Cases reported "Prostatic Neoplasms"

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1/14. Intraoperative cytodiagnosis of metastatic brain tumors confused clinically with brain abscess. A report of three cases.

    BACKGROUND: Cystic lesions of the brain may have diverse etiologies, ranging from true cysts to malignant tumors with cystic degeneration. Preoperative determination of the exact nature of them as well as intraoperative diagnosis may be sometimes difficult or even impossible. sensitivity and specificity of diagnosis will be improved by introducing new methods or combining traditional procedures. CASES: Three metastatic brain carcinomas with primary sites of breast, pancreas and prostate presented as cystic lesions and were confused clinically with abscess. Intraoperative frozen section was not revealing. Cytologic study of sediments of aspirated fluid uncovered malignant cells. CONCLUSION: When combined with frozen section, intraoperative cytologic studies in the form of crush preparation, fine needle aspiration or evaluation of aspirated fluid in cystic lesions (as in our cases) can improve diagnostic accuracy by detecting important diagnostic features that otherwise may be missed.
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2/14. Surgical confirmation of ProstaScint abnormalities in two patients with high risk prostate cancer.

    We describe our initial experience using ProstaScint scanning in addition to conventional imaging modalities for staging of high risk prostate cancer. Using our protocol, ProstaScint images detected abnormalities in pelvic lymph nodes not seen on CT scan or magnetic resonance imaging (MRI) in two patients. Subsequent surgical pelvic lymphadenectomy confirmed these abnormalities. Further patients will be accrued on this study to estimate the sensitivity and specificity of ProstaScint scanning.
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3/14. autoantibodies to photoreceptor membrane proteins and outer plexiform layer in patients with cancer-associated retinopathy.

    Cancer-associated retinopathy (CAR) is a paraneoplastic syndrome that is characterized by degeneration of the retina as a remote effect of cancer outside the eye. The detection of autoantibodies associated with the retinopathy may precede the diagnosis of the underlying cancer. We have examined the sera of two patients with CAR by Western blot analysis. autoantibodies to a 40kD antigen doublet and a 35 kD antigen were detected. Tissue specificity of the autoantigens was determined by testing several different tissues. The 40 kD antigen doublet was most abundant in retinal extract but was also present in lung and spleen extracts. The 35 kD antigen showed little tissue specificity and was present in all tissues tested. Fractionation of retinal proteins into water-soluble and -insoluble proteins revealed that the 40 kD antigen doublet was highly insoluble and probably represented membrane-associated proteins. Immunohistochemical analysis of the retina showed that the 40 kD antigens locate to the photoreceptors while the 35 kD antigen is located in the outer plexiform layer.
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keywords = specificity
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4/14. MR spectroscopy as a reliable diagnostic tool for localization of prostate cancer.

    BACKGROUND: magnetic resonance spectroscopy (MRS) is a new diagnostic tool which allows the detection of cellular metabolites. We assessed the usefulness of single- voxel MRS diagnosis for localization of prostate cancer. patients and methods: The study population consisted of 10 patients with prostate cancer. We set I or 2 voxels at the peripheral zone (PZ) of the prostate where biopsy had confirmed adenocarcinoma. MRS provided metabolic information about citrate, creatine and choline levels. We calculated the ratio of these metabolites ([choline creatine]/citrate) and judged areas where the metabolic ratio was greater than 0.86 as positive. RESULTS: Thirteen out of 19 voxels showed a cancer pattern which indicated a high choline peak and low citrate peak The accuracy, sensitivity and specificity of MRS diagnosis of tumor localization were 84.2%, 81.3% and 100%, respectively. CONCLUSION: MRS is useful for the diagnosis of prostate cancer localization.
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keywords = specificity
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5/14. Gamma probe assisted biopsy of suspected metastatic rib lesions.

    Retrieving diagnostic tissue from a rib lesion can be challenging. Using a hand-held intraoperative gamma probe to target and biopsy the areas of increased radioisotope uptake has been limited largely to use by thoracic surgeons and interventional radiologists. Such techniques also have been used by orthopaedic oncologists in localizing osteoid osteomas. We pursued a similar technique in localizing the rib lesion. During the 10 months, two patients with a history of cancer and recent bone scans indicative of possible rib metastasis required biopsies for definitive tissue diagnosis. Both patients had gamma-probe localization of their rib lesions intraoperatively using minimally invasive techniques. The operation of the probe was simple with a short learning curve. Both patients had biopsies that yielded diagnoses verifying the abnormality on the staging bone scan. Localization was sensitive and accurate with histologic confirmation in both patients. The length and extent of surgery were markedly reduced with no complications. These results match those reported in the literature by thoracic surgeons and radiologists. The hand-held gamma probe assisted biopsy of suspicious rib abnormalities can be an effective surgical technique that the orthopaedic surgeon should consider. Additional experience with the technique will allow an assessment of the sensitivity and specificity.
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6/14. Combined MR examination of prostate: is it reliable?

