Status of the p53, p16, RB1, and HER-2 genes and chromosomes 3, 7, 9, and 17 in advanced bladder cancer: correlation with adjacent mucosa and pathological parameters.

AIMS: To evaluate a panel of well known genetic alterations for frequency of changes in bladder cancer that could be considered genomic instability determinants or adjunctive prognostic predictors. METHODS: Fluorescence in situ hybridisation analysis was performed to evaluate chromosomes 3, 7, 9, and 17 and the 9p21 (p16), 17p13.1 (p53), 13q14 (RB1), and 17q11.2 (HER-2) chromosomal loci in 48 muscle invasive bladder cancer specimens and the adjacent normal mucosa. RESULTS: There were significant differences between the frequency of chromosome 7 monosomy/polysomy and 17 monosomy in the two groups (tumours and adjacent mucosa) (p = 0.004, p = 0.037, and p = 0.015, respectively). There were no differences in the frequency of gene deletions between tumours and the adjacent mucosa. 17q11.2 amplification was found in 14.5% of tumours examined, but not in the non-malignant epithelium. Chromosome 3, 7, and 17 monosomy and the RB1 heterozygous deletion were significantly associated with stage T3-4 (p = 0.03, p = 0.04, p = 0.04, and p = 0.03, respectively). CONCLUSIONS: These results demonstrate the importance of chromosomes 3, 7, and 17 and gene alterations in bladder cancer progression, highlighting their usefulness as prognostic markers. Larger studies with longterm follow up of these patients are needed to determine the validity and clinical relevance of these genetic findings, and molecular prognostic markers should be incorporated into phase II and III trials to define their roles in predicting clinical outcome.

Renal oncocytoma: image diagnostics and therapeutic aspects.

The renal oncocytoma is a solid epithelial neoplasm with a generally benign course. The improved image diagnostics with the computerized tomography (CT) and magnetic resonance imaging (MRI) should today permit the identification of these lesions preoperatively so that conservative rather than radical surgery can be employed, especially in the presence of an early or incidental diagnosis, this latter being always more frequent today. Eighteen patients (9 women and 9 men) with renal oncocytoma are presented. The sizes of the lesions ranged from 1.5 to 12 cm and all were studied by means of ultrasonography, CT and MRI. The MRI was found to be superior to both the ultrasonography and the CT in identifying smaller than 5 cm lesions, presenting typical, homogeneous low-density images in the T1-weighted image sequences which appeared hyperintense in the T2-weighted ones. The presence of a central scar or stellate architecture, the absence of hemorrhage and necrosis and the presence of a pseudocapsule are other elements to differentiate an oncocytoma from a renal carcinoma. These aspects are less characteristic in greater than 5 cm lesions, making the differential diagnosis more difficult. Twelve patients were submitted to a radical nephrectomy and 6 underwent enucleation. The follow-up of the patients (6-74 months) showed a disease-free survival in 17, while one patient died of distant metastases. No local recurrences were observed after conservative surgery which should be considered the treatment of choice in cases of renal oncocytoma with lesions of less than 5 cm.

[Nerve-sparing cystectomy and ileal bladder substitution]. / Cistectomia nerve-sparing e neovescica ileale di sostituzione.

Nerve-sparing techniques and bladder substitution following radical cystectomy allow today to obviate functional sequelae once registered in this type of surgery. Intraoperative identification of the pelvic plexus, which provides autonomic innervation to the corpora cavernosa, is necessary to preserve sexual function. Ileal orthotopic bladder substitution with preservation of the distal urethral sphincter assures a micturition per urethram and the urinary continence. The Authors report their experience with the Studer and Zingg procedure (ileal orthotopic bladder reservoir) performed in 26 cases. Results, technique, complications, and long-term evaluation are stressed.

Orthotopic ileal neobladder in female patients after radical cystectomy: 2-year experience.

We describe a surgical technique to conserve urinary continence in 7 women who underwent radical cystectomy with construction of an orthotopic ileal neobladder for infiltrating bladder carcinoma. The selection of the patients and the surgical procedure to preserve the anatomical and functional integrity of the female urethra are described. Followup ranged from 7 to 28 months. There were no postoperative deaths or serious clinical complications. The urinary continence rate was 100% during the day and 71% at night with micturition at regular 3-hour intervals. The vesical capacity varied from 250 to 400 cc and pressure at maximum capacity from 10 to 25 cm. water. Urinary flow was satisfactory and the urethral pressure profile showed a normal sphincteric mechanism at rest. Two patients died of metastases at 14 and 8 months postoperatively, and 5 are alive and disease-free. We believe that these results confirm the possibility of obtaining micturition in women via the urethra following radical cystectomy.

Serum osteocalcin in monitoring bone metastases in advanced prostatic cancer.

Osteocalcin, a K-dependent vitamin protein, was studied in a group of advanced prostatic carcinoma patients to test the usefulness of this marker for diagnosing bone metastases. Osteocalcin levels were above the norm in 22 out of 27 patients with bone metastases, although high levels were not observed in patients without bone metastases. High sensitivity and specificity levels of serum osteocalcin appear to be strongly correlated to metastatic bone involvement and disease relapse after hormone treatment. Although these results must be confirmed on a larger series of patients, this protein appears to be a useful biological marker in prostatic cancer.

Lower urinary tract reconstruction following cystectomy: experience and results in 96 patients using the orthotopic ileal bladder substitution of Studer et al.

Between 1989 and 1993 96 patients (89 males and 7 females) affected with invasive neoplasms of the bladder underwent surgery consisting of the creation of an orthotopic ileal neobladder according to Studer et al., after radical cystectomy. Patient selection and details of the surgical procedure are described. An accurate follow-up of 3-60 months (mean: 28 months) is presented. There have been 6 perioperative deaths (6.2%) and 11 early complications, all directly related to the neobladder and requiring reoperation in 6 cases (6.2%). Late complications required rehospitalization in 23 cases (23.9%) and a second reoperation was necessary in 10 (10.4%). The urodynamic tests show that the neobladder assumes an average capacity at about 330 cm3 after 1 year. Pressure at maximum capacity decreases in time and ranges from 10 to 20 cm H2O at 2 years. After 1 year, the complete urinary continence rate by day is 97% and the stress incontinence rate is 22%. Night-time continence, instead, increases to 74% after 1 year and to 83% after 2 years. In female patients, the functional results were satisfactory thanks to careful patient selection and to the surgical procedure adopted. Twenty-four patients had disease progression; 17 of these patients with locally advanced neoplasms died. The authors believe that the orthotopic ileal continent reservoir can be a satisfactory solution after cystectomy for bladder cancer, offering the patients a better quality of life compared to other urinary diversions both in male and female patients.