Valor diagnóstico y predictivo del estudio en orina del gen PCA3 para el manejo clínico de pacientes con antígeno prostático específico alterado / Diagnostic and Predictive Value of Urine PCA3 Gene Expression for the Clinical Management of Patients with Altered Prostatic Specific Antigen

Objetivo: Analizar el impacto de la introducción del estudio del gen PCA3 en orina posmasaje prostático, en el manejo clínico de pacientes con PSA alterado, valorando su capacidad diagnóstica y predictiva de agresividad tumoral. Métodos: Estudio observacional, prospectivo y multicéntrico de pacientes con sospecha de adenocarcinoma de próstata (AP) candidatos a biopsia. Presentamos una serie de 670 muestras consecutivas de orina posmasaje prostático recogidas durante 3 años en las que se determinó el «score de PCA3» (s-PCA3). Se indicó biopsia únicamente en los casos con s-PCA3 positivo. Resultados: El s-PCA3 fue positivo en el 43,7% de las muestras. En las 124 biopsias realizadas, la incidencia de AP o proliferación microacinar atípica fue del 54%, llegando al 68,6% en s-PCA3 ≥ 100. Demostramos relación estadísticamente significativa entre el s-PCA3 y el grado tumoral. En los casos con s-PCA3 positivo pero inferior a 50, solo el 23% de AP fueron de alto grado (Gleason ≥ 7); en cambio, en los casos con s-PCA3 superior a 50 lo fueron el 76,7%. La relación entre el s-PCA3 y el porcentaje de cilindros afectados en la biopsia fue significativa. Ambas relaciones se confirmaron al aplicar el modelo log-lineal. Conclusiones: La incorporación del PCA3 permite prescindir de la biopsia en un 54% de los pacientes. La positividad del s-PCA3 aumenta la probabilidad de biopsia positiva, especialmente en s-PCA3 superior a 100 (68,6%). El s-PCA3 es también un indicador de agresividad tumoral y aporta información esencial en la toma de decisiones terapéuticas

Objective: Analyze the impact of the introduction of the study of PCA3 gene in post-prostatic massage urine in the clinical management of patients with PSA altered, evaluating its diagnosticability and predictive value of tumor aggressiveness. Methods: Observational, prospective, multicenter study of patients with suspected prostate cancer (PC) candidates for biopsy. We present a series of 670 consecutive samples of urine collected post-prostatic massage for three years in which we determined the «PCA3 score»(s-PCA3). Biopsy was only indicated in cases with s-positive PCA3. Results: The s-PCA3 was positive in 43.7% of samples. In the 124 biopsies performed, the incidence of PC or atypical small acinar proliferation was 54%, reaching 68,6% in s-PCA3≥100. Statistically significant relationship between the s-PCA3 and tumor grade was demonstrated. In cases with s-PCA3 between 35 and 50 only 23% of PC were high grade (Gleason≥7), compared to 76.7% in cases with s-PCA3 over 50. There was a statistically significant correlation betweens-PCA3 and cylinders affected. Both relationships were confirmed by applying a log-linear model. Conclusions: The incorporation of PCA3 can avoid the need for biopsies in 54% of patients.s-PCA3 positivity increases the likelihood of a positive biopsy, especially in higher s-PCA3 100(68.6%). s-PCA3 is also an indicator of tumor aggressiveness and provides essential information nin making treatment decisions

Diagnostic and predictive value of urine PCA3 gene expression for the clinical management of patients with altered prostatic specific antigen.

