Monographs in pathology最新文献

While probably not necessary in routine diagnosis, whole-mount sections of radical prostatectomy specimens can provide valuable information that is difficult to obtain by other means. Contrary to popular belief, the technique can be carried out in the routine histology laboratory with only minor modifications of existing methods. The use of this technique has provided valuable insight into the tumor biology of early stage prostatic cancer pointing to a multifocal origin for this disease. Likewise, the study of tumor volume, histological grade, and capsular penetration has provided a basis for the use of such prognostic markers in clinical management. The continuing development of new screening tools such as TRUS and MRI requires careful correlation with histopathology to assure a fundamental understanding of their abilities and limitations to detect and stage early-stage tumors. Only with such continued effort will diagnosis and clinical intervention allow us to make a meaningful impact on the natural history of this common malignancy.

Urothelial neoplasia is a complex subject that can be only partially understood by careful study of the light microscopic features of individual lesions. Despite decades of study, our knowledge concerning the interaction of neoplastic events and host responses remains rudimentary. Most information has been collected by observing cases (usually in retrospect) that have been grouped according to relatively arbitrary criteria based on the phenotypic appearances of lesions as they are viewed through the light microscope. When evaluating human disease, we are always forced to reason backwards to determine the most likely histogenesis and to project forward to assess the most likely prognosis. Both types of reasoning must be filled with conjecture since direct observations from the initial events to the end results are not possible. Under these constricting circumstances, a conceptual framework into which our often anecdotal observations can be placed is more important than we would like to admit. With this in mind, I have taken advantage of the monograph format to risk a speculative approach to the subject, at least as it applies to the significance of the pathological features. In the past, we have accepted the view that all human hosts are essentially the same and that variations in cancer type and behavior are related almost entirely to the genetic ingenuity of the cancer cells themselves. Perhaps we should now entertain the opposite view, that carcinogenic events are ubiquitous and that cancer in any individual patient represents only what that patient will allow to grow in his or her body. We have devoted almost all of our collective research energy to examining the tumor. I believe that the pace of future progress can be significantly increased if we can think of more ways to examine the patient.

Because the present ability to treat and cure patients with prostate cancer is limited to those patients with pathologically organ-confined disease, it has become increasingly important to diagnose this disease at an early stage when cure is most likely. Recent advances in imaging may allow the urologist and pathologist to make the diagnosis of prostate cancer much earlier in the natural course of the disease. It therefore becomes imperative to have methods available to predict which patients have a high probability of progressing so that treatment can be assigned logically and appropriately. Our current methods of prognosis determination (stage and grade) do not allow accurate assessment of tumor behavior in the majority of individual patients with prostate cancer. Therefore, more accurate quantification of nuclear and cellular changes that take place as a tumor progresses to take on the aggressive (metastatic) phenotype are urgently needed. Experimental techniques have proven useful in answering these questions in animal models and now seem ready for large-scale testing in clinical studies.

This article has reviewed the diagnostic value of testicular biopsy in the evaluation of male infertility. In order to optimize the interpretation of morphologic findings, it is essential that a full medical and occupational history and careful hormonal evaluation be performed. A karyotype may be indicated in some cases. The pathologist has the opportunity to render a diagnostic opinion based on examination of seminiferous tubules and interstitium and correlated with the results of the history, physical examination, and laboratory studies. A rapid quantitative method is available for determining the likelihood that a significant epididymal obstruction exists that may be relieved surgically.