Renal chromophobe cell carcinoma and oncocytoma. A comparative morphologic, histochemical, and immunohistochemical study of 124 cases.

BACKGROUND: Renal oncocytoma has several features that overlap with other renal neoplasms, including the eosinophilic subtype of chromophobe cell carcinoma. In fact, strict criteria for renal oncocytoma have not been well defined and remain a matter of controversy. Ultrastructural studies or sophisticated methods such as flow cytometry and cytogenetic techniques can be of great use in distinguishing the two tumors, but are difficult to propose as routine methods because of their limited availability. OBJECTIVE: To further characterize the histologic criteria of these tumors, we undertook a retrospective study to define the utility of routinely available histochemical and immunohistochemical techniques. DESIGN AND SETTING: Twenty-one cases of chromophobe cell carcinoma, eosinophilic subtype, and 103 cases of oncocytoma were tested with histochemical (Perls, periodic acid-Schiff, and Hale's colloidal iron) and immunohistochemical (peanut agglutinin antigen and UEA-1 for lectins; cytokeratin KL1, epithelial membrane antigen, vimentin, S100 protein, and lysozyme) staining. RESULTS: The antibodies tested and the histochemical staining using Hale's colloidal iron allowed eosinophilic chromophobe cell carcinoma to be distinguished by its characteristic reaction pattern. Seventy-six percent of the chromophobe cell carcinomas showed a microvacuolated pattern, and 89% of the renal oncocytomas showed an apical positivity with Hale's colloidal iron staining (P < .01). Peripheral cell accentuation reactivity for cytokeratin KL1 was observed in 66% of the chromophobe cell carcinoma cases, and apical cytoplasmic positivity was observed in 37% of the renal oncocytoma cases (P = .01). Significant patterns were observed with anti-epithelial membrane antigen and anti-peanut agglutinin antigen antibodies (P = .05 and P = .01, respectively). Positive reactions for vimentin, S100 protein, lysozyme, and UEA-1 were not significant characteristics. CONCLUSION: Our study demonstrated that a precise morphologic description associated with simple histochemical and immunohistochemical techniques provides sufficient criteria for a high level of discrimination between the eosinophilic subtype of chromophobe cell carcinoma and renal oncocytoma.

Local staging of prostate cancer by endorectal MRI using fast spin-echo sequences: prospective correlation with pathological findings after radical prostatectomy.

OBJECTIVE: To evaluate the accuracy of endorectal magnetic resonance imaging (MRI) with fast spin-echo sequences in the local staging of clinically localized prostate cancer. PATIENTS AND METHODS: Seventy-one patients with a clinical T1 (18 patients) or T2 tumour (53 patients) underwent endorectal MRI 2-12 weeks before radical prostatectomy. Extraprostatic tumour was diagnosed if MRI showed signs of capsular penetration and/or invasion of the seminal vesicle and/or distal urethra or bladder neck. If the pathological examination showed a single positive margin with no periprostatic tissue, the tumour was classified as indeterminate and not as a T3 tumour. RESULTS: Of the 25 cases of capsular penetration. MRI correctly identified 10 (sensitivity 42%, specificity 100%). Of the 14 cases with seminal vesicle invasion, MRI correctly identified six (sensitivity 43%, specificity 100%), but showed other signs of extraprostatic tumour spread in seven of the eight unidentified cases. Overall, MRI identified 16 of the 30 patients (53%) with occult extraprostatic spread of tumour; there was only one false-positive result. The sensitivity, specificity and accuracy of MRI were 53, 96 and 74%, respectively. CONCLUSION: Endorectal MRI can reduce the rate of preoperative understaging from 42% to 22% and it can be used for a given individual because it can detect extraprostatic invasion with 96% specificity, ensuring that very few, if any, patients will be deprived of curative surgery.

Phenotypic and functional analysis of tumour-infiltrating lymphocytes from patients with renal cell carcinoma.

Twenty renal cell carcinomas were cultured in the presence of 200 IU/ml of recombinant interleukin-2; tumour-infiltrating lymphocytes (TIL) developed in 70% of cases; the phenotypic profile was heterogeneous in 11 TIL tested on day 30: 4 were mostly CD8 positive, 4 mostly CD4 and 3 showed CD4-CD8-CD56 mixed phenotypes. The cytotoxic activity was also heterogeneous, and no TIL developed a tumour-specific cytotoxic activity. The phenotypic profile and cytotoxic activity were also tested after thawing, and this study demonstrated that TIL can be frozen at the time of the nephrectomy, then thawed and cultured for the purposes of therapeutic trials when metastases appear. The differences between TIL derived from renal cell carcinoma and TI1 derived from melanoma are discussed.

[Non-seminomatous germ cell tumors of the testis. Role of the pathologist in the assessment of prognostic factors based on the specimen of orchiectomy. Proposal of an anatomopathological examination report defined by the Study Group of the Committee of Cancerology of the French Association of Urology]. / Tumeurs germinales non séminomateuses du testicule. Rôle de l'anatomopathologiste dans l'établissement des facteurs du prognostic sur la pièce d'orchidectomie. Proposition d'une fiche d'etude anatomopathologique établie par le Groupe de Travail du Comité de Cancérologie de l'Association Française d'Urologie.

