Latent malignancies at autopsy: a little used source of information on cancer biology.

Latent carcinomas, found incidentally at autopsy, are defined, and information about such tumours in the prostate, adrenal gland, kidney and thyroid is reviewed. A previously unsuspected carcinoma of the prostate was found in 350 of 1327 (26.4%) autopsies performed in seven countries on men over 45 years of age. The prevalence of latent carcinoma of the prostate at autopsy was greater in older men and in areas of higher incidence and/or mortality, as for clinical carcinomas. Neuroblastomas of the adrenal gland have been reported at a rate of 1:39 in newborn infants who died of other causes; this rate is comparable to that of latent prostatic carcinoma. Neuroblastomas are not found in the adrenal glands of infants older than three months, indicating that the body has a method for destroying them. Latent carcinomas are also found in the thyroid gland at autopsy, at rates ranging from 10 to 30%. The age and area differences seen for prostatic carcinoma do not appear to be operative for these tumours; moreover, latent carcinomas are found more frequently in males, whereas the clinical disease is twice as frequent in females. More research should be carried out to elucidate the differences between people who develop clinical carcinoma, those who have a latent carcinoma 'under control' and those who have neither.     

Insomnia in the context of cancer: a review of a neglected problem.

This article reviews the evidence on the diagnosis, epidemiology, etiology, and treatment of insomnia in the context of cancer and proposes several areas for future research. Clinical and diagnostic features of insomnia are described and prevalence estimates of insomnia complaints in cancer patients are summarized. Then, potential etiologic factors (ie, predisposing, precipitating, and perpetuating factors) and consequences of insomnia (ie, psychologic, behavioral, and health impact) in the context of cancer are discussed. Finally, pharmacologic and psychologic treatments previously shown effective to treat insomnia in healthy individuals are discussed as valuable treatment options for cancer patients as well. Because long-term use of hypnotic medications is associated with some risks (eg, dependence), it is argued that psychologic interventions (eg, stimulus control, sleep restriction, cognitive therapy) are the treatment of choice for sleep disturbances in the context of cancer, especially when it has reached a chronic course. However, the efficacy of these treatments has yet to be verified specifically in cancer patients.     

Clinician-oriented and cytology-oriented autopsy. III. The pancreas

The autopsy is performed with multiple purposes such as medical education, searching direct cause of the death and researches. The first purpose of the autopsy is, however, a service for clinicians. The dissection technic should be determined to present the best clinical-pathological correlation of the lesions. In addition to the careful evaluation of the gross lesions of the pancreas, Smears (Imprints) of the lesions are most useful to make initial pathological diagnoses during autopsy examination. Multiple photographs illustrate both the gross pathological lesions and cytological data of the pancreas.     

The centenary of discovery of radium.

Henri Becquerel presented the discovery of radium by Pierre and Marie Curie at the Paris Academy of Science on 26th December 1898. One century later, radium has been abandoned, mainly for radiation protection difficulties. It is, however, likely that modern techniques of brachytherapy have inherited to those designed for radium sources, and that radium has cured thousands and thousands patients all over the world for about eighty years. The history of discovery and medical use of radium is summarised.     

Hairy cell leukemia: an autopsy study.

Autopsy material from 5 patients with hairy cell leukemia was examined. In addition to the expected widespread involvement of the hematopoietic system and of the liver, all of the patients had various amounts of pulmonary infiltration by leukemic cells. This infiltration was so severe in one instance that the resulting pulmonary insufficiency was the cause of death. Other areas of hairy cell infiltration included the peripancreatic connective tissue in all cases, kidneys in 3 cases, pericardium in 2 cases, and skin in 1 case. Association of plasma cells with the infiltrating neoplastic cells was prominent. In one patient, foci of large, bizarre cells were found in several lymph nodes and in the pericardium. Whether these cells represent transformation of the hairy cells into a larger, less differentiated cell type, or the emergence of a second hematopoietic neoplasm, is unknown.     

Radiation recall: a well recognized but neglected phenomenon

INTRODUCTION: Radiation recall is an inflammatory skin reaction at a previously irradiated field subsequent to the administration of a variety of pharmacologic agents. Although skin has been the major site of radiation recall toxicity, instances involving other organ have been reported. MATERIALS AND METHODS: Data for this review were identified by searches of Medline and Cancerlit. The search terms "radiation", "recall", and "toxicity" were used. References identified from within retrieved articles were also used. There was no limitation on year of publication and no abstract forms were included. Only articles published in English were taken into consideration. RESULTS: Idiosyncratic drug hypersensitivity phenomenon is a recent hypothesis which correlates best with the available facts at this moment. The phenomenon may occur days to years after radiotherapy has been completed. The majority of the drugs commonly used in cancer therapy have been involved in the radiation recall phenomenon. A mixed non-specific inflammatory infiltrate seems to be the common histopathologic criteria in previous published reports. Universally, corticosteroids or the use of non-steroidal anti-inflammatory agents, in conjunction with withdrawal of the offending agent, produce prompt improvement. CONCLUSION: We propose to collect all future radiation recall phenomenon in a Rare Cancer Network database in order to augment our understanding of this rare reaction.     

