Angelo A. Baccala

Pathological evidence of necrosis in recurrent renal mass following treatment with sunitinib

Abstract:  Sunitinib is a highly potent, selective vascular endothelial growth factor‐receptor types 1 to 3, platelet‐derived growth factor (PDGF)‐R‐α, and PDGF‐R‐ß. Preclinical data suggest that sunitinib (SU11248) has antitumor activity that may result from both inhibition of angiogenesis and direct antiproliferative effects on certain tumor cell types. Sunitinib resulted in tumor shrinkage in 80% of patients who had failed treatment with Bevacizumab and 13% of patients demonstrated an objective Response Evaluation Criteria in solid Tumors (RECIST) in a study presented at the 2006 American Society of Clinical Oncology (ASCO) meeting. We report the first published pathological evidence of sunitinibs effect on recurrent renal cell carcinoma. This was seen in a patient with renal cell carcinoma who developed a renal fossa recurrence 2 years following radical nephrectomy. Tumor shrinkage was evident in the nephrectomy bed after treatment with sunitinib. The pathology of the resected retroperitoneal mass and its implications are discussed.

Documenting the Location of Systematic Transrectal Ultrasound-Guided Prostate Biopsies: Correlation with Multi-Parametric MRI.

Abstract During transrectal ultrasound (TRUS)-guided prostate biopsies, the actual location of the biopsy site is rarely documented. Here, we demonstrate the capability of TRUS-magnetic resonance imaging (MRI) image fusion to document the biopsy site and correlate biopsy results with multi-parametric MRI findings. Fifty consecutive patients (median age 61 years) with a median prostate-specific antigen (PSA) level of 5.8 ng/ml underwent 12-core TRUS-guided biopsy of the prostate. Pre-procedural T2-weighted magnetic resonance images were fused to TRUS. A disposable needle guide with miniature tracking sensors was attached to the TRUS probe to enable fusion with MRI. Real-time TRUS images during biopsy and the corresponding tracking information were recorded. Each biopsy site was superimposed onto the MRI. Each biopsy site was classified as positive or negative for cancer based on the results of each MRI sequence. Sensitivity, specificity, and receiver operating curve (ROC) area under the curve (AUC) values were calculated for multi-parametric MRI. Gleason scores for each multi-parametric MRI pattern were also evaluated. Six hundred and 5 systemic biopsy cores were analyzed in 50 patients, of whom 20 patients had 56 positive cores. MRI identified 34 of 56 positive cores. Overall, sensitivity, specificity, and ROC area values for multi-parametric MRI were 0.607, 0.727, 0.667, respectively. TRUS-MRI fusion after biopsy can be used to document the location of each biopsy site, which can then be correlated with MRI findings. Based on correlation with tracked biopsies, T2-weighted MRI and apparent diffusion coefficient maps derived from diffusion-weighted MRI are the most sensitive sequences, whereas the addition of delayed contrast enhancement MRI and three-dimensional magnetic resonance spectroscopy demonstrated higher specificity consistent with results obtained using radical prostatectomy specimens.

Laparoscopic Partial Nephrectomy for Tumour in the Presence of Nephrolithiasis or Pelvi-Ureteric Junction Obstruction.

To report on patients with a small renal mass and concomitant calculus or pelvi‐ureteric junction obstruction (PUJO), and to propose an algorithm for minimally invasive management when these conditions coexist, as the success of laparoscopic partial nephrectomy (LPN) depends greatly on the absence after surgery of ureteric obstruction.

LAPAROSCOPIC PYELOLITHOTOMY IN A PELVIC KIDNEY

orientation of the renal pelvises and the location of the calculus often prevents percutaneous access. However, we show that by keeping a few key principles in mind, laparoscopic surgical success can be achieved in such situations. METHODS: We performed a left laparoscopic pyelolithotomy in a 33 year old woman with a 5cm staghorn calculus. The patient had no evidence of ureteral pelvic junction (UPJ) obstruction on mag-3 renal scan. A retrograde was performed and a 7 fr. double J stent was placed prior to the procedure. Port placement was performed with 4 ports placed in a diamond shape below the umbilicus. The ureter and renal pelvis