A case of synchronous triple early cancer occurring in the stomach, colon and gallbladder

Tissue expansion is one of the most important armamentaria for aesthetic scalp reconstruction after burn; however, the proper way to employ this technique for the scalp reconstruction usually presents a challenge to the plastic surgeon, especially in the case of a "sideburn" scenario or a large lesion, as with, for example, hemiscalp alopecia. In this article, 11 patients, with different degrees of hair-bearing scalp loss as a result of burn, and including four patients with hemiscalp alopecia were successfully treated by using tissue expansion. The results show that tissue expansion is a simple, safe, and efficient technique for aesthetic scalp reconstruction. Versatile design of the expanded scalp flap can distribute the expanded hair-bearing scalp properly in the reconstructed recipient site.     

Second primary cancers following cancers of the kidney and prostate in New South Wales (Australia), 1972-91

In order to find an explanation for the eventual disappearance of all chromosome aberrations in two radiosensitive human tumour cell lines, the type and stability of different aberration types was investigated in more detail. To classify the aberrations into unstable and stable types, three-colour fluorescence in situ hybridization was performed, including a whole-chromosome probe, a pancentromere probe, and a stain for total DNA. This technique enables the appropriate classification of the aberrations principally by the presence (stable) or not (unstable) of a single centromere per chromosome. Unstable-type aberrations were found to disappear within 7 days (several divisions) in the two radiosensitive and the two radioresistant tumour lines investigated. Stable-type aberrations were found to remain at an approximately constant level over the duration of the experiment (14 days; 8-10 divisions) in the two radioresistant lines. In contrast, the majority of these stable-type aberrations had disappeared by 14 days in the two radiosensitive lines. The previous findings of disappearance of total aberrations in radiosensitive cells was therefore not due to a reduced induction of stable-type aberrations, but the complete disappearance of cells with this aberration type. These results could not be explained by differences in apoptosis or G1 blocks. Two possible explanations for these unexpected findings involve non-random induction of unstable-type aberrations, or lethality of stable-type aberrations. The results suggest caution in the use of stable-type aberration numbers as a predictor for radiosensitivity.     

The metastatic spread of kidney and prostate cancers in man

This research was performed on 66 autopsy reports of kidney cancers and 58 autopsy reports of prostate cancers. Two alternative hypotheses were tested, i.e. whether metastases spread at random from the primary tumor throughout the body or whether the metastatic spread occurs in steps, referred to as a cascade spread, requiring one or more disseminating sites. It was found that in cancer of the prostate two disseminating sites exist, i.e. bones and lungs. Metastases from the primary tumor appear first in the skeleton and then in the lungs, not vice versa. In cancer of the kidney, the lungs are the major disseminating site. The lymphatic areas did not seem to play a major role in the dissemination of both cancers; on the contrary, the presence of metastases in the lymph nodes seem to depend on the presence of carcinomatous cells in key sites, i.e. the skeleton and the lungs. These results, however, should be interpreted with caution, as explained in the text. Considerations were proposed for future research.     

A case of primary malignant lymphoma of the bladder

There are few reports of the sonographic appearance of Meckel's diverticulum. We present a case of torsion of a Meckel's diverticulum that was suggested by sonography and confirmed pathologically. We discuss the sonographic differential diagnosis, which includes acute appendicitis, enteric duplication cyst and intestinal volvulus.     