OBJECTIVE: Analyze the impact of the introduction of the study of PCA3 gene in post-prostatic massage urine in the clinical management of patients with PSA altered, evaluating its diagnostic ability and predictive value of tumor aggressiveness. METHODS: Observational, prospective, multicenter study of patients with suspected prostate cancer (PC) candidates for biopsy. We present a series of 670 consecutive samples of urine collected post-prostatic massage for three years in which we determined the "PCA3 score" (s-PCA3). Biopsy was only indicated in cases with s-positive PCA3. RESULTS: The s-PCA3 was positive in 43.7% of samples. In the 124 biopsies performed, the incidence of PC or atypical small acinar proliferation was 54%, reaching 68,6% in s-PCA3≥100. Statistically significant relationship between the s-PCA3 and tumor grade was demonstrated. In cases with s-PCA3 between 35 and 50 only 23% of PC were high grade (Gleason≥7), compared to 76.7% in cases with s-PCA3 over 50. There was a statistically significant correlation between s-PCA3 and cylinders affected. Both relationships were confirmed by applying a log-linear model. CONCLUSIONS: The incorporation of PCA3 can avoid the need for biopsies in 54% of patients. s-PCA3 positivity increases the likelihood of a positive biopsy, especially in higher s-PCA3 100 (68.6%). s-PCA3 is also an indicator of tumor aggressiveness and provides essential information in making treatment decisions.

La hibridación in situ fluorescente en la predicción de recurrencia del carcinoma urotelial / Fluorescent in situ Hybridization as a Predictor of Relapse in Urotelial Carcinoma

Objetivo: Evaluar la utilidad del estudio de alteraciones cromosómicas mediante hibridación in situ fluorescente en una serie de pacientes diagnosticados de carcinoma urotelial con un seguimiento mínimo de 24 meses, y analizar su posible efecto anticipador. Material y métodos: La serie global incluye 338 muestras procedentes de 98 pacientes con 84 episodios de carcinoma urotelial. Para evaluar la capacidad de predicción del test se estudió un subgrupo de 24 pacientes que presentaron como mínimo una recurrencia a lo largo del seguimiento (serie de recurrencia). Se consideraron 3 categorías (episodio coherente positivo, episodio coherente negativo y episodio no coherente) en función de la relación entre los resultados de la hibridación in situ fluorescente del estudio concomitante al nuevo episodio y las muestras precedentes. Resultados: La hibridación in situ fluorescente presentó mayor sensibilidad independientemente del grado, valor predictivo negativo y exactitud, mientras que la especificidad y el valor predictivo positivo fueron superiores para la citología convencional. En la serie de recurrencia 19/29 episodios resultaron coherentes, 11/19 fueron coherentes positivos, todos con carcinoma urotelial de alto grado, y 8/19 coherentes negativos, la mayoría de bajo grado. Conclusiones: La hibridación in situ fluorescente muestra una alta sensibilidad en un seguimiento de 24 meses, y es capaz de predecir recurrencias, especialmente en casos de alto grado. Nuestros datos demuestran también la existencia de carcinomas uroteliales sin alteraciones cromosómicas detectables con la metodología actualmente disponible. Los resultados apoyan un seguimiento multidisciplinar con la utilización combinada de la hibridación in situ fluorescente, citología y cistoscopia (AU)

Objective: To assess the value of the study of chromosomal alterations by fluorescent in situ hybridization in a series of patients diagnosed of urothelial carcinoma and a minimum follow up of twenty four months, as well as evaluate its putative predictive potential. Material and methods: The overall series includes 338 samples from 98 patients with 84 episodes of urothelial carcinoma. A subgroup of 24 patients who had at least one recurrence during the follow up was used to evaluate the predictive potential of the test. Three categories were considered (positive coherent episode, negative coherent episode, and incoherent episode) depending on the relationship between the fluorescent in situ hybridization result in the concomitant study of the new episode and those of the preceding samples. Results: Fluorescent in situ hybridization showed higher sensitivity regardless of grade, negative predictive value and accuracy, while specificity and positive predictive value were superior with conventional cytology. In the recurrence, series 19/29 episodes were coherent, 11/19 were positive coherent with urothelial carcinoma all high grade and 8/19 negative coherent, most low grade. Conclusions: Fluorescent in situ hybridization test shows good sensitivity during a follow up of twenty four months and is able to predict recurrence, especially in cases of high grade. Our data demonstrate the existence of urothelial carcinomas without detectable chromosomal abnormalities by currently available methodology. The results support a multidisciplinary follow up combining fluorescent in situ hybridization, cytology and cystoscopy (AU)

Fluorescent in situ hybridization as a predictor of relapse in urothelial carcinoma.

