherapy 1990 to 1997 (1400 lung examinations in all). The primary tumors consisted of: 6 testicular, 2 ovarian, 2 breast and 1 renal cancers; 3 non-Hodgkin lymphomas; 1 acute myeloid and 1 chronic lymphatic leukemia; 1 melanoma, 1 uterine leiomyosarcoma, 1 liposarcoma, 1 osteosarcoma and 1 head and neck carcinoma. All the patients underwent a CT examination with contiguous 8-10 mm slices and thin (4-5 mm) detail slices or with the high resolution technique. All the cases had clinical, laboratory and pathologic confirmation of the drug-related lung damage.

RESULTS

Four alveolar opacities, 11 interstitial opacities, 2 solitary and 4 multiple nodular lesions were demonstrated. Bleomycin was the most toxic drug in 14/21 cases, the total dose always exceeding 450 mg. Methotrexate followed and then cytosine-arabinoside (both 2/21). Bleomycin was responsible for all nodular lesions, cytosine-arabinoside and interleukin-2 for pulmonary edema. After drug discontinuation and appropriate treatment in 14 cases, we found favourable evolution with restitutio ad integrum (9 cases) or CT findings of clear improvement (5 cases); fibrosis progressed in 6 cases and one patient died.

CONCLUSIONS

CT provides important information for the diagnosis of drug-induced lung damage. Despite the nonspecific patterns of the lesions, CT can demonstrate the early, and thus potentially reversible, stages of lung damage. CT is also very helpful in monitoring the onset, resolution, or progression of fibrosis.

[Ovarian lymphoma. Findings with ultrasonography, computerized tomography and magnetic resonance]

PURPOSE

Lymphomatous ovarian involvement is an uncommon event, both for primary and systemic lymphoma. It presents different diagnostic and therapeutic implications from the more common ovarian epithelial cancer. We investigated the role of imaging techniques in the diagnosis of these lesions.

MATERIAL AND METHODS

Eight patients, aged 13 to 70 years (mean: 47) were selected from all the CT examinations performed from 1986 to 1996 to assess the most typical imaging patterns. All the patients underwent a CT examination, with contiguous 8 or 10 mm thick slices and thin (4-5 mm) detailing slices; iodinated contrast agents were administered in 6 cases. Six patients were also examined with sonography (US). Lastly, 3 patients underwent a MR examination, 2 of them with paramagnetic contrast agent.

RESULTS

All the patients were affected with non-Hodgkin lymphoma (6 diffuse lymphomas--1 lymphoplasmocytoid, 2 Burkitt, 1 large cells, 1 large and oat cells, 1 immunoblastic large cells, 2 follicular large cells lymphomas). Two patients had primary lesions and the other 6 had a systemic lymphoma; ovarian involvement was bilateral in 6 cases. The lesion size always exceeded 5 cm. Ascitis was present in only one case. The US patterns of the lesions were aspecific, homogeneous and hypoechoic; color Doppler US showed mild vascularization. CT showed clear-cut lesions, hypodense and with mild contrast enhancement in all cases. Spin-echo MRI showed homogeneous masses which were moderately hypointense on T1-weighted images and slightly hyperintense on T2-weighted images. Gd-T1-weighted images showed mild enhancement.

DISCUSSION

The differential diagnosis of ovarian primary lymphoma is usually made with ovarian epithelial neoplasms, which normally have a complex structure with cystic or necrotic areas and solid components usually enhancing after contrast agent administration. Also sarcomas and, in children, neuroblastomas usually have an inhomogeneous structure. In ovarian involvement with systemic lymphoma the concrurrent finding of adenopathy can help the diagnosis.

CONCLUSIONS

Despite the absence of typical imaging patterns, we emphasize the importance of considering ovarian lymphoma in the differential diagnosis of ovarian cancers, especially if bilateral and homogeneous, without ascitis. These findings, uncommon in ovarian epithelial tumors, can help to make the correct diagnosis.

