Interleukin-1, interleukin-1 receptor antagonist and macrophage populations in rheumatoid arthritis synovial membrane

OBJECTIVES: To describe the anatomoclinical characteristics of 4 cases of sclerosing adenosis of the prostate in order to determine the diagnostic features and clinical significance of this disease entity, which histologically mimicks adenocarcinoma of the prostate. METHODS: Specimens from our Pathological Anatomy Service obtained by transurethral resection (TUR) and prostatic adenomectomy, with a clinical diagnosis of a benign pathology, were reviewed. Three cases with a histological diagnosis of sclerosing adenosis of the prostate were found over the last 10 years. A fourth case, an adenomectomy specimen corresponding to 1986 whose initial diagnosis had been changed to that of sclerosing adenosis of the prostate, was identified in a review conducted on incidentally detected carcinomas Tla. RESULTS: The four cases (2 adenomectomy, 2 TUR specimens) were microscopic findings. Patient mean age was 73 years. All cases were associated with a nodular hyperplasia, without clinical or analytical signs of malignant neoplasm or an associated carcinoma. One case showed involvement of 3 fragments of the TUR specimen; the rest had a single focus or involvement of a single fragment. At 5 years mean follow-up, no evidence of new lesions have been observed. CONCLUSIONS: Sclerosing adenosis of the prostate is an uncommon lesion, which is generally microscopic and more frequently found in the prostatic transitional zone, and can be confused histologically with microacinar carcinoma. It is usually an incidental histopathological finding without clinical significance or relationship with carcinoma of the prostate.     

Cosmetics, skin care products, and the dermatologic surgeon. Postsurgical selection of cleansing products

A wide variety of architectural patterns of adenocarcinoma may be seen in the prostate. We have recently encountered a hitherto-undescribed pattern of growth characterized by intraluminal ball-like clusters of cancer cells reminiscent of renal glomeruli, which we refer to as prostatic adenocarcinoma with glomeruloid features. To define the architectural features, frequency, and distribution of prostatic adenocarcinoma with glomeruloid features, we reviewed 202 totally embedded radical prostatectomy specimens obtained between October 1992 and April 1994 from the files of the Mayo Clinic. This series was supplemented by 100 consecutive needle biopsies with prostatic cancer from January to February 1996. Prostatic adenocarcinoma with glomeruloid features was characterized by round to oval epithelial tufts growing within malignant acini, often supported by a fibrovascular core. The epithelial cells were sometimes arranged in semicircular concentric rows separated by clefted spaces. In the radical prostatectomy specimens, nine cases (4.5%) had glomeruloid features. The glomeruloid pattern constituted 5% to 20% of each cancer (mean, 8.33%) and was usually located at the apex or in the peripheral zone of the prostate. Seven cases were associated with a high Gleason score (7 or 8), one with a score of 6, and one with a score of 5. All cases were associated with high-grade prostatic intraepithelial neoplasia and extensive perineural invasion. Pathological stages included T2c (three cases), T3b (four cases), and T3c (two cases); one of the T3b cases had lymph node metastases (N1). Three (3%) of 100 consecutive routine needle biopsy specimens with cancer showed glomeruloid features, and this pattern constituted 5% to 10% of each cancer (mean, 6.7%). The Gleason score was 6 for two cases and 8 for one case. Two cases were associated with high-grade prostatic intraepithelial neoplasia, and one case had perineural invasion. Glomeruloid features were not observed in any benign or premalignant lesions, including hyperplasia and intraepithelial neoplasia. Glomeruloid structures in the prostate represent an uncommon but distinctive pattern of growth that is specific for malignancy. Glomeruloid features may be a useful diagnostic clue for malignancy, particularly in some challenging needle biopsy specimens. This pattern of growth is usually seen in high-grade adenocarcinoma, often with extraprostatic extension. Further investigations are required to determine its independent predictive value and correlation with stage and Gleason score.     