OBJECTIVE: To assess the value of the study of chromosomal alterations by fluorescent in situ hybridization in a series of patients diagnosed of urothelial carcinoma and a minimum follow up of twenty four months, as well as evaluate its putative predictive potential. MATERIAL AND METHODS: The overall series includes 338 samples from 98 patients with 84 episodes of urothelial carcinoma. A subgroup of 24 patients who had at least one recurrence during the follow up was used to evaluate the predictive potential of the test. Three categories were considered (positive coherent episode, negative coherent episode, and incoherent episode) depending on the relationship between the fluorescent in situ hybridization result in the concomitant study of the new episode and those of the preceding samples. RESULTS: Fluorescent in situ hybridization showed higher sensitivity regardless of grade, negative predictive value and accuracy, while specificity and positive predictive value were superior with conventional cytology. In the recurrence, series 19/29 episodes were coherent, 11/19 were positive coherent with urothelial carcinoma all high grade and 8/19 negative coherent, most low grade. CONCLUSIONS: Fluorescent in situ hybridization test shows good sensitivity during a follow up of twenty four months and is able to predict recurrence, especially in cases of high grade. Our data demonstrate the existence of urothelial carcinomas without detectable chromosomal abnormalities by currently available methodology. The results support a multidisciplinary follow up combining fluorescent in situ hybridization, cytology and cystoscopy.

What is the added value of combined core biopsy and fine needle aspiration in the diagnostic process of renal tumours?

PURPOSE: Non-diagnostic results still hinder the routine use of core biopsy (CB) and fine needle aspiration (FNA) in the diagnostic process of renal tumours. Furthermore, substantial interobserver variability has been reported. We assessed the added value of combining the results of CB and FNA by five pathologists in the ex vivo diagnosis of renal mass. METHODS: Two ex vivo core biopsies were taken followed by two FNA passes from extirpated tumours. All samples were evaluated by five blinded pathologists. A consensus diagnosis of the surgical specimen was the index for comparison. For each pathologist, the number of non-diagnostic (non-conclusive or undetermined biology and failed biopsies), correct and incorrect scored cases of each technique was assessed. When a non-diagnostic CB or FNA had a correct diagnostic counterpart, this was considered as of added value. RESULTS: Of the 57 assessed tumours, 53 were malignant. CB was non-diagnostic in 4-10 cases (7-17.5%). FNA established the correct diagnosis in 1-7 of these cases. FNA was non-diagnostic in 2-6 cases (3.5-10.5%), and the counterpart CB established the correct diagnosis in 1-6 of these cases. For the 5 pathologists, accuracy of CB and FNA varied between 82.5-93% and 89.5-96.5%, respectively. Combination of both types of biopsy resulted in 55-57 correct results (accuracy 96.5-100%), i.e., an increase in accuracy of 3.5-14%. CONCLUSION: Combining the result of CB and FNA in renal mass biopsy leads to a higher diagnostic accuracy. Recommendations on which technique used should be adapted to local expertise and logistic possibilities.

Fundació Institut d`Investigació en Ciències de la Salut Germans Trias i Pujol

Instituto cuya misión es descubrir, preservar, diseminar y potenciar el conocimiento multidisciplinar, traslacional, y de desarrollo tecnológico de excelencia de las ciencias biomédicas. La página incluye información institucional, líneas de investigación, servicios de soporte, novedades, publicaciones, etc.