Point mutation and homozygous deletion of PTEN/MMAC1 in primary bladder cancers

A new tumor suppressor gene PTEN/MMAC1 was recently isolated at chromosome 10q23 and found to be inactivated by point mutation or homozygous deletion in glioma, prostate and breast cancer. PTEN/MMAC1 was also identified as the gene predisposing to Cowden disease, an autosomal dominant cancer predisposition syndrome associated with an increased risk of breast, skin and thyroid tumors and occasional cases of other cancers including bladder and renal cell carcinoma. We screened 345 urinary tract cancers by microsatellite analysis and found chromosome 10q to be deleted in 65 of 285 (23%) bladder and 15 of 60 (25%) renal cell cancers. We then screened the entire PTEN/MMAC1 coding region for mutation in 25 bladder and 15 renal cell primary tumors with deletion of chromosome 10q. Two somatic point mutations, a frameshift and a splicing variant, were found in the panel of bladder tumors while no mutation was observed in the renal cell carcinomas. To screen for homozygous deletion, we isolated two polymorphic microsatellite repeats from genomic BAC clones containing the PTEN/MMAC1 gene. Using these new informative markers, we identified apparent retention at the gene locus indicative of homozygous deletion of PTEN/MMAC1 in four of 65 bladder and 0 of 15 renal cell tumors with LOH through chromosome 10q. Identification of the second inactivation event in six bladder tumors with LOH of 10q implies that the PTEN/MMAC1 gene is occasionally involved in bladder tumorigenesis. However, the low frequency of biallelic inactivation suggests that either PTEN/MMAC1 is inactivated by other mechanisms or it is not the only target of chromosome 10q deletion in primary bladder and renal cell cancer.     

A case of bladder agenesis

A plasmid (5.4 kbp) from Salmonella Typhi D4 has been identified as encoding a restriction and modification (R-M) system. DNA fragments (2537 bp) that carried the genes for restriction endonuclease and methyltransferase encoded on the plasmid were sequenced. Two divergently arranged open reading frames of 957 bp for the restriction endonuclease consisting of 318 aa (amino acids) and 1140 bp for the DNA methyltransferase consisting of 379 aa were identified. These sequences were similar to the sequences of the SsoII R-M system, including the interspace between the two genes.     

Development of synchronous bilateral lung cancers after esophagectomy for esophageal cancer: report of a case

It is well known that squamous cell carcinoma of the esophagus can be associated with carcinoma of other organs. We report herein the rare case of a 60-year-old man who developed synchronous bilateral lung cancers after undergoing esophagectomy for esophageal cancer. Staged bilateral lobectomy was successfully performed to minimize respiratory complications 3 years after his esophagectomy. This case report serves to demonstrate that aggressive and careful surgical approach with adequate followup offers the chance of long-term survival for patients with multiple primary cancers.     

A case of unrecognized bladder pheochromocytoma

Pheochromocytoma rarely occurs in the bladder. We report a fortuitously observed case and review the main clinical, biological and radiological features.     

The canine urinary bladder and prostate

Nonrecurrence and variations in the ascending course of the recurrent laryngeal nerves make it essential to identify the nerve to avoid injury to it during thyroidectomy. We believe that visual identification of the nerve without undue handling is all that is necessary. The recurrent nerve is no more delicate than other similar nerves. Unilateral injury to the recurrent nerve may result in temporary hoarseness which will improve with time. Some restriction of the airway during exertion may be present. Bilateral injury to the recurrent nerves may produce initially a loss of voice without airway constriction. Later the voice may return, accompanied by serious respiratory embarrassment on exertion.     

Association between coronary heart disease and cancers of the breast, prostate, and colon

Coronary heart disease (CHD) and cancers of the breast, prostate, and colon are more common in industrialized countries than in the developing world, and to some degree, these conditions appear to share risk factors. To investigate whether there is an association between these cancers and a prior history of CHD, a hospital-based case-control study was conducted at Columbia-Presbyterian Medical Center in New York. The study was based on 252 breast cancer cases, 256 colorectal cancer cases, and 322 benign surgical controls, all of whom underwent biopsy or surgery between January 1989 and December 1992, and on 319 prostate cancer cases and 189 benign prostatic hypertrophy controls diagnosed between January 1984 and December 1986 (prior to widespread use of prostate-specific antigen screening). Medical records were reviewed on each, focusing on the preoperative anesthesia and surgical clearances. No association was found between a history of CHD and breast or colorectal cancer, but an elevated risk was found for prostate cancer (odds ratio, 2.00; 95% confidence interval, 1.18-3.39), using unconditional logistic regression with adjustment for appropriate confounders. No association was found between cigarette smoking and any of the three cancers. Aspirin use was protective for colorectal cancer (odds ratio, 0.35; 95% confidence interval, 0.17-0.73) but had no association with breast or prostate cancer. The study suggests that individuals with CHD are at elevated risk for prostate cancer but not breast or colorectal cancer. Etiological risk factors associated with CHD should be investigated with regard to prostate cancer. Patients with CHD may represent a high-risk group for prostate cancer and potential future targets for prostate cancer screening interventions.     

