Sidney L. Saltzstein

Prostatic Carcinoma: Incidence and Location of Unsuspected Lymphatic Metastases

Prospective pathologic staging by pelvic lymphadenectomy in 60 patients with clinically localized carcinoma of the prostate disclosed a high incidence (35 per cent) of clinically silent and unsuspected lymph node metastases. When present, metastatic disease was frequently bilateral (57 per cent) and most commonly involved the obturator-hypogastric lymph nodes (87 per cent). Micrometastases alone were found in 5 patients and the potential significance of this finding on survival is discussed. Although the presence or absence of metastases could not be accurately predicted by histologic analysis of biopsy or prostatectomy specimens, the finding of undifferentiated tumor, marked anaplasia and penetration through the capsule correlated positively with nodal metastases. Pelvic lymphadenectomy is a safe and important diagnostic tool in the accurate staging of these patients. Its widespread use is advocated in patients with clinical stage B1, B2 and C tumors prior to definitive therapy. Based on the prospective data generated in this study lymphatic metastasis appears to be an early event in the spread of prostatic cancer.

Racial/Ethnic and Gender Disparities in Renal Cell Carcinoma Incidence and Survival

PURPOSE We used a population based cancer registry to examine trends in renal cell carcinoma incidence and survival among 4 racial/ethnic groups (white, black, Hispanic and Asian/Pacific Islander) and both genders. MATERIALS AND METHODS Race/ethnicity, gender, age, staging, length of survival and cause of death data were analyzed using 39,434 cases of renal cell carcinoma from 1988 to 2004 from the California Cancer Registry. Annual age adjusted incidence rates and relative survival rates were calculated for the racial/ethnic and gender groups. These rates and the percent of localized cancer were plotted by year, and Microsoft Excel was used to calculate linear regression equations. Median age was also calculated. Z-tests and chi-square tests were performed to determine p values. RESULTS An increase in renal cell carcinoma incidence was found with localized cancer accounting for most of the increase. Black patients had a significantly higher incidence rate (p <0.0001) and lower survival rate (p <0.0001) than all other races/ethnicities despite having more localized cancer (p <0.005). Black patients were also diagnosed at a younger age (p <0.0001) than their counterparts. On the other hand Asian/Pacific Islanders had a lower incidence rate (p <0.0001) and higher survival rate (p <0.05) than all other races/ethnicities. Males had approximately twice the incidence rate of females and a lower survival rate (p <0.005). CONCLUSIONS Higher incidence rates and lower survival rates were identified among black and male patients compared to their counterparts, while Asian/Pacific Islanders showed the opposite trends. Such racial/ethnic and gender disparities in renal cell carcinoma incidence and survival may help elucidate biological, behavioral and environmental factors that can potentially be addressed.

Clinically occult inflammatory carcinoma of the breast.

Four women with no clinical evidence that their breast cancers were inflammatory carcinoma were found to have tumor in the dermal lymphatics on histologic examination. All four followed the progressive course characteristic of inflammatory carcinoma. The term „clinically occult inflammatory carcinoma”︁ is proposed for this presentation of this tumor. This small series supports the argument that inflammatory carcinoma is a histologic rather than clinical diagnosis.

Hypothenar hammer syndrome. Form of reversible Raynaud's phenomenon

Hypothenar hammer syndrome is a reversible yet uncommonly encountered cause of Raynauds phenomenon. Characteristic findings include coldness in the dominant hand of a male, absence of triphasic color change and thumb involvement, and occupational or recreational use of the hand as a hammer. Angiography demonstrates the specific findings of irregularity or occlusion of the ulnar artery, downstream occluded proper digital arteries, and intraluminal emboli at the sites of distal obstruction. A vulnerable area of traumatic occlusion is provided by the anatomic relationship of the superficial branch of the ulnar artery to the hamate bone and the palmar aponeurosis. Pathologic studies separate the hypothenar hammer syndrome from clinically similar vasculitis. It is important to recognize the hypothenar hammer syndrome as a distinct entity because treatment is curative and consists of resection of the affected vascular segment and avoidance of the aggravating conditions.

Age and time as factors in the left-to-right shift of the subsite of colorectal adenocarcinoma: a study of 213,383 cases from the California Cancer Registry.