Carcinoma urotelial de vejiga estadio T1: subestadiaje, patrones morfológicos de invasión y su significado pronóstico / Bladder urothelial carcinoma stage T1: substaging, invasion morphological patterns and its prognosis significance

Desde 1990 en que se publicaron las primeras series sobre subestadiaje, han aparecido numerosas publicaciones sobre el subnivel de invasión de los carcinomas de alto grado T1. La invasión profunda conlleva un elevado riesgo de progresión (alrededor del 30-35% de casos progresan) frente a los casos de invasión superficial por encima de la muscularis mucosae, en los que la progresión se encuentra alrededor del 10%, por lo que para la mayoría de autores vale la pena tener en cuenta los subT1, en el manejo del paciente. En esta revisión se presentan las series más exhaustivas que han valorado el subestadiaje y se valoran los diferentes métodos de efectuar esta estadificación teniendo en cuenta la dificultad inherente a las muestras que proceden de resección transuretral (RTU)

Since 1990 when the first series on substaging were published, they have published numerous publications on the invasion sublevel of high degree T1 carcinomas. The deep invasion entails a high risk of progression (around 30-35% of cases progress) as opposed to the cases of superficial invasion over “muscularis mucosae”, in which the progression is around 10%, reason why most authors consider subT1, in patient management. In this revision the more exhaustive series that have evaluated substaging are shown and also the different methods to carry out this staging considering the inherent difficulty to the samples that come from transurethral resection (RTU)

Pseudoneoplastic lesions of the testis and paratesticular structures.

Pseudotumors or tumor-like proliferations (non-neoplastic masses) and benign mimickers (non-neoplastic cellular proliferations) are rare in the testis and paratesticular structures. Clinically, these lesions (cysts, ectopic tissues, and vascular, inflammatory, or hyperplastic lesions) are of great interest for the reason that, because of the topography, they may be relevant as differential diagnoses. The purpose of this paper is to present an overview of the pseudoneoplasic entities arising in the testis and paratesticular structures; emphasis is placed on how the practicing pathologist may distinguish benign mimickers and pseudotumors from true neoplasia. These lesions can be classified as macroscopic or microscopic mimickers of neoplasia.

[Bladder urothelial carcinoma stage T1: substaging, invasion morphological patterns and its prognosis significance]. / Carcinoma urotelial de vejiga estadio T1: subestadiaje, patrones morfológicos de invasión y su significado pronóstico.

Since 1990 when the first series on substaging were published, they have published numerous publications on the invasion sublevel of high degree T1 carcinomas. The deep invasion entails a high risk of progression (around 30-35% of cases progress) as opposed to the cases of superficial invasion over "muscularis mucosae", in which the progression is around 10%, reason why most authors consider subT1, in patient management. In this revision the more exhaustive series that have evaluated substaging are shown and also the different methods to carry out this staging considering the inherent difficulty to the samples that come from transurethral resection (RTU).

[Usefulness of the present renal cell carcinoma classifications]. / Aplicación clínica de las actuales clasificaciones del cáncer renal.

The purpose of classifying neoplasias is to recognize groups with similar progress and prognosis and, if possible, receiving the same treatment. This is why those classifications are systematically being submitted to review and improvement through the new technologies. Differentiation of various entities in renal cancer has been comparatively fast, as the new genetic and molecular discoveries have confirmed the morphologic criteria of the different cell types, thus making it possible to open new therapeutic pathways. Using the current WHO classification we recognize subtypes with excellent prognosis (Multilocular cystic renal carcinoma, Type I renal papillary carcinoma, Tubular and fusocellular mucinous carcinoma), other very aggressive ones (Bellini's collecting duct carcinoma, Medullary carcinoma), and also that the sarcomatoid transformation, even in small areas, impacts the prognosis negatively. Childhood-characteristic renal carcinomas associated with chromosome translocations have been recognized (genetic fusion TFE3 or TFEB), as well as the family forms of renal carcinoma. Regarding the UICC (International Union Against Cancer) classification, there are a series of aspects under argument (size, venous invasion, microvascular invasion, invasion of the adipous tissue of the renal sinus) that shall be discussed too, since it is possible that some modifications of the TNM might occur in the near future.

