The objective of this study was to evaluate the diagnostic value of chromosomal analysis by fluorescence in situ hybridization (FISH) for predicting recurrence of urothelial carcinoma (UC) after transurethral resection. One hundred and thirty-eight patients (median age 68.5 years) with a history of UC were eligible for this prospective study. FISH was applied to cytospin specimens prepared from bladder washings taken during a negative control cystoscopy. The multi-target FISH test UroVysion 1 (Abbott/Vysis) containing probes to the centromeres of chromosomes 3, 7, 17 and the 9p21 locus was used. UC recurrence was defined as a positive biopsy during follow-up. The median follow-up time was 19.2 (4-52) months. FISH was positive in 50 (36%) patients and negative in 88 (64%) patients. A recurrence occurred in 39% of the patients with a positive FISH test and in 21% of patients with a negative FISH test. FISH positivity according to manufacturer's criteria, at the time of a negative cystoscopy, was not significantly associated with the risk of recurrence (p 5 0.12). However, the sensitivity of the FISH test to predict recurrence was significantly improved by considering specimens with rare ( 10) tetraploid cells as negative (p < 0.006). In addition, presence of 9p21 deletion was significantly associated with recurrence (p < 0.01). Notably, positive standard cytology was an independent factor for subsequent recurrence in this study (p < 0.001). Taken together, multitarget FISH may help to stratify the risk of recurrence of UC at the time of a negative follow-up cystoscopy. Defining the optimal threshold for FISH positivity requires consideration of tetraploid pattern and 9p21 deletion. Our results also emphasize the paramount importance of conventional cytology for UC surveillance. ' 2006 Wiley-Liss, Inc.Key words: bladder cancer; recurrence; fluorescence in situ hybridization; cytology; bladder washings Papillary urothelial cancers (pTa) recur in about 70% of cases and progress, in about 5%, to invasive bladder cancer. There are 2 key questions regarding the follow-up after treatment of noninvasive bladder cancer: at what intervals and for how long should the patients be subjected to follow-up cystoscopies? Since the disease can recur even after long, disease-free intervals, some authors advocate lifelong surveillance. Traditionally, indicators of an increased recurrence risk include high tumor stage and grade, multifocality and presence of carcinoma in situ (CIS). Intensity of surveillance is mostly individualized based on these clinical risk factors. 1 The classic follow-up protocol after initial tumor resection consists of cystoscopic and cytologic examinations every 3 months for 18-24 months after tumor resection, then every 6 months for the following 2 years and then annually. Cystoscopy is an efficient method for the detection of primary or recurrent bladder cancer, but it is invasive and causes discomfort to the patient. Furthermore, flat tumors or CIS may be difficult to detect. Cytology has a high specifici...

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Background: Pneumonitis after pemetrexed has been rarely reported in conjunction with radiation therapy. Methods: Two cases of pemetrexed-induced pneumonitis in different clinical settings and with unequal outcomes are discussed with a review of the literature. Results: Two patients with stage IIIB non-small cell lung cancer developed interstitial lung disease after chemotherapy with pemetrexed. The first patient was previously treated with thoracic radiotherapy, and radiation pneumonitis was initially suspected. He died shortly after pemetrexed reexposition. The second patient developed pemetrexed-induced interstitial lung disease despite no prior radiotherapy. After discontinuation of pemetrexed and administration of steroids, pneumonitis resolved completely. Conclusion: Interstitial lung disease is a rare but potentially fatal side effect of pemetrexed. It occurs more often after radiotherapy but can also be encountered in the absence of radiotherapy. Reexposition to pemetrexed may lead to severe interstitial lung disease and even death and should be strictly avoided.

Accumulating evidence suggests that anti-CD20 treatments are associated with a more severe course of COVID-19. We present the case of a 72-year-old woman treated with the B-cell-depleting anti-CD20 antibody rituximab for seropositive rheumatoid arthritis with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing a clinical relapse more than 4 weeks after the first manifestation. Persistently positive reverse transcription polymerase chain reaction (RT-PCR) results along with a drop in cycling threshold (Ct) values, in addition to recovery of identical viral genotype by whole genome sequencing (WGS) during the disease course, argued against reinfection. No seroconversion was noted, as expected on anti-CD20 treatment. Several other case reports have highlighted potentially fatal courses of COVID-19 associated with B-cell-depleting treatments.

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