The accuracy of renal tumor biopsy: analysis from a national prospective study.

OBJECTIVE: To assess preoperative renal tumor biopsy (RTB) accuracy. MATERIALS AND METHODS: As part of the prospective NEPHRON study, data from 1,237 renal tumors were collected, including the use and results of RTB and final histology following nephrectomy. During the 6 months period of inclusion, 130 preoperative biopsies were performed. We used the kappa coefficient of the McNemar test to determine the concordance between the biopsy and the nephrectomy specimen (NS) regarding four parameters: malignant/benign status, histological subtype, Fuhrman grade and microscopic necrosis. RESULTS: Preoperative biopsies were performed in 9.7 and 11.4 % of the 667 radical and 570 partial nephrectomies, respectively. Tumor biopsy was inconclusive in 7.7 % of the cases. In 117 cases, a comparison between RTB and NS was available. Benign tumors accounted for three (2.6 %) and five (4.3 %) of the RTB and NS, respectively (κ = 0.769, good). With seven (6 %) discordant results in terms of histological subtype characterization between RTB and final pathology, RTB accuracy was considered excellent (κ = 0.882). In 33 cases (31.7 %), Fuhrman grade was underestimated at biopsy resulting in an intermediate concordance level (κ = 0.498). Tumor microscopic necrosis was identified in 12 RTB (10.4 %) versus 33 NS (28.4 %) (κ = 0.357, poor). CONCLUSIONS: RTB provides good to excellent diagnostic performance for discriminating malignancy and tumor histological subtype. However, its performance is intermediate or even poor when considering prognostic criteria like Fuhrman grade or microscopic necrosis. Thus, this possible inaccuracy should be taken into consideration when using RTB for accurate guidance of treatment strategy.

[The sexual future of patients cured of testicular cancer]. / L'avenir sexuel du malade guéri d'un cancer du testicule.

The sexual future of patients cured of testicular cancer is a legitimate preoccupation due to the high rate of successful treatment for this disease. The psychological and functional aspects and the fertility before and after treatment of operated patients are reviewed and the least harmful solution is proposed for each handicap. The question of induction of new cancers by chemotherapy remains unanswered; a number of years of follow-up will be required before an answer can be proposed.

[Cancer of the testicle: diagnosis]. / Le cancer du testicule: diagnostic.

Although great progress has been made in the treatment of testicular cancer over recent years, little progress has been made in the detection of this disease. The time between the discovery of a scrotal swelling by the patient and the first consultation is still too long. The authors study the presenting symptoms of the disease and the clinical examination which have not changed since the description by Chevassu. Complementary investigations have become essential: particularly, ultrasonography and tumour markers. The place of magnetic resonance imaging has yet to be defined. The last step in the diagnostic work-up consists of exploratory orchidotomy.

[Radical orchiectomy]. / L'orchidectomie élargie.

The authors recall that exploratory orchidotomy remains an essential operation for the diagnosis of testicular cancer and orchidectomy constitutes the primary therapeutic procedure. The operative technique is described together with its intangible principles, its difficulties and its variants. The tumour markers are best assayed on a sample of cord blood. The insertion of a testicular prosthesis, which is usually well supported, decreases the psychological effects of castration and does not cause any delay in possible adjuvant treatment.

[2 cases of carcinoid tumor of the testis]. / A propos de deux cas de tumeur carcinoïde du testicule.

The authors report two cases of carcinoid tumour of the testis in young subjects. One case was isolated and the other was associated with a teratoma. The authors attempt to define this disease on the basis of a review of the literature.

[A rare diagnosis of an intrascrotal tumor: polyorchidism]. / Un diagnostic rare de tumeur intra-scrotale: la polyorchidie.

The authors report a new case of polyorchidism and review the literature. They discuss the different anatomo-clinical forms and the therapy of this rare anomaly.

[Exeresis of residual masses of germinal tumors of the testis after chemotherapy]. / L'exérèse des masses résiduelles des tumeurs germinales du testicule après chimiothérapie.

Between 1978 and 1988, amongst the 184 patients treated at the Hôpital du Val de Grâce for a testicular germ cell tumour, 47 patients underwent resection of residual masses after chemotherapy: 27 patients were classified as stage II and 20 were classified as stage III. The chemotherapy, administered for 3 to 6 cycles, used three types of protocols: VAB 6, PVeBV or BEP. Resection of residual masses was only undertaken after return to normal of the biological markers with persistently abnormal medical imaging. Histology of the testicular tumour revealed 3 seminomas and 44 non-seminomatous germ cell tumours. The histology of the residual masses after retroperitoneal lymphadenectomy (42 operations), thoracotomy (9 operations) or craniotomy (1 operation) revealed 22 cases of fibrosis or necrosis (47%), 10 cases of teratoma (21%), 8 cases of cancer (17%) and 7 normal cases (15%). The progression towards fibrosis, necrosis or nature teratoma is synonymous with cure, but the persistence of cancer cells corresponds to a very poor prognosis even after salvage treatment.