US and CT findings of secondary neoplasms of the thyroid--a pictorial essay

Although clinical series report a low (3%) incidence of metastases to the thyroid gland, autoptic studies have showed occurrences as high as 17%, probably because of the high vascularization of the thyroid. We selected 9 patients who had pathologically proven thyroid metastases at CT and US, during follow-up for a known primary neoplasm. The most common originating neoplastic primaries include mostly those that generally give rise to blood-borne metastases such as breast and lung cancers, mucoid adenocarcinoma of the stomach, colon cancer and renal cancer, as well as melanoma and leiomyosarcoma. Because of its diffusion, sensitivity, and noninvasiveness, ultrasonography can justifiably be introduced in the staging protocols of those neoplasm that more frequently give blood-borne metastases to the thyroid, but a US-guided biopsy is warranted for hypoechoic or otherwise suspicious nodules. This holds particularly true in disease-free patients or previously diagnosed with generally slow-growing malignancies (breast or kidney), since the secondary localization, often metachronous in our experience, may be effectively managed surgically. CT features, on the other hand, are extremely variable and are directly dependent on the histology of the primary lesion, as well as the size of the secondary lesions.

Structural and ultrastructural changes in ileal neobladder mucosa: a 7-year follow-up

OBJECTIVE

To investigate the long-term morphological changes in the intestinal segment used to create an orthotopic ileal neobladder.

MATERIALS AND METHODS

Periodic endoscopy with biopsy of the ileal mucosa was performed in 90 patients 3-84 months after radical cystectomy and urinary diversion via an orthotopic neobladder. Three cold-cup biopsies were taken from each patient and mucosal specimens processed for light and electronic microscopy.

RESULTS

Early changes (up to 1 year after surgery) comprised a marked shortening of the villi with loss of microvilli. After 4 years, the prevalent finding was of flat, avillous epithelium that tended to stratify in some areas. The avillous areas were mixed with islets of villous mucosa. There was no dysplasia or malignancy in any of the 90 patients.

CONCLUSIONS

Prolonged contact with urine elicited a biphasic response in the ileal mucosa, i.e. an early inflammatory phase, ascribed to the noxious action of urine, followed by a regressive phase in which the epithelium tended to assume a morphology similar to the urothelium. The atrophic changes were almost totally completed after 4 years, although areas with marked modifications alternated with others where the morphology was normal, even many years after surgery. Late changes in the ileal neobladder mucosa appear to be an expression of a functional adaptation of the mucosa to the new environment.

[Vesica ileale Padovana (VIP): surgical technique, long-term functional evaluation, complications and management]

OBJECTIVE

An original technique for complete bladder replacement using an ileal segment--the VIP pouch--is described. The long-term functional results and early and late complications are presented.

METHODS

The records of 209 VIPs performed following radical cystectomy for invasive bladder cancer from 1987 through 1995 were reviewed. Follow-up ranged from 6 to 87 months (mean: 24 mo.); the age of the patients ranged from 35 to 76 years (mean: 59.6 yrs.).

RESULTS

188 patients with a follow-up of at least 6 months have been evaluated. There was 1 postoperative death from massive pulmonary embolism, 23 pts. died from tumor progression and 4 are still alive with metastases. Early complications were observed in 10.5% of the pts., comprising 9 cases of prolonged ileus (5 functional and 4 obstructive), 3 pelvic hematomas, 2 deep venous thrombosis and 2 fistulas between the enteric anastomosis and the VIP pouch. Late complications were observed in 39.5%, in particular, 28 uretero-ileal stenosis (15%), 21 urethro-ileal stenosis (11%) and 15 laparoceles (8%). Clinically relevant metabolic disturbance has not been observed. Complete daytime continence was achieved in more than 90% of the cases and night-time continence was observed in 75% of the patients. The mean VIP manometric capacity was around 400 ml with low pressure during reservoir emptying; 39 patients (20%), showed voiding problems with a mean postmicturition residual of 150 ml (3 pts. require clean intermittent self-catheterization).

CONCLUSIONS

VIP offers a simple and easy-to-perform surgical technique to provide a good capacity, low pressure, non refluxing reservoir employing only a 40 cm. ileal segment. The clinical and urodynamic results are good and offer high quality of life to patients undergoing cystectomy. The overall rate of late complications is fairly high, although conservative management is effective in most cases.

