Benign Nodular Hyperplasia Research Articles

SAT549 False Alarm: Profoundly High Thyroglobulin Level Without Evidence Of Thyroid Malignancy

Abstract Disclosure: F.L. Thelmo: None. J. Watari: None. J.L. Miller: None. Thyroglobulin (TG) remains a clinical mainstay for monitoring of disease burden and recurrence in patients with differentiated thyroid cancer. TG levels are expected to be low to undetectable in patients who undergo total thyroidectomy and less than 30 ng/mL in patients who undergo thyroid lobectomy. We describe a case of a 52-year-old patient who underwent thyroid lobectomy for a 16 mm minimally invasive follicular thyroid carcinoma (single vessel angioinvasion) who was later found to have a TG level in excess of 2,000 despite no signs of metastatic disease. A 52-year-old male with past medical history of prediabetes and minimally invasive follicular thyroid cancer presented for follow-up after right lobectomy five years prior. The patient was lost to follow-up after his lobectomy. During work-up of paresthesias, a cervical spine MRI incidentally noted a 41 mm enhancing mass in the left thyroid lobe. The patient had a TSH of 1.1 mIU/L. A dedicated thyroid ultrasound was performed which found a left 2.9 cm TI-RADS 3 nodule which was biopsied and found to be benign (Bethesda II). TG level was obtained and found to be significantly elevated at 2,479.9 ng/mL with negative thyroglobulin antibodies. This was repeated twice with subsequent levels being 1,857.5 ng/mL and 2,555.1 ng/mL. TG antibodies remained undetectable throughout the clinical course. The patient had a CT chest, abdomen, and pelvis exam for which no signs of metastatic disease were detected. A skeletal survey was performed which showed no evidence of metastatic disease. The patient elected for a completion thyroidectomy to ensure there was no undetected malignancy. The patient underwent successful completion thyroidectomy. Surgical pathology showed benign nodular hyperplasia. The patient was started on replacement levothyroxine and one month later the TG level became undetectable. We would like to draw attention to this patient’s profoundly high TG levels which are normally associated with recurrence of thyroid malignancy or large goiter. After comprehensive evaluation this patient was found to have no underlying disease recurrence. A completion thyroidectomy showed no malignancy within remnant thyroid tissue or adjacent lymph nodes and repeat TG level was undetectable after completion showing that native thyroid tissue had significantly high TG production without underlying disease. We believe his remaining relatively normal thyroid lobe was a super producer of thyroglobulin. Despite TG being a sensitive marker for residual thyroid tissue and disease, the standard cut-off for lobectomy must be used with caution and may not apply to every patient. Presentation Date: Saturday, June 17, 2023

Feature and Presentations of Suspected Harboring Prostate Cancer Patients: A Study in a Tertiary Care Hospital in Bangladesh

Background: Prostate cancer is the most common cancer in males of increasing age. It is the second leading causes of cancer mortality among the men throughout the world. There are many etiological factors are associated with increased the risk of prostatic carcinoma including male hormone and its active metabolites, genetic predisposition, environmental factors, racial difference, food habits etc. A pathway with an imaging test may decide which men with an elevated PSA and/or suspected digital rectal examination will undergo biopsy. Aim of the study: The aim of this study was to assess the feature and presentations of suspected harboring prostate cancer patients. Methods: This was cross- sectional analytical study conducted in the Department of Urology, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh during the period from July 2018 to June 2020. A total of 50 male patients had undergone mpMRI of prostate and TRUS biopsy and histopathology were enrolled in this study as study population. All data were processed, analyzed and disseminated by using MS Excel and SPSS version 22.0. Results: In this study, the mean age of the participants was found as 69.14±8.48 years. The most frequent complaint of them was frequency of urination in 84%. The mean S. PSA was found as 41.78 ± 28.097 ng/ml. More than one third (38%) of patients were found to have volume of prostate 41-60 cc and the mean volume was found as 57.26 ± 19.026 cc. The mean PI-RADS score of our respondent was 3.32±1.34 ranging from 1 to 5. As mpMRI of prostate, majority (36%) patients had PI-RADS: 4. As per the histopathological diagnosis, it was found that, 34% of study patients were diagnosed as benign nodular hyperplasia. On the other hand, remaining 66% were diagnosed as carcinoma of prostate. In this study, the range of Gleason scores of the participants was found as 6-10. Conclusion: PI-RADS score, mpMRI and S. PSA assessment may be considered as some prominent evaluation methods .....

