Transplantation of Renal Allograft After Removal of Renal Cell Carcinoma: Case Report and Review of the Literature.

With the rising incidence of end-stage renal disease in the United States, patients needing renal transplants are waiting longer for increasingly scarce grafts. Formerly, the general practice was to avoid organs with tumors for transplant because of the risk of malignancy transmission to the recipient. However, with comprehensive donor selection and a small-sized primary tumor, the positive outcomes of transplant outweigh the risks of transmission after a partial nephrectomy. In our case, a 31-year-old woman, the daughter of the recipient, underwent a laparoscopic nephrectomy with an existing 8-mm tumor later confirmed as renal cell carcinoma. An ex vivo tumor enucleation was performed before the allograft was transplanted into the 69-year-old patient with endstage renal disease. At last follow-up, graft function has remained excellent with no evidence of local recurrence or metastasis in both the donor and recipient. Here, we describe our case and perform a literature review on the incidence and management of renal allografts with incidentally detected renal cell carcinoma during transplant.

Cytologic processing of ureteral microbiopsies is associated with higher sensitivity for detection of urothelial carcinoma compared with conventional biopsy processing.

INTRODUCTION: Because of the high rates of false-negative or nondiagnostic ureteral Piranha microbiopsies associated with low cellularity, we assessed the effect of processing these using cytology. MATERIALS AND METHODS: We included 2 groups of 44 consecutive microbiopsies processed from formalin as a standard surgical biopsy and 22 processed by cytology. All samples were from the ureter or renal pelvis or calyx. The cytology samples were collected in alcohol-based media and were prepared with a Cellient cell block only (n = 9) or with a Cellient cell block for the visible particles, together with ThinPrep, to capture the remaining desquamated cells (n = 13). RESULTS: Malignancy was diagnosed in 5 of 44 conventionally processed microbiopsies (11%) compared with 14 of 22 cytologically processed microbiopsies (64%; P < 0.001), including 1 case with invasion. Nineteen site-matched biopsies from 2 patients had undergone both cytologic and surgical processing, with 8 of 8 cytologically processed biopsies diagnosed as malignant. None of the 11 surgically processed biopsies from the same patients matched for site were diagnosed as malignant. Of the 11, 2 (18%) were suspicious for high-grade urothelial carcinoma and 6 (55%) were considered atypical. Increased sensitivity from cytologic processing appears related to increased cell recovery; large numbers of well-preserved urothelial cells were identified in the ThinPrep (range, 1000-25,000 cells/slide), and a nonsignificant trend was found toward increased urothelium (defined as >200 cells/profile) in the Cellient cell blocks (14 of 22 [64%]) compared with the histologic biopsies (17 of 44 [39%]; P = 0.070). CONCLUSIONS: Cytologic processing of ureteral microbiopsies showed superior sensitivity for detecting high-grade urothelial carcinoma, apparently owing to the increased cellular recovery.

Mass Forming Eosinophilic Cystitis in Pediatric Patients.

Eosinophilic cystitis (EC) is an uncommon inflammatory disorder of uncertain etiology that has been described in adult and pediatric populations. We describe 3 recent cases of EC that presented as a mass lesion in pediatric patients from the New England region of the United States. All patients were initially suspected to have a malignancy, and biopsy was performed, which ultimately led to the diagnosis of EC. We propose the use of eosinophil density of >25 eosinophils per high-power field and myocyte degeneration as supportive histopathologic features to make this diagnosis. It is of utmost importance to consider EC in the differential diagnosis when approaching a pediatric patient with a bladder mass.

Robot-assisted laparoscopic partial nephrectomy for recurrent renal-cell carcinoma in patients previously treated with nephron-sparing surgery.