Goals Using a data set of more than 200,000 cases, we can measure the effects of age, time, sex, and race/ethnicity on the shift of the site of origin of colorectal adenocarcinoma from the left to the right side. Background As people become older, there is a shift of the site of origin of adenocarcinoma of the colorectum from the left to the right side. Although some studies do show some relationship of this shift, in addition to age, to race/ethnicity and to sex, there are no large, total population-based data studying the effects of these factors and time trends in this shift. Study 213,383 cases of adenocarcinoma of the colorectum for the years 1988 to 2003 from the California Cancer Registry have been studied. Results The left-to-right shift increases significantly with increasing age and year of diagnosis, and is greater in women than in men and is greater in whites than in other racial/ethnic groups. The time-related shift is a reflection of a lesser decrease in the incidence of colorectal adenocarcinoma on the right side than on the left. Conclusions The most attractive hypothesis is that a greater likelihood of prior polypectomy, and thus prevention of more cancers, occurs on the left side than on the right.

Features of Cancer in Nonagenarians and Centenarians

OBJECTIVE: To describe the incidence rates and sites of cancer, the causes of death, and gender and ethnic variations in patients with cancer in a population of people 90 years of age and older.

Late age (85 years or older) peak incidence of bladder cancer.

PURPOSE We examined the incidence rates of bladder cancer using California Cancer Registry data to determine if any trends exist. MATERIALS AND METHODS Complete records of the 55,159 cases of invasive bladder cancer were examined from the original 92,677 bladder cancer cases recorded in the California Cancer Registry between 1988 and 2004. RESULTS California Cancer Registry data showed a universal late age peak in age specific incidence of bladder cancer in men and women, and across ethnic boundaries. The rate of annual increase in the percent of bladder cancer in individuals 85 years or older was increasing about 10 times as rapidly as the percent of the population that was 85 years or older (slope = 0.395 vs 0.0336). Furthermore, during all 17 years the proportion of patients 85 or older with bladder cancer was about twice that of patients with other cancers regardless of gender. CONCLUSIONS California Cancer Registry data illustrate a peak in the incidence of bladder cancer in individuals 85 years or older. However, to our knowledge there is no known explanation for this late peak in bladder cancer. With the rate of bladder cancer in the population 85 years or older increasing at a rapid pace, it is critical to encourage investigators to include this age group as they continue to search for causative factors and genetic contributors to bladder cancer as well as effective treatments.

Long bone ossifying fibromas

Ossifying fibromas involving the tibia were seen in two patients. In both patients, the radiographic appearance of the lesions suggested fibrous dysplasia, but histopathologic evaluation demonstrated findings similar to ossifying fibroma of the mandible and facial bones. Radiologic and pathologic recognition of this entity is necessary for proper treatment.

Early cancer detection among rural and urban californians

BackgroundSince the stage of cancer detection generally predicts future mortality rates, a key cancer control strategy is to increase the proportion of cancers found in the early stage. This study compared stage of detection for members of rural and urban communities to determine whether disparities were present.MethodsThe California Cancer Registry (CCR), a total population based cancer registry, was used to examine the proportion of early stage presentation for patients with breast, melanoma, and colon cancer from 1988 to 2003. Cancer stage at time of detection for these cancers was compared for rural and urban areas.ResultsIn patients with breast cancer, there were significantly more patients presenting at early stage in 2003 compared to 1988, but no difference in the percentage of patients presenting with early stage disease between rural and urban dwellers. There were no differences in incidence in early stage cancer incidence between these groups for melanoma patients, as well. In colorectal cancer in 1988, significantly more patients presented with early stage disease in the urban areas (42% vs 34%, p < 0.02). However, over time the rural patients were diagnosed with early stage disease with the same frequency in 2003 as 1988.ConclusionThis analysis demonstrates that people in rural and urban areas have their breast, melanoma or colorectal cancers diagnosed at similar stages. Health care administrators may take this information into account in future strategic planning.

Dorsal Defect of the Patella (DDP): A Characteristic Radiographic Lesion

The dorsal defect of the patella (DDP) is a benign lesion with specific radiographic features. Seven cases of DDP are reviewed; all 7 lesions were identical in location and radiographic appearance. The characteristic lesion is round and lytic, with well-defined margins; it is located in the superolateral aspect of the patella adjacent to the subchondral bone. Arthrography reveals intact cartilage. DDP may occur in both sexes and may be bilateral. It is often found incidentally on radiographs ordered for acute trauma. Its etiology is not known. Differential diagnosis is also discussed.