Can CT texture analysis parameters be used as imaging biomarkers for prediction of malignancy in canine splenic tumors?

Splenic hemangiosarcoma has morphological similarities to benign nodular hyperplasia. Computed tomography (CT) texture analysis can analyze the texture of images that the naive human eye cannot detect. Recently, there have been attempts to incorporate CT texture analysis with artificial intelligence in human medicine. This retrospective, analytical design study aimed to assess the feasibility of CT texture analysis in splenic masses and investigate predictive biomarkers of splenic hemangiosarcoma in dogs. Parameters for dogs with hemangiosarcoma and nodular hyperplasia were compared, and an independent parameter that could differentiate between them was selected. Discriminant analysis was performed to assess the ability to discriminate the two splenic masses and compare the relative importance of the parameters. A total of 23 dogs were sampled, including 16 splenic nodular hyperplasia and seven hemangiosarcoma. In each dog, total 38 radiomic parameters were extracted from first-, second-, and higher-order matrices. Thirteen parameters had significant differences between hemangiosarcoma and nodular hyperplasia. Skewness in the first-order matrix and GLRLM_LGRE and GLZLM_ZLNU in the second, higher-order matrix were determined as independent parameters. A discriminant equation consisting of skewness, GLZLM_LGZE, and GLZLM_ZLNU was derived, and the cross-validation verification result showed an accuracy of 95.7%. Skewness was the most influential parameter for the discrimination of the two masses. The study results supported using CT texture analysis to help differentiate hemangiosarcoma from nodular hyperplasia in dogs. This new diagnostic approach can be used for developing future machine learning-based texture analysis tools.

Canine Non-Angiogenic, Non-Myogenic Splenic Stromal Sarcoma: a Retrospective Clinicopathological Analysis and Investigation of Podoplanin as a Marker of Tumour Histogenesis

Splenic stromal sarcomas are rarely reported tumours that were previously grouped as non-angiomatous, non-lymphomatous mesenchymal neoplasms of the canine spleen. Highly variable survival times have been reported probably due to their heterogeneous nature. The purpose of this study was to assess the outcome and prognostic factors in dogs with splenic stromal sarcoma after treatment by splenectomy. Clinical data were collected retrospectively and histopathology was reviewed for 47 patients. Histological classification, based on morphology in haematoxylin and eosin-stained sections, in conjunction with immunolabelling of macrophage scavenger receptor-A (CD204), desmin, factor VIII-related antigen and smooth muscle actin ,yielded diagnoses of undifferentiated stromal sarcoma (n=22), complex nodular hyperplasia (CNH, n=9), sarcoma arising from benign complex nodular hyperplasia (n=3), histiocytic sarcoma (n=3), haemangiosarcoma (n=1) and leiomyosarcoma (n=1). Four samples were excluded from analysis due to extensive necrosis. An anti-podoplanin (PDPN) antibody was validated on canine tissue and used to assess expression of this protein as a potential indicator of the tissue of origin of the neoplasms (28/42 tumours were positive). There was a statistically significant difference in survival time between patients with stromal sarcoma (sarcoma from benign CNH and undifferentiated stromal sarcoma) and CNH (178d versus 637d, respectively; P=0.027). Dogs with stromal sarcomas and high mitotic count (≥9 per 10 high-power fields) had a significantly shorter survival time (67d versus 439d; P=0.01). Clinical diagnosis of splenic tumours should include evaluation for the presence of benign nodular hyperplasia morphology and immunohistochemistry to exclude more aggressive malignancies where adjuvant therapy is recommended. As in humans, PDPN may be an effective marker for stromal sarcomas of the canine spleen and immunopositivity suggests a fibroblastic reticular or follicular dendritic cell origin.

