Christian Coulange

Prognostic significance of incidental renal cell carcinoma.

From 1980 to 1991, 236 patients with renal cell carcinoma were treated in our department. We studied the characteristics and the prognostic significance of 74 patients with incidental renal cancer in comparison with those with symptomatic tumors. The mean age of the patients was 59.8 years and the sex ratio 2 males/1 female. The incidence of incidental tumors increased from 14% in 1980 to 48% in 1991. Incidental tumors were discovered mainly during examination for cardiovascular diseases (26%), hepatobiliary diseases (22%) and general health examination (23%). Local tumoral stage and histologic grade were significantly lower for the incidental tumors than for symptomatic ones (p = 0.002 and p = 0.001). In the same way, the rates of the patients with metastases or nodal involvement were lower for those with incidental tumors than for those with symptomatic tumors (p = 0.008 and p = 0.001). The mean tumoral size was 5.7 +/- 3 cm for incidental tumors and 7.6 +/- 3.5 cm for symptomatic tumors (p = 0.0001). The survival was significantly different according to the circumstances of detection of the tumors (p < 0.001); the 5- and 10-year actuarial survival rates was 85% for the patients with incidental tumors and respectively 61 and 44% for the patients with symptomatic tumors. The multivariate analysis by Cox proportional hazard model showed three important and independent prognostic factors: the presence of metastases (relative risk (RR): 6.7), nodal involvement (RR: 4.6) and symptomatic tumors (RR: 1.7). The patients with incidental tumors had a better prognosis than those with symptomatic tumors because of lower tumoral size and local stage. The early diagnosis of renal cell carcinoma improved the prognosis of the patients.

High-intensity focused ultrasound in prostate cancer; a systematic literature review of the French Association of Urology.

We discuss the efficacy and safety of high‐intensity focused ultrasound (HIFU) in patients with prostate cancer, to define the best indications for HIFU in daily clinical practice as primary therapy. We searched Medline and Embase for clinical studies evaluating the efficacy and safety of HIFU in prostate cancer (July 2007), and abstracts presented at the 2005–2007 annual meetings of the European Association of Urology and American Urological Association were screened. In all, 37 articles/abstracts were selected. As the data on HIFU as salvage therapy were limited, we focused on HIFU as primary therapy. Studies consisted of case series only. Included patients were ≈70 years old with T1‐T2 N0M0 disease, Gleason Score ≤7, a prostate‐specific antigen (PSA) level of ≤28 ng/mL and a prostate volume of ≤40 mL. Negative biopsy rates with the AblathermTM device (EDAP TMS S.A., Vaulx‐en‐Velin, France) were 64–93%, and a PSA nadir of ≤0.5 ng/mL was achieved in 55–84% of patients. The 5‐year actuarial disease‐free survival rates were 60–70%. The most common complications were stress urinary incontinence, urinary tract infection, urethral/bladder neck stenosis or strictures, and erectile dysfunction. For the Ablatherm device, the rate of complications has been significantly reduced over the years, due to technical improvements in the device and the use of transurethral resection of the prostate before HIFU. In conclusion, HIFU as primary therapy for prostate cancer is indicated in older patients (≥70 years) with T1‐T2 N0M0 disease, a Gleason score of <7, a PSA level of <15 ng/mL and a prostate volume of <40 mL. In these patients HIFU achieves short‐term cancer control, as shown by a high percentage of negative biopsies and significantly reduced PSA levels. The median‐term survival data also seem promising, but long‐term follow‐up studies are needed to further evaluate cancer‐specific and overall survival rates before the indications for primary therapy can be expanded.

Attempted Isolation of Nanobacterium sp. Microorganisms from Upper Urinary Tract Stones

ABSTRACT A single team has reported isolation of nanobacteria in human and bovine blood products, as well as, more recently, kidney stones. This has raised controversy. To confirm the data, we searched for nanobacteria from 10 aseptically removed upper urinary tract (UUT) stones. We used scanning electronic microscopy (SEM) with four stones and culture of stones on either 3T6 fibroblast monolayers or liquid RPMI medium. Detection of nanobacteria was made with a commercially available monoclonal antibody, 16S ribosomal DNA amplification with specific primers, and transmission electronic microscopy (TEM) of inoculated cells. SEM showed nanoparticles in four of four UUT stones similar to those recently described. TEM of inoculated 3T6 cell monolayers has shown transient intracytoplasmic vacuolar formations containing 200- to 500-nm particles in 3 of 10 cell cultures. Gimenez staining, Hoechst staining, and specific monoclonal immunofluorescence failed to reveal nanobacteria. Finally, we could not grow Nanobacterium sp. microorganisms by the techniques described. Although with SEM, we observed nanoparticles morphologically similar to nanobacteria, we failed to isolate Nanobacterium sp. microorganisms in culture and to prove the bacterial nature of these nanoparticles in stones.

A french national epidemiologic survey on renal cell carcinoma

In this multicenter study, the yearly national evaluation of tumors of the kidney was out by the Oncology Committee of the French Association of Urology.