Pancreatic metastases: CT assessment

We report the CT appearance of pancreatic metastases and describe their features in relation to the originating primary tumor. We also discuss some limitations in their differential diagnosis and report some theories explaining the pathogenesis of their occurrence. A total of 20 cases (9 males and 11 females) of pancreatic metastases were diagnosed at staging or follow-up of oncologic patients. All patients were evaluated with CT before and after contrast medium administration and had subsequent pathologic confirmation. In 1 case metastases were located solely in the pancreas; in 6 there was only another metastatic location, and in the remaining 13 there was diffuse spread throughout the body. Two of our patients exhibited a multinodular metastatic involvement of the pancreas, 11 had a solitary nodule or mass, and the remaining 7 had a diffusely enlarged pancreas, without any signs of focal disease. All but one of the solitary lesions measured more than 4 cm. In 2 cases a metachronous malignancy was detected at follow-up. Primary malignancies were located: 6 in the lungs, 2 on the skin (melanomas), 3 in breasts, 2 in the ovaries, 3 in the colon, 1 in the stomach, 2 in the kidney, and 1 the thyroid. Our findings confirm the existence of three patterns of metastatization to the pancreas: large solitary masses, multinodular lesions, and diffuse enlargement of the pancreas without focal signs at CT. In contrast to other studies, the large solitary lesion was our most frequent encounter, therefore making differential diagnosis vs primary cancer difficult. Metastases tended to repeat the imaging pattern of the primary. Nevertheless, we wrongly diagnosed pancreatitis due to a small nondetected metastasis, pseudo-cystic mass as a mucinous cystadenocarcinoma, conglomerate of peripancreatic lymph nodes, and a solitary pancreatic mass diagnosed as primary pancreatic cancer. Thus, when faced with a solitary pancreatic lesion at follow-up, histologic diagnosis is strongly recommended. In 2 cases changes in aspect and size were related to therapy.

Laparoscopy in the diagnosis and treatment of cryptorchidism

Laparoscopy plays an outstanding role in the diagnosis of non palpable testis. Laparoscopy is as accurate as surgical exploration but, compared with the latter, is less invasive and faster; moreover in cases of testicular absence it makes surgery unnecessary. Concerning laparoscopic surgery in the case of abdominal testis, orchiectomy is an easy procedure which prolongs diagnostic laparoscopy for only a short time. It is indicated in pediatric patients with hypoplasic testis. In adult patients, except for cases of monorchidism and bilateral abdominal testis, orchiectomy is always recommended. At present laparoscopic orchiopexy does not seem to offer sure advantages compared to traditional surgery.

[AIDS-related neoplasms: a clinico-radiological study]

Although high-grade non-Hodgkin's lymphoma (NHL) and an unusually aggressive form of Kaposi's sarcoma (KS) remain the most common malignancies seen in AIDS patients, other tumors such as cervical cancer, Hodgkin's disease and others, have been increasingly observed, probably because these patients now live longer. We report the imaging findings of 80 AIDS patients with pathologically confirmed neoplasms from a series of 340 AIDS patients examined 1986-1994. Twenty-four of 80 patients had NHL, 4 Hodgkin's disease, 31 KS, 4 cervical cancer, 2 leukemia, 2 testicular, 1 larynx, 2 lung, 2 breast, 1 esophagus, 1 stomach, 1 liver, 2 kidney and 3 adrenal carcinomas. Twenty of 24 NHLs exhibited extranodal involvement--to the liver (13/24), brain (9/24), lung (7/24) and gastrointestinal tract (6/24). Visceral KS involved the gastrointestinal tract (6/32), lung (4/32) and liver (2/32). The most accredited pathogenetic theories concerning the role of HIV infection in oncogenesis advocate the effect of multiple growth factors produced by HIV-infected lymphocytes (KS) or the disregulation of B-cells caused by T-cell destruction (NHL). The atypical morphostructural features of AIDS-related tumors are discussed--e.g., atypical presentation, occurrence in younger individuals, aggressive clinical course and poor response to conventional therapy--together with the differential diagnostic problems, especially vs. opportunistic infections.