Spectrum of prostate gland lesions: a clinico-pathologic study in south-western Bihar, India

Background: Prostate gland is an endocrine dependent organ in males and age-related lesions involve it. Inflammation, benign nodular hyperplasia and tumours are the commonest to involve it worldwide. Occasionally some other pathological changes can also involve it. The study was carried out for the first time to know the spectrum and prevalence of prostate lesions which will be of help to the clinicians in this location.Methods: Retrospective study was carried out for a period of four years and out of surgical cases of males which underwent operative procedure, prostate cases were retrieved and in the department of pathology, haematoxylin and eosin stained slides were evaluated and diagnosed.Results: A total of 138 cases were included and five cases were excluded from this series. Benign nodular hyperplasia (73.9%) was the commonest finding followed by chronic prostatitis associated with hyperplasia (15.2%), atypical glandular hyperplasia (2.9%) and prostatic intraepithelial neoplasia (2.1%). Malignant tumours were 5.8% constituting adenocarcinoma prostate as the most common (62.5%). A case of hemangiopericytoma was also diagnosed.Conclusions: Benign nodular hyperplasia of prostate is the most common affliction among males starting at age 45 years. Early consultation and screening will be of immense value. Adenocarcinoma prostate may involve at age around 58 years.

Nuisance Neighbors: Gut-Lung Cross Talk in a Case of Crohnʼs Disease

Crohn's disease (CD) is a systemic illness with a plethora of extra-intestinal manifestations (EIM) affecting various organs, of which lungs are relatively rare. The clinicopathological patterns of pulmonary involvement consist of subclinical alterations, airway diseases, lung parenchymal diseases, pleural diseases and drug-related diseases. Tracheobronchial involvement is the most common respiratory presentation, whereas CD-related interstitial lung disease (ILD) is seen less frequently. A 41-year-old woman with a past medical history of CD (s/p subtotal colectomy) presented to the hospital for an enlarging ground-glass opacity (GGO) in her right middle lobe (RML) detected on routine CT abdomen for a CD workup six months back. She was asymptomatic, HR- 62/min, BP- 90/70 mm Hg, FEV1-122%, DLCO 106% on PFT. Contrast-enhanced CT chest showed the GGO in RML had increased in size from 21 x 18 mm to 28 x 18 mm and another GGO in the right lower lobe (RLL) increased in size from 5 mm to 12.4 mm. A robotic RML lobectomy with lymph node dissection and bronchoscopy, to rule out adenocarcinoma with lepidic growth, showed benign nodular lymphoid hyperplasia and a single perivascular epithelioid granuloma. A year later, her relapsing episodes of a cough and shortness of breath were managed with prednisone 20 mg for a probable pulmonary manifestation of CD. A non-contrast CT (NCCT) chest showed interval resolution of RLL GGO. A year later, she presented to the hospital with increasing cough, shortness of breath and a new GGO RLL (14 x 14 mm) on NCCT chest and is being managed with steroids with consideration of immunosuppression. In conclusion, pulmonary manifestations of CD present in a myriad of varieties often representing confounding diagnostic problems necessitating an extensive work-up. Thus, CD should be kept in the differential list in the case of unusual clinical symptoms and radiological signs of a pulmonary presentation. These infrequent, and sometimes life-threatening, EIM need to be considered when dealing with CD, to avoid further impairment of health status and alleviate patient symptoms by prompt recognition and treatment.2082_A Figure 1. Initial CT Abdomen & CT Chest2082_B Figure 2. CT Chest six months later2082_C Figure 3. NCCT Chest s/p lobectomy and most recent one

