[Combined therapy of advanced adrenal cortical adenocarcinoma].

OBJECTIVE: To analyze the clinical efficacy of combined therapy in the treatment of advanced adrenal cortical adenocarcinoma. METHODS: The clinical data of 12 cases with advanced adrenal cortical adenocarcinoma at our hospital from 1986 - 2006 were analyzed. And the relevant literatures were reviewed. RESULTS: Eleven patients underwent operation to remove primary lesions. Only 1 case received a biopsy. All cases were treated with chemotherapy or chemotherapy pulse post-operative radiotherapy. Pathological diagnosis was all of adrenal cortical adenocarcinoma. According to the staging criteria of Jacques and Brennan, all 12 cases were of IV stage. The follow-up duration was 6 - 40 months. According to evaluation criterion of chemotherapeutic effect by WHO in 1987, the results were: CR (complete remission) (n = 0), PR (partial remission) (n = 7), SD (stable disease) (n = 3) and PD (progressive disease) (n = 2). The effective rate was 58.3% (7/12). The median survival time was 14 months and median progression-free survival time 9 months. CONCLUSION: Combined therapy of adrenal cortical adenocarcinoma is effective to prolong the patient lifespan. Radiotherapy offers partial symptomatic relief for those with osseous metastasis. Making an early diagnosis and offering a novel therapy yield a better outcome.

[Diagnosis and treatment of sarcomatoid renal cell carcinoma].

OBJECTIVE: To study the clinical diagnosis and treatment of sarcomatoid renal cell carcinoma, and to analyze the connection of prognosis with therapy. METHODS: 10 cases with sarcomatoid renal cell carcinoma from 1997 - 2007 in our hospital were analyzed, and the related literatures were reviewed. RESULTS: All patients were performed with operation, and pathologically diagnosed as sarcomatoid renal cell carcinoma. Cases with metastasis were performed with chemical therapy, biological therapy or radiotherapy after operation. Clinical stage (TNM) of 10 cases is T1N0M0 1 case, T2N0M0 3 cases, T3N0M0 1 case, T4N0M0 1 case, T2N0M1 3 cases, T4N0M1 1 case. 60% (6/10) of patients were diagnosed with metastasis or diffusion. In these 6 cases, 4 cases were diagnosed with pulmonary metastasis, 1 with brain metastasis, and 1 with osseous metastasis, and 1 with inferior vena cava tumor thrombus. The average life span of all 10 cases was 17 months, and cases with advanced stage was 8 months. Otherwise, the average survival time of cases with earlier stage was 30 months, and it was 21 months from diagnosis to metastasis. CONCLUSION: Sarcomatoid renal cell carcinoma is a special type of renal cell carcinoma with features of high malignant and rapid progress. It is clinical rare and with bad prognosis. Operation is the first choice for the therapy, the effect of radiotherapy or chemical therapy is not obviously. The lung is main position for metastasis. Early diagnosis and treatment are effective to prolong the life span of patients, and the new therapy may be more important.

Feasibility of prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques.

BACKGROUND: Routinely, after receiving prostate specific antigen (PSA) testing and digital rectum examination, patients with suspected prostate cancer are required to undergo prostate biopsy. However, the ability of ultrasound-guided prostate biopsy to detect prostate cancer is limited. Nowadays, a variety of diagnostic methods and more sensitive diagnostic methods, such as multi-parameter prostate magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) can be applied clinically. Furthermore, laparoscopic/robot-assisted prostatectomy is also a safe and effective procedure for the treatment of benign prostatic hyperplasia. So maybe it is time to reconsider the necessary to perform prostate biopsy before radical prostatectomy. AIM: To explore the feasibility of radical prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques. METHODS: From June 2014 to November 2018, 11 cases of laparoscopic radical prostatectomy without prostate biopsy were performed at the three tertiary medical centers involved in this study. All patients received prostate magnetic resonance imaging and prostate cancer was suspected, including six patients with positive 68Ga-PSMA PET/CT results. Laparoscopic radical prostatectomy and pelvic lymph node dissection were performed for all patients. RESULTS: All surgeries were accomplished successfully. The mean age was 69 ± 7.7 year, the mean body mass index was 24.7 ± 1.6 kg/m2, the range of serum PSA was 4.3 to >1000 ng/mL, and the mean prostate volume was 40.9 ± 18.3 mL. The mean operative time was 96 ± 23.3 min, the mean estimated blood loss was 90 ± 90.9 mL, and the median duration of catheter placement was 14 d. The final pathology confirmed that all specimens were prostate cancer except one case of benign prostatic hyperplasia. No major complications occurred in 90 d postoperatively. CONCLUSION: The current practice of mandating a prostatic biopsy before prostatectomy should be reconsidered in the era of new imaging technology and minimally invasive techniques. Radical prostatectomy could be carried out without the evidence of malignancy. Large-sample randomized controlled trials are definitely required to confirm the feasibility of this new concept.

[Diagnosis and treatment of malignant bladder non-epithelial tumors].

OBJECTIVE: To study the clinical diagnosis, treatment, and prognosis of malignant bladder non-epithelial tumors. METHODS: The clinical data of 17 cases with malignant bladder non-epithelial tumor, 15 males and 3 females, aged 28 (3-73), were analyzed. RESULTS: Ten of the 17 cases were diagnosed as with rhabdomyosarcoma, 2 with malignant lymphoma, and 2 with malignant pheochromocytoma, 2 with leiomyosarcoma, and 1 with carcinosarcoma. All patients underwent operation, or were treated with radiotherapy or chemotherapy. Among the 10 cases with rhabdomyosarcoma, 7 were aged under 5, 5 of them survived for more than 8 years, and 2 were lost to follow-up; other 3 adult patients died in one year with metastasis all over the body. Two patients with malignant lymphoma underwent partial cystectomy and adjuvant radiotherapy or chemotherapy, and survived for more than 3 years. Of the 2 cases with malignant pheochromocytoma, one underwent lymphadenectomy and adjuvant chemotherapy and survived for more than 5 years; and another case died 2 years after operation and chemotherapy. Two patients with leiomyosarcoma underwent simple resection, one survived for more than 5 years; and another survived 1 year after operation. One case with carcinosarcoma receiving operation followed by chemotherapy died in one year. CONCLUSION: Malignant bladder non-epithelial tumors are rare clinically and most of them occur in children. Most of them are rhabdomyosarcoma. The prognosis of malignant bladder non-epithelial tumors, different in pathological types, is relatively worse in adults.

[Expression of Survivin in transitional cell carcinoma of urinary bladder and its clinical significance].

OBJECTIVE: Survivin is a member of the inhibitors of apoptosis protein (IAP) family. Recent researches had shown that survivin plays an important role in oncogenesis. This study was designed to investigate the expression of survivin in transitional cell carcinoma (TCC) of urinary bladder and its clinical significance. METHODS: Immunohistochemical assay was used to detect the expression of survivin in 75 cases of tumor tissue and 7 cases of normal bladder tissue. RESULTS: The expression rates of survivin were 77.3% (58/75) in TCC of urinary bladder, whereas no expression of survivin was detected in the 7 cases of normal bladder tissue. CONCLUSIONS: Expression of survivin protein was observed in the tumor tissue derived from the patients with bladder TCC, indicating that this protein may play an important rule in carcinogenesis of human urinary bladder. The expression of survivin was statistically significant associated with tumor grade. Our results suggested that the expression of survivin may be considered as a prognostic factor for bladder TCC.