Testicular calcifications: incidence, histology and proposed pathological criteria for testicular microlithiasis

PURPOSE: Testicular microlithiasis is a clinical syndrome in which men present with innumerable testicular calcifications. Indirect evidence suggests that this syndrome may be associated with an increased risk of germ cell neoplasia. The incidence and types of testicular calcification in normal and diseased testes is unknown. MATERIALS AND METHODS: A series of 131 orchiectomy specimens were reviewed, including 79 germ cell tumors, and 100 entirely embedded autopsy testes in men with no known testicular pathology. RESULTS: Two types of calcifications were identified. Hematoxylin bodies, consisting of amorphous calcific debris, were present in 6 cases associated with germ cell tumors. In contrast, laminated calcifications were found not only in association with germ cell tumors (35 cases), but also in 2 of 4 cryptorchid testes and 6 of the remaining 145 testes (4%). Of these calcifications 61% were multiple. When laminated calcifications were associated with germ cell tumors there was an increased incidence of extension beyond the tunica albuginea (43 versus 21%) and lymphatic invasion (52 versus 17%, p = 0.046 and 0.012, respectively). CONCLUSIONS: Testicular calcifications are heterogeneous. Hematoxylin bodies are specific for germ cell tumors but laminated calcifications, while more common in germ cell tumors, also occur in otherwise normal testes. The pathological criteria for testicular microlithiasis should include the identification of multiple laminated calcifications within seminiferous tubules.     

Ductal carcinoma in situ

The incidence of ductal carcinoma in situ (DCIS) has increased significantly in the last 2 decades, due to the diagnosis of asymptomatic cancers by screening mammography. These cancers are usually diagnosed by the presence of calcification on mammography. Histologic classification of these tumors is controversial, and established and proposed classification systems are reviewed. The role of breast conservation in the treatment of many of these lesions is generally accepted, although areas of debate regarding its application in these patients persists.     

Endometrial hyperplasia and carcinoma in situ

Endometrial hyperplasias--both simple and adenomatous are presented, as well as the differences between them and the endometrial carcinoma. The concept of endometrial carcinoma in situ (ESIS) and the criteria for invasiveness by the malignancies of the uterine corpus are discussed. Illustrations for various cases with ESIS are provided and the clinical behaviour by ESIS is discussed.     

Mammary ductal carcinoma in situ with microinvasion

BACKGROUND: The natural history of patients with intraductal carcinoma (DCIS) and microinvasion is poorly defined, and the clinical management of these patients, with particular reference to management of the axilla, has been controversial. Previous studies of this lesion have used varied and/or arbitrary criteria for the evaluation of microinvasion. METHODS: Thirty-eight DCIS lesions with microinvasion (n=29) or probable microinvasion (n=9), diagnosed during the period 1980-1996, were retrospectively analyzed after cases not treated with mastectomy and axillary lymph node dissection were excluded. Microinvasion was defined as a single focus of invasive carcinoma < or = 2 mm or up to 3 foci of invasion, each < or =1 mm in greatest dimension. RESULTS: The patients were all females with a mean age of 56.4 years. DCIS was of comedo (n=31) or papillary (n=7) subtype. Microinvasion was often associated with an altered, desmoplastic stroma (55%) or a lymphocytic infiltrate (39%). The foci of microinvasion ranged from 0.25 to 1.75 mm (mean, 0.6 mm), with an aggregate mean size of 1.1 mm (range, 0.25-2.25 mm). Foci of microinvasion, ranging from 1 to 3 (mean, 1.7), were adjacent to DCIS in 95.3% of cases. The extent of DCIS did not correlate with the number of foci of microinvasion. Axillary lymph node dissections yielded a mean of 19.3 lymph nodes (range, 7-38), and all lymph nodes were negative for metastasis. None of 33 patients, followed for a mean of 7.5 years (range, 1.0-14.4 years), developed local recurrence or metastasis. CONCLUSIONS: The cases of microinvasive carcinoma examined in this study, as defined above, were not associated with axillary lymph node metastases and appeared to be associated with an excellent prognosis. Further study is indicated to determine the appropriate management and long term prognosis of patients with this lesion.     