[Influence of radioactive concentration and storage time on radiochemical purity of 18F-FDG]. / Influencia de la concentración radiactiva y el tiempo de almacenamiento sobre la pureza radioquímica de la 2-[18F]-fluoro-2-desoxi-D-glucosa.

OBJECTIVE: To study the influence of the 18F-FDG radioactive concentration and the usual greatest storage time of the radiopharmaceutical at the Radiopharmacy Unit (RU) over its radiochemical purity. MATERIAL AND METHODS: Thirty 18F-FDG preparations coming from different batches were studied. The radiochemical purity was determined at the RU by means of TLC to saline-diluted (1:10) and undiluted samples of each preparation, in the early 30 minutes since its arrival and 5 hours later. The radiochemical purity of the original 18F-FDG was determined at the PET radiopharmaceutical producer Laboratory (PETL) by means of HPLC in the early hour since the 18F-FDG dispensing. RESULTS: The increase of 18F-Fluoride found in the (5 h-30 min) period was significantly greater in the samples without diluting than in the diluted ones (p < 0.0001). We found a significant correlation between the percent of this increase of 18F-Fluoride (y) and the radioactive concentration of the 18F-FDG (x): y = 0.00061x + 0.1759 (R2 = 0.198; p < 0.0005). The percent of 18F-Fluoride determined at the RU was significantly higher than the percent of 18F-Fluoride determined at the PETL (p < 0.0001). A significant correlation between the differences of the percent of 18F-Fluoride determined by TLC and HPLC (y) and the radioactive concentration (x) was found: y = 0.0139x + 0.3146 (R2 = 0.196; p = 0.016). A significant correlation among the differences of percent 18F-Fluoride determined by TLC and HPLC ([%F] RU - [%F] PETL), the radioactive concentration (RC) and the time since the radiopharmaceutical dispensing (t) was found: [%F] RU - [%F] PETL = 0.01159*RC (mCi/mL) + 0.250*t (h) - 0.01903 (R2 = 0.226; p < 0.014). CONCLUSIONS: The stability of the 18F-FDG preparations with time increases when diminishing its concentration. We recommended the dilution of these preparations with physiological saline solution.

Influencia de la concentración radiactiva y el tiempo de almacenamiento sobre la pureza radioquímica de la 2- (18F) -fluoro-2-desoxi-D-glucosa / Influence of radioactive concentration and storage time on radiochemical purity of 18F-FDG

Objetivo. Determinar la influencia de la concentración radiactiva de la 2-[ 18F]-fluoro-2-desoxi-D-glucosa ( 18F-FDG) y el tiempo de almacenamiento máximo habitual del radiofármaco en la Unidad de Radiofarmacia (UR) sobre su pureza radioquímica. Material y métodos. Se estudiaron 30 preparaciones de 18F-FDG procedentes de lotes diferentes. Se determinó la pureza radioquímica en la UR dentro de los 30 minutos siguientes a su recepción y a las 5 horas mediante cromatografía en capa fina (TLC) a las muestras diluidas con suero salino fisiológico (1:10) y sin diluir. La pureza radioquímica también se determinó en el Laboratorio de radiofármacos PET (LPET) dentro de la primera hora posterior a su dispensación por cromatografía líquida a alta presión (HPLC). Resultados. El aumento de porcentaje de 18F-Fluoruro a las 5 horas fue significativamente mayor en las muestras sin diluir que en las diluidas (p < 0,0001), encontrándose una correlación significativa entre el aumento de porcentaje de 18F-Fluoruro con el tiempo (y) respecto a la concentración radiactiva (x): y = 0,0061x + 0,1759 (R 2 = 0,1977; p < 0,0005). El porcentaje de 18F-Fluoruro determinado en la UR fue significativamente mayor que el determinado en el LPET (p < 0,0001), obteniéndose una correlación significativa entre el aumento de porcentaje de 18F-Fluoruro (y) y la concentración radiactiva (x): y = 0,0139x + 0,3146 (R 2 = 0,196; p = 0,016). Se obtuvo una correlación significativa entre este aumento ([ %F] UR ­ [ %F] LPET), la concentración radiactiva (CR) y el tiempo desde la dispensación (t): [ %F] UR ­ [ %F] LPET = 0,01159*CR (mCi/ml) + 0,250*t (h) ­ 0,01903 (R 2 = 0,226; p = 0,014). Conclusiones. La estabilidad de las preparaciones de 18F-FDG aumenta al disminuir su concentración. Aconsejamos la dilución de estas preparaciones con solución salina fisiológica

