Arthur N. Tessler

Renal cell carcinoma: Survival and prognostic factors

Three hundred twenty-six patients treated at New York University from 1970 to 1982 were studied for survival in relationship to surgical stage, type of therapy, and pathologic characterization of the primary tumor. At the time of diagnosis 25.5 per cent of tumors were Stage I, 15 per cent Stage II, 28.5 per cent Stage III, and 31 per cent Stage IV. The retrospective study showed that patients with tumor confined within the capsule achieved the highest five- and ten-year survivals of 88 per cent and 66 per cent, respectively. Survivals decreased as tumor invaded perirenal fat (67% and 35%) or regional lymph nodes (17% and 5%). Tumor invasion into the renal vein alone did not significantly change five-year survival (84%) but lowered ten-year survival to 45 per cent. Patients with metastases at the time of nephrectomy did poorly regardless of site of metastases or kind of adjuvant therapy, except for those managed by surgical extirpation of the secondary lesion. Certain tumor characteristics were associated with a better prognosis, e.g., size below 5 cm in diameter, lack of invasion of collecting system, perirenal fat or regional lymph nodes, and predominance of clear or granular cells growing into a recognizable histologic pattern.

Partial Nephrectomy for Renal Cell Carcinoma: Indications, Results and Implications

Of 52 patients who underwent partial nephrectomy for tumor 44 were found to have renal cell carcinoma. The indications for this parenchyma-sparing procedure were categorized according to the initial status of the contralateral kidney and included bilateral tumors or tumor in a solitary kidney in 16 patients (mandatory indications), unilateral carcinoma with compromise of the contralateral kidney by a benign disease process in 9 (relative indications) and small peripheral tumor with a normal contralateral kidney in 19 (elective indications). There were 4 recurrences that accounted for 3 deaths, all in patients with mandatory indications. All patients who underwent partial nephrectomy for relative or elective indications were without definite evidence of recurrent disease at last followup (over-all mean 36 months). Our results suggest that conservative surgery can often provide effective and advantageous therapy for renal cancer and we encourage further consideration of the role of partial nephrectomy as an alternative to radical nephrectomy in selected patients with small peripheral tumors and normal contralateral kidneys.

Aggressive Treatment of Metastatic Renal Cancer

Radical nephrectomy and excision of metastases were performed in 21 patients with metastatic renal cell carcinoma. Followup was 12 years. Eight patients had metastases at the time of diagnosis and survived an average of 54 months, with 50 per cent alive 5 years postoperatively. Metastases developed after nephrectomy for localized disease in 13 patients. After extirpation of the secondary lesions these 13 patients survived an average of 38 months and 25 per cent were alive at 5 years. Survival varied with the length of time free of disease. Patients in whom metastases developed later than 2 years after nephrectomy survived 55 months compared to only 22 months for those in whom metastases developed earlier. Survival also was influenced by tumor aggressiveness (reflected by prognostic index number) and completeness of surgical excision of the secondary lesion.

AIDS and germ cell tumors of testis

A retrospective analysis of all testicular tumors treated at our institution over a seven-year period was conducted. Twenty-five of 115 patients were found to have acquired immune deficiency syndrome (AIDS), AIDS-related complexes, or to be at risk for AIDS developing. Non-seminomatous germ cell tumors were more common in the AIDS group.

Inverted papilloma of the bladder. A distinct urological lesion

With the addition of six new cases, 104 cases of inverted papilloma of the bladder are reviewed. Pathological and epidemiological characteristics of this distinct bladder lesion are outlined, comparison with transitional cell papilloma is investigated, and recommended therapy and follow‐up are offered.

Radiotherapeutic prophylaxis of estrogen-induced gynecomastia: A study of late sequela

Radiation therapy is an effective means of preventing the development of hormone-induced gynecomastia in men with cancer of the prostate. The efficacy and morbidity of this type of radiation was studied in a retrospective analysis of 87 patients referred for treatment from 1972 to 1982. Patients receiving DES as treatment for prostate carcinoma were treated with irradiation to the breast tissue. Patients were treated with 4 MV, 60Co superficial X rays. Doses range from 1200 to 1500 cGy in 3 fractions. The majority of patients had satisfactory results in terms of prevention of gynecomastia and mammalgia. There were few acute reactions noted and no evidence of long term sequela.

Extragenital mixed heterologous tumor of müllerian type arising in retroperitoneum

A case report of extragenital tumor of müllerian type arising from the posterior peritoneum and compressing the kidney is presented. The embryologic basis for this type of tumor arising in the peritoneum is discussed.

Proximal tubular adenoma of kidney

Abstract Fourteen cases of benign tumor, radiographically and angiographically indistinguishable from a renal malignancy, are presented. Clinically, these cases are distinguished by the absence of symptoms referable to the lesion and pathologically differentiated both grossly and microscopically. Our recent experience with 5 cases suggests the possibility that its incidence is increasing and may be related to some specific epidemiologic etiology.

Polyorchidism with normalspermatogenesis

Abstract A case of polyorchidism with normal spermatogenesis is reported; embryology and possible mechanisms of development are discussed.

The Buschke-Loewenstein tumor

Abstract The Buschke-Loewenstein tumor, clinically indistinguishable from squamous cell carcinoma, is probably a well-differentiated carcinoma from the beginning and should be treated as such. Areas of anaplastic change that develop subsquently probably represent loss of differentiation in a previously well-differentiated malignancy and not the malignant degeneration of a benign lesion. Because of the malignant behavior of this lesion, early aggressive extirpative therapy is recommended.