Histopathological examination of transurethral electrovaporization of the prostate

Transurethral electrovaporization of the prostate (TVP) has been devised to eliminate prostatic tissue by electric vaporization and to create a dry coagulation layer beneath to minimize bleeding from the site of TVP. However, vaporization induces degeneration due to thermal coagulation deep in the tissue beneath the vaporized layer, and local tissue damage is thus greater than that caused by the standard transurethral resection of prostate (TURP) loop. Since this results in difficulty with histopathological examination, the percentages of tissue-diagnosable area were determined in sections resected using various vaporization electrodes (Roller Loop, Band & Wedge Loop). The percentage of tissue-diagnosable area was 92.0 +/- 3.3% with the standard TUR loop, 2.4 +/- 0.9% with the Roller Loop, 42.7 +/- 21.1% with the Band Loop, and 39.7 +/- 24.4% with the Wedge Loop. Concerning speed of resection, the best vaporization effect was obtained when the speed of operation was 1/2 or 1/3 that with the standard TUR loop. Since the region in which tissue diagnosis was smaller with the vaporization electrode than with standard TURP, more careful examination was required for diagnosis of incidental cancers. Therefore, postoperative observation by PSA measurement appeared to be important.     

Apoptosis in labial salivary glands from Sj?gren''s syndrome (SS) patients: comparison with human T lymphotropic virus-I (HTLV-I)-seronegative and -seropositive SS patients

Patients with solitary rectal ulcer syndrome (SRUS) frequently present with a mass that can be misinterpreted as cancer. In contrast, the occurrence and characteristics of SRUS-like histopathology produced by underlying malignancy have not been reported in detail. We report seven patients whose rectal mass that was induced by infiltrating carcinoma showed only histopathologic changes of SRUS on initial mucosal biopsy specimens. Carcinoma was evident in subsequent specimens after one to five repeat biopsies with delay in diagnosis from 1 week to 18 months in six patients. In one patient, infiltrating carcinoma was suggested on the first biopsy specimen by immunohistochemistry for cytokeratin. Three of the patients had primary rectal adenocarcinoma, two had metastatic carcinoma from stomach or ovary, and two had direct invasion of anal squamous cell carcinoma or prostatic adenocarcinoma. We conclude that the histopathology of SRUS may occasionally represent a characteristic but nonspecific mucosal reactive change to a deeper seated malignancy. The terminology "solitary rectal ulcer syndrome/mucosal prolapse changes" with a cautionary note may be useful for reporting biopsy results to emphasize the possibility of underlying primary or metastatic malignancy in the differential diagnosis.     

Outcomes of balloon coronary angioplasty of bifurcation stenoses in patients with ischemic heart disease

Specialists of the Research Institute of Urology have practiced combination of transurethral resection (TUR) with electrovaporization in endoscopic treatment of bladder cancer (BC) since 1995. A total of 46 patients with transient cell BC (29 males and 17 females aged 49-87) stage Ta-T1 (32 patients) and T2-T3b (14 patients) underwent TUR or electrovaporization (if morphologically verified) of the exophytic part of the tumor. In addition, electrovaporization of the base of the tumor was made. Main indications for such treatment were standard indications for TUR in contraindications for more radical treatment. 6-24-month follow-up was possible in 23(71.9%) patients with superficial BC (group 1) and in 9(64.2%) patients with invasive BC (group 2). Endoscopically, the recurrence was detected in 3(13%) and 5(55.5%) patients of group 1 and 2, respectively. They were reoperated on with electrovaporization. It is inferred that TUR-vaporization of the bladder is an effective endoscopic treatment of superficial BC. Electrovaporization is a good palliative treatment in patients with invasive BC when radical surgery is impossible. It inhibits the progression of the disease, prevents hemorrhages due to the tumor destruction, reduces intraoperative blood loss, improves endoscopic visualization. It may also increase the operation ablasticity.     