Topical chemo-immunotherapy in upper urinary tract transitional cell carcinomas

— Intracavitary chemo or immunotherapy for upper urinary tract transitional cell carcinomas has been recently introduced. From published data, Bacillus Calmette-Guerin appears to give significant and durable response rates (70% as prophylaxis, 81% as therapy) with acceptable side effects. The anecdotal use of chemotherapeutical agents prevents any conclusion being made about the therapeutical impact. To date, intracavitary percutaneous Bacillus Calmette-Guerin treatment is suggested for patients with “in situ” or occult carcinoma of the upper urinary tract, bilateral and synchronous tumors and/or with severe renal failure or not suitable for radical surgery.

Is stage pT4a (D1) reliable in assessing transitional cell carcinoma involvement of the prostate in patients with a concurrent bladder cancer? A necessary distinction for contiguous or noncontiguous involvement

PURPOSE

A series of patients with concurrent transitional cell carcinoma involvement of the prostate and bladder is reviewed to define the impact of prostate involvement pathways and the degree of prostate invasion on survival rate.

MATERIALS AND METHODS

A total of 72 patients who underwent radical cystectomy for pathological stage pT4a (D1) cancer was divided into contiguous--stage pT4a, transitional cell carcinoma of the bladder extended into the prostate through the bladder wall and noncontiguous--stage pT4a simultaneous transitional cell carcinoma of the prostate and bladder carcinoma that did not directly infiltrate into the prostate through the bladder wall. In the latter group the degree of prostate invasion was classified as urethral mucosal involvement, ductal/acinar involvement, stromal invasion and extracapsular extension. The survival rate was estimated by the Kaplan-Meier and Cox proportional hazards methods. Comparisons between curves were performed by univariate log rank and multivariate L-ratio tests.

RESULTS

The overall 5-year survival rate for stage pT4a was 21.5% (median followup 64 months). Furthermore, 46% and 7% of patients in noncontiguous and contiguous pT4a groups, respectively, were estimated to be alive (p < 0.000). Those with positive nodes experienced a poor outcome in both groups. Of patients with noncontiguous pT4a stage 100% with urethral mucosal involvement, 50% with ductal/acinar involvement and 40% with stromal invasion were estimated to be alive. The major prognostic factors were bladder tumor stage, nodal involvement and degree of prostate invasion.

CONCLUSIONS

The invasion pathways of the prostate in patients with transitional cell bladder carcinoma have a statistically significant prognostic role. Contiguous and noncontiguous involvements are 2 distinct clinicopathological features and they should not be included in the same stage. In the noncontiguous stage pT4a group bladder and prostate transitional cell carcinoma should be separately staged, and prostate involvement also should be staged according to invasion degree.

Characteristics of hybrid modes in proton-exchanged lithium niobate waveguides

A rigorous numerical model, verified by experimental results, gives an explanation of the particular electromagnetic behaviors observed in x-cut proton-exchanged lithium niobate waveguides. This approach, which allows an exact calculation of the weights of the coupled ordinary and extraordinarywaves that make up the hybrid modes, provides deeper insight into the study of the strains induced by the proton-exchange process in the waveguide itself, showing that the optical axis of the exchanged layer is not parallel to the waveguide plane.

AIDS-related Burkitt's lymphoma. Morphologic and immunophenotypic study of biopsy specimens

In patients infected with HIV, high-grade B-cell non-Hodgkin's lymphomas (NHL), including the small noncleaved cell (SNCC) category, exhibit pleomorphic features, which makes precise definition difficult. Sixty-nine pathologic specimens with HIV-related systemic lymphomas, including 42 SNCC, 20 immunoblastic lymphomas (IBL), and 7 cases with features "intermediate" between SNCC and IBL were morphologically and immunophenotypically investigated. The host immune status was also analyzed in 57 of 69 patients. In 29 representative SNCC lymphomas, in 9 IBL cases, and an additional 3 intermediate lymphomas, both p53 protein overexpression and the association of Epstein-Barr virus (EBV) genetic information were assessed. Small noncleaved cell lymphomas included tumors exhibiting features of the 2 established subtypes (27 Burkitt's and 15 non-Burkitt's). In the seven intermediate cases, cells showed features intermediate between SNCC with plasmablastic differentiation and immunoblasts plasmacytoid. Immunoblast-like cells were also present. p53 protein overexpression and EBV association were found in a proportion of SNCC (14 of 29; 7 of 29) and intermediate (3 of 3; 2 of 3) lymphomas. Conversely, IBL cases were consistently p53 negative, but showed a high EBV association (7 of 9). All the evaluated patients with intermediate lymphomas had a considerably lower mean (76.6 per mm3 +/- 77.4 SD) and median (54 per mm3) number of CD4+ lymphocyte count than SNCC patients (mean 227.9 per mm3 +/- 186.9 SD, median 193 per mm3), thus mirroring IBL patients (mean 95.3 per mm3 +/- 82.8 SD, median 81 per mm3). All data provide evidence that lymphomas showing intermediate features constitute a distinct subgroup from either SNCC or IBL.

