Accuracy of contrast-enhanced ultrasound in the detection of bladder cancer

OBJECTIVE

To assess the accuracy contrast-enhanced ultrasound (CEUS) in bladder cancer detection using transurethral biopsy in conventional cystoscopy as the reference standard and to determine whether CEUS improves the bladder cancer detection rate of baseline ultrasound.

METHODS

43 patients with suspected bladder cancer underwent conventional cystoscopy with transurethral biopsy of the suspicious lesions. 64 bladder cancers were confirmed in 33 out of 43 patients. Baseline ultrasound and CEUS were performed the day before surgery and the accuracy of both techniques for bladder cancer detection and number of detected tumours were analysed and compared with the final diagnosis.

RESULTS

CEUS was significantly more accurate than ultrasound in determining presence or absence of bladder cancer: 88.37% vs 72.09%. Seven of eight uncertain baseline ultrasound results were correctly diagnosed using CEUS. CEUS sensitivity was also better than that of baseline ultrasound per number of tumours: 65.62% vs 60.93%. CEUS sensitivity for bladder cancer detection was very high for tumours larger than 5 mm (94.7%) but very low for tumours <5 mm (20%) and also had a very low negative predictive value (28.57%) in tumours <5 mm.

CONCLUSION

CEUS provided higher accuracy than baseline ultrasound for bladder cancer detection, being especially useful in non-conclusive baseline ultrasound studies.

Adenosquamous carcinoma of the head and neck: criteria for diagnosis in a study of 12 cases

AIMS

Adenosquamous carcinoma (ASC) of the head and neck is an unusual neoplasm in which a general consensus with regard to diagnostic criteria has not yet been reached. In this study we report the clinicopathological results of 12 ASCs, with special attention to their histological and immunohistochemical characteristics in order to define this neoplasm more precisely.

METHODS AND RESULTS

All the patients were male with a peak incidence in the sixth decade of life. The tumours were located most frequently in the larynx and oral cavity, followed by the nasal cavity and pharynx. ASCs had two distinct histological components. The most extensive one was an usual keratinizing squamous cell carcinoma, arising from the surface epithelium, where characteristically severe dysplasia or carcinoma in situ was found in all cases. The second component was an adenocarcinoma, usually displayed in the deepest areas of the tumour. Evidence of origin from salivary or seromucinous glands was not found. Immunohistochemical studies demonstrated in most cases positivity of glandular differentiated areas for carcinoembryonic antigen (CEA) (11/12), CK7 (9/12) and CAM5.2 (7/12), whereas the squamous cell component was unreactive or reacted only focally for these markers. High-molecular-weight cytokeratin 34BE12 was positive in both components and CK20 was always negative. All cases showed high expression of Ki67 antigen. Most of them had overexpression of p53 (8/12) and DNA aneuploidy (10/12). Fifty percent of patients with ASC died of disease after a mean period of 23 months (range 12-35 months).

CONCLUSIONS

ASC of the head and neck is an aggressive neoplasm that originates in the surface epithelium of the upper respiratory tract. Severe dysplasia or carcinoma in situ is usually found and its recognition helps to make the diagnosis. In addition to mucin stains, positive immunoreactivity for CEA, CK7 and CAM5.2 helps to identify the glandular component.

High-grade carcinoma component in epithelial-myoepithelial carcinoma of salivary glands clinicopathological, immunohistochemical and flow-cytometric study of three cases

Three cases of epithelial-myoepithelial carcinoma (EMC) with coexisting areas of high grade carcinoma are reported. In two of the cases there was a previous recurrence, and in all three patients there had been a sudden increase in size before final surgery. The typical ductal and myoepithelial components of EMC showed the usual biphasic pattern and the expected immunophenotypes, with expression of wide spectrum cytokeratins, Cam 5.2 and EMA in the ductal part, and muscle-specific actin, smooth muscle actin, S-100 protein, vimentin and cytokeratins in the myoepithelial component. These areas also had a low mitotic count and low proliferation rate as measured by immunohistochemistry and by flow cytometry. Conversely, areas of high-grade tumour had the features of a large cell carcinoma, with focal mucin secretion in two cases. This high-grade component showed an epithelial immunophenotype in two cases, and was negative for all tested markers in the third one. The mitotic counts and the proliferation rates were much higher in these anaplastic areas. One of the patients died 3 months after treatment; another developed lymph node metastases 1 year later and was alive after 6 years of follow-up. The third patient was alive without evidence of disease 7 months after wide surgical resection of the tumour. The possibility of anaplastic transformation in EMC makes thorough sampling mandatory in this type of neoplasm.