重复穿刺活检中高级别上皮内瘤对前列腺癌的预测价值

Objective: The significance of isolated high-grade prostatic intraepithelial neoplasia in initial biopsy as an predictor for prostate cancer has been extensively research, and the true relationship remnant is no clear till now. The aim of this study is to evaluate prediction value of cancer on repeat biopsy in patients with high-grade prostatic intraepithelial neoplasia,using multivariate analysis. Methods: Thirty-eight men with a diagnosis of isolated high-grade prostatic intraepithelial neoplasia in initial needle biopsy were studies, in the Fist Affiliated Hospital of Medical School of Xi'an Jiaotong University, from January 2003 to March 2009. These samples were using immunostaining of p63 and 34βE12 and P504s, with a median follow-up of 525 (range, 7 to 1650) days, and to researched the incidence of subsequent prostate cancer, and to predicted the risk of prostate cancer in clinicopathological parameters of isolated high-grade prostatic intraepithelial neoplasia on repeat biopsies by logistic regression analysis. Results: There were 10 of 38 (26.3%) men with prostate cancer on repeat biopsies after diagnosis isolated high-grade prostatic intraepithelial neoplasia in initial biopsy, of the rates of prostate cancer were 80% for micropapillary and 75% for cribriform high-grade prostatic intraepithelial neoplasia (P < 0.05), respectively. The positive cores of isolated high-grade prostatic intraepithelial neoplasia was the important for the risk of prostate cancer using Multifactor logistic regression analysis. The time range in 30 to 690 days was stronger risk for prostate cancer detection after diagnosis isolated HGPIN in initial biopsy. p63 and 34βE12 were disrupted positive expression, and P504S was weak positive expression in the 61% isolated high-grade prostatic intraepithelial neoplasia. Conclusion: Isolated high-grade prostatic intraepithelial neoplasia on repeat biopsy conferred a 26.3% risk of prostate cancer, and this risk level is lower than the previously reported risk of 24% to 58%. The number of positive cores and the histopathological pattern with high-grade prostatic intraepithelial neoplasia on initial biopsy was significantly associated with the risk of cancer.     

Cholestasis assessment by activity of antioxidant enzymes and composition of plasma lipoproteins in patients with liver diseases]

23 patients with benign prostatic hyperplasia (BPH) aged 60-82 years underwent transurethral resection (TUR) of the prostate in different periods after thermal treatment which had appeared uneffective or brought complications. In the performance of the endoscopic techniques we found macroscopic changes of the prostatic parts of the urethra and bladder cervix characteristic for certain thermal impact (energy, power, site of exposure). Intraoperative bleeding of prostatic tissue was also different depending primarily on the time which had passed after the thermal treatment. Minimal bleeding occurred at least 3 months after the thermotherapy. Thus, thermal treatment of the prostate can be used in combined treatment of BPH for reducing intra- and postoperative hemorrhage due to subsequent TUR. Among the methods of thermal therapy, transurethral microwave thermotherapy is preferable as minimally invasive and deeply penetrating into the depth of the prostatic gland with maximal effect. TUR of the prostate should be performed not earlier than 3 months after thermotherapy which is indicated only for patients at high risk of intraoperative hemorrhage because of unaffected circulation. Therefore, it is desirable to include transrectal dopplerography of the prostate to urological examination of BPH patients.     

The effect of desmopressin on platelet aggregation defect in systemic amyloidosis: a preliminary report

The contrasting radiological appearances of metastatic deposits in the mandible of prostatic adenocarcinoma in two patients are described. The clinical presentation was similar in that both presented with altered sensation of the lower lip. Radiologically, they differed in that one patient suffered from a large predominantly osteoblastic mass, while the other, who gave a history of previously treated prostatic adenocarcinoma, presented with a rather small osteolytic deposit. Investigations for bony metastatic disease usually include a bone scan which is a highly sensitive technique although non-specific. A skeletal survey can be useful although less sensitive than a bone scan. Blood investigations such as acid phosphatase and prostate specific antigen levels are also indicated in male patients where prostatic disease is suspected. Reasonable long term survival using relatively simple drug therapy without significant local surgery, highlights the need for accurate recognition and tissue diagnosis to differentiate this condition from osseous malignancy of the jaws, other metastatic disease or osteomyelitis.     

