[The cytologic differentiation of prostatis (author's transl)]. / Die zytologische Differenzierung der Prostatitis.

INTRODUCTION: Cytologists are often confronted with unexpected prostatitis in aspiration biopsy smears, because clinically prostatitis may lead to suspicious induration of the prostate similar to carcinoma and therefore subject to diagnostic biopsy. The question is whether cytodiagnosis is a reliable method for the exact morphologic diagnosis of prostatitis. The following paper attempts to answer this question. MATERIAL AND METHODS: The basis of our cytologic differentiation of prostatitis was a series of 129 cases of prostatitis in 664 aspiration biopsies according to Franzén. In 82 of these 129 cases, we had simultaneously performed a transrectal needle punch biopsy, which allowed a diagnostic comparison between the cytologic and histologic diagnosis with special reference to the reliability of cytology. Epithelial atypias were classified into 4 grades: Grade 1: No atypia; Grade 2: Slight atypia; Grade 3: Marked atypia; Grade 4: Malignant epithelium. Cytomorphologic characteristics of each grade are described. RESULTS: We found 6 different types in 4 main groups of prostatitis: 1. Acute prostatitis, purulent and abscessing types. 2. Chronic prostatitis. 3. Chronic relapsing prostatitis. 4. Granulomatous prostatitis, non specific and specific types. All types showed classic cytomorphologic inflammatory criteria. Marked atypias were found in group 3 and 4. Differential diagnosis with respect to carcinoma is not difficult, however, because marked atypias in these groups of prostatitis almost always appear focally. The diagnostic agreement between cytology and histology in 82 cases was found to be 87,6%. DISCUSSION: Our results showed that prostatis may be adequately diagnosed with cytology and may be differentiated into 6 different types. However, differentiation between periductal and interstitial forms of chronic prostatitis is impossible with cytology. Reliable cytodiagnosis of prostatitis requires a good aspiration smear, so that at least one half of slide is covered with material from the prostate. Furthermore, epithelial atypias must be present to prove the presence of prostatitis. Because of the good reliability of the cytologic differentiation of prostatitis, aspiration biopsy may be a valuable aid to the clinician in the primary diagnosis of prostatitis, especially the chronic type, which currently is sometimes uncertain.

[Experiences with lavage cytology from renal pelvis and ureter (author's transl)]. / Erfahrungen mit der Nierenbecken- und Harnleiter-Lavage-Zytologie.

In 41 cases of roentgenologic filling defects in renal pelvis and ureter, which could not be determined exactly preoperatively, we could confirm the diagnostic value of cytology from washings of renal pelvis and ureter (lavage cytology), especially in preoperative diagnosis of carcinoma of renal pelvis and ureter. Ten of fourteen tumors (71%) were detected by this method. The diagnostic reliability increased with tumor-stage and was more accurate than the normal exfoliative urinary cytology. In five cases of hypernephromas invading the renal pelvis lavage cytology was not successful and we had obtained only false negative results. In roentgenologic filling defects that were not tumor-induced especially uric acid stones, inflammatory processes, blood clots and renal cysts, we had no false positive results. Our findings are discussed together with the literature.

[Cytological monitoring of the therapy of conservatively treated prostate cancer. Classification and clinical significance]. / Zytologische Therapiekontrolle des konservativ behandelten Prostatakarzinoms. Klassifikation und klinische Bedeutung.

600 aspiration biopsies were performed under 6 different therapeutic conditions (estrogens, antiandrogen, Estracyt, irradiation, irradiation and estrogens, cytostatics) in patients mostly in stage T3 Nx Mo. The most important signs of regression were found in the nucleus. Compared to 102 simultaneous transrectal punch biopsies we found a diagnostic reliability for cytology of 97%. A detailed classification of the cytological signs of regression permitted a cytological grading of regression into 6 different regression grades. A surprisingly good correlation was found between grading of regression and clinical response or progression. Cytology was superior to rectal examination as a method of evaluating the effectiveness of therapies. The incidence of complications of aspiration biopsy was 1.6% and the incidence of insufficient cell material was 5.2%.

[Single cell photometry analysis of nuclear DNA in treated undifferentiated prostate cancer and its clinical significance]. / Einzelzellzytophotometrische Zellkern-DNS-Analysen beim behandelten, entdifferenzierten Prostatakarzinom und ihre klinische Bedeutung.

Based on 67 specimens from 20 conservatively treated undifferentiated prostate cancer patients cell nucleic acid analysis combined with a prospective clinical study was attempted using single cell scanning-cytophotometry. Regardless of therapy type a statistically significant difference in nuclear DNA-content was evident between successfully treated prostate cancers and therapy-resistant cancers. Good prognosis was suggested by a significant decline from aneuploid or polyploid to diploid nuclear-DNA-content with a narrow peak in 2c, especially within the first 12 weeks of treatment. Lack of DNA-content alteration or a DNA-frequency distribution change to the right were correlated with rapid clinical regression. Although all had undifferentiated prostate cancer morphology statistically significant differences in nuclear DNA-content were found. The prognostic value of this remains unknown.