Non-seminomatous germ cell tumors of the testis. Role of the pathologist in the definition of the prognostic factors based on examination of the orchidectomy specimen. Proposal of a pathological examination report form defined by the study Group of the Oncology Committee of the French Urological Association.

[Renal oncocytoma. Retrospective study of 38 cases]. / Oncocytome rénal. Etude rétrospective de 38 cas.

38 cases of renal oncocytoma were recognized at Cochin's hospital from 1982 to 1991. Accurate diagnosis was not possible before performing surgery. However, a benign tumor appearance on the preoperative morphologic investigations and an evocative peroperative macroscopic aspect of renal oncocytoma, allowed us to realize a conservative surgery in 4 cases. Follow-up of 27 patients (11 lost to follow-up) showed a benign clinical behaviour in all cases, de spite of invasion of the perirenal fat in 2 cases, and tumoral thrombosis of a proximal branch of the renal vein in 1 case. No metastases occurred after a mean follow-up of 32.5 months, within range from 11 to 101. Our experience as well as the literature leads us to believe that renal oncocytoma is a benign tumor. We conclude that conservative surgery must be systematically considered when peroperative histological examination assert the diagnosis of renal oncocytoma, especially when the tumoral diameter is less than 5 cm.

[Detection of a prostatic adenocarcinoma in the cysto-prostatectomy specimens of an invasive tumor of the bladder]. / Découverte d'un adénocarcinome prostatique sur les pièces de cystoprostatectomie pour tumeur infiltrante de vessie.

Among one hundred consecutive patients submitted to radical cysto-prostatectomy for invasive transitional cell carcinoma of the bladder, 26 also exhibited adenocarcinoma of the prostate on histological specimens: 17 microscopic foci and 9 larger prostate carcinomas. In 3 cases, the tumor was found in the apex of the prostate gland. Pelvic lymphadenectomy was positive in 4 cases but always corresponded to a urothelial metastasis. Follow-up was never marked by a metastatic development of this adenocarcinoma. This frequency of latent prostatic adenocarcinoma is not different from its observed incidence in the general population on autopsy studies. The high incidence of this association makes removal of the whole prostatic tissue during total cystectomy necessary.

[Bladder tumors: superiority of urinary cytology after bladder lavage]. / Tumeurs de vessie: supériorité de la cytologie urinaire sur lavage vésical.

Sixty two endoscopic examinations were performed on fifty five patients for the followup of bladder tumors. The results of urinary cytological examinations performed on voided specimens of urine, on specimens collected after introduction of the endoscope, and specimens obtained by bladder washing with saline, were compared with the results of histological examinations of the tumors, and mucosal biopsies. The results show a definite superiority of bladder washing over the other methods: the rate of non-diagnostic procedures falls from 17 to 1.5%, the detection of grade III tumors or carcinomas in situ improves from 55 to 75% and from 33 to 88% respectively. Bladder washing cytology is thus a useful adjunct to voided urinary cytology.

[Sarcoma of the bladder in adults]. / Sarcomes de vessie de l'adulte.

The authors report five cases of sarcoma of the bladder and make a distinction between homotypical and heterotypical sarcomas and lymphosarcomas presenting specific therapeutical problems. The prognosis is severe because of very frequent local relapse. They recommend disregard of the invasion of the muscular wall, and the performance of total cystectomy following a positive histological diagnosis. In their view, this is the basis for the treatment of sarcomas.

[The risk factors of bladder tumors stage "A". Description of a new parameter (author's transl)]. / Les facteurs de risque des tumeurs de vessie au stade A. Description d'un nouveau paramètre.

199 cases of carcinoma of the bladder stage A were reviewed with a follow-up from 5 to 15 years. Some "factors of risk" can be deducted from this study. The first is the depth of the invasion of the submucosa when it can be specified. If the superficial part only is invaded (these tumors are called A1) the understaging is less important and the survival rate is much better than when the chorion is totally invaded (called A2). The grade of the tumor is also significant, grade III having a more favorable prognosis than grade IV. The topography of the tumor influences the prognosis: the worse are the tumors of the bladder neck or of this trigone. The other factors of risk are: the rapidity of recurrences, the volume and the number of the tumors: when they are big and multiple, the prognosis is particularly bad, the type of differenciation: the cylindric tumors are worse than the urothelial or epidermoid.

[Sarcoidosis and Whipple's disease. Association? Relation?]. / Sarcoïdose et maladie de Whipple Association? Relation

On the basis of a personal case in which two successive diagnoses of sarcoidosis and Whipple's disease were made at an interval of four years, the authors discuss the possible association or relationship between these two disorders, both diffuse, affecting the reticulo-histiocytic system and diagnosed on a histological basis. Review in the literature of 54 cases of Whipple's disease with pleuro-pulmonary lesions makes it possible on the one hand to associate with the latter numerous examples of extra-intestinal involvement, the histological appearance of which of a non-specific epithelioid granuloma does not indicate the diagnosis during the long pre-intestinal phase, and on the other hand to explain that during this period, the presence of pleuro-pulmonary lesions leads to an initial diagnosis of the probability of sarcoidosis. The practical consequences are as follows: The appearance of intestinal signs during "sarcoidosis" should lead to intestinal or mesenteric node biopsy to seek the macrophages with highly PAS positive cytoplasm characteristic of Whipple's disease. Their discovery necessitats long term antibiotic therapy which has recently transformed the outlook in this disease, invariably fatal in the past.