The presence of intraductal carcinoma of the prostate in needle biopsy is a significant prognostic factor for prostate cancer patients with distant metastasis at initial presentation.

Intraductal carcinoma of the prostate is an adverse prognostic factor in localized prostate cancer patients. However, whether it influences outcome of those patients with distant metastases discovered at initial diagnosis is unclear. Here, we evaluated whether the presence of intraductal carcinoma of the prostate in prostate needle biopsies is an adverse prognostic factor for cancer-specific survival and overall survival in such prostate cancer patients. We retrospectively enrolled 150 eligible patients. All patients received androgen-deprivation therapy and/or chemotherapy. Their age, performance status, pain, metastatic sites, clinical T stage, serum prostate-specific antigen, alkaline phosphatase, hemoglobin, Gleason score, and the presence of Gleason pattern 5 were analyzed. Primary end point was cancer-specific survival; secondary end points included prostate-specific antigen progression-free survival and overall survival. Fine and Gray's model and the Cox proportional hazards model were used as statistical tests. Intraductal carcinoma of the prostate was detected in 100 (67%) patients. At a median follow-up of 38 months, 79 patients (53%) had died of the disease and nine (6%) had died of other causes. The average time interval to cancer-related death was 28 months. On multivariate analysis, only intraductal carcinoma of the prostate was significantly associated with cancer-specific survival (P=0.018) and overall survival (P=0.001), and only the presence of Gleason pattern 5 was significantly associated with prostate-specific antigen progression-free survival (P=0.026). The presence of intraductal carcinoma of the prostate was the only significant prognostic parameter for cancer-specific survival and overall survival in prostate cancer patients with distant metastasis at presentation. These results may prove useful in planning future treatments.

A new treatment for retroperitoneal fibrosis: initial experiences of using Seprafilm® to wrap the ureter.

OBJECTIVE: To confirm the efficacy of using Seprafilm® (Genzyme Corp., Cambridge, MA, USA) for wrapping the ureter to treat the ureteric stenosis caused by retroperitoneal fibrosis (RPF). PATIENTS AND METHODS: Between August 2010 and September 2012, 11 ureters in eight patients with RPF (seven males and one female, mean age 65 years) were treated. The mean (range) length of the narrow segment of the ureter was 30 (10-90) mm. During surgery, after having been released from adhesive tissue, the stenotic segment of the ureter was wrapped with Seprafilm to isolate it from the surrounding tissue. A radiographic follow-up was performed every 6 months using computed tomography, i.v. pyelography and/or (99m) Tc-mercapto-acetylglycyl-glycyl-glycine ((99m) Tc-MAG3) renal scintigraphy. RESULTS: For the unilateral operations, the mean estimated blood loss was 39 mL, and the mean operating time was 154 min. All ureters were isolated from the fibrotic tissue and wrapped with Seprafilm successfully without major complications. During the mean follow-up period of 17 months, no ureteric restenoses were observed in the affected sides, but new stenosis occurred in the contralateral side of the ureter in one patient. CONCLUSIONS: Although the follow-up period is still limited, we believe that the use of Seprafilm has the potential to become an effective option in the treatment of ureteric stenosis caused by RPF, when the omentum cannot be used. To establish the relative advantages of using Seprafilm over performing a standard omental wrap, further experimentation will be required to compare the two techniques.

Tyrosine kinase inhibitor-induced vasculopathy in clear cell renal cell carcinoma: an unrecognized antitumour mechanism.