BACKGROUND AND PURPOSE: With the advent of robotics, it may be more feasible to offer minimally invasive nerve-sparing surgery (NSS), in the form of partial nephrectomy (PN), for patients with metachronous recurrence in the ipsilateral kidney after previous NSS. We studied the outcomes of patients undergoing robot-assisted laparoscopic partial nephrectomy (RAPN) after previous ipsilateral open or laparoscopic NSS for renal-cell carcinoma. METHODS: In this Institutional Review Board approved study, a prospectively maintained PN database was reviewed. Of 230 RAPNs performed between 2003 and 2011, five patients underwent RAPN after previous ipsilateral NSS. RESULTS: The mean age was 64.2 years, and time between the first and second surgery was 27 months (range 9-60 mos). All patients were men and previously had open (n=4) or laparoscopic (n=1) NSS for clear-cell (n=2), papillary (n=2), and other (n=1) pathology. Average follow-up was 15.6 months (range 8-21 mos). There were no conversions to open surgery or radical nephrectomy. Total and selective arterial clamping were performed in two and two cases, respectively. One RAPN was performed off-clamp. Mean warm ischemia time was 14 minutes (range 0-32 min), and mean blood loss was 220 mL (range 50-400 mL). Average length of stay was 1.4 days (range 1-2 days) with no perioperative complications. The glomerular filtration rate decreased by a mean of 10%. There were no recurrences detected on cross-sectional imaging at the most recent follow-up. CONCLUSION: RAPN after previous open or laparoscopic PN is safe and efficacious. It offers satisfactory intermediate functional and oncologic outcomes with minimal morbidity.

A rare presentation of nephrogenic adenoma: multiple upper tract lesions in a female patient.

Nephrogenic adenomas are rare benign lesions of the urinary tract occurring most frequently in the bladder of male patients. We report the case of a female patient presenting with gross hematuria, which lateralized to the left ureter on cystoscopy. At the time of ureteroscopy, two polypoid lesions were identified in an upper and lower pole calyx, which were found on biopsy to be nephrogenic adenomas. In addition to reporting this case, we review the literature for the pathophysiology of nephrogenic adenomas.

Presence of dextranomer-hyaluronic acid (DxHA) mound on postoperative ultrasound does not predict resolution of vesicoureteral reflux.

OBJECTIVE: Dextranomer-hyaluronic acid (DxHA) injection is an accepted treatment for vesicoureteral reflux (VUR), with success rates as high as 85-90% in selected patients. The DxHA mound can often be seen on postoperative ultrasound. We sought to determine whether the presence or absence of this mound on ultrasound can predict resolution of VUR on voiding cystourethrogram (VCUG). MATERIALS AND METHODS: A retrospective study evaluating patients who underwent cystoscopy and injection of DxHA from 2003 to the present was performed. Demographic variables, laterality and grade of VUR, postoperative ultrasound findings, and presence of VUR on postoperative VCUG were recorded. RESULTS: Fifty-one patients (95 ureters) underwent DxHA injection and had a postoperative ultrasound and VCUG for review. Five patients with persistent voiding dysfunction were excluded, leaving 46 patients and 86 ureters for review. The mean age at time of injection was 5.2 years (range 0.75-11 years) and mean grade of VUR was 2.5 (range 1-5). After DxHA injection, 75% of the ureters showed resolution of VUR, while 25% demonstrated persistent VUR. No correlation was made between the presence of DxHA mound and resolution of VUR on VCUG. CONCLUSION: In this series, the presence of a DxHA mound on initial postoperative ultrasound does not predict resolution of VUR. A larger prospective study is needed to evaluate additional parameters.

Parents and partners: enhancing participation in contraception use.

When adolescent girls choose to have sexual intercourse, it is important for them to have the knowledge, resources, and communication skills necessary to avoid unintended pregnancies. There are many barriers to contraceptive use that are specific to adolescents, and it is possible that parents and partners could help to support consistent and correct use of contraception. This paper reviews the existing literature on the role of parents and partners, and discusses the implications of this knowledge base for clinical practice. The specific recommendations in this manuscript are designed to aid health care providers in supporting the involvement of parents and partners in the lives of adolescent girls in order to promote the positive emotional and physical growth of adolescent girls.