[Adult renal neoplasms in the material of the Pathology Department of the Szeged University]. / Felnottkori vesedaganatok a Szegedi Tudományegyetem Patológiai Intézetének anyagában.

AIMS: The authors investigated the frequencies of the various histological types of adult renal tumours. METHODS: The slides of 469 nephrectomies performed in the Department of Urology, Szeged University between 1990 and 2003 were revised according to the 1997 Heidelberg and 2004 WHO classification schemes. RESULTS: 86.7% of all the tumours (n = 407) were malignant. Among the malignant tumours, the frequency of renal cell carcinomas was 91.1% (n = 371). 88.4% of the renal cell carcinomas (n = 328) were of conventional type, 5.6% (n = 21) were papillary and 4% (n = 15) were chromophobe. The authors observed 3 Bellini duct, 1 mucinous tubular and 3 non-classifiable carcinomas, with a combined incidence of 1.8%. 84.5% of the conventional carcinomas were clear cell (n = 277), 8.8% were eosinophilic granular (n = 29), 3.9% were multilocular cystic (n = 13) and 2.7% were sarcomatoid carcinomas (n = 9). The median age of the patients with conventional carcinoma was 60 (median, range: 25-84), in the papillary group it was 62 (43-78), and in the chromophobe group was 59 (17-77). The median age of patients affected by transitional cell carcinoma was 64 (range: 45-81). As far as benign tumours are concerned (13.2%, n = 62), oncocytomas (n = 37, 7.8% of all the tumours) affected mainly females, whereas angiomyolipomas (n = 21, 4.4% of all the tumours) occurred in females only. In 13 oncocytoma cases, the tumours were initially diagnosed as malignant. CONCLUSIONS: Adult malignant renal tumours affect mainly patients around the age of 60. The commonest diagnosis was clear cell carcinoma of conventional type. The incidence of clear cell carcinoma was 5% higher than that reported in the literature (84.5% vs 70-80%) whereas that of papillary carcinoma was 5% lower (5% vs 10-15%). In comparison with the literature data, oncocytomas were relatively common (8% instead of 3%), and not rarely, it was difficult to distinguish them from renal cell carcinomas.

Clinical and endocrine aspects of pituitary tumors.

OBJECTIVE: To study the clinical spectrum and endocrine profile of pituitary tumors presenting to a tertiary care endocrine center. METHODS: Retrospective analysis of clinical and hormonal data of patients with pituitary tumors admitted in the Endocrinology Department of Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir India between January 1989 and December 1998. RESULTS: Over a period of one decade, 75 subjects were diagnosed to have pituitary tumors. Somatotroph adenoma was the most common pituitary mass lesion seen (44/75) and followed in the decreasing order of frequency, by non-functioning pituitary tumor (12/75), prolactinoma (11/75) and corticotroph adenoma (8/75). Overall there was a male preponderance (male to female ratio was 41:34). Subjects with somatotroph adenoma presented with classical features of acromegaly: mean fasting and post glucose suppression growth hormone levels were 34.04+/-11.67 and 36.47+/-6.64 ng/ml. Eleven subjects (9 females and 2 males) had prolactinoma; females presented with the classical symptom complex of amenorrhea-galactorrhea while males presented with headache, visual disturbances and impotence. The 12 subjects with nonfunctioning pituitary tumors presented with features of mass lesion. Of the 8 subjects (6 females and 2 males) with corticotroph adenomas, 2 were confirmed to have periodic hormonogenesis. CONCLUSION: In an endocrine center, functioning pituitary tumors are more often seen than non-functioning tumors.

Effect of surgical removal of subcutaneous tumors on survival of rats.

Mammary and other subcutaneous tumors were surgically removed from aged Sprague-Dawley rats in an attempt to extend survival. The surgical technique was straightforward, and survival following mastectomy was good (17/21). The number of mammary and pituitary tumors in sexually intact rats and those that had previously undergone ovariectomy were compared. The frequency of mammary tumors was significantly lower in ovariectomized vs sexually intact rats (2/47 vs 24/49), as was the frequency of pituitary adenomas (2/46 vs 27/41). Survival to 630 days of age was higher in ovariectomized than in sexually intact rats (42/47 vs 29/49), although tumors did not contribute significantly to mortality.