Morphological study of prostate in different age groups of Indian population

Abstract Introduction: The prostate is a pyramidal shaped, fibromuscular glandular organ which surrounds the prostatic urethra. Three pathologic processes affect the prostate gland: Inflammation, Benign prostatic (Nodular) hyperplasia, and tumours. Of these three, the benign nodular hyperplasia and prostatic carcinoma are prevalent worldwide. Main treatment for both the above mentioned condition till date is surgical extraction of the prostate. A clear concept is required about the morphological features and measurements of prostate as it will play a major role in defining the disease and for the diagnosis. Material and Methods: The present study was conducted in the Department of Anatomy utilizing 50 samples of human prostate, age ranging from 10 to 80 years. The various morphological parameters studied were length, transverse diameter, antero-posterior diameter and weight of prostate. Results: The lowest and highest mean value were 1.76-2.79 cm; 3.35-4.04 cm; 1.65-2.30 cm and 16.8-26.6 gm for length, transverse diameter, antero-posterior diameter and weight respectively. Statistical measurements included mean, standard deviation, range and correlation coeficients of different parameters. Conclusions: Length and transverse diameter of prostate were maximum in the American population, Antero-Posterior diameter was maximum for Bangladeshi and weight was found maximum in Indian population.

Nodular lymphoid hyperplasia of urinary bladder admixed with non-invasive low-grade urothelial carcinoma

Primary malignant lymphoma of urinary bladder is extremely rare, and benign nodular lymphoid hyperplasia has not been reported in bladder. Nodular lymphoid hyperplasia of bladder associated with bladder carcinoma has also not been reported. Herein the author describe a 64-year-old man who presented with dysuria and his cystscopic examination revealed a papillary tumor in bladder. A transurethral resection of bladder tumor was carried out, and histopathologic examination revealed a non-invasive pTa low-grade papillary urothelial carcinoma and nodular lymphoid hyperplasia that were mixed up. The nodular lymphoid hyperplasia was composed of inner germinal centers and outer marginal and mantle zones. The germinal centers were composed of tangible body macrophages, centrocytes and centroblasts, while the outer zone of mature lymphocytes. Immunohistochemical profile of nodular lymphoid hyperplasia was as follows: cytokeratin AE1/AE3-, cytokeratin CAM5.2-, CD45+++, CD20+++, CD79a++, CD138-, CD3-, CD45RO-, CD15-, CD30-, p53- Ki67 80% (confined to germinal centers), bcl-2-, bcl-6++, CD10++, MUM1-, cyclinD1-, light chains-, CD56-, TdT-, CD68-. The patient is now followed up without any treatments by periodical cystscopy with BCG injection and cytology. No recurrence is noted 13 months after the first presentation. In conclusion, an extremely rare case of nodular lymphoid hyperplasia mixed with non-invasive urothelial carcinoma in bladder is reported.

SOME CHARACTERISTICS OF AGE, ULTRASOUND AND THE RELATION BETWEEN THE PSA DENSITY AND THE HISTOPATHOLOGY OF BENIGN NODULAR PROSTATIC HYPERPLASIA AND PROSTATIC CARCINOMA

Background: PSA density by the ratio of tPSA/prostatic volume plays a meaningful role for the orientation of diagnosis and the screening of the prostatic diseases, especially for the prostatic carcinoma and benign nodular hyperplasia. Objectives: - To describe some characteristics of the age, ultrasound of the patient with the prostatic carcinoma and benign nodular hyperplasia; - To determine the relation between PSA density and the histopathology of the patient with the prostatic carcinoma and benign nodular hyperplasia. Materials and Method: cross-sectional study on 70 patients including 35 cases with benign nodular prostatic hyperplasia and 35 ones with carcinoma of the prostate. Results: The average age was the same between 2 groups of the diseases, 73 for prostatic carcinoma and 75 for benign nodular hyperplasia. 100% of the lesions was discovered by ultrasound, the average weight of the carcinoma and benign nodular hyperplasia was 57.3g and 46.9g respectively. The tPSA density was higher in carcinoma than in benign nodular hyperplasia (1.22 vs 0.10); With the tPSA density threshold >0.15, the prostatic carcinoma accounting for 78.4%, then the benign group only 21.6%; the Sensitivity and the Specificity were 82.9% and 77.1% respectively. Conclusions: PSA density should be applied for the diagnosis and the screening of the prostatic tumors beside the tPSA test. Key words: tPSA (total PSA), PSA density, ultrasound, prostatic carcinoma, benign nodular prostatic hyperplasia.