[Estracyt therapy in advanced prostate cancer: current status and personal results]. / Estracyt-Therapie beim fortgeschrittenen Prostatakarzinom: Derzeitiger Stand und eigene Ergebnisse.

In addition to surveying biochemistry, clinical findings and side effects of Estramustin Phosphate therapy, this paper gives an account of our own results with primary and secondary Estramustin Phosphate therapy. A total number of 118 patients have been examined in three different studies since 1970. Apart from conventional clinical control examinations, an additional accurate parameter applied to control therapy response was cytological analysis of therapy induced regression signs in primary tumor. Thus objective therapy response was established for 87% resp. 93% of the patients on primary Estramustin Phosphate therapy, and for 35% resp. 45% of those on secondary therapy. Patients with cytologically poor therapy response 3 months after beginning of therapy entered significantly earlier into clinical progression than patients with favorable therapy response, with clinical progression being additionally and essentially influenced by the pretherapeutical metastatic stage. Gastro-intestinal side-effects were prevalent in 79% of cases on intravenous administration of the drug, while on oral administration they were found to be three times less.

[Cytostatic therapy of prostatic carcinoma. Current status and personal results]. / Zytostatische Therapie des Prostatakarzinoms. Gegenwärtiger Stand und eigene Ergebnisse.

Based on the pertinent literature, this paper discusses the results of cytostatic therapy for advanced prostatic cancer published so far with special consideration given to the extensive experience of the National Prostatic Cancer Project (NPCP) in the United States. Endoxan and 5-Fluoro-uracil, each as a monotherapy, haven proven still to be the optimal cytostatic therapies in secondary treatment following hormone resistance. Moreover, our own results reached with 33 patients on chemotherapy with Endoxan or 5-Fluoro-uracil, resp., are reported, in particular those in 24 of the 33 patients receiving these drugs as a third therapy after previous hormone resistance and secondary Estracyt resistance. Especially with regard to pain relief, we obtained good results in 50% of cases. The average survival period of the patients on third therapy was 6.7 months. Side effects prevailed in the gastrointestinal tract and the hemopoetic system. The results with Endoxan and 5-Fluoro-uracil as primary therapies have thus far been unsatisfactory with regard to therapy response and drug tolerance.

[Problems in diagnosis and therapy of renal adenomas (author's transl)]. / Diagnostische und therapeutische Probleme bei Nierenadenomen.

Diagnostic and surgical problems of renal adenoma are discussed on the basis of seven own cases and the literature. The surgical procedure should be based on exact histomorphological classification of the tumors, which can be classified as: "Benign adenoma", "adenoma with questionable malignancy", and "Malignant degenerated adenoma". The often recommended radical surgery in all cases of renal adenomas should not be necessary. Histological diagnosis is most accurate with serial sections of embedded tumor material. False positive results from intraoperative histomorphologic diagnosis of frozen sections are not here. The difficult preoperative diagnosis of renal adenomas could be improved by computed tomography and ultrasonography.

[Lavage-cytology of the renal pelvis and ureter with special reference to tumors (author's transl)]. / Lavage-Zytologie von Nierenbecken und Harnleiter unter besonderer Berücksichtigung von Tumoren.

On 138 patients with radiologic filling defects in the ureter and renal pelvis lavage cytology was done. With this method it was possible to recognize clearly 39 of 47 urothelial tumors of renal pelvis and ureter (81,3%). Lavage cytology failed in patients with hypernephroma. Severe cellular atypias could be seen in patients with urolithiasis and inflammation. The diagnostic reliability of lavage cytology with urothelial tumors of renal pelvis and ureter is far greater than that of exfoliative urinary cytology and reaches results as good as those from brush biopsy.

[Classification, histologic and cytologic grading and regression grading of prostate cancer]. / Klassifikation, histologisches und zytologisches Grading sowie Regressionsgrading des Prostatakarzinoms.

The submitted recommendation of the pathologic- urologic team "prostatic carcinoma" is the result of several meetings, in order to provide a basis for a uniform nomenclature in diagnosis, therapy, and prognosis of prostatic carcinoma to urologists and pathologists in practice.

Cytological and DNA-cytophotometric monitoring of the effect of therapy in conservatively treated prostatic carcinomas.