Ductal carcinoma in situ of the breast

PURPOSE: The increasing incidence and biological heterogeneity of ductal carcinoma in situ (DCIS) of the breast have made the management of this entity challenging and controversial. This paper reviews data on the natural history of the disease and results obtained with various management approaches. DATA SOURCES: Computerized MEDLINE search of articles related to DCIS published since 1966. STUDY SELECTION: Randomized trials were given higher value; however, because these were relatively scarce, retrospective studies and data published in abstract form were also included. DATA EXTRACTION: The authors reviewed all sources critically. No formal statistical calculations were made. DATA SYNTHESIS: The incidence of DCIS is increasing, and a greater proportion of diagnoses are being made in asymptomatic patients. No data from randomized trials compare mastectomy and breast-conserving therapy for the treatment of DCIS. A large randomized trial comparing lumpectomy with lumpectomy plus radiotherapy showed lumpectomy plus radiotherapy to be effective for management of this disease. The presence of comedo necrosis and surgical margin status are frequently used as predictors of subsequent recurrence, although this practice is controversial. The risk for in-breast recurrence at 5 years after lumpectomy and radiotherapy is approximately 8%. With more refined molecular analysis, the relation of DCIS to invasive breast cancer will be better defined. CONCLUSIONS: Treatment strategies for DCIS have evolved, and lumpectomy followed by radiotherapy is an appropriate alternative for most patients. The use of lumpectomy alone in selected patients remains controversial.     

Angiogenesis in squamous cell carcinoma in situ and microinvasive carcinoma of the uterine cervix

OBJECTIVE: To evaluate angiogenesis in squamous cell carcinoma in situ (CIS) and microinvasive squamous cell carcinoma of the uterine cervix and to investigate the relations among angiogenesis, stromal inflammation, and depth of invasion. METHODS: Three groups of women were studied: 22 controls who had undergone hysterectomy for benign conditions; 18 with squamous cell CIS of the cervix who underwent cone biopsy, hysterectomy, or both; and 14 with microinvasive squamous cell carcinoma who underwent conization of the cervix and subsequent surgical management according to depth of invasion. All specimens were stained immunohistochemically for factor VIII-related antigen. Areas below the basement membrane with the highest angiogenic density were selected. The degree of stromal inflammatory reaction was assessed. Statistical analyses included Kruskal-Wallis, analyses of variance and covariance, Scheffe and Bonferroni-Dunn post hoc procedures, and Pearson correlation analysis. P < .05 was considered statistically significant. RESULTS: Microvessel counts per high-power field (x 400) of microinvasive squamous cell carcinoma of the cervix differed significantly from those of controls and squamous cell CIS (median 34.5 per high-power field, range 9-76 versus median 17, range 7-47, and median 19, range 8-39, respectively; P < .005). Microvessel counts per high-power field in squamous cell CIS did not differ significantly from those of controls (P = .91). Among patients with microinvasive squamous cell carcinoma of the cervix, no significant correlation was found between microvessel counts per high-power field and the depth of invasion (r = 0.19, P = .51). Stromal inflammatory reaction (graded 0-3) differed significantly among controls, squamous cell CIS, and microinvasive carcinoma (mean 0.40, 0.83, and 1.64, respectively; P < .005). CONCLUSIONS: Microinvasive squamous cell carcinoma of the uterine cervix is angiogenic, but depth of invasion is not associated with increased angiogenicity. Squamous cell CIS is not angiogenic.     