Intercellular adhesion molecule 1 is a sensitive and diagnostically useful immunohistochemical marker of papillary thyroid cancer (PTC) and of PTC-like nuclear alterations in Hashimoto's thyroiditis.

Intercellular adhesion molecule 1 (ICAM-1) is important in the progression of inflammatory responses. Recently, increased levels of ICAM-1 have been reported in a number of types of malignancy. The present study aimed to investigate ICAM-1 expression in papillary thyroid cancer (PTC) and in Hashimoto's thyroiditis (HT) with PTC-like nuclear alterations, and to assess the predictive value of ICAM-1 in thyroid lesions. ICAM-1 expression was retrospectively investigated in 132 consecutive cases of PTC, 72 cases of HT, 10 of follicular cancer, 15 of follicular adenoma, 16 of nodular goiter and 8 samples of normal thyroid tissue using immunohistochemical analyses, and in 42 PTC patients using western blotting. ICAM-1 expression was not detected in normal follicular cells, follicular lesions (adenoma and cancer) and benign nodular hyperplasia, but was frequently overexpressed in PTC cells. ICAM-1 overexpression was associated with extra-thyroidal invasion and lymph node metastasis; no association was found with age, gender, tumor size, multifocality, pathological stage, recurrence or distant metastasis. ICAM-1 expression in HT patients with PTC-like nuclear alterations was significantly higher than that in HT cases with non-PTC-like features. Compared with antibodies against cytokeratin 19, galectin-3 and Hector Battifora mesothelial-1, ICAM-1 was the most sensitive marker for the detection of PTC-like features in HT. These findings demonstrate that ICAM-1 expression is upregulated in PTC and in HT with PTC-like nuclear alterations. This feature may be an important factor in the progression of cancer of the thyroid gland.

Fractal analysis and the diagnostic usefulness of silver staining nucleolar organizer regions in prostate adenocarcinoma.

Pathological diagnosis of prostate adenocarcinoma often requires complementary methods. On prostate biopsy tissue from 39 patients including benign nodular hyperplasia (BNH), atypical adenomatous hyperplasia (AAH), and adenocarcinomas, we have performed combined histochemical-immunohistochemical stainings for argyrophilic nucleolar organizer regions (AgNORs) and glandular basal cells. After ascertaining the pathology, we have analyzed the number, roundness, area, and fractal dimension of individual AgNORs or of their skeleton-filtered maps. We have optimized here for the first time a combination of AgNOR morphological denominators that would reflect best the differences between these pathologies. The analysis of AgNORs' roundness, averaged from large composite images, revealed clear-cut lower values in adenocarcinomas compared to benign and atypical lesions but with no differences between different Gleason scores. Fractal dimension (FD) of AgNOR silhouettes not only revealed significant lower values for global cancer images compared to AAH and BNH images, but was also able to differentiate between Gleason pattern 2 and Gleason patterns 3–5 adenocarcinomas. Plotting the frequency distribution of the FDs for different pathologies showed clear differences between all Gleason patterns and BNH. Together with existing morphological classifiers, AgNOR analysis might contribute to a faster and more reliable machine-assisted screening of prostatic adenocarcinoma, as an essential aid for pathologists.

Surgical Treatment of a Case of Ledderhose's Disease: A Safe Plantar Approach to Subtotal Fasciectomy.

Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted.