AIMS: To evaluate the pathological features of clear cell renal cell carcinoma (CCRCC) treated with tyrosine kinase inhibitors (TKIs), and to elucidate the mechanism of action of TKIs. METHODS AND RESULTS: Twenty cases of CCRCC treated with TKIs (sorafenib or sunitinib) were retrospectively analysed: 16 were patients who had undergone radical nephrectomy after neoadjuvant TKI therapy, and four were autopsy cases of patients who received TKI treatment. All tumours had two distinct regions: one characterized by necrosis and/or degeneration, indicating antitumour activity; and the other characterized by no or few pathological changes, indicating the absence of antitumour activity. Vasculopathy of tumour vessels was observed in or adjacent to the necrotic or degenerative areas; a decreased density of endothelial cells was noted in the tumour vessels. Few or no changes of vasculopathy were observed in tumour vessels in the other CCRCC areas, indicating the absence or low levels of antitumour activity. CONCLUSIONS: This is the first pathological report of vasculopathy in TKI-treated CCRCC cases. Our data suggest that TKIs initially induce vasculopathy in tumour vessels, and consequently cause reduction or diminution of blood supply to the CCRCCs, resulting in antitumour activity characterized by necrosis and hyalinization.

Growth pattern, an important pathologic prognostic parameter for clear cell renal cell carcinoma.

OBJECTIVES: To assess the validity of growth pattern as a unique prognostic parameter for clear cell renal cell carcinoma (ccRCC). METHODS: In total, 561 patients with pathologic tumor stage 1 (pT1), pT2, and pT3a ccRCC without preoperative metastasis were evaluated. Clinicopathologic parameters, including pathologic tumor stage, Fuhrman grade, tumor necrosis, lymphovascular invasion, and growth pattern, were analyzed to predict disease-free survival (DFS) and cancer-specific survival (CSS). RESULTS: Growth patterns were defined as follows: expansive included tumors with well-circumscribed margins without normal renal tissue in the tumor, and infiltrative involved tumors with ill-circumscribed margins or normal renal tissue in the tumors. In multivariate analysis, Fuhrman grade, tumor necrosis, and growth pattern were useful predictors of DFS, whereas Fuhrman grade and growth pattern were useful predictors of CSS, although only 30 cases showed the infiltrative pattern. CONCLUSIONS: Growth pattern can be considered a new prognostic parameter for ccRCC.

Is pT3 urothelial carcinoma of the renal pelvis a homogeneous disease entity? Proposal for a new subcategory of the pT3 classification.

AIMS: The prognosis of urothelial carcinoma of the renal pelvis (UCRP) is heterogeneous, especially in pT3 patients. The degree of tumour parenchymal invasion is not considered for pathological tumour (pT) staging. The aim of this study was to investigate whether quantitative assessment of invasion provides a better estimation of prognosis for UCRP in pT3 patients. METHODS AND RESULTS: We reclassified pT3 cases into two subcategories: pT3a, in which UCRP extended only into the renal medulla; and pT3b, in which UCRP extended into the renal cortex and/or in which UCRP exhibited peripelvic fat invasion. We examined our proposed pT classification and other pathological parameters, including necrosis, lymph-vascular invasion (LVI), 1973 World Health Organization (WHO) grading, WHO/International Society of Urological Pathology grading, adjuvant chemotherapy, and pathological lymph node metastasis (pN). The study included 275 patients. Among 96 patients with pT3, there was a statistically significant difference between the pT3a and pT3b subcategories in cancer-specific survival (P < 0.001). Our proposed pT classification, as well as necrosis, LVI, 1973 WHO grading, and pN, demonstrated prognostic differences in univariate analysis, whereas in multivariate analysis, only our proposed classification (P = 0.008) and pN (P = 0.002) were statistically significant. CONCLUSION: The pT3b subcategories should be regarded as true pT3, having the established features of that stage, whereas pT3a has a better prognosis.

The post-operative pathological prognostic parameters of clear cell renal cell carcinoma in pT1a cases.