A total of 464 aspiration biopsies were carried out on 180 patients with variously treated prostatic carcinomas. Characteristic signs of regression could be detected cytomorphologically in the cell nucleus and cytoplasm, which permitted 6 different regression grades to be distinguished. Analysis of 102 punch and aspiration biopsies, carried out for the first time simultaneously, revealed a diagnostic reliability of at least 97%. The incidence of complications on aspiration biopsy was 1.7%. In 30 cases additional prospective single cell DNA determinations were carried out on advanced prostatic carcinomas undergoing treatment. It could be shown that tumors with extensive aneuploidization and lack of change in the ploidal distribution in response to treatment showed poor clinical progress whereas those in which a change from aneuploidy to euploidy became apparent, showed good clinical progress.

[Conservative surgery of kidney adrenoma]. / Zur Frage des konservativ-chirurgischen Eingriffs bei adenomatösen Nierentumoren.

Adenomas of the kidney are often tumors of doubtful dignity because the histopathological criteria are unclear and, moreover, the preoperative diagnosis lacks complete reliability. As a result, the clinician frequently has problems deciding on conservative surgery. This is demonstrated in the light of 6 cases of renal adenoma. The surgical management of these tumors depends on exact classification of their dignity by the pathologist. Proposals on the subject are put forward and discussed.

[Cytodiagnosis of pathologic changes in the renal pelvis and ureter]. / Zytodiagnostik pathologischer Veränderungen in Nierenbecken und Harnleiter.

In 80 cases of roentgenologic filling defects in renal pelvis and ureter, which could be determined exactly preoperatively, we could confirm the diagnostic value of cytology from washings of renal pelvis and ureter (lavage cytology) especially in preoperative diagnosis of carcinoma of renal pelvis and ureter. Twenty of 25 tumors (80%) were detected preoperatively. There were no false positive results. The diagnostic reliability of this method was more accurate than with normal exfoliative urinary cytology from other authors. The results are discussed together with the literature.

Estracyt therapy of advanced prostatic cancer with special reference to control of therapy with cytology and DNA cytophotometry.

81 patients with advanced prostate carcinoma, mainly estrogen resistant, were treated with Estracyt. After a pilot study had shown encouraging results in the first 39 cases, the preparation was used on a further 42 patients and for 38 of these its therapeutic effectiveness was evaluated according to internationally defined clinical criteria. In this way, an objective therapeutic success quota of 55% of all 38 patients was obtained. In the group with estrogen-resistant tumors the value was still found to be as high as 35%. These clinical results were confirmed by cytomorphological control of the degree of regression of the tumor effected by the therapy, and also by single-cell cytophotometric analysis of the DNA content of various prostate carcinomas treated wtih Estracyt.

Lavage of cytology of the renal pelvis and ureter with special reference to tumors.

Lavage cytology was done in 101 patients with radiological filling defects in the ureter and renal pelvis. This simple and inexpensive technique is valuable in the preoperative diagnosis of tumors of the ureter and renal pelvis. In our series it was possible to recognize clearly 29 of 36 such tumors (80.5 per cent) through preoperative lavage cytology. No falsely positive diagnoses were made. Lavage cytology failed in 6 patients with hypernephroma. The diagnostic reliability of lavage cytology with urothelial tumors is far greater than that of exfoliative urine cytology and reaches almost equally good results as brush biopsy.

Tumor of mesonephric origin in a diverticulum of the urethra. An ultrastructural study.

A case of a rare tumor arising in a diverticulum of the urethra was studied. Light microscopy revealed the typical structures of mesonephric tumor with obvious infiltration of the muscularis. Electron microscopic appearance indicated that the tumor cells were immature and not totally characteristic of any tissue of origin. Apart from appearances suggesting rapid growth, cellular inclusions of various appearance were found.

[The inverted papilloma of the urinary bladder (author's transl)]. / Beitrag zum invertierten Papillom der Harnblase

Regarding the characteristics of the inverted papilloma of the urinary bladder a report is given on two of our own observations, and its histogenesis is discussed. Out of 41 reported cases 21 patients developed symptoms of bladder obstruction and 15 patients had macrohaematuria. With exception of two cases, all the tumors were localized in the bladder neck, they were mostly solitary and in some cases pedunculated. Microscopically they showed papillomatous structures growing inverted into the stroma with only little signs of proliferation as well as microcysts with PAS-positive material, and always they had distinct borders between epithelium and connective tissues. In 33 out of 41 cases control cytoscopy was performed between 6 months and 17 years after resection. Only one case showed recidivation of the tumor.

Problems of assessment in the surgery of renal adenomas.

We report 6 cases of renal adenomas in which difficulties were encountered in the determination of malignancy. The clinical and anatomical data are discussed, particularly the difficulties with the histological frozen section diagnosis of such tumors, together with the therapeutic outcome. The objective of a differentiating procedure is to increase the number of operations with organ conservation, while avoiding metastasis that could be derived from apparently benign renal adenomas.