English

BACKGROUND: Large numbers of male elderly population suffers from prostatism due to enlargement of the prostate as a result of what is now regarded as male climacteric. Prostatic obstruction must be diagnosed early so that a definite treatment can be instituted to relieve the patient of symptoms and to prevent the sequelae of the obstruction. Diagnosis of prostatic cancer was first described in 1930 by transperineal aspiration biopsy. Many published papers demonstrate the higher sensitivity of FNA of the prostate than core biopsy. FNAC has been evaluated as screening test for occult prostatic cancer, benign hyperplasia of prostate and various inflammatory lesions of prostate. AIMS AND OBJECTIVES: This study has been undertaken with the objective of finding as to how far needle aspiration method is reliable to establish the diagnosis of lesions of prostate and to correlate them with histopathological findings. MATERIAL AND METHODS: The study of 50 cases of prostatic lesions was conducted in the department of pathology on the patients admitted to surgery wards. OBSERVATIONS: The present study was conducted on 50 cases having symptoms of prostatism. The highest incidence of prostatic enlargement is seen in 6 th decade followed by 5 th decade and least in 3 rd decade. Out of 50 cases, 21 cases (42%) were diagnosed as benign nodular hyperplasia, 23 (46%) as benign nodular hyperplasia with chronic prostatitis, 4 cases (8%) as malignancy and two cases (4%) were inconclusive due to inadequate material. Maximum benign nodular hyperplasia and benign nodular hyperplasia with chronic prostatitis were observed in 5th to 7th decade but malignancies were observed in 6th to 7th decade. The accuracy of diagnosing BNH by FNAC is 80%. The accuracy of diagnosing prostatitis by FNAC is 88%. Sensitivity of diagnosing non malignant lesions was 100% while specificity 80%, positive predictive value 97.4% and negative predictive value were 100%. Sensitivity of diagnosing malignant lesions was 80%, specificity 100%, positive predictive value 100% and negative predictive value 97.4%. CONCLUSION: FNAC by transrectal route is easiest, accurate, quick with minimal discomfort to the patient and can be used as OPD diagnostic procedure in the prostatic lesions. It may also be helpful for early detection of

Lobular Invasive Carcinoma of the Male Breast: A Case Report of An Uncommon Disease

INTRODUCTION: The male breast cancer is rare, representing 1% of all breast cancers. The most common invasive subtype is infiltrating ductal carcinoma (85% of tumors). Invasive Lobular Carcinoma (ILC) is very unusual in men, representing 1% of male breast cancers. This probably occurs because lobules are not found in normal male breast tissue. The lobular development is associated to progesterone and estrogen action during menstrual cycles in the women breast. In a database with 843 patients diagnosed with ILC treated in INCA (Brazilian National Cancer Institute) between 2000 and 2009 we have found only one male patient. Here we report a case of ILC in a man that was previously treated with cyproterone. CASE REPORT: A 70 year old male patient was admitted to INCA in 2001 referring increased bilateral breast volume and ulceration of the left papilla. The patient had a prostate cancer story treated with surgery followed by radiotherapy and cyproterone acetate one year earlier. Physical examination revealed a 9.5 cm mass occupying the entire right breast and an ulcerated lesion measuring 12.5 cm in the left breast with bilateral linfonodal involvement (Stage IIIb). Mammography showed increased breast volume with bilateral densification, skin thickening and bilateral retraction of the nipple-areolar complex. Incisional biopsy showed poorly differentiated invasive carcinoma. Tamoxifen was prescribed for two months with no response. He started neoadjuvant chemotherapy (Adriamycin and Cyclophosphamide) but the disease remained stable after 3 cycles. It was performed bilateral Modified Radical Mastectomy on July 2000. Histopathological examination of surgical specimens revealed bilateral ILC, histologic grade II Elston. The left breast showed a 10.5 cm tumor and metastatic carcinoma to 4 lymph nodes from 15 isolated nodes. The right breast showed a 5.5 cm tumor and metastatic carcinoma to 2 lymph nodes from 10 isolated nodes. E-cadherin and hormone receptors were negative in both breasts. In March 2001, he presented cutaneous nodules in his left plastron. Lesion’s biopsy showed metastatic ILC. On May 2001 it was diagnosed bone metastasis. Palliative chemotherapy (5-Fluorouracil and Pamidronate) was started. He developed neutropenic fever and was hospitalized for treatment, but died from sepsis on August 2001. DISCUSSION: One of the most important risk factors to male breast cancer is an abnormal balance between estrogen and androgen. In this case, the patient used cyproterone, a steroid with progestin-like and antiandrogenic activity. This possibly could explain the development of lobules and consequently an increased risk of lobular carcinoma. Cyproterone is notoriously associated to gynecomastia, benign nodular breast hyperplasia and galactorrhea. Futhermore, there are reports of bladder and hepatic carcinoma related to it’s use. However there is still no well-established relationship between the use of cyproterone and breast cancer.