Latent thyroid carcinoma at autopsy: a study from Oporto, Portugal.

Thirty-nine (6.5%) latent thyroid carcinomas were found in 600 thyroid glands removed at autopsy in Oporto Medical School Laboratory of Pathology. The prevalence of latent thyroid carcinomas was significantly higher in women (sex ratio 4.3:1) and in elderly people (p less than 0.005) and appeared to be independent from the existence of another malignant neoplasm. The mean thyroid weight and the concurrent thyroid pathology of patients with thyroid carcinomas were not significantly different from those of patients without them. The study of cervical lymph nodes in the first 400 autopsies did not show any significant difference concerning histologic pattern, number of germinal centers and sinus histiocytosis between patients with thyroid carcinomas and those without them. Further investigation is required to evaluate the role of host factors on the peculiar characteristics of latent thyroid carcinomas.     

Quality of life in chronic lymphocytic leukemia: a neglected issue

Improvement in quality of life (QoL), together with overall survival and disease-free survival, is a relevant endpoint for patients affected by chronic lymphocytic leukemia (CLL), a disease still considered as not curable. In addition, the study of the QoL can significantly contribute to investigate particular aspects related to different treatments which generally are not taken into account in clinical trials. A comprehensive approach to CLL should include also in the day-by-day practice the development of an appropriate and friendly interaction between the physician and patients aimed at improving the process of adaptation encompassing either the 'watch and wait' phase or the treatment period. The present review points out the role of QoL in the global patient management and care of CLL patients also in view of changes in the philosophy of treatment we have witnessed nowadays.     

Metastatic disease: a drug discovery perspective

Disseminated tumor cells are present in many patients at diagnosis. At a time when the disseminated disease becomes prominent, patients have already been treated with many cycles of therapy to which their metastases were also exposed. These metastases have genetically evolved from primary tumors. Furthermore, their interaction with the tissue microenvironment plays an important role in all phases of disease development. These facts have only partially been taken into consideration when profiling anti-cancer compounds foreseen to treat patients with disseminated metastatic disease. In this perspective, we discuss the unique features of metastatic disease and review the model systems available for drug profiling. Based on an analysis of how compounds are profiled today in pre-clinical models of metastatic disease and what would be desirable and possible with the present know-how, we recommend a refined profiling process to validate drugs with potential to treat patients with overt metastatic disease.     

Adenomatous lesions of the large bowel: an autopsy survey.

A comprehensive autopsy survey of the large bowel showed that adenomas were very common lesions occurring in about one-half of the 518 cases studied. The great majority were small adenomatous polyps (tubular adenomas), 86.7% measuring less than 10 mm in diameter. Adenomas with a more complex tubulovillous pattern were larger with a mean diameter of 19.0 mm. There was no apparent incresae in mean size of adenomas with age. Nineteen clinically unsuspected cancers were discovered. Fourteen (8 in situ and 6 invasive) cancers had areas of residual benign adenoma. Five invasive cancers had no residual benign component. No in situ carcinomas or small (less than 10 mm) invasive cancers not containing residual adenoma were found. The results suggest that, although adenomas of the large bowel are very common, the vast majority are simple adenomatous polyps which do not undergo progressive growth and malignant change. Conversely, it appears that cancers may arise from benign adenomas which have the characteristics of large size and a more complex villous architecture.     

Metastases from carcinoma of mammary gland: an autopsy study.

Information on metastases from carcinoma of the mammary gland in an autopsy study of 707 cases occurring in white women over a 15-year period are presented and tabulated. Multiple primary cancers occurred in 19% of the cases. Of the 137 cases that exhibit more than one neoplastic malignancy, 31 (23%) were present in the contralateral mammary gland. Seventy patients had no metastasis from the mammary cancer at the time of death, and 55 of these patients had another cancer. Additional information has been added concerning the frequency of metastasis in parathyroid and thymus. When a parathyroid contains a metastasis, extensive metastases were noted in many organs and thus represents a late stage of the cancer.     

The mitotic machinery as a source of genetic instability in cancer.

Development and growth of all organisms involves the faithful reproduction of cells and requires that the genome be accurately replicated and equally partitioned between two cellular progeny. In human cells, faithful segregation of the genome is accomplished by an elaborate macromolecular machine, the mitotic spindle. It is not difficult to envision how defects in components of this complex machine molecules that control its organization and function and regulators that temporally couple spindle operation to other cell cycle events could lead to chromosome missegregation. Recent evidence indicates that the persistent missegregation of chromosomes result in gains and losses of chromosomes and may be an important cause of aneuploidy. This form of chromosome instability may contribute to tumor development and progression by facilitating loss of heterozygocity (LOH) and the phenotypic expression of mutated tumor suppressor genes, and by favoring polysomy of chromosomes that harbor oncogenes. In this review, we will discuss mitotic defects that cause chromosome missegregation, examine components and regulatory mechanisms of the mitotic machine implicated in cancer, and explore mechanisms by which chromosome missegregation could lead to cancer.