Metastatic adenocarcinoma of an unknown primary site. A comparison of the relative contributions of morphology, minimal essential clinical data and CEA immunostaining status

Measurement of the relative contributions of morphology alone; minimal essential clinical data; immunohistologic reactivity of a prototypic tumor marker, carcinoembryonic antigen (CEA); and the process by which a pathologist can identify the origin of a metastatic adenocarcinoma of unknown primary site is the subject of this report. To standardize the case material, we used an image digitizing and archival system to present 100 metastatic adenocarcinomas of known primary site as unknowns to two pathologists. The images were selected to show only gland-forming areas of the carcinomas and excluded all normal tissue elements. They were viewed, initially without, and then with, identification of gender and metastatic site. Subsequently, the results of immunoperoxidase staining for CEA, assessed independently by a third pathologist, were provided. Our analysis showed that, overall, the correct primary site was chosen as choice 1, 2, or 3 in 72% and 76%, and as choice 1 in 49% and 47% of cases, respectively. Accuracy was highest for prostatic, ovarian, and breast carcinomas, and lowest for upper-gastrointestinal tract, biliary tract, and pancreatic adenocarcinoma. Statistical analysis showed the largest increments in accuracy in the choice 1 prediction in each tumor category were achieved by provision of minimal essential clinical data. Knowledge of CEA status did not affect overall accuracy; however, it increased the odds of making the correct diagnosis for ovarian, colorectal, and endometrial (both pathologists) carcinomas, and for prostatic, pulmonary and esophago-gastric adenocarcinomas (one pathologist). The study exemplifies a model for the objective measurement of the contribution of ancillary studies, such as immunoperoxidase markers, to the accuracy of pathologic diagnosis.     

Local control of prostate cancer with transurethral intracavitary radiation therapy

As of January 1986, 13 patients with adenocarcinoma of the prostate had been treated in our clinic by remote after-loading transurethral high dose rate radiotherapy using a 60Co source. Of these patients, four were at stage B2, three at stage C, three at stage D1, and three at stage D2. The mean total dose of transurethral radiotherapy was 35.2 Gy to the most distant prostatic capsule from the source. Three patients with stage D1 disease and one patient with stage C disease received additional external radiation with a total dose of 20 Gy to the prostate and 40 Gy to the pelvis. Local tumor response proved rapid and satisfactory as verified by rectal examination, ultrasonography, and needle biopsy. Serious complications such as proctitis, cystitis, incontinence, and urethral stricture were not evident during the average follow-up term of 34.9 months.     

Evaluation of c-ras oncogene product (p21) in superficial bladder cancer

OBJECTIVES: The aim of our study is the evaluation of the prognostic importance of p21 protein in superficial bladder cancer. METHODS: One hundred and fourteen patients with an initial diagnosis of monofocal bladder cancer (stage Ta-T1) following TUR were investigated. On the tissue removed by TUR, besides the usual pathological evaluation, an immuno-histochemical investigation was carried out in order to ascertain the presence of c-ras oncogene product (protein p21). The actuarial curves concerning the time free from the first recurrence were computed, comparing different subgroups in regard to protein p21 presence, grade and stage of the tumour. RESULTS: The analysis of the results shows the importance of tumour stage as a predictor of recurrence, as well as that of the presence of c-ras products. This last factor increases the risk of recurrence almost 2-fold, in the same time lag, for c-ras-positive patients (p < 0.001). The prognostic significance of c-ras is independent of stage. CONCLUSION: Our data underline the possibility of acquiring important information on the prognosis of superficial bladder cancer patients, pointing out the significance of c-ras oncogene product.     