Caracterización hormonal de los adenomas hipofisarios no funcionantes / Hormonal characterization of the non fuctioning pituitary adenomas

Se estudiaron 98 pacientes con adenomas no funcionantes, 34 hombres y 64 mujeres, realizando un estudio hormonal en suero para conocer su perfil endocrino. Con tal objeto, se efectuaron determinaciones de hormona folículo estimulante y hormona luteinizante (FSH, LH), prolactina (PRL), estadiol (E2), testosterona (T), cortisol, hormona del crecimiento (GH), hormona adrenocorticotrópica (ACTH), hormona estimulante del tiroides (TSH) y gastrina (Ga) por radioinmunoanálisis. Los resultados mostraron marcado hipergonadotropismo en el 47//de los pacientes, con niveles séricos de FSH y LH muy elevados y un incremento inesperado de la concentración de Ga (Grupo I). En contraste, el resto de los pacientes tuvo concentraciones normales o bajas de gonadotrofinas y Ga (Grupo II). El grupo I mostró una relación inversa entre los niveles de gonadotropinas y esteroides gonadales (E2 o T) con cifras significativamente menores que los valores normales y los encontrados en el Grupo II (<0,00l) en el cual la relación fue lineal positiva. Tambien se observó una relación directa entre la concentración de FSH conTSH (r=0,75) y Ga (r=0,80), probablemente por los neurotransmisores que determinan la secreción de estas hormonas. La TSH al igual que las hormonas tiroideas, tuvo cifras más elevadas en el Grupo I, mientras que los valores de PRL fueron más bajos (P<0,0001). La concentración de GH y ACTH fuer normal en ambos,no obstante,el 33 por ciento de los pacientes del Grupo II presentó hipocortisolismo e hipotiroidismo. La edad promedio de los pacientes analizada por décadas, no fue estadísticmente diferente entre los grupos y no explica las diferencias encontradas, aunque en el Grupo I predominaron las mujeres. En éstas, la elevación de FSH podría estar condicionada por la deficiencia gonadal, acorde a la edad de las pacientes (49,8 Ð 9,6 años), sin embargo, algunos valores fueron extraordinariamente elevados y existe la posibilidad de que la hipófisis en condiciones patológicas, como es la forma adenomatosa,pueda producir en forma autónoma,moléculas de LH y FSH alteradas y carentes de actividad biológica, o bien, subunidad Ó libre, como se ha demostrado en algunos gonadotropomas. Por otra parte, algunos de los casos con TSH elevada podrían considerarse verdaderos TS-Homas, que no suprimen su secreción a pesar de la elevada concentración de hormonas tiroideas. Así, podría decirse que dentro de los no funcionantes, están enmarcados algunos de estos adenomas. Se concluye que, desde el punto de vista hormonal, los adenomas del Grupo II son los verdaderos no funcionantes

Pituitary tumours in African and Indian patients.

Over a five year period 55 patients with pituitary tumours (35 African and 20 Indian patients) were seen at the Endocrine Unit, King Edward VIII Hospital. Of the 33 patients with secretory tumours 20 had GH-secreting tumours (acromegaly), 8 prolactinomas and 5 ACTH-producing tumours (Cushing's disease); in addition 4 of the patients with acromegaly probably had combined GH and prolactin secreting tumours. The group with non-secretory tumours comprised 13 patients with craniopharyngioma, 7 with chromophobe adenomas and 2 patients with parasellar tumours. The majority of patients with non-secretory tumours were of African descent. Hormonal deficiencies present in the patients tested, were as follows: GH deficiency 73.3%; hypocorticolism 66.7%; hypogonadism 35.9% and hypothyroidism 14%. It thus appears that the patients in the present study differ from populations studied elsewhere with respect to the relative frequency of the various secretory tumours and the prevalence of certain hormonal deficiencies.

Second primaries in children with central nervous system tumors.

Among 670 children diagnosed with central nervous system tumors before age 20 and recorded in the Connecticut Tumor Registry, nine had a second neoplasm as well. From known age-specific and year-specific cancer incidence figures for Connecticut, the expected number of second neoplasms for the series of 670 is 0.99; therefore the relative risk is 9.1 (95% confidence limits: 4.0, 17.3). Three patients developed two central nervous system tumors, while 0.16 were expected, giving a relative risk of 19 (95% confidence limits: 3.8, 55). Six patients developed two neoplasms in childhood, versus 0.66 expected; the relative risk of this event is 9.1 (95% confidence limits: 3.3, 20). In four cases of lapse in time between the diagnosis of the first and second tumor, the first tumor had been treated with radiation. Five cancers occurred in parents or siblings of these nine patients, versus 0.91 expected; the relative risk is 5.5 (95% confidence limits: 1.2, 10.0). Three of these relatives had leukemia, while only 0.04 cases were expected (relative risk = 75). We conclude that not only is a child with CNS cancer at increased risk for other cancers, but such a child with two cancers is often part of a familial cluster with increased risk of cancer.