KP1/CD68 expression in malignant neoplasms including lymphomas, sarcomas, and carcinomas

Expression of KP1/CD68 macrophage-associated antigen in a series of 840 selected malignant neoplasms, including immunomorphologically characterized cases of non-Hodgkin's lymphoma (NHL) (434), Hodgkin's disease (HD) (115), soft tissue sarcoma (147), carcinoma (49), and other tumors (95), was examined. KP1 expression was detected in a significant number of NHLs (107 of 434; 24.7%), most of them (65 of 107; 60.7%) of the diffuse small cell subtype. Only 14 of the 155 large cell lymphomas, compared to 10 of the 51 Ki-1/CD30+ anaplastic large cell (ALC) lymphomas examined, were KP1 positive. Conversely, none of the T-lineage NHL--other than Ki-1/CD30+ ALC lymphomas--or the HD cases tested was labeled by KP1 antibody. Among the other neoplasms tested, KP1 was reactive with a variable proportion of cases of malignant fibrous histiocytoma (19 of 24; 79.2%), malignant schwannoma (8 of 22; 36.4%), liposarcoma (3 of 9; 33.3%), leiomyosarcoma (8 of 37; 21.6%), cutaneous or metastatic melanoma (51 of 73; 69.9%), and renal cell carcinoma (3 of 5; 60%). These results indicate that KP1 shows a relatively wide spectrum of immunoreactivity with malignant neoplasms of presumed non-histiocyte origin, thus arguing against its expected specificity and high value in diagnostic pathology. Although the significance of KP1 expression by some subsets of NHLs remains to be elucidated, its close association with B-cell NHLs, mostly of the diffuse small cell type, should stimulate further pathologic and clinical investigations.

CT of secondary neoplasms. Unusual structural features--a pictorial essay

The newer anticancer therapies, the routine employment of cross-sectional imaging modalities for staging and follow-up, and the increased survival rate of patients with neoplastic lesions have markedly widened the range of pathological and imaging features of secondary neoplasms. Moreover, the changes occurring in morphological and structural aspects of metastases may be the direct effect of the improved therapeutic tools, and in turn may offer revealing clues to the clinician regarding the outcome of therapy itself. The scope of this essay is to show the atypical computed tomographic (CT) aspects of a series of metastatic lesions. We selected the lesions on the basis of their unusual structural features, such as calcification; hemorrhage; superinfection; pseudocystic, cystic, and lipoid appearance; and hypervascularity. A highly detailed assessment of such changes is nowadays possible and appears mandatory.

CT of renal metastatic disease. A pictorial essay

The routine use of computed tomography (CT) for the staging and follow-up of malignant neoplasm has improved the detection of secondary spread to the kidneys. This essay illustrates the gamut of the CT aspects of such secondary lesions. Seven main patterns of metastatic features are identified. Some of these patterns appear to reproduce the same radiological features seen in the corresponding primary lesions. Where feasible, differential diagnostic criteria are offered.