Pulmonary hypertrophic osteoarthropathy and clubbing of fingers in patients with lung cancer

We examined clinical characteristics of patients with primary lung cancer associated with clubbing of the fingers or pulmonary hypertrophic osteoarthropathy. Clubbing was observed in 12.5% of patients with lung cancer. Squamous cell carcinoma was frequently associated with clubbing. Clubbing was found in all clinical stages. PaO2 and PaCO2 were normal in patients with lung cancer, which suggests that neither hypoxemia nor hypercapnia caused the clubbing in these patients. Pulmonary hypertrophic osteoarthropathy was found in three patients with lung cancer (two men and one woman, mean age 49 years). The incidence was 2.9% among lung cancer patients with clubbing, 0.22% in all lung cancer patients, and was apparently lower than those in reports from outside Japan. One of these patients has stage IIIA squamous cell carcinoma, one had stage IV large cell carcinoma, and one had stage IV adenocarcinoma. In all cases bone scans were useful for diagnosis and for following the clinical course.     

Extraorganic hepatic artery aneurysm: failure of transcatheter embolization

BACKGROUND: We evaluated the safety and efficacy of transurethral electrovaporization of the prostate (TVP) as a new alternative treatment for patients with benign prostatic hyperplasia. METHODS: A total of 22 patients with symptomatic benign prostatic hyperplasia, including 4 with urinary retention, underwent TVP. If enough of a cavity was not created after 60 minutes of vaporization, transurethral resection of the prostate (TURP) was performed successively. International Prostate Symptom Score (I-PSS) with quality-of-life index, maximum flow rate, and postvoid residual volume were measured at baseline and at 2 weeks, 1, 3, and 6 months. A pressure-flow study was performed at baseline and at 3 or 6 months after surgery. RESULTS: TURP was required in 10 of 22 patients. At 6 months, mean I-PSS decreased from 20.0 to 5.2, quality-of-life index decreased from 4.6 to 1.1, mean maximum flow rate increased from 6.9 to 16.7 mL/s, and postvoid residual volume decreased from 152 to 32 mL. Detrusor pressure at maximum flow decreased from 108 to 39 cm H2O, with a significant relief of bladder outlet obstruction in 93% of the patients. Mean decrease in hematocrit was 4.4%, and in serum sodium, 4.8 mEq/L. None of the patients required transfusions or had TUR syndrome. A urethral stricture and a severe stress incontinence developed in 1 patient. CONCLUSION: TVP seems to be a safe and effective alternative to a standard TURP associated with fewer intraoperative complications. Although preliminary clinical results have been promising, further study is necessary to establish long-term efficacy and safety of this procedure.     

Does mandating continuing education mandate competence?

Serial prostate-specific antigen (PSA) measurements (PSA velocity) as an additional instrument to detect prostatic cancer was introduced in 1992. It has previously been reported that PSA increase per year differed in the last 5 years prior to diagnosis in patients with benign prostatic hyperplasia (0.18 ng/ml/year), locally confined (0.75 ng/ml/year) and metastasized (4.4 ng/ml/year) cancer of the prostate (CaP) in contrast to healthy men (0.04 ng/ml/year). The ability of PSA velocity to detect organ-confined CaP in patients with intermediate PSA serum values depends therefore on a reliable and reproducible PSA result. The present study comprised 85 men with PSA values between 3 and 8 ng/ml (Abbott IMx). PSA measurements were repeated with Abbott IMx (n = 85 patients) and Hybritech Tandem-E (n = 59 patients) assays. The PSA serum values differed from one examination to the other from 0.02 to 2.74 ng/ml with the Abbott IMx. Standard deviation amounted to 0.35 ng/ml with the Abbott IMx PSA assay. Using the Hybritech Tandem-E assay, mean standard deviation was 1.15 ng/ml and therefore higher than with the Abbott IMx assay. The difference from one test to the other ranged from 0.05 to 4.05 ng/ml with the Hybritech Tandem-E. Using the Abbott IMx assay, 10.6% of all repeat measurements exceeded 1 ng/ml whereas in the Hybritech Tandem-E assay 62.7% of the second measurements differed > 1 ng/ml from the first PSA result. An increase in PSA serum values may therefore be due to intratest variation, physiological day-to-day variation as well as prostatic disease. It is important to notice that the intra-assay variation may be greater than the PSA increase per year in a patient with CaP. Therefore, PSA velocity seems to be of limited value.     