A bladder nephrogenic adenoma. A case report

OBJECTIVE: To report an additional case of nephrogenic adenoma of the bladder. METHODS/RESULTS: A case of nephrogenic adenoma of the urinary bladder in a 28-year-old female is described. Patient clinical history and diagnostic imaging findings are presented. CONCLUSIONS: Nephrogenic adenoma of the bladder is a rare benign tumor with specific histological features that has been associated with previous surgery, trauma, infections and lithiasis. Although it is currently not considered to be a premalignant lesion, its rate of recurrence is high (37%-49%). The treatment of choice is by transurethral resection and yearly cytological, ultrasound and cystoscopic follow-up evaluation to detect recurrence.     

Second primary cancers after cancers of the colon and rectum in New South Wales, Australia, 1972-1991

In this article, we present a survey on dental care and oral implantology in Beijing, China. The Chinese population comprises 1.2 billion or about 20% of the world's population. This survey shows: (i) there is a well-developed dental system in China, mostly operated by the Chinese government; (ii) in Beijing, there are 1328 dentists and oral surgeons and 515 special dental nurses working in dental departments of hospitals; (iii) about 2 million new patients visit the dentist every year; (iv) oral implantology is a new technology for the Chinese dentist and oral surgeon, as shown by the finding that in 1992, only 384 persons were treated with oral implants in a few hospitals in Beijing; however, most hospitals are interested in performing oral implantology in the near future; (v) imported implants are too expensive for Chinese patients, and therefore good qualified domestic implants and cheaper imported implants have a great market potential.     

The synchronous occurrence of acute myeloid leukemia and kidney carcinoma

HISTORY AND CLINICAL FINDINGS: During the past year a 52-year-old man had developed quarterly bouts of fever, up to 38.5 degrees C, associated with fatigue and arthralgia. The fourth bout continued as undulating periods of fever with markedly impaired general state. Physical examination was unremarkable except for mild generalised lymphadenopathy. INVESTIGATIONS: Extensive imaging and serological studies failed to find an infectious or autoimmunological cause. But computed tomography and angiography revealed a space-occupying lesion in the left kidney, yet the suspected diagnosis of renal carcinoma insufficiently explained the clinical picture. DIAGNOSIS TREATMENT AND COURSE: Haematological tests having shown anaemia (Hb 8.1 g/dl) and blast cells (10%) in the peripheral blood a bone marrow biopsy was performed which indicated acute myeloid leukaemia. Three courses of intensive chemotherapy brought about only partial remission and the patient died 6 months later from a cerebral haemorrhage. An autopsy confirmed both the acute myeloid leukaemia and a renal carcinoma. CONCLUSION: The possibility of synchronous occurrence of two malignancies should always be kept in mind especially if the initially diagnosed tumor cannot explain the clinical symptoms.     

A similar pattern of chromosomal alterations in prostate cancers from African-Americans and Caucasian Americans

A combination of genetic and epigenetic factors may explain the disproportionate incidence and mortality of prostate cancer among African-American males (AAMs) as compared with Caucasian American males (CAMs). We wished to determine whether primary prostate cancers from AAMs and CAMs harbor different patterns or frequencies of chromosomal alterations. Comparative genomic hybridization (CGH) was performed on clinically localized, untreated primary prostate cancers from 16 AAMs and 16 CAMs. Detailed statistical analysis was used to delineate gains and deletions with high sensitivity and specificity and to compare the frequency and pattern of alterations between the two groups of tumors. The two groups of patients had indistinguishable preoperative serum prostate-specific antigen levels, and the two groups of tumors had similar pathological stages and grades. Chromosomal gains and deletions occurred in regions known to be frequently altered in prostate cancer. Specifically, the most frequent alterations were deletions of regions on chromosomes 13q, 5q, 16q, and 8p and gains of regions on 8q and 5q. When tumors from AAMs and CAMs were compared, the frequencies of alteration (deletion, gain, or no alteration) were similar across 98.9% of the length of the genome. The patterns of alterations of the most frequently altered chromosomes were also similar between tumors from AAMs and CAMs. We concluded that primary prostate cancers from AAMs and CAMs harbor a similar pattern and frequency of chromosomal alterations. These data support the notion that sporadic prostate cancers from AAMs and CAMs develop by similar chromosomal mechanisms. Biological differences, if present, do not occur on the chromosomal level.     