There has been a recent increase in the number of small clear cell renal cell carcinoma (ccRCC) cases, particularly in pT1a cases. The prognostic parameters for small ccRCC, however, are not well described. Herein, we assess the pathological parameters of pT1a patients. Various clinicopathological parameters were analyzed in 293 patients with pT1a ccRCC without pre-operative metastasis to predict the disease-free survival rate (DFS) and the cancer-specific survival rate (CSS). Clinicopathological parameters included age, tumor location, Fuhrman grade, lymph-vascular invasion (LVI), tumor necrosis, and growth pattern (expansive or infiltrative). In the univariate analysis, Fuhrman grade (grade 1 + 2 vs. 3 + 4), LVI, growth pattern, and tumor necrosis were parameters associated with a worse prognosis (P < 0.0001) in both the DFS and CSS. In the multivariate analysis, Fuhrman grade (P = 0.0048), growth pattern (P = 0.0275), and tumor necrosis (P = 0.0188) were statistically significant in the DFS. Fuhrman grade (P = 0.0189) and growth pattern (P = 0.0016) were also statistically significant in the CSS. Fuhrman grade, tumor necrosis, and growth pattern were independent prognostic parameters in pT1a ccRCC. Growth pattern, a previously unrecognized parameter for prognosis, can be considered a new prognostic parameter in ccRCC.

Renal cell carcinomas in haemodialysis patients: does haemodialysis duration influence pathological cell types and prognosis?

BACKGROUND: It is well known that renal cell carcinoma (RCC) is one of the most important complications in haemodialysis (HD) patients. However, the influence of HD duration on the development of RCCs has not yet been described. This study sought to determine whether HD duration is related to pathological RCC types and to prognosis. METHODS: We examined 69 patients having HD (73 kidneys) who underwent radical nephrectomy for renal tumours between 1991 and 2008. We divided the patients into three groups according to the duration of HD (< 10 years, between 10 and 20 years, and > 20 years). All histological examinations were performed without knowledge of clinical outcomes. In each case, pathological cell types and clinical parameters were recorded. RESULTS: The patients with HD duration of > 10 years showed distinct pathological characteristics, including acquired cystic disease of kidney-associated RCCs. The disease-free survival (DFS) rates of these groups were statistically different from one another (P < 0.05). RCC with a sarcomatoid component was found in cases having HD durations of > 10 years. The DFS rate of the patients with a sarcomatoid component was 55.9% at 5 years and 37.3% at 10 years. CONCLUSIONS: HD duration influenced pathological cell types and tumour stages of RCCs in HD patients. Patients receiving > 10 years of HD experienced RCCs with a sarcomatoid component, which resulted in poor outcomes. Hence, patients receiving long-term HD, and especially those with > 10 years of HD, should have frequent and careful medical examinations.

[Renal cell carcinoma presenting high serum level of CA19-9 due to hydronephrosis: a case report].

A 58-year old female was referred to our hospital due to left renal cyst that was pointed out at her health check-up. Abdominal CT scan showed left hydronephrosis with a 20 x 12 x 11cm tumor. The serum CA19-9 level elevated to 4,400 U/ml. Urinary cytology in the left renal pelvis was negative, therefore we could not diagnose whether the mass was renal cell carcinoma or renal pelvic tumor before surgery. She underwent left radical nephrectomy, and frozen section revealed renal cell carcinoma. Immunohistological stain clarified CA19-9 was limited to epithelium lining the renal pelvis and was not contained in carcinoma cells. After the surgery, the serum CA19-9 decreased to the normal range. Serum CA19-9 is known to be sometimes elevated in patients with urothelial carcinoma, but rarely elevated in those with renal cell carcinoma. We thought that hydronephrosis by tumor occlusion caused CA19-9 elevation in our case.

[Triple cancer in the urinary system: a case report].

A 74-year-old male was referred to our hospital due to microhematuria that was pointed out at his health check-up. Cystoscopy showed many papillary bladder tumors under 5 mm in size. Intravenous pyelography also showed deformity of the right kidney and shadow defects in the left renal pelvis. Abdominal computed tomography revealed an 8 cm tumor invading the renal vein in the right kidney, and a 3 cm tumor in the left renal pelvis. Prostate biopsy was performed with PSA 3.4 ng/ml, and he was also diagnosed with prostate carcinoma. First, he received right radical nephrectomy, and secondly left nephroureterectomy and cystectomy. Our case should be called triple cancer because bladder cancer was thought to be daughter tumor of renal pelvic tumor. This is, to our knowledge, the 11th case report that occurred in the urinary tact, and the first case that needed total resection of urinary tract.