Clinical problems of the breast carcinoma in situ

The results of diminution mammoplasties are reported. From 1972 to 1974, 70 diminution mammoplasties according to Str?mbeck were carried out. Indication for the operation was hypertrophy of the breasts with side effects of morbid value. In 47 patients side effects of the body posture were the leading indication. In 23 patients, psychosocial problems were the indication. Only patients with side effects of morbid value were considered to be sufficiently motivated to tolerate the total stress of the operation and the possible post-operative complications. The technical problems of the operation and the post-operative complications are described. 43 patients were followed up at least one year after the operation. In 36 patients the pre-operative complaints were alleviated by the operation. In 7 patients there was improvement. No patient had continuing pre-operative complaints. The mentally depressed and physically and psychologically in their relationship to their environment handicapped patients became usually more satisfied by the operation. Diminution mammoplasties are recommended for the operative treatment of hypertrophy of the breast with side effects of morbid value.     

Ductal carcinoma in situ: the mammographer's perspective

Ductal carcinoma in situ represents a heterogeneous group of lesions now most commonly discovered by mammography. The biological behavior of ductal carcinoma in situ ranges from indolent, essentially benign lesions to obligate precursors of invasive carcinoma. This article reviews the natural history of this disorder, its mammographic and pathologic features, and current considerations in patient management, including the role of mammography. The results of recent clinical trials are summarized.     

Ductal carcinoma in situ. Part 2: Treatment

In the last decades, the classification of schemes of haematological malignancies have undergone considerable changes both in terms of modifications of previous concepts and of methodological approaches, in parallel with the acquisition of new information on the physiopathological and functional pattern of haemic cells and of their precursors both at the lymph node and bone marrow level. The cyto-morphological aspects of haemic were better defined and integrated by the application of cyto- and histochemical methods, which were subsequently supplemented by bioenzymatic and cytogenetic techniques, then by immunophenotypical studies and finally by biomolecular investigations. Through the use of monoclonal antibodies and the introduction both in research and routine diagnostic practice of multiparameter analysis techniques, it is now possible to correlate several cellular parameters, to identify clonality of malignant cells as well as their lineage assignment and maturation stage. Flow cytometry has become an important, rapid and objective method for the diagnosis of haematological neoplasias. In the present survey we have illustrated the different expression of surface, cytoplasmic and nuclear antigens in haematological malignancies, their correlation with the clinical course of the disease and their diagnostic and prognostic significance.     

Nasal septal pediculate carcinoma in situ: differential diagnosis

Pediculated lesions of the nasal cavities are relatively common in daily practice, and include inflammatory polyps, benign tumors (papillomas being the most common), malignant tumors, and specific processes, such as polypoid rhinosporidiosis. The authors describe a female patient with a warty, pediculated, and asymptomatic lesion in the nasal septal mucosa. The anatomo-pathological exam showed this to be a "carcinoma in situ". The few bibliographic citations report only an association between the tumor and contact with wood dust, such as oak, ebony and beech. The patient was not exposed to these elements. It is important to emphasize the routine performance of a complete otolaryngological exam for patients seeking out specialists, in order to detect potentially malignant lesions whose early removal would permit a complete cure.     

Management of ductal carcinoma in situ of the breast

The natural course of primary osteoarthritis of the knee with or without treatment by intraarticular corticosteroid injections was investigated in 446 patients presenting from 1970 to 1973. Sixty-one of these patients were able to be followed up in 1982 and were divided into two groups. One group included 53 patients (82 knees) without corticosteroid injections. The other group had eight patients (14 knees) who received intraarticular steroids (mean number of injections: 25; range:4-78). The standing femorotibial angle at followup in the male patients receiving injections (p < 0.05) was four degrees of greater varus angulation. Radiographic degeneration was more advanced in 11 of the 24 steroid-treated knees (78.6%), and in 43 of the 82 knees without steroid injections (52.4%) (p < 0.01).     