Tumour progression and survival in patients with T1G3 bladder tumours: 15-year outcome

OBJECTIVE: To evaluate tumour progression and survival of patients with T1G3 bladder tumours who were followed for 15 years. PATIENTS AND METHODS: A subset of 48 patients with T1G3 bladder tumours was entered into a randomized trial of transurethral resection (TUR) or TUR plus bacille Calmette-Guèrin (BCG) therapy and followed for a minimum of 15 years. Thirty-nine (81%) patients received one or more courses of BCG. The endpoints of the study were stage progression (defined as muscle invasion of metastasis) and disease-specific survival. RESULTS: Of the 48 patients, 25 (52%) progressed and 15 (31%) died from the disease; 33 patients (69%) survived, including 24 (50%) with an intact bladder. The median progression-free survival time was 151 months. Tumour progression occurred in 35% of the patients within the first 5 years, in 16% after 5-10 years and in 12% of those followed for 10-15 years. Deaths from cancer occurred in 25% of the patients in the first 5 years and in 10% of patients at risk from 5 to 15 years. CONCLUSIONS: Patients with T1G3 bladder tumours who are treated conservatively are at life-long risk of having a muscle-invasive tumour and dying from bladder cancer.     

Intermittent cholestatic jaundice and nonmetastatic prostatic carcinoma

Hepatomegaly and abnormal liver function can occur in nonmetastatic malignancies. A patient with metastatic prostatic adenocarcinoma that had spared the liver and extrahepatic biliary tree is described. He had puzzling episodes of jaundice for a period of 2 1/2 years. The results of appropriate investigations and an exploratory laparotomy performed dlring the patient's four antemortem hospitalizations were indicative of "recurrent intrahepatic cholestasis," the cause of which remained an enigma even after exploratory laparotomy. At autopsy, no evidence of hepatic metastases or extrahepatic biliary obstruction was found. Alcohol, hepatotoxic drugs, toxins, viral and chronic active hepatitis, hemolysis, and extrahepatic biliary obstruction were eliminated as causes of the jaundice. We believe that the intermittent intrahepatic cholestasis is one of the nonmetastatic manifestations (nonmetastatic hepatopathy of malignancy) of the prostatic adenocarcinoma.     

Case diagnosis as positive identification in prostatic neoplasia

OBJECTIVE: To apply a distance measure and Bayesian belief network-based methodology to the positive identification of case diagnosis in prostatic neoplasia. STUDY DESIGN: Eight morphologic and cellular features were analyzed in 20 cases of normal prostate, 20 of low grade prostatic intraepithelial neoplasia (PIN), 20 of high grade PIN, 20 of prostatic adenocarcinoma with a cribriform pattern and 20 of prostatic adenocarcinoma with an acinar pattern. The diagnostic distance was evaluated to measure the "extent" to which the feature outcomes of the individual cases differed from the expected profile of outcomes in typical cases of normal prostate, low and high grade PIN, and cribriform and large acinar adenocarcinoma. Belief values were evaluated with a Bayesian belief network (BBN). RESULTS: A bivariate representation of the cumulative absolute diagnostic distances of all the cases from the prototypes of normal prostate and cribriform adenocarcinoma was made. Three separate groups of cases were observed, corresponding to normal prostate, low grade PIN and cribriform adenocarcinoma. An additional group was formed by the cases of high grade PIN and acinar adenocarcinoma--i.e., there was complete overlap between the diagnostic distance values of cases belonging to these two categories. However, these cases showed differences in clue outcomes. To explore the contribution of such observations to case identification, a bivariate representation of the diagnostic distances from high grade PIN and acinar adenocarcinoma was made. The cases then formed five separate groups corresponding to the five diagnostic categories. When the individual cases were considered, their shortest distance was from the prototype of the category into which they were originally diagnosed. The BBN gave these diagnostic categories the highest belief values. CONCLUSION: The combined evaluation of diagnostic distance and belief represents an identification procedure. The numeric value of certainty characterizes individual cases according to the level of progression from PIN toward cancer.     

