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Background: Among patients with clinically localized prostate cancer, preoperative prediction of tumor volume and pathologic stage has been unreliable. This study examines the application of transrectal ultrasound-guided sextant biopsies to predict the extent of disease., Methods: One hundred and two patients with clinically resectable prostate cancer were evaluated by systematic sextant biopsies. Radical prostatectomy specimens were embedded totally as whole mounts, tumor areas were outlined, and volume was measured using a digital scanner. The number of positive sextant biopsies was compared with age, race, preoperative prostate specific antigen (PSA), PSA density, DNA ploidy, pathologic stage, capsular and seminal vesicle involvement, prostate and tumor volume, and Gleason score. Stepwise logistic regression was used to determine if pathologic stage or tumor size could be predicted by these parameters., Results: The number of positive sextant biopsies correlated with traditional prognostic indicators. When patients with three or fewer positive biopsies were compared with those with four or more positive sextant biopsies, significant differences were identified relative to preoperative PSA (P < 0.001), tumor volume (P < 0.001), pathologic stage (P < 0.001), Gleason score (P < 0.001), seminal vesicle involvement (P < 0.001), and capsular penetration (P < 0.001). There were no significant differences based on age, race, DNA ploidy, and overall prostate volume. Logistic regression showed that patients with four or more positive sextant biopsies and high Gleason score had a greater likelihood of pT3 classification. Likewise, the probabilities of a tumor volume less than 0.5 ml could be predicted by the number of positive sextant biopsies and PSA alone. The number of positive sextant biopsies was the only factor that could predict a tumor volume greater than 4.0 ml., Conclusion: The number of positive sextant biopsies appears to be an important prognostic indicator of pathologic (pT) classification and tumor volume. This information is valuable in selecting the treatment strategy for patients with prostate cancer.

Thirty-four cases of adenoid cyctic carcinoma seen at the University of Virginia Hospital from 1946 to 1974 were reviewed, with special emphasis on lymph node involvement by tumor. Lymph node involvement was found in three cases of primary tumors of the submaxillary gland, and all of the affected lymph nodes were in the immediate vicinity of the primary tumor. Two lymph nodes were involved in two of the cases, and one node was involved in the third case. In all of these lymph nodes, adenoid cystic carcinoma was present in the soft tissue surrounding the node, and the tumor extended into the node. No metastatic tumors were observed in 46 lymph nodes removed incidentally at the time of local excision of the primary tumors in 10 additional cases or in 212 lymph nodes examined after unilateral radical neck dissections in six other cases. Five autopsies in this series showed no lymph node metastases. In this series of cases adenoid cystic carcinoma only invades lymph nodes in the immediate vicinity of the primary tumor. When lymph node involvement does occur, it does not result from embolic lymph node metastasis; rather, a direct invasion of the lymph node from tumor in the perinodal soft tissue occurs. Obviously, this small study does not completely exclude the possibility of embolic metastasis; however, if it does occur, it must be extremely rare.

This study presents the clinical and pathologic data on 38 patients with adenoid cystic carcinoma. Most of the tumors arose from the major salivary glands or the mucus glands of the upper respiratory tract and oral cavity. The typical biological behavior of these tumors was slow but aggressive local growth despite all therapy, followed by eventual death from local disease and/or metastases. Twenty-eight of the patients have died, 22 from adenoic cystic carcinoma, 3 from postoperative complications, and 3 from intercurrent disease. Of the 10 living patients, 4 have active disease, 2 have no evidence of disease 14 years after diagnosis, and 4 have no evidence of disease but follow-up is less than 5 years. We compared various microscopic features of the tumors, including histologic grading, with prognosis but did not demonstrate a correlation in this small series.

Although secondary leptomeningeal lymphoma is relatively common, primary leptomeningeal lymphoma is rare. We report a patient with the extremely unusual clinical and pathologic presentation of a primary T-cell lymphoma of the leptomeninges. Diagnosis was established by morphologic and immunologic studies of cerebrospinal fluid (CSF) and brain biopsy. The leptomeningeal lymphoma responded well to intrathecal chemotherapy and irradiation but the patient has severe residual motor paralysis. The clinical and pathological features of primary and secondary central nervous system (CNS) lymphoma are reviewed in reference to this most unusual patient.

Acute leukemia with bone or joint symptoms of sufficient magnitude to obscure and delay the correct diagnosis has been reported but is rarely mentioned in the recent literature, particularly in adults. The authors report an adult with rapidly fatal acute leukemia and a clinical course dominated by recurrent osteoarticular symptoms; osteoarticular symptoms preceded the diagnosis of leukemia by 3 months and delayed diagnosis and treatment. The correct diagnosis requires awareness of the osteoarticular manifestations of acute leukemia and examination of blood or bone marrow smear by an experienced observer; a biopsy specimen of bone or joint lesions or examination of cytocentrifuged synovial fluid may aid in diagnosis. The immediate cause of death in our patient was respiratory failure with prominent leukemic interstitial pulmonary infiltrates at autopsy; clinically significant leukemic pulmonary infiltrates have only rarely been reported. The authors review the literature on pulmonary and osteoarticular manifestations caused by acute leukemic infiltrates.

Extramedullary tumors of hematopoietic tissue can be divided into two categories: those associated with a bone marrow disorder, myelolipomas which have no apparent relation to a bone marrow disorder. The etiology of myelolipoma is unknown and the vast majority are adrenal in location. Extramedullary myelolipomas are usually presacral in location and none of the approximately ten reported cases has been diagnosed before surgery. Although radiographic and ultrasound features of myelolipomas are relatively characteristic, they are not specific and biopsy is required for diagnosis. Microscopic diagnosis requires demonstration of benign lipomatous tissue admixed with cellular hematopoietic tissue resembling normal bone marrow. This study reports a patient with presacral myelolipoma and an unusual finding of urinary retention and azotemia associated with compression of urinary bladder neck by the myelolipoma.