Objective. To study the influence of the 18F-FDG radioactive concentration and the usual greatest storage time of the radiopharmaceutical at the Radiopharmacy Unit (RU) over its radiochemical purity. Material and methods. Thirty 18F-FDG preparations coming from different batches were studied. The radiochemical purity was determined at the RU by means of TLC to saline-diluted (1:10) and undiluted samples of each preparation, in the early 30 minutes since its arrival and 5 hours later. The radiochemical purity of the original 18F-FDG was determined at the PET radiopharmaceutical producer Laboratory (PETL) by means of HPLC in the early hour since the 18F-FDG dispensing. Results. The increase of 18F-Fluoride found in the (5 h-30 min) period was significantly greater in the samples without diluting than in the diluted ones (p < 0,0001). We found a significant correlation between the percent of this increase of 18F-Fluoride (y) and the radioactive concentration of the 18F-FDG (x): y = 0,00061x + 0,1759 (R 2 = 0,198; p < 0,0005). The percent of 18F-Fluoride determined at the RU was significantly higher than the percent of 18F-Fluoride determined at the PETL (p < 0,0001). A significant correlation between the differences of the percent of 18F-Fluoride determined by TLC and HPLC (y) and the radioactive concentration (x) was found: y = 0,0139x + 0,3146 (R 2 = 0,196; p = 0,016). A significant correlation among the differences of percent 18F-Fluoride determined by TLC and HPLC ([ %F] RU ­ [ %F] PETL), the radioactive concentration (RC) and the time since the radiopharmaceutical dispensing (t) was found: [ %F] RU ­ [ %F] PETL = 0,01159*RC (mCi/mL) + 0,250*t (h) ­ 0,01903 (R 2 = 0,226; p < 0,014). Conclusions. The stability of the 18F-FDG preparations with time increases when diminishing its concentration. We recommended the dilution of these preparations with physiological saline solution

Urinary retention secondary to presacral myelolipoma; first reported case diagnosed by prostate TUR and requiring a cystectomy.

Obstructive voiding symptoms may exceptionally be caused by extrinsic compression. We herein present a singular case of a 68-year-old male that presented with urinary retention and underwent prostate trans-urethral resection (TUR) with histology showing benign prostatic hyperplasia admixed with large amounts of myelolipoma tissue. To the best of our knowledge this is the first reported presacral myelolipoma diagnosed at prostate trans-urethral resection (TUR). Computed tomography revealed a 13 x 9 cm presacral mass displacing the rectum. Even though myelolipomas are regarded as benign, this case behaved aggressively since compressive effect evolved to severe constipation and eventually required a cystectomy.

Initial high-grade T1 urothelial cell carcinoma: feasibility and prognostic significance of lamina propria invasion microstaging (T1a/b/c) in BCG-treated and BCG-non-treated patients.

