No abstract

Traditionally, patients who die with a malignancy have been excluded from donation. However, it has become a common practice to accept organs from donors that have low-grade tumors or tumors with low metastatic potential. The aim of this study was to analyze our experience with the use of liver grafts from donors with central nervous system (CNS) tumors. A retrospective review of 1173 liver transplants performed between 1992 and 2006 identified 42 donors diagnosed with a CNS tumor. Thirty-two tumors were malignant, and 10 tumors were benign. Forty-two liver transplant recipients received livers from these donors. All patients were followed until May 2007 with a mean follow-up of 29 Ϯ 17 months. Among 42 donors, there were 28 males and 14 females. The mean donor risk index was 1.78 Ϯ 0.39. Twenty (47.6%) of the CNS tumors were glioblastoma multiforme (astrocytoma grade IV), 11 (26.2%) were other astrocytomas, and 1 (2.4%) was an anaplastic ependymoma. Twenty (62.5%) neoplasms were grade IV tumors, 8 (25%) were grade II tumors, and 4 (12.5%) were grade III tumors. Over 80% of the patients had at least 1 kind of invasive procedure violating the blood-brain barrier. The rate of recurrence for the entire group was 2.4% (all CNS tumors). There were 7 (7.2%) deaths in all. The most common cause of death was sepsis (n ϭ 3, 7.2%). There was no difference in survival between recipients of grafts from donors with CNS tumors and recipients of grafts from donors without CNS tumors (1 year: 82% versus 83.3%, P ϭ not significant; 3 years: 77.4% versus 72%, P ϭ not significant). In conclusion, in our experience, despite violation of the blood-brain barrier and high-grade CNS tumors, recurrence was uncommon. Grafts from these donors are often an overlooked source of high-quality organs from younger donors and can be appropriately used, particularly in patients who, despite low Model for End-Stage Liver Disease scores, carry a high risk of mortality.

Autoimmune hemolysis is rare in multiple myeloma. We describe a rare case of multiple myeloma who presented with autoimmune hemolytic anemia at initial presentation.

We have studied transcription in vitro by Q␤ replicase to deduce the minimal features needed for efficient end-to-end copying of an RNA template. Our studies have used templates ca. 30 nucleotides long that are expected to be free of secondary structure, permitting unambiguous analysis of the role of template sequence in directing transcription. A 3-terminal CCCA (3-CCCA) directs transcriptional initiation to opposite the underlined C; the amount of transcription is comparable between RNAs possessing upstream (CCA) n tracts, A-rich sequences, or a highly folded domain and is also comparable in single-round transcription assays to transcription of two amplifiable RNAs. Predominant initiation occurs within the 3-CCCA initiation box when a wide variety of sequences is present immediately upstream, but CCA or a closely similar sequence in that position results in significant internal initiation. Removal of the 3-A from the 3-CCCA results in 5-to 10-fold-lower transcription, emphasizing the importance of the nontemplated addition of 3-A by Q␤ replicase during termination. In considering whether 3-CCCA could provide sufficient specificity for viral transcription, and consequently amplification, in vivo, we note that tRNA His is the only stable Escherichia coli RNA with 3-CCCA. In vitro-generated transcripts corresponding to tRNA His served as poor templates for Q␤ replicase; this was shown to be due to the inaccessibility of the partially base-paired CCCA. These studies demonstrate that 3-CCCA plays a major role in the control of transcription by Q␤ replicase and that the abundant RNAs present in the host cell should not be efficient templates.Genome replication among the positive-strand RNA viruses is accomplished by sequential end-to-end transcriptions, first of the encapsidated positive sense RNA and subsequently of the newly synthesized negative-sense antigenome. Except for viruses whose genomes are covalently linked at the 5Ј end to a specialized protein, these transcriptions occur by de novo initiation (9). For successful replication by this pathway, transcriptional initiation must occur predominantly or exclusively at the 3Ј ends of genome and antigenome RNAs, with minimal initiation occurring internally or on other RNAs present within the cell. Q␤ replicase provides a convenient means to study the template properties underlying these required specificities for a representative positive-strand RNA virus.Q␤ replicase is the 4-subunit RNA-dependent RNA polymerase (RdRp) enzyme complex that amplifies the 4.2 kb positive-strand genome of bacteriophage Q␤, a phage infecting Escherichia coli (6,34). Unlike the RdRp of any eukaryotic positive-strand RNA virus, Q␤ replicase has been purified to homogeneity and shown to be capable of supporting the full viral genome amplification cycle in vitro (6). This enzyme catalyzes de novo strand initiation with GTP opposite a short cluster of C residues in the CCCA 3Ј termini that are a feature of both positive and negative strands of almost all amplifiable templates described in...

We report a case of an oncocytic papillary adenocarcinoma of the endometrium in an 89-year-old female with vaginal bleeding. Imaging studies revealed lesions in the uterus, kidneys, pancreas, gluteus, and an enlarged portacaval lymph node. Diagnostic workup included an endometrial biopsy which showed malignant, oncocytic cells in a predominantly papillary pattern. These cells stained positive for epithelial markers (pan-cytokeratin, CK7, epithelial membrane antigen) and weakly for estrogen receptor. The cells were negative for cytokeratin 903, CAM 5.2, progesterone receptor, CD10, RCC Marker, CA-125, c-kit, and vimentin. Consultation with experts in Gynecologic and Genitourinary pathology returned a diagnosis of "adenocarcinoma compatible with metastatic renal cell carcinoma"--an intriguing possibility worthy of further exploration. To our knowledge, there are no reports in the literature of metastatic oncocytic papillary renal cell carcinoma to the endometrium. The clinical and pathologic features of oncocytic papillary endometrial lesions, including primary and metastatic processes, are reviewed.