Predictive value of cyclooxygenase-2 over expression for identifying prostate cancer from benign prostatic hyperplasia in prostate biopsy specimens

BACKGROUND

We studied cyclooxygenase-2 (COX-2) immunohistochemical staining intensity both in prostatic biopsy and surgical samples of patients with prostate cancer to determine if it might provide prognostic information for the decision of re-biopsy indication.

METHODS

Twenty-eight patients undergone radical prostatectomy whose final pathologic examination revealed prostatic adenocarcinoma were included in the study. Twelve patients with BPH in their pathological examination of both prostatic biopsy and open prostatectomy were considered as a control group. Intensity of COX-2 receptor was examined with immunohistochemical staining according to standard techniques.

RESULTS

Positive COX-2 receptor staining was obtained 89.3% of biopsy samples and 93% of surgical samples in all cancer patients. The rate of agreement in COX-2 receptor staining of biopsy samples and radical prostatectomy samples was 76% in same patients (P=0.54). Similarly, the COX-2 receptor levels in biopsy specimens of patients with BPH open surgery compared with samples of the agreement still rate was 41% (P=0.41). Prostate cancer exchanging COX-2 receptor levels in patients with biopsy specimens in patients with BPH were found significantly more (P=0.008).

CONCLUSIONS

In this study the feasibility of presence of COX-2 receptor staining in biopsy samples was shown. We have also demonstrated that COX-2 staining intensity was higher in prostatic biopsy samples of patients with prostatic cancer than patients with BPH. This leads a conclusion that, higher COX-2 expression levels in biopsy specimens may be used to decide re-biopsy in borderline preoperative PSA levels as well as in the cases with suspicious pathological findings for cancer.

Urachal urothelial carcinoma diagnosed at a radical prostatectomy operation: a case report

BACKGROUND

Urachal carcinomas are rare tumors, and the majority of them are adenocarcinomas. Up to now, only 21 urachal urothelial carcinomas (UCas) have been reported. Here, we describe a case of high grade UCa arising from the urachal remnants.

CASE

A 66-year-old man presented with voiding difficulties. Prostate specific antigen (PSA) was 5.46 ng/mL. Prostatic adenocarcinoma (PCa) (Gleason score 6) was diagnosed by needle biopsies. After the diagnosis of high grade, muscle invasive UCa with intact mucosa on frozen examination of the dome of bladder wall during the radical prostatectomy operation (RPO), partial cystectomy was performed. Microscopically, among the tumoral islands, cystic structures lined by cells with a benign appearance, which are considered urachal remnants, were noted. Cytokeratin 7 and high-molecular-weight cytokeratin were strongly positive, PSA and carcinoembryonic antigen were negative. Radiotherapy was given for both UCa and PCa. Six months after the diagnosis, an undifferentiated tumor was detected in a bladder transurethral resection specimen; thus, chemotherapy was given. After 1 course of chemotherapy, the patient was doing well.

CONCLUSION

The origin of urachal carcinomas is usually obscured as it is a highly invasive carcinoma. The patient presented here was diagnosed incidentally during RPO. Although the stage was advanced, the tumor was detected before urachal remnants were destroyed. The treatment choice for urachal carcinomas is cystectomy. Adjuvant chemotherapy and radiotherapy are controversial.

Primary orbital neuroblastoma in a neonate

Neuroblastoma is an undifferentiated malignant tumor of the primitive neuroblasts. Orbital neuroblastoma is typically a metastatic tumor. We describe a two-days-old girl, who presented with a large tumor in her left orbit. Magnetic resonance imaging revealed that the tumor originated from the retrobulbar area, extending into the upper and lateral orbit. She was operated on the fifth day of life. A histopathologic diagnosis of neuroblastoma was made. Medical evaluation including chest roentgenogram, ultrasonography of the abdomen, whole body computerized tomogram and bone scintigraphy showed no evidence of systemic involvement or metastasis. Neuroblastoma should be considered in the differential diagnosis of neonatal orbital tumors.

Reproducibility of the 1998 World Health Organization/International Society of Urologic Pathology classification of papillary urothelial neoplasms of the urinary bladder

OBJECTIVES

This study assessed the diagnostic agreement and intra- and inter-observer reproducibility of the World Health Organization/International Society of Urologic Pathology Consensus Classification of Urothelial Neoplasms (1998 WHO/ISUP classification) and the 1973 WHO classification.