OBJECTIVES: This study aimed to determine the prognostic value of depth of lamina propria invasion in initial high-grade T1 bladder tumors. Secondary aims were to evaluate the prognostic significance of concomitant carcinoma in situ (CIS) and the impact of bacillus Calmette-Guérin (BCG) treatment as well as to assess the feasibility of microstaging by pathologists in a community setting. PATIENTS AND METHODS: Ninety-seven tumors were available for study and were substaged according to invasion superficial to, into or beyond the muscularis mucosae (MM) (T1a, T1b, T1c). Outcomes were compared by chi-square analysis. Recurrence-free and progression-free survival estimates were obtained by Kaplan-Meier analysis. BCG treatment impact and prognostic significance of CIS were also evaluated (Cox regression). RESULTS: T1 subclassification was possible in 87% (85/97) of cases: 38 (39.1%) T1a, 10 (10.3%) T1b, and 37 (38.1%) T1c; in 12 patients (12.4%) substaging was not possible. Mean age was 66.4 years and mean follow-up was 53 months. Recurrence rates were similar for all groups. By contrast, the progression rate for deep lamina propria-invasive tumors, i.e. T1b and T1c, was 34% (16/47) in comparison to 8% (3/38) for T1a (p=0.016). Progression-free intervals were significantly different in patients with (T1b, T1c) or without (T1a) deep lamina propria involvement (p=0.003), regardless of BCG treatment (p=0.02). BCG-treated patients (67 cases) showed a slight trend towards a better outcome, but differences were not significant. CIS was associated with more than 50% of cases that progressed. On multivariate analysis, depth of invasion and CIS remained two independent prognostic factors, increasing the hazards ratio of progression to 4.47 and 3.19 respectively. CONCLUSIONS: The depth of invasion in the TURB specimens is an independent prognostic factor for T1 bladder cancer even in BCG-treated patients. Associated CIS significantly increases the risk of progression in these patients. The percentage of cases that can be substaged according to the depth of lamina propria involvement increases over time with the collaboration between urologists and pathologists. Consequently, we support that routine pathological assessment of the level of MM invasion in patients with stage T1 bladder cancer should be included in the histopathological report.

Renal collecting (Bellini) duct carcinoma displays similar characteristics to upper tract urothelial cell carcinoma.

OBJECTIVES: To describe 3 cases of tumors located in the kidney that may relate collecting (Bellini) duct carcinoma (CDC) to urothelial cell carcinoma (UC). We hypothesized that these distinct tumor types may share a common origin. CDC is a subtype of renal cell carcinoma associated with a highly aggressive course, poor prognosis, and limited response to immunotherapy, behaving similarly to UC. METHODS: We present 2 cases of CDC and 1 case of UC of the renal papilla. We compared the clinical presentation and survival rate, together with the radiologic, histologic, and immunostaining (including p53) findings, with strong emphasis on the similarities. RESULTS: One patient with CDC had a previous history of grade 3, Stage Ta bladder UC. The urothelial carcinoma from the kidney papilla (case 3) presented carcinoma in situ of the adjacent urothelium and displayed mixed characteristics with CDC, namely location, positive staining for Ulex europaeus and pyelonephritic changes. p53 staining showed marked positivity in the tumor of patient 2. Disease progression was rapid, with a median survival of 5.6 months (range 5 to 7). CONCLUSIONS: The results of this study suggest that the broad category of renal cell carcinoma includes a spectrum of lesions. In this range of diseases, CDC might be distinct from conventional renal cell carcinoma but share biologic features with UC, with the consequent implications for management. This association between CDC and UC may reflect the common embryologic origin of collecting duct and urothelial cells, since they derive from progressive branching of the mesonephric (wolffian) duct. Furthermore, the differential cytogenetic expression profiles suggest that the molecular events underlying the development of distal nephron and proximal tubule renal cancers are distinct.

Handling and pathology reporting of renal tumor specimens.

The gold standard in the treatment of renal tumors is radical or partial nephrectomy. The surgical specimen handling is important since the pathologic features result in clinico-pathologic knowledge that determines prognosis, additional treatment and scientific studies. The correct handling of the specimen by urologists and pathologists becomes very basic in order to enable retrieval of a maximum of information. This protocol aims at standardization of the minimal criteria for handling, cellular subtyping, grading, staging and margin evaluation that must allow the comparison among the different scientific groups.

Small cell carcinoma of the urinary bladder. Presentation of 23 cases and review of 134 published cases.

