Secondary Signet Ring Cell Carcinoma of Prostate

True metastases to prostate from solid tumors are reported only in 0.2% of all surgical prostatic specimens and 2.9% of all male postmortems. Clinical context, morphological features, and immunohistochemical localization of prostate specific antigen (PSA) are supposed to clarify the differential diagnosis between a secondary and a primary tumor. We report an unusual and rare case of secondary signet ring cell carcinoma (SRCC) of prostate in which the clinical data and signet ring cell morphology pointed toward the diagnosis of a primary SRCC. Immunohistochemistry (IHC) for PSA not only proved the case to be a secondary SRCC but also initiated the process for diagnosis of the occult primary malignancy in the patient’s stomach.Keywords: Prostate specific antigen, prostate, signet ring cell carcinomaNigerian Journal of Surgery, Jan-Jun 2012 | Volume 18 | Issue

Differential usage of alternate promoters of the human stress response gene ATF3 in stress response and cancer cells

Stress response gene ATF3 plays a pleiotropic role in determining cell fate in response to mitogenic or stress stimuli. An alternate promoter of the human ATF3 gene (designated P1 in this study) has recently been reported, which is located ∼43.5 kb upstream of the previously reported P2 promoter. We showed here that the P1 promoter is highly conserved between human and mouse and is functional in response to various stimuli, whereas the P1 promoter was dominantly induced by serum and the P2 promoter was more efficiently activated in response to TGF-β and oncogenic HRAS. The P1 promoter contains multiple transcriptional start sites, and the different 5′-UTRs markedly affected their translation in response to stress. In human prostate and Hodgkin Reed–Sternberg cancer cells with elevated expression of ATF3, the P1 promoter was constitutively activated and its chromatin structure was modified into active configuration. The differential usage of alternate promoters of the ATF3 gene at both transcriptional and translational level and the modification of chromatin structure may provide a novel mechanism for expressing ATF3 in determining cell fate during stress response and cancer

Juvenile xanthogranuloma-diagnostic challenge on fine-needle aspiration cytology

Juvenile xanthogranuloma (JXG) is a rare cutaneous lesion with paucity of literature on its cytological features. We report one such case which on fine-needle aspiration cytology yielded a mixed population of foamy histiocytes, multinucleated giant cells and variable admixture of lymphocytes and eosinophils causing diagnostic dilemma with other differentials, especially Langerhans cell histiocytosis. However, clinical correlation followed by histopathology confirmed the diagnosis. Hence, JXG has characteristic and diagnostic cytologic features

Adult Congenital Heart Disease-Coping And REsilience (ACHD-CARE): Rationale and methodology of a pilot randomized controlled trial

Background and Aim: As a result of significant advances in diagnosis and treatment, approximately 90% of infants born with congenital heart disease (CHD) are now expected to reach adulthood. However, an increased risk of cardiac sequelae necessitates lifelong cardiac surveillance and can significantly impact psychosocial development. One-third of North American adults with CHD have diagnosable mood or anxiety disorders and most do not receive appropriate mental health treatment. There are currently no published trials investigating psychological interventions for this unique patient population. It is thus important to establish the feasibility of conducting a psychological intervention trial in this population. In this methods paper, we describe (1) the development of a group psychosocial intervention aimed at improving the psychosocial functioning, quality of life, and resilience of adults with CHD, and (2) the design of a study to determine the feasibility of a future full-scale randomized controlled trial. Methods: Based upon quantitative and qualitative (focus group) research, we developed an 8-session Adult CHD–Coping And REsilience (ACHD-CARE) Program. We subsequently designed a 2-parallel arm non-blinded pilot randomized trial with a 1:1 individual patient allocation ratio. Inclusion criteria are documented CHD, age >18 years, English-language proficiency, no planned surgery, and clinically-elevated score (i.e., >8) on the Hospital Anxiety and Depression Scale depression (HADS-D) or anxiety (HADS-A) subscale. Exclusion criteria are current psychotherapy, reported suicidal intent, or significant cognitive impairment, psychosis, or personality disorder. Patients from a single tertiary centre are randomized to the ACHD-CARE intervention or Usual Care. The intervention is delivered during 90-minute sessions held weekly in small groups. Feasibility is assessed in the following five domains:(i) process (e.g., participant recruitment and retention), (ii) resources, (iii) management, (iv)scientific outcomes, and (v) acceptability of the intervention. Results: Our initial experiences indicate that the study design is feasible and acceptable to stakeholders. We have been able to successfully recruit and retain participants, although travel distance and competing time demands are barriers for many potential study participants. There have been no insurmountable challenges in study management. At the conclusion of the study, we will be poised to make one of three determinations: (1) a full-scale RCT is feasible, (2) a full-scale RCT is feasible with modifications, or (3) a full-scale RCT is not feasible. Conclusions: This study underscores the importance of carefully developing and testing the feasibility of psychosocial interventions in medical populations before moving to full-scale clinical trials. Feasibility outcomes from this study will guide the future evaluation and provision of psychological treatment for adults with CHD

Red Flags for Maltese Adults with Congenital Heart Disease: Poorer Dental Care and Less Sports Participation Compared to Other European Patients-An APPROACH-IS Substudy.

Studies in recent years have explored lifestyle habits and health-risk behaviours in adult congenital heart disease (ACHD) patients when compared to controls. The aim of this study was to investigate differences in lifestyle habits between Maltese and other European ACHD patients. Data on alcohol consumption, cigarette smoking, substance misuse, dental care and physical activity collected in 2013-2015 during "Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease-International Study" (APPROACH-IS) were analysed. Responses from 119 Maltese participants were compared to those of 1616 participants from Belgium, France, Italy, Norway, Sweden, Switzerland and the Netherlands. Significantly fewer Maltese patients with simple (Maltese 84.1% vs. European 97.5%, p < 0.001) and moderately complex CHD (Maltese 83.6% vs. European 97.4%, p < 0.001) brushed their teeth daily. Only 67.2% of Maltese with moderately complex disease had dental reviews in the previous year compared to 80.3% of Europeans (p = 0.02). Maltese patients with simple (Maltese 31.8% vs. European 56.1%, p = 0.002) and moderately complex lesions (Maltese 30.0% vs. European 59.2%, p < 0.001) performed less regular sport activities. Comparison by country showed Maltese patients to have significantly poorer tooth brushing and sports participation than patients from any other participating country. Alcohol consumption, cigarette smoking and substance misuse were not significantly different. This study highlights lifestyle aspects that Maltese ACHD patients need to improve on, which might not be evident upon comparing patients to non-CHD controls. These findings should also caution researchers against considering behaviours among patients in one country as necessarily representative of patients on the larger scale