Slit-scan cytofluorometry. Basis for automated prescreening of urinary tract cytology.

A study was undertaken to assess the applicability of the slit-scan technique to automated prescreening of urinary tract cytology. Cells from voided and catheterized urines were stained with acridine orange and measured on a static cell slit-scan cytofluorometer. Analysis of data from the specimens indicates that nuclear fluorescence alone appears adequate for recognition of abnormal specimens. Remaining problems in the automation of urinary tract cytology prescreening are discussed.

Splenic B cell lymphoma with lymphocyte clusters in peripheral blood smears.

EDTA induced clumping of lymphoid cells, both benign and malignant, in peripheral blood samples has been reported only rarely. Such clustering presents the laboratory and pathologist with unique difficulties in the accurate diagnosis of these disorders. A case of low grade B cell splenic lymphoma is presented with lymphocyte clumping in smears made from EDTA anticoagulated peripheral blood, the fourth case described in which neoplastic lymphoid cells form clusters in vitro in peripheral blood. The association with splenic lymphomas (three of the four cases) is intriguing but its significance remains uncertain.

Ultrasonic examination of scrotum. Review of 108 cases.

Ultrasound is a reliable and safe method for the evaluation of scrotal anatomy. The usual method of ultrasonic examination has been contact scanning with a conventional articulated arm scanner. We herein report our experience in 108 cases using an ultrasonic technique which provides panoramic scans of the entire scrotum and precision tomographic plane placement without distorting the scrotum or causing patient discomfort.

Artifactual urethral stricture in male child.

Artifactual urethral obstruction at the suspensory ligament of the penis may be produced if the penis is left in its normally dependent position during a urethrogram. We present 2 such cases to re-emphasize this phenomenon so that caution is taken in interpreting distal bulbous urethral strictures.

Mucinous urethral caruncle.

A case of urethral caruncle, composed exclusively of mucin-secreting colonic-type glands and believed to be the first on record, is described. The lesion presented clinically as an ordinary caruncle and was treated by local excision. The histogenesis of the lesion is discussed, and its probable origin from an intraurethral cloacogenic colonic gland rest is proposed.

Primary localized amyloidosis of urinary bladder.

Primary localized amyloidosis of the bladder is rare. Two new cases are presented, and 44 cases from the literature are reviewed. The disease tends to occur in a younger age group in men than in women. It presents most frequently with gross painless hematuria, and usually appears at cystoscopy as a tumefied, yellowish, and occasionally ulcerated lesion. The amyloid deposits usually involve suburothelial connective tissue, suburothelial vessels, and less markedly the vesical muscularis. The treatment varies from transurethral resection to total cystectomy with urinary diversion. Transurethral resection appears to be the treatment of choice, if feasible. Close follow-up of the patient is necessary because of the frequency of multiple recurrences, which may require an ablative procedure.

Leydig cell tumor of testis.

In adult patients with Leydig cell tumor of the testis, endocrinologic signs occur in 30 per cent of the cases and often precede the onset of a palpable testicular mass. Gynecomastia is the most common endocrinologic manifestation and probably is due to increased estrogen secretion by the Leydig cells. In the patient with adrenogenital syndrome and testicular enlargement it is difficult to distinguish Leydig cell tumor from adrenal rest hypertrophy. Four patients with Leydig cell tumor and endocrinologic manifestations are discussed; three are adults who presented with gynecomastia and the fourth is a patient with congenital adrenogenital syndrome. In the adult patient inguinal orchiectomy is the treatment of choice, while in the patient with adrenogenital syndrome initial management by high-dose steroid suppression should be attempted prior to testicular exploration.

Congenital posterior urethral valves in an adult.

An adult male with posterior urethral valves who had obstructive urinary symptoms and painless gross hematuria is presented. The diagnosis, development, and treatment of posterior urethral valves is discussed. The importance of also treating the hypertrophied bladder neck is stressed.

Automated water-path ultrasonic examination of scrotum.

A new method of examining the scrotum by ultrasound with an automated water-path scanner is described. This method allows immobility of the scrotum in a more acceptable and painless way than in contact scanning methods. Panoramic scans of the entire scrotum and precision tomographic plane placement are advantages over conventional techniques. A description of normal scrotal anatomy includes the mediastinum of the testis, an important scrotal landmark. Representative cases of benign and malignant scrotal disease are presented to emphasize the utility of water-path scanning.

Renal cell carcinoma: incidental diagnosis and natural history: review of 235 cases.