OBJECTIVE: To investigate the morphological diagnostic criteria and biology of the urinary bladder small cell carcinoma (SCC). METHODS: Study of 23 cases of bladder SCC, looking for the clinical presentation, pathological features and evolution, and review of 134 previously published cases. RESULTS: The SCC is infrequent (0.48-1%), 50% of them have areas of transitional cell carcinoma, supporting the metaplastic theory. The classic small cell morphology is the best diagnostic criterion. The neurone-specific enolase and chromogranin A are good markers, but not indispensable. An early metastatic incidence (56%) with a high mortality rate (68.7%), mostly before 2 years after the diagnosis, is the typical evolution. Only the patients with additional cis-platinum-based chemotherapy have better prognosis. CONCLUSION: The pathologist should watch out for the presence of SCC and the urologist should consider the possibility of combined treatment for these cases.

[Morphologic course of prostatic hyperplasia]. / Evolución morfológica de la hiperplasia de próstata.

OBJECTIVE: To find a morphologic model of the development of prostate hyperplasia. METHODS: Study of the transitional zone in 60 patients (30 with infravesical obstruction, 30 with no obstructive symptoms) and quantification of the involved surface, number of pure stromal and glandular-stromal nodes, node area for each of them, and non-nodular area of the transitional zone, correlating each parameter to age based on clinical status. RESULTS: The greater transitional zone area is seen in patients with obstruction: 1376.83 +/- 408.17 mm2 vs 321.39 +/- 151.49 mm2 in asymptomatic patients, mainly due to a higher number of glandular-stromal nodes (17 vs 2.2) and their size, with a correlation to age (p = 0.03). Moderate increases of non-nodular areas are also found. CONCLUSIONS: These findings suggest that onset of prostate hyperplasia may be due to a consistent increase of the transitional area, and that in some patients, probably because of local factors, nodular development occurs as a result of both an increase in nodes number and size.

Evolución morfológica de la hiperplasia de próstata / Morphologic evolution of prostate hyperplasia

OBJETIVO: Hallar un modelo morfológico del desarrollo de la hiperplasia prostática. MÉTODOS: Se estudia la zona de transición de 60 pacientes (30 con obstrucción infravesical, y otros 30 sin síntomas obstructivos), cuantificándose la superficie de dicha zona, el número de nódu-los estromales puros y glándulo-estromales, el área nodular de cada uno de ellos, y el área no nodu-lar de la zona de transición, correlacionando cada uno de estos parámetros con la edad, de acuerdo a la situación clínica. RESULTADOS: La mayor área de la zona de transición se observa en los pacientes obstruidos, que es de 1376,83 ñ 408,17 mm2 frente a los 321,39 ñ 151,49 mm2 en los asintomáticos, y, a expensas, sobre todo, al incremento del número de nódulos glándulo-estromales (17 vs 2.2), y de su tamaño, correlacionándose con la edad (p = 0,03). También hay un moderado incremento del área no nodular. CONCLUSIONES: Estos hallazgos sugieren que el inicio de la hiperplasia prostática puede ser un incremento homogéneo de la zona de transición, y que en algunos pacientes, probablemente por fac-tores locales, se produce el desarrollo nodular, preferentemente glándulo-estromal, tanto por el aumento del número de nódulos como de su tamaño (AU)

Benign myoepithelioma of the skin.

A case of cutaneous myoepithelioma is reported. The tumor was composed of spindle-shaped, epithelioid, and plasmacytoid (hyaline) cells. It exhibited a widespread immunoreactivity for low molecular weight keratins and protein S-100, being irregularly positive for smooth muscle actin. Ultrastructural studies of tumor cells showed a variable content of intermediate filaments, with focal densities resembling smooth muscle dense bodies. A well-developed basal lamina, pinocytotic vesicles, and some desmosomes were also observed. In spite of being accepted as an individual entity, myoepitheliomas probably belong to a family of lesions that include mixed tumors. Therefore, this case can be considered as a salivary-gland-type tumor, probably originating from myoepithelial cells of sweat glands. The existence of this unique neoplasm provides further support to the debated role of myoepithelial cells in the development of mixed tumors.