Primary transitional cell carcinoma of the prostate. An infrequent tumor

Primary prostatic carcinoma accounts for 2% to 4.5% of all neoplasias to this organ, and it has been observed in 2.8% of all radical cystoprostatectomies performed in the Mayo clinic. It originates in the poorly differentiated reservoir cells of the prostatic periurethral ductus which explains why diagnosis is most often obtained in advanced stages (stromal involvement), thus limiting its management to radical surgery. This paper contributes one case report of a patient diagnosed by transrectal biopsy of a primary prostatic transitional carcinoma presenting with incoercible rectorrahges and urinary obstruction symptoms. Treatment was through pelvic exenteration, and urinary and gut by-pass.     

Can insignificant prostate cancer be predicted preoperatively in men with stage T1 disease?

This study reviews the pathological findings in nonpalpable prostate cancer detected on transurethral resection (TUR) (stages T1a and T1b) and on needle biopsy (stage T1c) to determine whether insignificant cancers can be predicted preoperatively. The majority of stage T1a cancers are insignificant and all stage T1b cancers are significant. Preoperative pathological parameters cannot identify the minority of T1a cancers that are more significant and the minority of T1b cancers with relatively little residual cancer. Although most nonpalpable tumors diagnosed by screening techniques are usually significant tumors, which would be treated aggressively if they were palpable, 12% to 26% of cancers removed from nonpalpable disease are relatively insignificant. There is conflicting data as to whether a combination of needle biopsy findings and PSA density measurements can aid in the prediction of insignificant cancers. If conservative management is considered, a patient should undergo repeat biopsies (including transition zone biopsies) to detect those more significant cancers that may have been undersampled. In addition, serial serum PSA measurements should be performed to detect whether serum PSA levels increase to a point where these tumors would be reclassified as significant. When planning therapy for T1 patients, the age, comorbidity, and treatment preferences of the patient are key factors that must also be taken into account.     

Distribution of lipochrome pigment in the prostate gland: biological and diagnostic implications

Lipochrome pigment is characteristically found in Wolffian duct-derived structures including seminal vesicles and ejaculatory ducts. The presence of lipochrome pigment is helpful in identifying atypical histological patterns of seminal vesicle or ejaculatory duct that mimic prostatic adenocarcinoma. The authors studied the distribution of lipochrome pigment in 28 radical prostatectomy specimens using a modified Ziehl-Neelson stain and fluorescence microscopy. In all cases secretory epithelium of the central zone contained lipochrome pigment often in significant amounts (2 to 3+). Secretory epithelium from peripheral and transition zones in each of four specimens (14.3%) contained lipochrome pigment. In addition, occasional examples of nodular hyperplasia, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma contained lipochrome pigment. The preferential distribution of lipochrome pigment in central zone epithelium adds further support to the hypothesis that central zone glands are derived embryologically from Wolffian duct (mesoderm) rather than urogenital sinus (endoderm), which gives rise to transition and peripheral zone glands. Furthermore, lipochrome pigment should not be used as the sole diagnostic criterion for separating atypical histological patterns of seminal vesicle and ejaculatory duct from those of prostatic origin.