Two hundred thirty-five cases of histologically proved renal cell carcinoma (1976-1987) were reviewed to determine the impact of incidental tumor detection on the natural history of this cancer. One hundred sixty-eight patients (71.5%) presented with clinical signs and/or symptoms of renal pathology. Of these, 25 (18%) were investigated without consideration of renal cell carcinoma in the differential diagnosis. Sixty-seven cases (28.5%) were diagnosed as an incidental finding on diagnostic imaging for extrarenal symptomatology. Approximately 30 percent of patients were found to have metastatic disease on initial presentation regardless of incidental, or suspected discovery of these tumors. Stages A and B tumors were encountered with equal frequency in patient groups with both suspected and incidental diagnosis. Intravenous pyelography was the diagnostic modality used to detect the diagnosis in 83 percent of cases. While incidental detection of renal cell carcinoma has become more frequent than in previous years, it appears to have impacted minimally on the discovery of earlier stage tumors than those with presenting clinical symptoms. In contrast to prior reports, our data show that the natural history of renal cell carcinoma is not significantly altered by the incidental detection of tumor.

Simplified new approach to endoscopic photography.

Information obtained by endoscopic examination can be shared with others by viewing sequentially through the same endoscope, "teaching attachments" allowing viewing ports through the same instrument, drawings based on the observers' recollection of the findings, and by endoscopic photography. Of these methods, endoscopic photography has the important advantages of speed and faithfulness of reproduction. Herein, we describe a simple technique for endoscopic color still-photography with illustrations of normal and pathologic findings.

DNA cytometry and chromosome 9 aberrations by fluorescence in situ hybridization of irrigation specimens from bladder cancer patients.

OBJECTIVES: To determine the sensitivity and specificity of combining fluorescence in situ hybridization (FISH) measurement of chromosome 9 and DNA cytometry of bladder irrigation specimens in the detection of bladder cancer. METHODS: Bladder irrigation specimens were obtained from 37 normal control patients and 317 bladder cancer patients during cystoscopic examinations. Bladder cancer patients were sampled in the absence of observable tumor (256 specimens) and concurrently with tumor (204 specimens). Chromosome 9 copy number was determined on a cellular basis by FISH, and cellular DNA content was determined by Feulgen DNA staining and image cytometry. RESULTS: Sensitivity of chromosome 9 FISH was 42% for all tumors and was not correlated to transitional cell carcinoma tumor grade, while the sensitivity of DNA cytometry was 55% and improved with increasing grade from 38% for grade 1 to 90% for grade 3 tumors. The results of FISH and DNA cytometry were combined, resulting in specificity of 92% and sensitivity of 69% for grade 1, 76% for grade 2, and 97% for grade 3 tumors. CONCLUSIONS: The lack of increase with grade in the percentage of positive specimens by FISH supports the hypothesis that chromosome 9 aberrations are critical events in bladder tumorigenesis for many patients. These data demonstrate the presence of cells in irrigation specimens with specific genomic lesions of chromosome 9 and DNA content. Combining FISH on chromosome 9 and DNA cytometry provides an increase in sensitivity to transitional cell carcinoma over either test alone.

Blunt renal trauma in the pediatric patient.

Injury to the kidney from blunt trauma occurs rather frequently in the active, pediatric patient. Early evaluation and treatment of these children is essential in order to preserve maximum renal function. Ninety cases of pediatric renal trauma from blunt injury have been reviewed. The majority of these responded well to careful conservative, non-operative management. Many of those requiring surgical intervention responded well to initial conservative treatment followed by surgical intervention conducted as an elective procedure within the first week after injury. Five case reports with associated radiographic studies are presented.

Percutaneous aspiration in the treatment of renal abscess.

The conventional treatment of a renal abscess has been surgical exploration, drainage and marsupialization of the cavity. There have been isolated reports in the literature regarding the successful use of systemic antibiotics alone in the management of patients with renal abscesses. We report a case in which percutaneous aspiration of a renal abscess led to successful non-operative management. In addition, 4 previously reported cases of renal abscesses treated with this modality are analyzed.

Intravesical formalin for hemorrhagic cystitis: analysis of therapy.

In an extensive search of the literature 235 cases of intractable hemorrhagic cystitis treated with intravesical formalin were identified. Effectiveness of therapy, rate of recurrence of hematuria, morbidity and mortality were analyzed with respect to concentration of formalin and to the etiology of hematuria. Increasing concentrations of formalin slightly improved effectiveness of therapy and reduced the rate of recurrence of hematuria. However, this often resulted in an increase in morbidity. When patients were categorized according to the etiology of intractable hematuria it was noted that lower concentrations of formalin were effective in controlling hematuria caused by either cyclophosphamide cystitis or unresectable carcinoma of the bladder. In contrast, higher formalin concentrations were required to control bleeding due to radiation cystitis.

Hemorrhagic tension cyst of the kidney.

A case of a benign renal cyst, which was filled with blood under pressure and causing acute flank pain, is presented. The pain was relieved after cyst puncture and aspiration. Although benign hemorrhagic renal cysts are well recognized, this is the first report of a benign renal cyst filled with blood under pressure.