Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.

The expression of mucin (MUC2) in prostate cancer has not been well studied previously and may be of prognostic and pathobiologic significance. It is, however, well known that MUC2 expression in mucinous pancreatic and breast cancer represents an indolent pathway since these tumors have a significantly better outcome than their conventional counterparts. Twenty-five cases each of Gleason pattern 3 and 4 mucinous adenocarcinoma of the prostate defined by greater than 25% mucinous component and nonmucinous adenocarcinoma of the prostate were obtained from the surgical pathology files of the Johns Hopkins Hospital and Emory University Hospital. Immunohistochemical stains were performed for MUC2 on all 50 cases. Mean patient age was 60 years (range 44-72 years). MUC2 was expressed in all 25 cases (100%) of mucinous adenocarcinoma of the prostate, irrespective of the Gleason pattern. The nonmucinous component of these cases was negative for MUC2. In contrast, MUC2 expression was significantly lower in nonmucinous adenocarcinoma of the prostate, detected in only 6/25 cases as a focal finding, while 19/25 (76%) of nonmucinous adenocarcinoma of the prostate were completely negative for MUC2 (P<0.01). In six cases that showed focal positivity, MUC2 was expressed in areas with Gleason pattern 3 cancer with extensive mucinous fibroplasia (one case) and prominent intraluminal mucin (five cases). Other areas of these tumors were negative for MUC2. Mucinous adenocarcinoma of the prostate shows diffuse expression of MUC2, a known tumor suppressor, which is not present in either normal prostate or the majority of conventional adenocarcinomas of this organ. This indicates that mucinous adenocarcinoma of the prostate is indeed of the ‘colloid type’ akin to those in other exocrine organs. It is highly conceivable that this de novo expression of MUC2 has a role, not only in the mucinous differentiation of these tumors and their colloid pattern, but also in their relatively indolent behavior that has been recently elucidated.Modern Pathology advance online publicaton, 16 May 2008; doi:10.1038/modpathol.2008.47.

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Affiliations of authors: Department of Surgery, University of cancer Michigan, Ann Arbor, MI (AMM, AJH, JDB); Michigan Surgical Collaborative for Outcomes Research and Evaluation, University of Michigan, Ann Arbor, MI (AMM, JDB); Department of Family Medicine, University of Washington, Seattle, WA (BM, LMB); Department of cancer Surgery, Oregon Health and Science University, Portland, OR (KGB).

Background Black patients with rectal cancer are considerably less likely than white patients to receive adjuvant therapy. We examined the hypothesis that the lower treatment rate for blacks is due to cancer underreferral to cancer medical and radiation cancer oncologists. Methods We used 1992-1999 Surveillance, Epidemiology, and End Results-Medicare data to identify elderly (>/=66 years of age) patients who had been hospitalized for resection of stage II or III rectal cancer (n = 2716). We used chi(2) tests to examine associations between race and 1) consultation with an cancer oncologist and 2) receipt of adjuvant therapy. We then used logistic regression to analyze the influence of sociodemographic and clinical characteristics (age at diagnosis, sex, marital status, median income and education in area of residence, comorbidity, and cancer stage) on black-white differences in the receipt of adjuvant therapy. All statistical tests were two-sided. Results There was no statistically significant difference between the 134 black patients and the 2582 white cancer patients in the frequency of consultation with a medical oncologist (73.1% for blacks vs 74.9% for whites, difference = 1.8%, 95% confidence interval [CI] = >5.9% to 9.5%, P = .64) or radiation oncologist (56.7% vs 64.8%, difference = 8.1%, 95% CI = >0.5% to 16.7%, P = .06), but blacks were less likely than whites to consult with both a medical oncologist and a radiation oncologist (49.2% vs 58.8%, difference = 9.6%, 95% CI = 0.9% to 18.2%, P = .03). Among patients who saw an cancer oncologist, black patients were less likely than white patients to receive cancer chemotherapy (54.1% vs 70.2%, difference = 16.1%, 95% CI = 6.0% to 26.2%, P = .006), radiation therapy (73.7% vs 83.4%, difference = 9.7%, 95% CI = 0.4% to 19.8%, P = .06), or both (60.6% vs 76.9%, difference = 16.3%, 95% CI = 4.3% to 28.3%, P = .008). Patient and provider characteristics had minimal influence on the racial disparity in the use of adjuvant therapy. Conclusion Racial differences in oncologist consultation rates do not explain disparities in the use of adjuvant cancer treatment for rectal cancer. A better understanding of patient preferences, patient-provider interactions, and potential influences on provider decision making is necessary to develop strategies to increase the use of adjuvant treatment for rectal cancer among black patients.

