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  • Harrison's Internal Medicine Chapter 91. Benign and Malignant Diseases of the Prostate Benign and Malignant Diseases of the Prostate: Introduction Benign and malignant changes in the prostate increase with age. Autopsies of men in the eighth decade of life show hyperplastic changes in 90% and malignant changes in 70% of individuals. The high prevalence of these diseases among the elderly, who often have competing causes of morbidity and mortality, mandates a risk-adapted approach to diagnosis and treatment. This can be achieved by considering these diseases as a series of states.

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  • The PSA criteria used to recommend a diagnostic prostate biopsy have evolved over time. The goal is to increase the sensitivity of the test for younger men more likely to die of the disease and to reduce the frequency of detecting cancers of low malignant potential in elderly men more likely to die of other causes. Age-specific reference ranges reduce the upper limit of normal for younger men and increase it for older men. Different thresholds alter the sensitivity and specificity of detection. The threshold for performance of a biopsy was 4.0 ng/mL, which has been reduced to 2.6...

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  • General Aspects of Lymphoid Malignancies Etiology and Epidemiology The relative frequency of the various lymphoid malignancies is shown in Fig. 105-1. Chronic lymphoid leukemia (CLL) is the most prevalent form of leukemia in western countries. It occurs most frequently in older adults and is exceedingly rare in children. In 2007, 15,340 new cases were diagnosed in the United States, but because of the prolonged survival associated with this disorder, the total prevalence is many times higher. CLL is more common in men than in women and more common in whites than in blacks.

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  • Other B Cell Lymphoid Malignancies B cell prolymphocytic leukemia involves blood and marrow infiltration by large lymphocytes with prominent nucleoli. Patients typically have a high white cell count, splenomegaly, and minimal lymphadenopathy. The chances for a complete response to therapy are poor. Hairy cell leukemia is a rare disease that presents predominantly in older males. Typical presentation involves pancytopenia, although occasional patients will have a leukemic presentation. Splenomegaly is usual.

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  • Harrison's Internal Medicine Chapter 93. Gynecologic Malignancies Ovarian Cancer Incidence and Epidemiology Ovarian cancer can develop from three distinctive cell types (germ cells, stromal cells, and epithelial cells), and each of these presents with distinctive features and outcomes and requires widely different management approaches. Epithelial ovarian cancer is the most common of the three and the leading cause of death from gynecologic cancer in the United States. In 2007, 22,430 new cases were diagnosed, and 15,280 women died from ovarian cancer.

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  • Table 93-1 Staging and Survival in Gynecologic Malignancies St age Ovarian -Year 5 trial Endome 5 -Year x Surviv al, % Cervi -Year 5 Surviv al, % Surviv al, % 0 — — Carcin oma in situ 00 1 I Confined 9 Confine 8 Confin 8 to ovary 0 d tocorpus 9 ed to uterus 5 II Confined to pelvis 0 7 corpus cervix Involves and 0 8 s Invade beyond 5 6 uterus but not to pelvic wall III Intraabdo minal spread 5–20 1 Extends outside the 0 3 Exten 3 ds to pelvic 5 wall and/or uterus but not outside the true pelvis lower third of vagina, or hydronephros is ...

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  • Malignant germ cell tumors are usually large (median—16 cm). Bilateral disease is rare except in dysgerminoma (10–15% bilaterality). Abdominal or pelvic pain in young women is the usual presenting symptom. Serum human chorionic gonadotropin (β-hCG) and α fetoprotein levels are useful in the diagnosis and management of these patients. Before the advent of chemotherapy, extensive surgery was routine, but it has now been replaced by careful evaluation of extent of spread, followed by resection of bulky disease and preservation of one ovary, the uterus, and the cervix, if feasible.

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  • Uterine Cancer Incidence and Epidemiology Carcinoma of the endometrium is the most common female pelvic malignancy. Approximately 39,080 new cases are diagnosed yearly, although in most (75%), tumor is confined to the uterine corpus at diagnosis, and therefore most can be cured. The 7400 deaths yearly make uterine cancer only the eighth leading cause of cancer death in females.

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  • Harrison's Internal Medicine Chapter 105. Malignancies of Lymphoid Cells Malignancies of Lymphoid Cells: Introduction Malignancies of lymphoid cells range from the most indolent to the most aggressive human malignancies. These cancers arise from cells of the immune system at different stages of differentiation, resulting in a wide range of morphologic, immunologic, and clinical findings. Insights on the normal immune system have allowed a better understanding of these sometimes confusing disorders. Some malignancies of lymphoid cells almost always present as leukemia (i.e.