[An important endemic in the Marquesas: neural angiostrongylosis]. / Une importante endémie marquisienne: l'angiostrongylose nerveuse.

The authors report on 37 new cases of eosinophilic meningitis collected in two years in an island with a population of 1,800. Recalling first the epidemiology of the disease, they describe the most frequent clinical signs met and the results of rachiocentesis which confirm the diagnosis. The disease strikes more than 1% of the population. It might not rapidly disappear as the only efficient prophylaxis would be to deprive the population, very attached to its traditions, of one traditional dish.

[Hydronephrosis and ureteropelvic junction syndrome. Apropos of 93 cases]. / Hydronéphrose et syndrome de la jonction pyélo-urétérale. A propos de 93 cas.

So called "congenital" hydronephrosis, a relatively frequent condition, is increasingly benefiting from modern investigative techniques such as ultrasound. This should enable a reduction in the time interval between clinical symptomatology and treatment. In a series of 93 cases, the authors demonstrate that pathological anatomy is of little value as regards etiology, while plastic surgery of the pyelo-ureteral junction still remains the most simple and reliable treatment with a low associated morbidity.

[Rupture of the bile ducts in closed abdominal injuries]. / Rupture des voies biliaires au cours des traumatismes fermés de l'abdomen.

A further case of rupture of the biliary pathways from a closed injury to the abdomen is reported. The exceptional nature of the lesion was further evidenced by the delay in diagnosis of this rupture: on the 45th day after the injury. Reports in the literature describe the most frequent characteristics of such lesions: affecting young adults they are usually the result of road accidents, they are diagnosed at a late stage due to lack of information from complementary examinations, and they raise problems related to the choice of therapy.

[Mature teratomas of testicular origin. Discussion of 12 cases]. / Les tératomes matures d'origine testiculaire. Réflexions à propos de douze cas.

Between 1979 and 1989, 135 patients with a non-seminomatous germ cell tumour of the tests were treated in the Val de Grâce Military Hospital in Paris. In twelve patients, histological examination of a residual mass after chemotherapy revealed the presence of mature teratoma. Although this tumour, considered to be benign, generally represents a favourable form of the initial tumour, it nevertheless has a potential for progression. The possibility of long-term recurrences, which are sometimes difficult to eradicate, justifies very careful long-term surveillance of these patients. The authors report three particularly demonstrative cases and present a review of the literature.

[Testicular prosthesis. Study of complications, apropos of 63 cases]. / Les prothèses testiculaires. Etude des complications, à propos de 63 cas.

The authors report 63 cases of insertion of testicular prostheses (Lattimer model in Silastic, manufactured by Dow Corning) in patients who had undergone castration for testicular cancer. A study of the early and late post-operative complications, which were relatively rare and always benign, allows several simple rules to be proposed regarding this surgical procedure. There does not seem to be any problem with long term tolerance to medical silicones, after a ten year follow up period for the earliest cases. The insertion of an implant does not in any way delay continuation of treatment for testicular cancer.

[A rare cause of hematuria: vesical nephrogenic adenoma]. / Une cause rare d'hématurie: L'adénome néphrogénique vésical.

The authors report a case of a 20 year old patient with macroscopic hematuria due to a rare bladder tumor: a nephrogenic adenoma. Although a benign condition, its tendency to recurrence often means that aggressive therapy is required. Bladder ultrasonography is the principal examination for surveillance of these patients.

[Biological markers and germinal tumors of the testis. Value and limitations of the assay of chorionic gonadotrophin hormone and alpha-fetoprotein]. / Marqueurs biologiques et tumeurs germinales du testicule. Intérêts et limites du dosage de l'hormone chorionique gonadotrope (HCG) et de l'alpha-foeto-protéine (AFP).

Between 1978 and 1985, 128 patients with germinal tumors of the testes were treated at the Val-de-Grâce Hospital; biological market levels--beta HCG and AFP--were determined before and after orchidectomy in the peripheral blood and during orchidectomy in testicular blood in 76 patients. HCG levels were elevated in 13% of seminomas and HCG and/or AFP levels were elevated in 76% of non seminomas; the sensitivity of the determination was greater in testicular blood. However, in our study, there was no parallelism between marker levels before orchidectomy and tumor stage or prognosis. The change in HCG and/or AFP levels appears to an index of the response to therapy: 4 patients with high HCG and/or AFP levels during chemotherapy died. The diagnosis of recurrence is not always documented by elevated marker levels and monitoring must always documented by elevated marker levels and monitoring must always include both determination of marker levels and imaging.