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A 42-year-old man presented with an 8-mm elliptical indolent solid mass on the superior surface of the corona glandis at our institution 3 months after its appearance. The lesion was excised by using a wedge resection performed by a cool blade knife. The subsequent pathologic evaluation defined the lesion as a leiomyoma. Immunohistochemical analysis using the streptavidin-biotin peroxidase technique and immunoreactivity for cytokeratin, S100 protein, and the proliferative marker MIB1 was performed, confirming the pathologic diagnosis. Early local excision of these tumors is indicated because of the trend toward their dimensions increasing quickly, with subsequent difficulties for cosmetic glandis reconstruction.

We designed and developed two different optical fibre probes for combined Raman and fluorescence spectroscopic measurements on human tissues. The experimental setup combines fluorescence spectroscopy and Raman spectroscopy in a multimodal approach. Two laser diodes, respectively emitting in the UV (378 nm) and in the visible (445 nm), were used for fluorescence spectroscopy. An additional laser diode emitting in the NIR (785 nm) was used for Raman spectroscopy. Laser light was delivered to the tissue under examination through a multimode optical fibre located in the centre of the fibre bundle probe. The surrounding 24 optical fibres were used for collection of the signal of interest and for delivering light to a common detection unit. Both fluorescence and Raman spectra were acquired on a cooled CCD camera, connected to a spectrograph. The device was successfully used for diagnosing melanocytic lesions in a good agreement with common routine histology. Additional measurements were performed on other human tissue samples, such as colon tissue and brain tissue in order to test the capability of the device for diagnosing a broader range of tissue lesions and malignancies. The system has the potential to improve diagnostic capabilities on a broad range of tissues and to be used for endoscopic inspections in the near future. © 2013 OSA-SPIE.

We developed two different probes for combined Raman-fluorescence spectroscopy on human tissues. The device was successfully used for diagnosing melanocytic lesions in a good agreement with histology and further tested on bladder and brain tissues.

An emerging group of high-grade renal cell carcinomas (RCCs), particularly carcinomas arising in the hereditary leiomyomatosis renal cell carcinoma syndrome (HLRCC), show fumarate hydratase (FH) gene mutation and loss of function. On the basis of similar cytomorphology and clinicopathologic features between these tumors and cases described as tubulocystic carcinomas with poorly differentiated foci (TC-PD) of infiltrative adenocarcinoma, we hypothesized a relationship between these entities. First, 29 RCCs with morphology of TC-PD were identified retrospectively and assessed for FH expression and aberrant succination (2SC) by immunohistochemistry (IHC), with targeted next-generation sequencing of 409 genes-including FH-performed on a subset. The 29 TC-PD RCCs included 21 males and 8 females, aged 16 to 86 years (median, 46), with tumors measuring 3 to 21 cm (median, 9) arising in the right (n=16) and left (n=13) kidneys. Family history or stigmata of HLRCC were identifiable only retrospectively in 3 (12%). These tumors were aggressive, with 79% showing perinephric extension, nodal involvement in 41%, and metastasis in 86%. Of these, 16 (55%) demonstrated loss of FH by IHC (14/14 with positive 2SC). In contrast, 5 (17%) showed a wild-type immunoprofile of FH+/2SC-. An intriguing group of 8 (28%) showed variable FH± positivity, but with strong/diffuse 2SC+. Next-generation sequencing revealed 8 cases with FH mutations, including 5 FH-/2SC+ and 3 FH±/2SC+ cases, but none in FH+/2SC- cases. Secondly, we retrospectively reviewed the morphology of 2 well-characterized cohorts of RCCs with FH-deficiency determined by IHC or sequencing (n=23 and n=9), unselected for TC-PD pattern, identifying the TC-PD morphology in 10 (31%). We conclude that RCCs with TC-PD morphology are enriched for FH deficiency, and we recommend additional workup, including referral to genetic counseling, for prospective cases. In addition, based on these and other observations, we propose the term "FH-deficient RCC" as a provisional term for tumors with a combination of suggestive morphology and immunophenotype but where genetic confirmation is unavailable upon diagnosis. This term will serve as a provisional nomenclature that will enable triage of individual cases for genetic counseling and testing, while designating these cases for prospective studies of their relationship to HLRCC.

The current diagnostic standard for detection of bladder tumors is standard white light cystoscopy. The major concerns related to cystoscopy include its invasive, causes discomfort to the patient and also misses flat tumors such as carcinoma in situ (CIS). Grading and staging of tumors would help the clinician for selecting the proper treatment thereby preventing recurrence and progression of bladder tumors. In this context, we propose to use different optical techniques based on fluorescence, diffuse reflectance and Raman spectroscopy to obtain complementary information for the grading and staging of bladder tumors. Spectroscopic techniques offer the advantage of being minimally invasive, real time and quantitative. We used fluorescence excitation at two distinct wavelengths, 378 and 445 nm excitation. Considerable differences were observed in the wavelength range between 520 and 650 nm of the emission spectra. Raman spectroscopy yields biochemical spectral fingerprints typical of normal and tumor tissues. The advantage of Raman spectroscopy is that it provides spectral signatures which are unique for each molecule. Additionally, reflectance spectroscopy could provide information related to tissue vasculature and scattering phenomena which is found to vary between normal and tumor tissues.

