Clinical versus Pathologic staging of Renal Tumors: Role of Multi-Detector CT Urography.

INTRODUCTION: Our ability to diagnose renal cell carcinoma (RCC) has increased in the past 30 years as a result of the extensive application of imaging techniques, such as ultrasonography, computed tomography, and magnetic resonance imaging. Multi-detector computed tomography (MDCT) remains the most appropriate imaging modality for the diagnosis and staging of RCC. The aim of this work was to compare the findings of MDCT with surgical pathology to determine the accuracy of delineating tumor size, localization, organ confinement, lymph node metastases, and the extent of tumor thrombus in the renal vein and inferior vena cava. METHODS: The clinical, surgical, and anatomo-pathologic records of 99 patients treated by nephrectomy (radical or partial) for solid renal tumors at Theodor Bilharz Research Institute and Nasser Institute from 2005 to 2011 were reviewed retrospectively. All cases were staged pre-operatively with abdominal MDCT (pre- and post-contrast enhancement) in addition to the routine biochemical, hematological, and radiological work-up. The tumors' histologic types were determined according to the WHO classification of renal tumors in adults in 2004, and staging was updated to the TNM 2010 system. Data were analyzed using the t-test. RESULTS: The mean age was 52 (range 21-73). Seventy-eight patients were males, and 21 patients were females (Male/Female ratio: 3.7:1). There were no significant differences in the mean tumor size between radiographic and pathologic assessments in different tumor stages. The overall incidence of lymph node invasion in surgical specimens was 76%, whereas MDCT showed a positive incidence in 68.4% of cases (false negative result in 7 cases, 7.6%). CONCLUSION: Our findings indicated that MDCT urography is an accurate method to estimate renal tumor size, lymph node, vascular and visceral metastases preoperatively. Also, preoperative staging of renal tumors with MDCT represents a valuable and accurate tool.

Single-step renal dilatation in percutaneous nephrolithotomy: A prospective randomised study.

OBJECTIVE: To perform an economical single-step renal dilatation (RD) during percutaneous nephrolithotomy (PCNL), using directly a 30-F Amplatz dilator over the central Alken dilator, in a trial to reduce the operative duration and radiation exposure during RD while avoiding an exchange of dilators that might increase the risk of blood loss. PATIENTS AND METHODS: In a prospective randomised study including 49 patients divided into two groups, the first had RD before PCNL using the standard metallic telescopic dilators (Alken), and the second had RD using the 30-F Amplatz dilator over the central Alken dilator. The operative duration, with X-ray exposure, was calculated. The procedure outcome in terms of complications, stone-free rates and hospital stay was evaluated statistically. RESULTS: The tract was dilated correctly in all cases. The operative duration and X-ray exposure was shorter in patients undergoing single-step RD (P < 0.05). There were perioperative complications, according to the Clavien grading system, in 17 (34%) patients but there was no statistically significant difference between the groups. The stone-free rates were comparable in both groups. CONCLUSION: A single-step RD during PCNL is feasible, with a shorter operative duration and X-ray exposure. The outcomes were comparable with those of a standard metallic telescopic RD.

Molecular markers and bladder carcinoma: Schistosomal and non-schistosomal.

OBJECTIVES: Detection of telomeric repeat amplification protocol (TRAP) activity, the human telomerase reverse transcriptase (hTERT), tumor suppressor gene (p53) and proliferating marker (MIB-1) in bladder specimens. DESIGN AND METHODS: Specimens were obtained from 85 patients and 10 controls. TRAP technique and immunohistochemistry (IHC) method were performed. RESULTS: TRAP activity, hTERT, p53 and MIB1 were detected in 62.4%, 65.9%, 57.6% and 62.4% of all 85 patient cases, respectively. TRAP activity was detected in 75% of schistosomal urothelial carcinoma, 100% in schistosomal squamous cell carcinoma (SQCC) and 71.4% in non-schistosomal urothelial carcinoma. hTERT protein was detected in schistosomal urothelial carcinoma (83.3%), 93.3% in schistosomal SQCC and 75.7% in non-schistosomal urothelial carcinoma. CONCLUSIONS: TRAP and hTERT are useful for the detection of telomerase with special emphasis on their role in the detection of schistosomal-associated bladder cancer. Correlation of TRAP and hTERT protein with MIB1 and p53 reveals the importance of telomerase as a new marker in cancer bladder.

Effectiveness of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer: short and long-term follow-up.

PURPOSE: We analyzed the impact of a single Mitomycin C instillation in patients with low risk superficial bladder cancer with short and long-term follow-up. PATIENTS AND METHODS: This study was conducted on 63 patients with low risk superficial bladder transitional cell carcinoma (TCC), admitted to the Urology Department, Theodor Bilharz Research Institute (TBRI) during the period from January 2002 to August 2005. All patients had a 2 cm. or less single, papillary, primary or recurrent tumor and were disease-free for more than 1 year. Patients with muscular invasion, G III tumor or bladder carcinoma in situ on pathological examination were excluded from the study. The tumor was completely resected before patients were divided randomly into 2 arms: first group who have received no further treatment (control group) and a second group with a single immediate instillation of 30 mg. Mitomycin C (mitomycin C group). Recurrences were considered early if they occurred within the first 2 years of follow-up. RESULTS: At 24-months follow-up, the recurrence-free interval was significantly increased and recurrence, recurrence per year and tumor per year rates were decreased in the mitomycin C group compared to the control group. Early recurrence was (16.1%) in the mitomycin C group versus (34.3%) in the control group. It was noted also that early recurrences were concentrated in the first year in the control group (18.7%) versus (3.2%) in the mitomycin C group. However, at long-term follow-up, these differences were not statistically significant (26.9%) in the mitomycin C group versus (28.6%) in the control group, and the recurrence-free interval curves were parallel. A significant relationship between early and late recurrences was found in the mitomycin C, but not in the control group. Shorter hospital stay and catheterization periods were noted in the mitomycin C group compared to the control group, but the differences were not statistically significant. CONCLUSION: These data confirm the positive effect of a single immediate mitomycin C instillation in patients with low risk superficial bladder cancer. This benefit is limited to early recurrence and is not maintained with long-term follow-up. Thus, this approach is an alternative to observation or classic long-term intravesical chemotherapy. Our study also suggests that cell implantation as a mechanism of early recurrence can be controlled or minimized with a single mitomycin C instillation.