Laparoscopic resection of large adrenal ganglioneuroma.

We report on a 23-year-old woman with a right adrenal tumor 13 cm in diameter who was treated by laparoscopy. The patient was asymptomatic, and the tumor was incidentally diagnosed on abdominal ultrasonography. A subsequent computed tomography (CT) of the abdomen confirmed a 12 x 7 x 8-cm homogenous mass of the right adrenal. Magnetic resonance imaging (MRI) showed a solid mass measuring 13 x 7 x 7.5 cm arising from the right adrenal. Laparoscopic complete excision of the mass was accomplished through a transabdominal lateral approach. The postoperative period was uneventful, and the patient was discharged on the second postoperative day. Histology was consistent with an adrenal ganglioneuroma. Two years later, there is no evidence of recurrence on abdominal CT scan.

Multicentricity in renal cell carcinoma: can primary tumor location serve as a co-determinant of surgical treatment?

OBJECTIVE: To assess the incidence of multicentricity in our series of renal cell carcinoma (RCC) patients and to investigate whether certain clinicopathological parameters could assist the selection of the appropriate surgical modality. METHODS: We performed a retrospective analysis of 235 RCC specimens that had been resected by radical nephrectomy at our institution from June 1995 to 2001. RESULTS: Twenty-six (11%) kidneys contained at least one small accompanying nodule. Fourteen (6%) kidneys exhibited satellite tumors that were histologically consistent with the adenomas, while "true" multicentricity was detected in 12 (5%) specimens. In the latter, the number of concomitant foci was independent of the size of the primary tumor. No correlation was observed between histological pattern and multifocality. In five out of seven (71%) specimens that contained the main tumor mass within the upper or middle portion of the kidney, satellite lesions were found to be located at the mid-kidney, whereas specimens with lower-pole RCC demonstrated no restriction in the distribution of accompanying nodules. All patients had been screened pre-operatively by ultrasonography and CT scanning. CONCLUSIONS: Our findings may be suggestive of a putative link between primary tumor location and multicentricity, although this relation could not be statistically confirmed. The 5% incidence of multicentricity renders the biological significance of satellite adenomas and/or adenocarcinomas unclear.

Immunodetection of c-met-oncogene's protein product in renal cell neoplasia.

The proto-oncogene c-met encodes a transmembrane tyrosine kinase receptor for hepatocyte growth factor and is expressed in normal kidney tissue. This receptor may be involved in the carcinogenesis of various organs. The aim of this study was to investigate the relationship between c-met immunohistochemical expression and pathological tumor variables in human renal cell carcinomas (RCCs) and adenomas (RAs). Formalin fixed, paraffin embedded tissues from 35 RCCs, 16 RAs and 17 normal kidneys were immunostained (Strept. ABC/HRP) with a polyclonal antibody against c-met protein (Santa Cruz, Clone C-12). The statistical analysis was performed using the linear trend in proportions and Fisher's exact test. C-met protein was detected in the cytoplasm and the plasma membranes of neoplastic cells in 19/35 RCCs (54%), 10/16 adenomas (63%) (p = 0.41) and in 17/17 controls in the epithelial cells of distal renal tubules and collecting ducts. C-met protein expression was not related with gender (p = 0.45), age (p = 0.18), tumor size (p = 0.99), cell type (p = 0.26), grade (p = 0.86) and stage (p = 0.33). Moreover, c-met immunopositive tumor cell percentage and intensity were increased in stage [RCCs, but these results were not statistically significant. Apart from glandular differentiation, c-met protein expression was not related to other histopathological features (i.e. to the type of cells or to any selective overexpression in tumor cells). C-met product may be involved in the malignant transformation of tubular epithelial cells as an early event in RCC carcinogenesis. C-met expression does not seem to have any prognostic significance for RCCs, as it was not associated with any pathological prognosticator.