Endoluminal Sonographic Evaluation of Ureteral and Renal Pelvic Neoplasms

Printed in J. Urol., 159 318, 1997 Editorial Comment: These authors describe 38 patients who had endoluminal ultrasound evaluation of upper tract neoplasms. This examination was performed with a 12.5 or 20 MHz. transducer housed in only a 6.2F catheter. Invasion was demonstrated ultrasonographically in 5 patients and was confirmed pathologically in 3. There were 2 false-positives with diffuse wall thickening and focal mucosal edema. However, in most patients the ultrasonographic evaluation was accurate. These higher megahertz transducers provide increased tissue resolution, although less tissue penetrance. In some endoscopic or laparoscopic procedures ultrasound can provide the operator with vision beyond the immediate surface on which he/she is working. Fray F. Marshall, M.D. Epithelioid Angiomyolipoma of the Kidney. A Report of Five Cases With a Prominent and Diagnostically Confusing Epithelioid Smooth Muscle Component J. N. EBLE, M. B. AMIN AND R. H. YOUNG, Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, Henry Ford Hospital, Detroit, Michigan, and Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts Amer. J. Surg. Path., 21: 1123-1130, 1997 We report five angiomyolipomas with a prominent component of epithelioid smooth muscle cells that occurred in patients from 20 to 48 (mean, 36) years of age. The tumors often posed problems in diagnosis, particularly with regard to distinction from renal cell carcinoma. Two patients had tuberous sclerosis. Two patients with more than 5 years’ follow-up are alive and well. The epithelioid smooth muscle cells typically formed sheets that in two tumors were traversed by hyaline cords. The epithelioid cells ranged from medium sized and polygonal with slightly pleomorphic nuclei and eosinophilic cytoplasm to giant cells with prominent nucleoli. Hemorrhage, necrosis, and clusters of foamy macrophages were present in three tumors. Mitotic figures were easy to find in two of the tumors, but they were absent in the others. Obvious elements of typical angiomyolipoma were present in two tumors. The others contained only scattered, thick-walled blood vessels or a few fat cells suggestive of typical angiomyolipoma. None of the tumors was positive for lowor high-molecular-weight cytokeratins or epithelial membrane antigen. Actin was detected in the epithelioid areas in four tumors. Melanoma-associated antigens related to the ~ 1 0 0 c l gene product, HMB-45 and HMB-50, were present in all the tumors. Another melanoma-associated antigen, CD63 RENAL TUMORS, RETROPERITONEUM, URETER, AND URINARY DIVERSION AND RECONSTRUCTION (NKUC31, also was present in all the tumors, a finding suggesting that angiomyolipoma has features in common with melanoma beyond premelanosomal structures. Editorial Comment: The authors describe 5 cases of angiomyolipoma with a prominent component of epithelioid or smooth muscle cells. These tumors present diagnostic uncertainty and in some cases were originally interpreted as renal cell carcinoma. Immunohistochemistry was helpful. Cytokeratins or epithelial membrane antigens are typically found in renal cell carcinoma. However, epithelioid angiomyolipomas typically contain actin, HMB-45, HMB-50 and CD63, which are absent from renal cell carcinoma. These features should help in distinguishing these 2 entities, particularly when renal cell carcinoma is unlikely, such as in a young patient or one with tuberous sclerosis. Fray F. Marshall, M.D. Decreased Expression of a-Catenin is Associated With Poor Prognosis of Patients With Localized Renal Cell Carcinoma T. SHIMAZUI, P. P. BRINGUIER, H. VAN BERKEL, E. RUIJTER, H. AKAZA, F. M. J. DEBRUYNE, E. OOSTERWUK AND J. A. SCHALKEN, Urological Research Laboratory and Department of Pathology, University Hospital, Nijmegen, The Netherlands, and Department of Urology, Znstitute of Clinical Medicine, University of Tsukuba, Zbaraki, Japan Int. J. Cancer, 74: 523-528, 1997 During the progression of many cancers, cell-cell adhesion molecules, e.g., E-cadherin (EC), may be down-regulated. In a number of carcinomas, EC has been described as an independent prognostic variable. We have studied the expression of adhesion molecules participating in cadherin-catenin complexes in renal cell carcinoma (RCC) specimens. Expression of EC catenins and pl20cas protein was examined in frozen tissue of 90 RCC specimens by immunohistochemistry, and these molecules were evaluated for their significance as prognostic markers. Staining was scored as normal (homogeneously positive at cell-cell borders) or abnormal (heterogeneous or absent). A significant correlation between poor survival and decreased expression of a-, por y-catenin was observed, whereas no association between survival and EC or pl20cas expression was seen. Cox’s proportional hazard regression analysis showed that in patients with pTI-3NOMO disease, reduced a-catenin expression correlated with poor survival, suggesting that a-catenin expression might be an independent prognostic indicator for patients of this group. Editorial Comment: Grade and stage are prognostic features for patients with renal cell carcinoma. Nuclear morphometry, proliferation rates and p53 expression are other potential prognostic markers. Cellular adhesion molecules, such as cadherins or catenins, have a role in the evohtion of neoplasia. Cadherins are transmembrane glycoproteins that interact and connect with cytoplasmic proteins, such as the catenins. Cadherin mediated cellular adhesiveness is important for the integrity of epithelial cells, and decreased E-cadherin expression may be associated with tumor invasion and a poor prognosis. In this study decreased expression of a, p and y catenin was observed, and there appeared to be a significant correlation between poor survival and decreased expression of a-catenin. Fray F. Marshall, M.D. 1955 Dendritic Cells for the Immunotherapy of Renal Cell Carcinoma M. THURNHER, H. K L O C ~ R , C. PAPESH, R. RAMONER, C. RADMAYR, A. HOBISCH, G. GASTL, N. ROMANI, S. EBNER, G. BOCK AND G. BARTSCH, Departments of Urology, Hematology, Oncology and Dermatology, and Znstitute of General and Experimental Pathology, University of Znnsbruck, Innsbruck, Austria Urol. Int., 5 9 1-5, 1997 No Abstract Editorial Comment: This article provides an excellent background of information on dendritic cells, which have become recognized as increasingly important components in cytolytic T cell mediated immunotherapy, especially in renal cell carcinoma. Fray F. Marshall, M.D. Should Continent Diversion be Performed in Patients With Locally Advanced Bladder Cancer? A, M. WARD, T. OLENCKI, D. PEERBOOM AND E. A. KLEIN, Departments of Urology and Medical Oncology, Urology, 51: 232-236, 1998 Objectives. To assess the effect of local, regional, and distant recurrence on pouch function in patients with locally advanced bladder cancer treated by cystectomy and continent diversion. Methods. A review of 64 consecutive patients undergoing orthotopic (n = 40) or continent cutaneous (n = 24) urinary diversion was performed; 25 patients (39.1%) had locally advanced cancers as defined by deep Cleveland Clinic Foundation, Cleweland, Ohio