Primary adenocarcinoma of the endometrium associated with genital tuberculosis. A case report

BACKGROUND

Adenocarcinoma of the endometrium is a common tumor of the female reproductive tract, and tuberculosis accounts for only about 1% of postmenopausal metrorrhagia. Tuberculosis of the fallopian tubes is the most frequent location; that of the cervix is the most uncommon.

CASE

A case of primary adenocarcinoma of the endometrium was diagnosed after curettage in a 58-year-old, postmenopausal woman complaining of a bloody vaginal discharge. A laparotomy was performed, and histologic examination of the uterus disclosed an endometrial carcinoma, grade 2/3, with extension to both tubes. The tumor was associated with an extensive granulomatous reaction, with numerous tubercles composed of epithelioid cells, multinucleate giant cells of Langhans and central necrosis type. These granulomas were seen close to the carcinoma in the endometrium and tubes and far from the neoplasm in sections of the cervix, myometrium and lymph nodes.

CONCLUSION

The association of endometrial adenocarcinoma with genital tuberculosis is extremely rare. Moreover, similar granulomas may appear in the surrounding stroma of the tumor. For these reasons a diagnosis of genital tuberculosis associated with this neoplasm should be made with caution.

[Changes in the cellular proliferation of the healthy mucosa in patients with colorectal cancer]

AIM

To analyze differences in the proliferative pattern of normal mucosa between patients with colorectal cancer and healthy subjects.

PATIENTS AND METHODS

By using flow cytometry we examined the proliferative pattern (Proliferative Index and S-Phase) in samples of normal mucosa from 34 patients operated on for colorectal cancer at our hospital and from 14 healthy subjects as a control group.

RESULTS

All examined samples were diploid. The Proliferative Index and S-Phase in the Cancer Group were significantly higher than in the Control Group (16.7 +/- 5.9 vs 11.4 +/- 4, p < 0.003, and 11.9 +/- 3.9 us 6.6 +/- 3 p < 0.0004).

CONCLUSIONS

These findings provide evidence for an altered proliferative pattern in the healthy colonic mucosa of patients with colorectal cancer.

[DNA as a prognostic factor in colorectal cancer. A retrospective analysis of 34 patients]

OBJECTIVE

We study the tumoral DNA as a prognostic factor in patients operated for colo-rectal cancer.

DESIGN

Retrospective. We analyze by flow cytometry the DNA content of tumoral tissue: Ploidy, DNA Index, Proliferative Index, S Phase.

PATIENTS

34 operated patients, for colo-rectal cancer, with a minimum 3 years of follow-up.

RESULTS

Ploidy doesn't show any relation with other prognostic factors. Only Dukes C aneuploid patients had more positive nodes than diploid. Ploidy was not related to better evolution or survival. Neither DNA Index, Proliferative Index and S Phase were related to the evolution of the disease.

CONCLUSIONS

The DNA study by flow cytometry has no better prognostic value then other classical factors.

[A cellular proliferation study in patients with colorectal cancer, solitary, synchronous and with polyps]

Colonic carcinogenesis is probably related to a disturbance in cell proliferation of the colonic mucosa. The present study was designed to determine whether patients with adenomatous polyps of the colon, which have a tendency to develop synchronous malignancies of the colon, have any disturbance in mucosal cell proliferation. Using flow cytometry the proliferative index, and the S and G2M phases of normal mucosa and tumoral tissue of patients with colorectal cancer (synchronous, alone, or associated with adenomatous polyps) were studied. No differences were found between the there groups of study at the level of proliferation pattern of normal mucosa. Our findings do not support the development of synchronous or metachronous colon cancer in patients with polyps on the basis of different patterns of cell proliferation.

Bladder wash cytology and flow cytometry for the diagnosis of transitional cell carcinoma of the urinary bladder

The role of bladder wash (BW) cytology and flow cytometry in the diagnosis of low-grade transitional cell carcinoma (TCC) of the bladder is yet to be demonstrated. We have studied a series of BW specimens by both conventional cytology and flow cytometry: there were 16 BW from patients with histologically proven TCC and 14 BW from patients with clinical suspicion of tumor or under follow-up for previous TCC in which no evidence of tumor was found by cystoscopy and multiple biopsies. As control group, 21 BW were studied from patients undergoing cystoscopy for causes other than TCC. In conclusion, the conventional cytologic study of BW specimens was highly sensitive for grade II-III TCC, but missed most grade I TCC; flow cytometric analysis did not improve significantly the detection rate in low-grade TCC.