No abstract

The major neoplastic transformation-inducing genes of human solid tumors are members of the ras oncogene family. We used an immunohistochemical assay to assess expression of both the unaltered and the mutated ras oncogene protein (p21) in normal and neoplastic prostatic cells. With the concentration of monoclonal antibody used in this study, epithelial and stromal cells from subjects with normal prostates and from 19 patients with benign prostatic hyperplasia were negative for p21 antigen. This antigen was detected in 2 of 6 prostates with Grade I carcinoma, 4 of 6 with Grade II, and all of 17 with higher grades. A semiquantitative immunohistochemical method demonstrated that expression of the p21 antigen in a carcinoma strongly correlated with nuclear anaplasia and was inversely related to the degree of glandular differentiation. However, markedly anaplastic tumors were often more heterogeneous in expression of p21 and contained areas of low staining for the antigen. Comparison of p21 antigen with tumor carcinoembryonic antigen and prostate-specific antigen demonstrated that ras p21 was the only phenotypic marker that correlated with histologic tumor grade. Thus, ras oncogene p21 may represent a new class of biologically relevant tumor markers and may be a useful adjunct to histopathologic examination in determining the prognosis of patients with prostate cancer.

ras Oncogene p21 antigen is present in the most superficial cells of the normal bladder urothelium, as demonstrated by immunohistochemical staining. The pattern and intensity of p21 staining of cells in epithelial hyperplasia and low grade bladder carcinoma were similar to that seen in the normal urothelium. In contrast, epithelial cells in "premalignant" (dysplastic) lesions and high grade carcinomas exhibited an intense staining reaction for p21 antigen. ras p21 may be a useful marker for the malignant potential of both premalignant lesions and carcinomas of the bladder.

Renal oncocytomas are uncommon, benign tumors that can be treated by local excision or heminephrectomy; their preoperative differentiation from renal cell carcinoma, treated by radical nephrectomy, would be invaluable. A particularly important finding, a central scar--not stressed in previous reports, is frequently demonstrated by CT examination. We evaluated radiographic studies of 18 pathologically confirmed cases of oncocytoma and compared findings with results of CT, sonography, and angiography studies of 18 renal cell carcinoma cases. Oncocytomas can be suggested if a stellate scar is identified within an otherwise homogenous tumor on ultrasound (US) and CT; if the mass appears homogeneous but no scar is present, angiography should be performed. An oncocytoma can be suggested in these cases if a spoke-wheel configuration and homogeneous blush are present. These criteria, which are reliable only if the mass is 3 cm or larger, would have resulted in the correct diagnosis of oncocytoma in 16/18 cases.

The first case of invasive squamous cell carcinoma (SCC) arising in the skin of a patient afflicted with keratitis, ichthyosis, and deafness (KID) syndrome is reported. A 35-year-old man, diagnosed as having KID syndrome in early childhood, developed bilateral fungating lesions on his feet. The entire left foot became involved with a multinodular fungating mass which proved to harbor a SCC, necessitating a left below-knee amputation. Although rare, KID syndrome can be associated with SCC of the skin. A case of squamous cell carcinoma (SCC) ofthe tongue was reported by Baden and Alpe9 in a 7-year-old boy with this syndrome. However, SCC of the affected integument has not been documented previously. We report a case of squamous cell carcinoma of the foot in a patient with KID syndrome. Case ReportA 35-year-old man was admitted with bilateral keratotic plaque-like masses on his feet. He had been diagnosed as having KID syndrome in early childhood. His feet were normal until the spring of 1982 when the masses appeared after repeated trauma (induced by jogging). The authors thank Dr. Jonathan Cohen for his editorial assistance in preparing the manuscript.Accepted for publication August 9, 1985. In August 1982, he underwent debridement and biopsy ofthe left foot ulcer with a split-thickness skin graft (STSG) in another hospital. The graft did not take, and a second debridement and grafting were performed 2 weeks later. After the second failure, he was referred to our hospital. On admission, he presented with the characteristic features of KID: keratitis, generalized ichthyosis, and deafness (Fig. 1). His skin was dry, scaly, and thick, and his nails revealed a horn-like thickness (Fig. 2). He was almost completely bald as a result of repeated scalp infections (Fig. 3).An extensive area (19 cm in diameter) of the skin surface of the left leg was profoundly altered. This area extended over the ventral surface of the leg and proximal half of the sole of the foot, encircling both lateral and anterior aspects of the foot and extending as much as 17 cm up the surfaces of the ankle. Only the anterior aspect of the ankle region and the dorsum of the foot were spared (Fig. 4).The surfaces were markedly irregular and multinodular with areas of hemorrhage and yellowish drainage. The entire lesion showed irregular and raised margins. The right leg showed a 5-cm fungating lesion on the medial aspect of the ankle. Sensation in both legs was intact. The left inguinal nodes were enlarged. Bone scan showed uptake of the left foot. He was tested for delayed cutaneous hypersensitivity and shown to be immunocompetent.Review of slides from the biopsy of the left foot showed a region of squamous cell carcinoma infiltrating through the dermis (Figs. 5A and 5B). The adjacent skin showed acanthosis, papillomatosis, and marked hyperkeratosis associated with foci of pseudoepitheliomatous hyperplasia (PEH) and chronic dermal inflammation. Biopsy specimens from the right foot showed qualitatively similar changes, but without evidence of SCC. A...