Microvascularity in transition zone prostate tumors resembles normal prostatic tissue

The objective of this study was comparison of characteristics of the microvasculature in transition zone tumor (TZT) and benign nodular hyperplasia (BPH) with normal prostatic transition zone (NTZ), applying accurate and objective quantification based on digital image analysis. Results of this study may increase understanding of prostate dynamic contrast enhanced (DCE) MRI analysis. Radical prostatectomy specimens of 28 patients containing TZT ranging from pT2-pT4 were used. In 11 patients a concomitant peripheral zone tumor (PZT) was present. Microvessels were visualized by CD31 immunohistochemistry. Specimens were scanned using a computer-controlled microscope with automatic recognition of microvessels. Pseudocolor maps were produced displaying microvessel density, perimeter, and area of an entire prostate transection. Mean, 75th percentile (p75) and coefficient of variation (CV) were calculated automatically in manually indicated areas of the tumor and corresponding contralateral normal tissue, and BPH. Large variability was seen in TZT microvascular parameters, indicating presence of patients having both hypo and hypervascularized tumors compared to NTZ. In contrast, areas of BPH showed a more consistent increase in vascular parameters, with decreased CV. Analysis of PZT confirmed results of our previous study, with mean and p75 of all vascular parameters being significantly increased and a decrease in CV. No correlation was found for clinicopathological parameters and microvascular parameters. Microvasculature of transition zone tumor showed increased heterogeneity compared to BPH and peripheral zone tumors, possibly explaining the difficulty of TZT detection on DCE-MRI.

Rectal endometriosis: a case report

We present the case of a 45-year-old female patient who was admitted with a history of pelvic pain, constipation, and dysmenorrhea. CT scan and u/s images revealed cholelithiasis, benign nodular hyperplasia of segment IV of the liver and uterine fibromyoma. During laparotomy, firm adhesions between the posterior wall of the uterus and the rectum were found and the incisional biopsy reveals an undifferentiated adenocarcinoma. Then, total resection of the uterus was performed with en block resection of the adherent part of the rectum and part of the posterior wall of the vagina. The final histopathological report showed the presence of uterine fibromyoma, nodular hyperplasia of the liver and rectal endometriosis without any sign of malignancy. The patient after 5 years of follow up remains healthy. Rectal endometriosis represents an uncommon localization of pelvic endometriosis where the symptoms and clinical findings are non-specific making the definitive preoperative diagnosis difficult. Endometriosis should be included in the differential diagnosis of chronic pelvic pain in combination with defecation disorders in female patients of reproductive age.

Common Variable Immunodeficiency Associated with Inflammatory Bowel Disease and Type I Diabetes

Common variable immunodeficiency (CVID) is a heterogeneous group of primary immunodeficiency disorders characterized by defective antibody production, low levels of serum immunoglobulins and increased susceptibility to infection. The patient was a 39-year-old male who was admitted to the gastroenterology department with a two week history of diarrhea, blunt abdominal pain below the umbilicus, prolonged febrile state, loss of appetite and loss of body weight of 18 kg during the previous six months. Screening tests of serum immunoglobulins showed decreased concentrations of three types of immunoglobulins: IgA < 0.24 g/L, IgM < 0.18 g/L and IgG < 1.55 g/L. Lymphocytes immunophenotypisation revealed inversed CD4(+)/8(+) T cells ratio, 0.31 and absence of plasma cells (CD138 negative). Colonoscopy showed a rectal mucosa like cobblestones with multiple longitudinal and serpentinous ulceration, without involvement of other segments of the colon and the small intestine. Histopathology revealed aphtous ulcerative lesions, transmural inflammation with multiple lymphoid aggregates and benign lymphoid nodular hyperplasia of the small intestine. Plasma cells were absent from the lamina propria. Magnetic resonance imaging of a perianal fistula demonstrated a trans-sphicteric type. This case is specific because of the three illnesses associated and only one case of an association of diabetes mellitus type I and immunodeficiency reported thus far.