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  • Pathway of normal T cell differentiation and relationship to T cell lymphomas. CD1, CD2, CD3, CD4, CD5, CD6, CD7, CD8, CD38, and CD71 are cell markers used to distinguish stages of development. T cell antigen receptors (TCR) rearrange in the thymus, and mature T cells emigrate to nodes and peripheral blood. ALL, acute lymphoid leukemia; T-ALL, T cell ALL; T-LL, T cell lymphoblastic lymphoma; T-CLL, T cell chronic lymphoid leukemia; CTCL, cutaneous T cell lymphoma; NHL, non-Hodgkin's lymphoma.

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  • Table 105-6 presents the best documented translocations and associated oncogenes for various subtypes of lymphoid malignancies. In some cases, such as the association of the t(14;18) in follicular lymphoma, the t(2;5) in anaplastic large T/null cell lymphoma, the t(8;14) in Burkitt's lymphoma, and the t(11;14) in mantle cell lymphoma, the great majority of tumors in patients with these diagnoses display these abnormalities. In other types of lymphoma where a minority of the patients have tumors expressing specific genetic abnormalities, the defects may have prognostic significance.

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  • Clinical Features, Treatment, and Prognosis of Specific Lymphoid Malignancies Precursor Cell B Cell Neoplasms Precursor B Cell Lymphoblastic Leukemia/Lymphoma The most common cancer in childhood is B cell ALL. Although this disorder can also present as a lymphoma in either adults or children, presentation as lymphoma is rare. The malignant cells in patients with precursor B cell lymphoblastic leukemia are most commonly of pre-B cell origin.

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  • B Cell Chronic Lymphoid Leukemia/Small Lymphocytic Lymphoma: Treatment Patients whose presentation is typical B cell CLL with no manifestations of the disease other than bone marrow involvement and lymphocytosis (i.e., Rai stage O and Binet stage A; Table 105-7) can be followed without specific therapy for their malignancy. These patients have a median survival 10 years, and some will never require therapy for this disorder.

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  • The diagnosis of Hodgkin's disease is established by review of an adequate biopsy specimen by an expert hematopathologist. In the United States, most patients have nodular sclerosing Hodgkin's disease, with a minority of patients having mixed-cellularity Hodgkin's disease. Lymphocyte-predominant and lymphocyte-depleted Hodgkin's disease are rare. Mixed-cellularity Hodgkin's disease or lymphocyte-depletion Hodgkin's disease are seen more frequently in patients infected by HIV (Fig. 105-11).

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  • The expression of proteoglycans (PGs), essential macromolecules of the tumor microenvironment, is markedly altered during malignant transforma-tion and tumor progression. Synthesis of stromal PGs is affected by factors secreted by cancer cells and the unique tumor-modified extracellular matrix may either facilitate or counteract the growth of solid tumors.

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  • Tham khảo sách 'malignant mesothelioma edited by carmen belli and santosh anand', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả

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  • Non-Hodgkin's lymphomas were separated from Hodgkin's disease by recognition of the Sternberg-Reed cells early in the twentieth century. The histologic classification for non-Hodgkin's lymphomas has been one of the most contentious issues in oncology. Imperfect morphologic systems were supplanted by imperfect immunologic systems, and poor reproducibility of diagnosis has hampered progress.

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  • Table 105-5 Diseases or Exposures Associated with Increased Risk of Development of Malignant Lymphoma Inherited immunodeficiency disease Klinefelter's syndrome Chédiak-Higashi syndrome Ataxia telangiectasia syndrome Wiscott-Aldrich syndrome Common variable immunodeficiency disease Acquired immunodeficiency diseases Iatrogenic immunosuppression HIV-1 infection Acquired hypogammaglobulinemia Autoimmune disease Sjögren's syndrome Celiac sprue Rheumatoid arthritis and systemic lupus erythematosus Chemical or drug exposures Phenytoin Dioxin, phenoxyherbicides Radiation P...

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  • Chapter 105. Malignancies of Lymphoid Cells (Part 8) Approach to the Patient: Lymphoid Cell Malignancies Regardless of the type of lymphoid malignancy, the initial evaluation of the patient should include performance of a careful history and physical examination. These will help confirm the diagnosis, identify those manifestations of the disease that might require prompt attention, and aid in the selection of further studies to optimally characterize the patient's status to allow the best choice of therapy.

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  • This book brings together the knowledge of eminent experts in the field of malignant mesothelioma, a highly invasive tumor of mesothelium that is the protective lining covering several body cavities. Malignant mesothelioma shows extremely poor progression and is refractory to almost any kind of therapy putting considerable challenges in its treatment. This book covers many important aspects of malignant mesothelioma like epidemiology, immunology, molecular mechanisms and clinical options and will be useful to anybody interested in its history, pathology, and treatment....

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