Improving the efficacy of BCG immunotherapy by dose reduction

Several clinical trials have shown intravesical bacillus Calmette-Guérin (BCG) to be effective in the prophylaxis of papillary tumour recurrences and in the therapy of bladder carcinoma in situ (CIS), as well as in delaying progression to muscle invasion. Nevertheless, the optimal regimen of BCG therapy for superficial bladder cancer has still to be defined. In a previous phase II trial, a low-dose regimen (BCG Pasteur strain, 75 mg) was able to achieve clinically significant response rates with a decrease in side-effects compared with other reported studies using standard-dose BCG. However, a phase III randomized trial--low dose versus standard dose (BCG Pasteur strain, 75 vs. 150 mg)--was considered necessary to clarify definitively the relationships between dose, efficacy and toxicity. The results of the interim analysis of 183 patients (performed in 1993) have shown response rates to be better in patients submitted to a low-dose BCG regimen (p = 0.0009) and a significant decrease in most of the common side-effects (cystitis, fever, haematuria; p < 0.05). Breaking down the results by stage, no differences in response rates were found in patients with stage TaM (70 vs. 62% in low-dose and standard-dose regimens, respectively, p = 0.5). In T1M and CIS stages, 82 and 0 (p = 0.07), and 64 and 0% (p = 0.0003) of patients were free of tumour following low-dose and standard-dose therapy, respectively. An additional 6-week course in patients who failed the induction course retrieved additional responses in both groups. No differences in progression rates were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal co-infection by Cyclospora sp. and Cryptosporidium parvum: first report in an AIDS patient

Cyclospora is recently described new human pathogenic coccidian causing intermittent diarrhoeal enteritis which may persist for weeks or months in immunocompetent subjects, particularly travellers visiting some tropical areas and countries, such as Nepal, the Caribbean, Peru and Mexico. More rarely this enteric pathogen affects immunocompromised humans, namely HIV-infected people or AIDS patients, with some clinical pictures recognized in normal hosts. We describe the first case of Cyclospora sp. and Cryptosporidium parvum associated diarrhoeal enteritis in an adult AIDS patient.

Antibodies producing complement-mediated thyroid cytotoxicity in patients with atrophic or goitrous autoimmune thyroiditis

Thyroid-cytotoxic antibodies (thyroid-cytotoxic Abs) have been described in patients with autoimmune thyroiditis, but their role in the development of hypothyroidism remains to be clarified. In this study, we evaluated the pathogenetic role of thyroid-cytotoxic Abs in 20 patients with atrophic thyroiditis (idiopathic myxedema; AT) and 94 patients with goitrous Hashimoto's thyroiditis (HT). Among patients with HT, 27 were euthyroid (HT-E), 27 had subclinical hypothyroidism (HT-SH), and 40 had overt hypothyroidism (HT-H). Seventeen normal subjects and 8 patients with nonthyroidal illnesses were used as controls (C). To detect thyroid-cytotoxic Abs, human thyroid cells expressing thyroid peroxidase (TPO) were labeled with 51Cr and challenged with the immunoglobulin G (IgG) fraction of serum plus rabbit complement. The cytotoxic effect of IgGs was calculated as the percent specific lysis (% SL), taking into account the lytic effect of complement alone and the maximal lysis produced by a detergent. Most C-IgGs decreased the cytotoxic effect of complement (median % SL, -3.3). IgGs from hypothyroid patients with thyroiditis had a greater cytotoxic effect than C-IgGs, either as a whole group (P < 0.001), or when subdivided according to clinical diagnosis: HT-SH (median % SL, 4.8; P < 0.005), HT-H (%SL, 2.2; P < 0.0001), or AT (%SL, 0.9; P < 0.01). Among patients with HT, the lytic activity of IgGs from patients with subclinical and overt hypothyroidism was higher than that of IgGs from euthyroid patients (P < 0.05). The results of IgGs from euthyroid patients with HT (median % SL, -0.9) did not significantly differ from those of C-IgGs. By taking a cut-off over the upper range of % SL produced by C-IgGs (> 2), the prevalence of thyroid-cytotoxic Abs was 30% in AT, 59% in HT-SH, and 55% in HT-H. However, 37% of euthyroid patients with HT also had thyroid-cytotoxic Abs. No IgG containing TPO antibodies (TPOAb) at low titer (< 40(2)) was cytotoxic. However, the levels of thyroid-cytotoxic Abs did not correlate with TPOAb titers, and preabsorption with TPO only partially abolished the lytic effect of some HT-IgG. These findings suggest that TPO is a target of thyroid-cytotoxic Abs, but other thyroid antigens are also involved in the cytotoxic reaction.(ABSTRACT TRUNCATED AT 400 WORDS)