Second cancers following in situ carcinoma of the breast

Most reports of midbrain infarction have described clinicoanatomical correlations rather than associations and aetiologies. Thirty nine patients with midbrain infarction (9.4%) are described out of a series of 415 patients with vertebrobasilar ischaemic lesions in the New England Medical Center Posterior Circulation Registry. Patients were categorised according to the rostral-caudal extent of infarction. The "proximal" vertebrobasilar territory includes the medulla and posterior inferior cerebellar artery territory. The "middle" territory includes the pons and anterior inferior cerebellar artery territory. The "distal" territory includes the rostral midbrain, thalami, superior cerebellum, and medial temporal and occipital lobes. Midbrain infarction was accompanied by "proximal" territory infarcts in four patients, and by "middle" territory infarction in 19 patients. Thirteen patients had associated "distal" territory infarcts, three of whom had occipital or temporal lobe infarcts. Only three patients had isolated midbrain infarcts. Cardioembolism (n=11), in situ thrombosis (n=9), large artery to artery embolism (n=7), and intrinsic branch penetrator disease (n=5) were the most common aetiologies. Bilateral infarction and accompanying pontine infarction were associated with the most extensive vertebrobasilar occlusive disease. Midbrain infarction was 10-fold more likely to be accompanied by ischaemia of neighbouring structures than it was to occur in isolation. Recognition of the different patterns of infarction may act as a guide to the underlying aetiology and vascular lesions.     

Surgical therapy strategies in carcinoma in situ of the breast

The surgical treatment of carcinoma in situ of the breast depends on the histological type. After detecting a lobular carcinoma in situ (CLIS) either an intensive (aftercare) follow-up is recommended or a bilateral mastectomy. The choice for one of these two very different forms of therapy can be done only after intensive psychological dialog with patient. The reason for the different forms of further treatment is the multicentric and often bilateral occurrence of CLIS and the potential risk of developing an invasive cancer. The therapy of the ductal carcinoma in situ (DCIS), which often spread out in a segment of one breast, is the total excision of the lesion with clear margins. The Van Nuys Prognostic Index depending on the histological results (tumor-diameter, thickness of clear margins, pathocytologic classification) indicates further treatment such as radiotherapy or mastectomy to lower the chance of local recurrence.     

Effect of cervical carcinoma in situ and its management on pregnancy outcome

Small decreases in hydration status can result in a dramatic decrement in athletic performance and greatly increase the risk of thermal injury. Because of its osmotic properties, which enable greater fluid retention than the ingestion of water alone, glycerol has been proposed as a hyperhydrating agent. In fact, glycerol is now commercially available and marketed as a sport supplement to be ingested with water or sport drinks; thus, dietitians need to be cognizant of this new addition to the sports nutrition table. The results of glycerol-induced hyperhydration research have been equivocal, most likely because of methodologic differences between studies, such as variations in the intensity of exercise, environmental conditions, and concentration or dose of glycerol administered. Although the suggested dosage of glycerol depends on body size and varies between manufacturers, 1 g/kg body weight with an additional 1.5 L fluid taken 60 to 120 minutes before competition is standard. Some test subjects reported feeling bloated or nauseated after ingesting glycerol. This review examines glycerol-induced hyperhydration research and the safety of ingesting glycerol, discusses commercial availability of glycerol, and makes recommendations for glycerol-induced hyperhydration research.     

Cryosurgical treatment of dysplasia and carcinoma in situ of the cervix uteri

Fifty-nine patients (age range 18-40 years, mean 28 years) with dysplasia or carcinoma in situ of the cervix uteri were treated with cryosurgery. Healing occurred in 54 patients (91.6%) after one treatment ("double-freeze" technic) and in 2 patients after refreezing. No early or late complications occurred during a follow-up period of 7-37 months. Five of the patients with carcinoma in situ were followed immunologically with determinations of serum TPA (tissue polypeptide antigen), which can be employed as a parameter of malignancy. In all instances, the initially elevated TPA normalized after cryosurgical treatment. Cryosurgery is a simple, painless and safe treatment method in ectocervically localized carcinoma in situ and dysplasia that is particularly suited for out-patient use.