METHODS

A teaching set with 5 slides of each papillary neoplasm of low malignant potential, low-grade papillary carcinoma, high-grade papillary carcinoma, and a guideline, as well as a study set of 30 slides containing ten cases of each category, were sent to participants. Six pathologists expert in urological pathology reviewed the 30 slides of non-invasive papillary urothelial tumors in the study set. Diagnostic accuracy and reproducibility were evaluated using intra- and inter-rater techniques (kappa statistic).

RESULTS

A moderate to substantial intra- and inter-observer reproducibility was achieved for both the 1998 WHO/ISUP and 1973 WHO classification. The results of the two classification systems were not different statistically ( P>0.05). Reproducibility was lower in low-grade tumors for both classifications.

CONCLUSIONS

The new proposed classification system for non-invasive urothelial neoplasms does not increase the reproducibility. There is still a need for uniformity in grading in order to compare the different studies and therapies and to provide more accurate information for management.

The systemic cellular immune response in the Helicobacter pylori-associated duodenal ulcer and chronic antral gastritis

BACKGROUND/AIMS

The exact pathogenesis of Helicobacter pylori infection is not fully understood. This study aims to evaluate the specific subset composition of peripheral blood lymphocytes in patients with H. pylori-positive duodenal ulcer n = 14), chronic antral gastritis n = 28), since reports so far have led to inconclusive and conflicting results.

METHODOLOGY

42 patients with dyspepsia and 50 controls underwent the following procedures: 1) gastroscopy and gastric biopsy (five specimens) 2) histology, 3) serologic test for anti-H. pylori antibodies IgG (Pyloriset EIA-G, Orion Diagnostica) and anticytotoxin associated gene A (cag A) IgG antibodies (VIVA Diagnositika by ELISA), 4) analysis of the peripheral blood lymphocytes using monoclonal antibodies reacting with lymphocyte cell surface antigens (anti-CD3, anti-CD19, anti-CD4, anti-CD8, anti-CD16 + CD56, anti-HLA DR) by flow-cytometry (Becton-Dickinson) to detect possible changes in the lymphocytes subpopulations in patients with duodenal ulcer and chronic antral gastritis.

RESULTS

We found no alteration in total T and B lymphocytes and CD4+ T, CD8+ T lymphocytes and natural killer cells of both duodenal ulcer and chronic antral gastritis patients compared to normal persons. Although there was a slight increase in the proportion of active T lymphocytes in duodenal ulcer and chronic antral gastritis groups comparing to healthy subjects the difference was not statistically significant.

CONCLUSIONS

These data indicate that there is no systemic alteration in the specific immune system in response to H. pylori in patients with duodenal ulcer and chronic antral gastritis.

Correlation of thallium-201 uptake with proliferating cell nuclear antigen in brain tumours

The aim of this study was to assess the correlation between thallium-201 (201Tl) uptake and proliferative activity measured using the proliferating cell nuclear antigen labelling index (PCNA-LI) in brain tumours. Twenty-nine patients with brain tumours were included in this study. Of these, seven were diagnosed with meningioma, 13 had high grade glioma (HGG) and nine had low grade glioma (LGG). A 210Tl single photon emission computed tomography study was performed on all patients before operation, and 201Tl uptake index (UI) and retention index (RI) values were calculated. Cell proliferation was determined by PCNA. While all of the HGGs and meningiomas showed intense 201Tl accumulation on visual interpretation, eight of the nine LGGs did not show accumulation of 210Tl at the tumour site. 201Tl UI values were 3.23+/-0.89 and 2.67+/-0.66 in HGG, 1.27+/-0.18 and 1.23+/-0.09 in LGG, and 4.35+/-1.60 and 2.52+/-0.78 in meningioma on early and delay images, respectively. There was a statistical difference between the 201Tl UI in HGG and LGG. PCNA-LI values were 16.72+/-6.15%, 1.63+/-0.81% and 2.00+/-1.88% in HGG, LGG and meningioma, respectively. The PCNA-LI in HGG was significantly higher than in LGG and meningioma. While the correlation coefficient between the 201Tl UI and the PCNA-LI was 0.94 in gliomas (n=22), there was no correlation in meningiomas. No statistically significant correlation was found between the RI and the PCNA-LI in gliomas. The presence of a strong positive correlation between 201Tl uptake and PCNA-LI indicates that 201Tl uptake can predict the proliferative activity of the glioma.