    A combination of magnetic resonance (MR) methods (T2-weighted MRI, proton MR spectroscopy, and dynamic contrast enhancement) gives the highest sensitivity and specificity for identification of prostate cancer by MRI. The prostate MR findings of a patient with a congenital cystic disease of seminal vesicle are presented. To our knowledge, this is the only case described in the literature. The MR examination resulted in a false-positive indication of prostate cancer.
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7/14. vaccination of cytotoxic T lymphocyte-directed peptides elicited and spread humoral and Th1-type immune responses to prostate-specific antigen protein in a prostate cancer patient.

    The authors studied humoral and CD4 T-cell responses in an HLA-A24 prostate cancer patient vaccinated with cytotoxic T lymphocyte (CTL)-directed peptides, including a prostate-specific antigen (PSA)248-257 peptide, to understand what kinds of immune responses are elicited in peptide-vaccinated patients. The levels of immunoglobulin g (IgG) reactive to the administered PSA248-257 peptide or the PSA protein were kinetically examined. The level of IgG reactive to the PSA248-257 peptide drastically increased after the peptide vaccination, with a peak after the seventh vaccination, whereas that of IgG reactive to the PSA protein continued to increase throughout the vaccination period. IgG reactive to the PSA protein after the 13th vaccination showed no reactivity to the administered PSA peptides. However, HLA-DRB1*1302-restricted and PSA protein-recognizing TH1-type CD4 T-cell clone and line, with different specificity, were successfully established from the post-7th and post-13th peripheral blood mononuclear cells, respectively. Both CD4 T cells produced interferon-gamma in response to naturally processed PSA secreted from prostate cancer cells, whereas their reactivity to the administered PSA248-257 peptide was undetectable or negligible. These findings indicate that vaccination with CTL-directed peptides, including a PSA-derived peptide, was able to elicit and spread humoral and TH1-type immune responses to the PSA protein.
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8/14. Metastatic prostate cancer with a normal prostate-specific antigen level.

    prostate-specific antigen (PSA) is the most commonly used tumour marker for prostate cancer, both in screening and in follow-up. However, there are many false positive increases in the presence of other prostate diseases and, currently, there is no consensus regarding sensitivity and specificity of the PSA test, nor what constitutes the upper limit of normality. We report a case of a 67-year-old patient with metastatic prostate cancer who, with increased level of alkaline phosphatase and normal PSA, showed clinical and radiological evidence of progression of the disease.
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9/14. The value of PSA, free-to-total PSA ratio and PSA density in the prediction of pathologic stage for clinically localized prostate cancer.

    OBJECTIVE: The ability of prostate-specific antigen (PSA), free/total PSA and PSA density to predict the pathologic stage in prostate cancer has not been clear yet. In this study, we evaluated the value of PSA subgroups in the prediction of pathologic stage after radical prostatectomy. methods: A total of 42 subjects 55-78-years-old who underwent radical retropubic prostatectomy were included in the study. Preoperative PSA, free/total PSA and PSA density (PSAD) values were compared according to the pathologic stages of radical prostatectomy specimens. Receiver operating characteristics (ROC) curves were measured for each parameter. RESULTS: The clinical stage that was estimated for all patients was between T1N0M0 and T2bN0M0. Pathologic examination revealed organ-confined disease in 18 patients. The area under curve (AUC) for organ confinement was 0.553 for PSA, 0.446 for free/total PSA ratio and 0.706 for PSAD. Cut-off values providing the best sensitivity and specificity in ROC analysis for PSA, free/total PSA and PSAD were 7.1, 0.15, and 0.17, respectively (likelihood ratio: 0.9, 1 and 2). The positive predictive values at these cut-off values were 0.54, 0.56, and 0.70, respectively. Only PSAD cut-off values was found statistically borderline significant for predicting organ-confined disease. CONCLUSION: While PSAD is more helpful than PSA and free/total PSA ratio for prediction of organ-confined disease, none of these parameters are significant predictor of pathologic stage for clinically localized prostate cancer.
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keywords = specificity
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10/14. Immunocytochemistry of fine needle aspirates. A tactical approach.

    To maximize the potential of immunocytodiagnosis for fine needle aspiration (FNA) samples, it is necessary to be aware of the pitfalls and limitations of these techniques and to formulate a strategy to deal with the many variables involved. Five cases are presented to illustrate some of these variables, which include determining the adequacy of the FNA specimen, selecting tactics for cytologic and immunocytochemical studies, selecting methods for processing the FNA sample, preparing smears to enrich and preserve cells of interest, selecting enzyme labeling methods to optimize sensitivity and specificity, selecting monoclonal antibodies to make the study efficient and pertinent and interpreting the study results. The adequacy of the FNA specimen could be determined by an immediate cytologic assessment of the aspirate as it was obtained. Alcohol-fixed smears and formalin-fixed tissue sections prepared from the aspirate were used for diagnosis; the immunocytochemical studies were used as a diagnostic adjunct for accurate cell identification. Immunocytochemical studies were done on air-dried cytocentrifuge smears of pre-washed cells. While both immunoperoxidase and immunoalkaline phosphatase methods were suitable, we recommend the immunoperoxidase method for the study of aspirates from nonhemopoietic tissues and the immunoalkaline phosphatase method for the study of aspirates with many blood cells present. The proper selection of monoclonal antibodies and the interpretation of the results are best made in the context of the cytologic characteristics of the FNA sample and the clinical features of the patient.
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ranking = 1
keywords = specificity
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