Background: Mutations in genes coding for the mitochondrial complex II succinate dehydrogenase (SDH) subunits cause familial neural crest derived (NCD) tumours. Methods: Index cases from six apparently unrelated families affected by NCD tumours were analysed for mutations in the SDHB, SDHC, and SDHD genes. Results: The same nonsense germline heterozygous mutation (Q109X) in exon 4 of the SDHD gene was found in each of the six families. Overall, 43 heterozygotes were identified. These were evaluated for the presence of NCD tumours through radiological examination of the neck, thorax, and abdomen, and measurement of urinary metanephrines and plasma chromogranin A. A novel missense SDHD variant, T112I, which did not segregate with the Q109X mutation and was not associated with phenotypic manifestations, was observed in one of the families. Microsatellite analysis showed a common haplotype in all individuals heterozygous for the Q109X mutation, indicating a founder effect. Overall, 18 heterozygotes were clinically affected by at least one NCD tumour. Every affected patient inherited the germline mutation from the father, confirming SDHD maternal genomic imprinting. Penetrance of the paternally inherited mutation progressively increased from 33% to 83% at 30 and 60 years, respectively. Affected patients showed high clinical variability, ranging from monolateral to bilateral glomus tumours variably associated or not with paragangliomas or phaeochromocytomas. Loss of heterozygosity was observed in tumour cells isolated by laser capture microdissection. Conclusions: This study shows that a single founder SDHD mutation is present in an area of central Italy and that this mutation is associated with widely variable interfamilial and intrafamilial expressivity.

A 48-year-old man presenting with perineal pain, weak stream and dysuria was found to have a Cowper's gland duct cyst measuring 1.8 x 3.5 cm, which was investigated with retrograde and voiding urethrography, cavernosography and perineal MRI, which was the single most useful imaging technique. Treatment consisted in complete surgical excision, which allowed an anatomical reconstruction of the urethra. This condition is typical of the pediatric age group, and seldom diagnosed in adults.

Mutations in genes encoding mitochondrial succinate dehydrogenase (SDH) are frequently involved in the development of neural crest-derived (NCD) tumors, such as pheochromocytomas (PHEOs) or paragangliomas (PGLs). In this study we report the results of sequencing analysis in leukocyte DNA of patients affected by PHEO/PGL who turned out to be SDH mutation carriers. A nonsense germline heterozygous mutation (Q109X) was found in the exon 4 of the SDHD gene in the index cases of six unrelated families affected by PHEO/PGL. Haplotype analysis showed the presence of a founder effect. Affected patients showed high clinical variability, ranging from monolateral to bilateral glomus tumors, variably associated or not with PGLs or PHEOs. A novel missense SDHD variant, T112I, was also found in one of our families. A new missense G106D mutation, involving a highly conserved amino acid, was found in two sisters affected by bilateral glomus tumors. A P81L mutation associated with abdominal and head and neck PGL was detected in three families. A G12S variant of the SDHD gene was found in one patient affected by a PHEO. The finding of this variant in 3 of 100 control subjects suggests that it is a polymorphism and not a mutation. A novel IVS2-1G>T variant was found at intron 2 of SDHD gene in one patient affected by a glomus tumor. All the tumors associated with SDHD mutations were benign. Conversely, the only mutation we found in SDHB gene (IVS3 + 1G>A) was associated with a malignant PHEO.

A multimodal spectroscopic fiber probe for combined Raman, fluorescence and reflectance measurements was designed, developed and used for tissue diagnostics. Two visible laser diodes emitting in the visible range, a laser diode emitting in the NIR, and a halogen lamp were respectively used for fluorescence, Raman and reflectance spectroscopy. The probe was based on a custom fiber bundle, equipped with various types of fibers for exciting and detecting the signals of interest. Fluorescence, Raman and reflectance spectra were acquired using the same detection unit, based on a cooled CCD camera, connected to a spectrograph. The probe was successfully employed for diagnostic purposes on various tissues in a good agreement with common routine histology. This study included skin, brain and bladder tissues and in particular the classification of: malignant melanoma against melanocytic lesions and healthy skin; urothelial carcinoma against healthy bladder mucosa; brain tumor against dysplastic brain tissue. The diagnostic capabilities were determined using a cross-validation method with a leave-one-out approach, finding very high sensitivity and specificity for all the examined tissues. The obtained results demonstrated that the multimodal approach is crucial for improving diagnostic capabilities, as well as for performing tumor grading. The system presented here can improve diagnostic capabilities on a broad range of tissues and has the potential of being used for endoscopic inspections in the near future.