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Department of Surgery, Lincoln Medical and Mental Health Center, Weill Medical College of Cornell University, 234 East 149th Street, Bronx, NY 10451, USA.

A literature search revealed only five recent articles with specific information on the incidence of performance of pancreaticoduodenectomy when the preoperative diagnosis is uncertain. The collected incidence of benign diagnoses in the five papers was 13.1%. Five other papers describing patients from before 1990 reported rates of benign diagnoses of 9.7%, p<0.007 compared to the more recent series. The introduction of advanced diagnostic tests has not decreased the incidence of benign pathology after pancreaticoduodenectomy for presumed cancer. Pancreaticoduodenectomy should be performed without a definitive diagnosis of cancer if, in the opinion of an experienced surgeon, clinical suspicion is high.

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Department of Otolaryngology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao Sung Hsiang, Kaohsiung County, 833, Taiwan.

This study is to determine the impact of virus in surgical outcomes among patients of head and neck cancer with N3 lymph node metastasis. A retrospective analysis was conducted for 32 patients with operable N3 neck metastasis undergoing surgical treatment between January 1987 and October 2006. The nuclei of the tumor cells were investigated for the presence of human papillomavirus (HPV) and Epstein-Barr virus (EBV) DNAs and were taken into account as the variable for survival analysis. The primary sites were oropharynx in 11 patients, tongue in 3, buccal mucosa in 1, hypopharynx in 8 and unknown primary in 9. The five-year cumulative overall survival rate was 40.7% and 5-year cumulative regional control rate was 55.8%. The 5-year cumulative overall survival rate of patients with unknown primary site (72.9%) and HPV or EBV positive in the tumor (77.8%) were significantly higher than those patients with known primary site (31.3%) and HPV or EBV negative in the tumor (27.4%), respectively (P = 0.0335 and P = 0.0348, log rank test). In conclusion, surgery with adjuvant therapy offers reasonable outcomes for operable N3 node in head and neck cancer in our cohort. In addition, patients with HPV or EBV positive in the tumor have a better survival.

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Department of Histology, Division of Morphology, School of Medicine, University of Crete, Heraklion, Greece.

The cancer microenvironment and the interactions between cancer and surrounding tissue cells are thought to play a pivotal role in tumor development and progression. Glycosaminoglycans (GAGs)/proteoglycans (PGs) are major constituents of the extracellular matrix, the composition of which may affect various cellular functions. In the present study, the effects of GAGs on the proliferation of HT29, SW1116, and HCT116 human colon cancer cell lines were examined using exogenously added GAGs, an inhibitor of endogenous GAG sulfation and specific glycosidase digestions. Our results demonstrate that colon cancer cell growth was exclusively stimulated by exogenously added heparin and insensitive to endogenous GAGs/PGs production, in a sulfation pattern-related manner. Treatment of the tested cell lines with the FGF-2 neutralizing antibody showed that the stimulatory effect of heparin on the cells’ growth was not FGF-2-dependent. Responsiveness of colon cancer cell lines to exogenous heparin/heparan sulfate may play a role in their growth and metastasis. (c) 2008 IUBMB IUBMB Life, 60(5): 333-340, 2008.

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