Phenotypic characterization of the infiltrating immune cells in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma

Background Immune cell infiltrate is a constant feature in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma. This study elaborates on the cells of the immune system present in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma. Hypothesis Here, we hypothesized that “the development of benign nodular prostatic hyperplasia and prostatic adenocarcinoma is associated with numeric alterations of the immune cell infiltrate”. Materials and methods A total of 50 transurethral prostatic resection specimens, each entailing normal prostate, benign nodular prostatic hyperplasia and high grade prostatic adenocarcinoma were evaluated for the density and phenotype of the immune cells using immunohistological methods and mouse monoclonal antibodies decorating T cells (CD3), histiocytes (CD68) and B lymphocytes (CD20). Results Immune cell infiltrate was composed of T cells, histiocytes and B-lymphocytes. CD +3 T lymphocytes and CD68 + cells were the predominant cell populations. We observed variations in the density of the immune cells among the normal prostate, benign nodular prostatic hyperplasia and high grade prostatic adenocarcinoma. Compared with normal prostate, benign nodular prostatic hyperplasia had a statistically significant high density of immune cells (3.4 ± 0.4versus 13.5 ± 1.0, P < 0.00). In contrast, a significant decrease in the counts of these cells was observed in high-grade prostatic adenocarcinoma compared to benign nodular prostatic hyperplasia (13.5 ± 1.0 versus 5.2 ± 0.3, P < 0.01). Conclusions The increased density of immune cells (predominantly CD +3 T cells) in benign nodular prostatic hyperplasia suggests that the initial response to cellular damage is mediated by cell-mediated immunity. The decreased density of immune cells in high-grade prostatic adenocarcinoma may reflect immunosuppression. The underlying mechanisms of these numeric variations are open for further investigations.

Fine Needle Aspiration Cytology of Metastatic Prostatic Adenocarcinoma, Pseudohyperplastic Variant

Pseudohyperplastic prostatic adenocarcinoma is a rare histologic variant of prostatic adenocarcinoma that resembles benign nodular hyperplasia. Immunohistochemistry can verify the absence of basal cells, but it is frequently admixed with conventional adenocarcinoma. Because fine needle aspiration cytology is rarely performed in primary prostatic adenocarcinoma, the cytology of the pseudohyperplastic variant has not been described. We experienced a case of metastatic pseudohyperplastic adenocarcinoma in a pulmonary nodule of 75-year-old man. The cytologic smear was mostly composed of large, flat sheets with elongated branching papillae in a clean background. The sheets showed a well-defined honeycomb appearance of tall columnar, regularly arranged monotonous cells with little cytologic atypia. In subsequent prostatic biopsy, pseudohyperplastic variants were identified together with conventional adenocarcinoma of Gleason's grade 3 and 4. The cytologic features of pulmonary nodules were identical to those of pseudohyperplastic components of prostatic adenocarcinoma.

Rupture d'une hyperplasie nodulaire focale. À propos de deux cas

The diagnostics of focal nodular hyperplasia is reached through the use of imaging. When the diagnostic is certain, surgical abstention is the rule. Nevertheless, we were confronted with two cases of a rare complication; that of intraperitoneal rupture. In this situation, we suggest to first do an arteriography to control the bleeding, then to perform surgery when the patient has reached hemodynamic stability. Spontaneous rupture as a complication of benign nodular hyperplasia remains a rare event and only five cases were reported in litterature.