[Radical prostatectomy for prostate carcinoma with ectopic ureter ; a case report].

A 71-year old male visited our hospital with a chief complaint of pollakisuria. The needle biopsies of the prostate were performed with PSA 8.0 ng/ml, and he was diagnosed as moderately differentiated adenocarcinoma. Imaging techniques revealed a right complete duplicated upper urinary system with an ectopic ureter draining to the prostatic urethra. He received radical prostatectomy with concomitant anastomosis of ureter to ureter. There is no evidence of hydronephrosis or tumor recurrence 11 months after operation. This is, to our knowledge, the second case report describing the association of radical prostatectomy and ectopic ureter.

[Giant condyloma with malignant degeneration: a case report].

We report a case of giant condyloma with malignant degeneration. A 56-year-old male was referred to our hospital due to a penile infection that was resistant to antibiotic therapy for more than a year. The swelling appeared to be a penile cancer. We suspected malignancy and performed penile biopsies twice; however, the histopathological diagnosis was condyloma acuminatum and malignant findings were absent. We continued the antibiotic therapy for 3 months; however, no improvement was achieved. Therefore, total penectomy and urinary diversion were performed. The pathological diagnosis of the resected tissues was not only condyloma but also squamous cell carcinoma, and cancer cells appeared on the cut surface of the specimens. We added radiation therapy. There was no evidence of recurrence or metastasis at 18 months after surgery.

Relationship between serum prostate-specific antigen and calculated epithelial volume.

OBJECTIVES: To estimate the relationship between serum prostate-specific antigen (PSA) and prostatic epithelial volume, a new simple method for measuring epithelial volume was developed and its efficacy evaluated in patients with benign prostatic hyperplasia. METHODS: Between March 1998 and June 2001, 122 patients without prostate cancer in the transurethral resected specimen were enrolled in this study. Of the 122 patients, 55 had a serum PSA level of 4.0 ng/mL or greater and negative sextant biopsies before surgery. First, we measured the epithelium/glandular lumen ratio by computer image analysis in 20 specimens. Second, we measured the percentage of glandular lumen in all 122 patients. The prostatic epithelial volume was then calculated as follows: calculated epithelium volume (in cubic centimeters) = epithelium/glandular lumen ratio percentage of glandularlumen x total prostate volume (in cubic centimeters). RESULTS: The epithelium/glandular lumen ratio was 1.01 in the 20 specimens. In the 122 patients with benign prostatic hyperplasia, the calculated epithelial volume correlated more strongly with the serum PSA level than did the total prostate volume, transition zone volume, or percentage of epithelium (gamma = 0.672, P <0.0001). The mean PSA level per calculated epithelial volume was 1.27 ng/mL/cm(3). The calculated epithelial volumes from the biopsy specimens correlated significantly with those from transurethral resection specimens (gamma = 0.956, P <0.0001). CONCLUSIONS: Serum PSA levels correlated significantly with prostatic epithelial volumes in patients with benign prostatic hyperplasia. The method of measuring prostatic epithelial volume used in this study is very convenient for clinical practice.

[Tunica vaginalis testis autografting for Peyronie's disease: report of two cases].

Two patients with refractory Peyronie's disease were treated by tunica vaginalis testis autografting following surgical excision of indurated tunica albuginea of the corpora cavernosa. One patient could achieve relief of pain and a straight erection of the penis 3 months after surgery. Another patient could not obtain a satisfactory erection during the follow-up of 6 months, but could have sexual intercourse after 7 months. A tunica vaginalis testis autograft might be an ideal substitute for tunica albuginea because it has several advantages: it causes no rejection at the recipient site; it is flexible enough to accommodate to expansion; there is no development of sebaceous glands and hair follicles that may occur in the use of a dermal graft; and it is easy to obtain.