A case of xanthogranuloma of the urinary bladder

A case of xanthogranuloma of the urinary bladder is reported. A 68-year-old man was referred to our hospital for the evaluation of microscopic hematuria. At that time, he did not have an abdominal tumor and ultrasonography showed no abnormality of the kidneys and the bladder wall. Two months later, he was admitted with the chief complaints of perineal discomfort and non tender fist size mass was palpable in the lower abdomen. Ultrasonography, computed tomographic scan and magnetic resonance imaging MRI demonstrated a supravesical mass which was strongly suspected as urachal tumor. Total cystectomy with urachal resection was performed. The histological diagnosis was xanthogranuloma. The patient has been in good health without recurrence, 4 years after surgery. We discuss xanthogranuloma of the urinary bladder in the literature.     

Characteristics of invasive bladder cancers: histological and molecular markers

Changes in gene expression permit the emergence of clones of cancer cells with biological properties that enable invasion and metastasis. We present in this article an overview of the variety of genetic and antigenic markers that have been reported for invasive bladder cancer. Although the prognostic and diagnostic usefulness of many of these markers in invasive bladder cancer remains to be fully evaluated, this review will serve as a resource for the clinician on the current state of the field. Alterations in the biology and genetics of cells no doubt contribute to the processes of invasion and metastasis and are likely to provide important, useful information for future identification and management of the patient with invasive bladder cancer.     

Microsatellite instability associated with primary head and neck cancers and secondary esophageal cancers

BACKGROUND: It is common that patients with head and neck cancers have secondary malignant neoplasm of esophageal cancer. METHODS: To know the genetic background of the development of these secondary cancers, we performed microsatellite assay at six loci and immunohistochemical analysis on head and neck cancers of eight patients with esophageal cancer and on those of 19 patients without esophageal cancer. RESULTS: Replication error (RER) at more than two loci was observed in two (25%) of eight double cancer patients, whereas it was not observed in the patients without the secondary cancer. Immunohistochemically, overexpression of cyclin D1 was detected in two (25%) of eight double cancer cases and in two (11%) of 19 non-double cancer cases, respectively, the incidence showing a higher tendency in the former. CONCLUSIONS: The results suggest that microsatellite instability may be implicated in the development of head and neck double cancers and that RER (+) phenotype may serve as a biomarker to predict the development of secondary esophageal cancer in patients with head and neck cancer.     

Tomodensitometry imaging and MRI of primary lung cancers

At present limited data exist describing the hospital use patterns of intravenous drug users (IVDUs) and women with AIDS. Our objective was to determine if frequency of hospitalization, length of stay (LOS), and cost per hospitalization varied by risk status and gender, controlling for a variety of confounders, including severity of illness as measured by the Turner-Kelly-Ball and Justice AIDS severity of illness systems. We performed a population-based cohort study that compared all women (n = 69) and male IVDUs (n = 74) with AIDS diagnosed in Massachusetts in 1987 with a random sample of all male, nonintravenous drug-using patients diagnosed in that year (n = 148). Frequency of hospitalization, LOS, and cost of hospital care were obtained from hospital billing records for 1987 and 1988. Regression analysis showed 42% longer lengths of stay (p < or = 0.001) and 38% higher cost (p < or = 0.001) per hospitalization for IVDUs with AIDS compared with non-IVDU homosexual AIDS patients. No statistically significant differences by gender were observed. Our results suggest that hospital care for IVDUs is likely to be more expensive. Policymakers should incorporate these data when planning for AIDS care. In addition, instruments to assess severity of illness should incorporate information on intravenous drug use.