Neural cell adhesion molecule expression in renal cell carcinomas: relation to metastatic behavior

Neural cell adhesion molecule (NCAM), a member of the immunoglobulin superfamily, is expressed by a subgroup of renal cell carcinomas (RCCs) and by a limited number of adult organs, including the central nervous system (CNS) and adrenal gland. Because the major function of NCAM is homophilic adhesion between homotypic and heterotypic cells, we hypothesized that NCAM-expressing RCCs should preferentially metastasize to the CNS and adrenal gland. We did a retrospective immunohistochemical analysis of NCAM expression both in 338 primary renal tumors, including 249 conventional RCCs and 31 metastases of conventional RCCs. In primary renal tumors, NCAM was expressed by only 38 (15.2%) conventional RCCs and by no other histological subtypes of renal tumor. This expression correlated with a higher risk of adrenal and CNS metastases (P <0.001). NCAM expression also correlated with tumor size (P <0.001), renal vein involvement (P = 0.02), perirenal invasion (P = 0.02), and Fuhrman grading (P < 0.001). Finally, patients with NCAM-expressing RCCs had a lower survival rate (P = 0.006), especially in the first 2 years after surgery. NCAM expression is of interest both for evaluating the prognosis of patients with conventional RCCs and for determining a subgroup of patients at high risk for adrenal and CNS metastases.

Adult mesoblastic nephroma.

We report a case of asymptomatic mesoblastic nephroma in a 54-year-old woman. The tumor showed immunohistochemical reactions similar to developing nephrons. Electron microscopy showed immature tubules with numerous intracytoplasmic intermediate filaments. Recent studies support the concept of pathogenesis of the mesoblastic nephroma originating from collecting ducts. However, this case exhibited a complex pattern of antigenic expression not restricted to the collecting ducts, but including the glycoprotein CD24 and the neural cell adhesion molecule (NCAM). The following differential diagnoses will be discussed: benign mixed epithelial and stromal tumor, metanephric adenoma, and nephrogenic adenofibroma.

Effect of digital rectal examination on serum complexed and free prostate-specific antigen and percentage of free prostate-specific antigen

OBJECTIVES To evaluate the effects of digital rectal examination (DRE) on serum total, calculated complexed, and free prostate-specific antigen (PSA) and the free/total PSA ratio and factors affecting variations of PSA. METHODS Serum total and free PSA and the percent free PSA ratio were determined in 91 urologically referred men (mean age 64 +/- 9 years) before and 30 minutes after DRE, with the Hybritech Tandem-R assay. Complexed PSA was calculated as the difference between total and free PSA. DRE effects on PSA were analyzed comparing pre-DRE and post-DRE values and by calculating the difference between pre-DRE and post-DRE PSA and the post/pre-DRE geometric ratio as a coefficient of variation. RESULTS Thirty minutes after DRE, the increase in total, calculated complexed, and free PSA and the percent free PSA ratio was statistically significant. The difference between post-DRE and pre-DRE values of serum total, calculated complexed, and free PSA and percent free PSA was +0.9, +0.3, and +0.6 ng/mL and + 10%, respectively. The post/pre-DRE ratio of serum total, calculated complexed, and free PSA and percent free PSA was x1.5, x1.22, and x2.5 and x1.7, respectively. Patient age, DRE findings, prostate volume, prostate histologic features, and the initial value of total PSA had no statistically significant effect on the change of percent free PSA after DRE. The initial percent free PSA had a statistically significant effect on the change of percent free PSA after DRE. The values of calculated complexed PSA before and after DRE were significantly higher in patients with a prostate volume greater than 40 cc, prostate cancer on biopsy, and an initial free/total PSA ratio greater than 18%. CONCLUSIONS In this study, DRE significantly increased total, calculated complexed, and free PSA and percent free PSA. The increase of PSA immediately after DRE was mainly due to the increase of free PSA. The change of percent free PSA after DRE depended on the initial percentage of free PSA. Complexed PSA seems less sensitive to DRE, and its changes after DRE were clinically modest. Free PSA measurement should be done before DRE and percent free PSA should be used only when the venipuncture is done before the DRE.

CD44s and CD44v6 expression in localized T1–T2 conventional renal cell carcinomas

To assess the prognostic value of CD44s and CD44v6 tumour expression for patients with T1–T2 conventional renal cell carcinomas, a retrospective immunohistochemical analysis of 95 patients was undertaken. These patients had undergone a radical nephrectomy, performed in three institutions in France between 1987 and 1993. The mean age of the patients was 62.9±10.2 years (range from 37 to 85 years) with 66.3% males. At the time of surgery, 84 patients had a T1 and 11 a T2 renal tumour. Fuhrman nuclear grading showed 44 (46.3%) tumours of grade 1, 39 (41.1%) of grade 2, and 12 (12.6%) of grade 3. The mean follow‐up period was 58.1±36.1 months. At the end of follow‐up, eight patients (8.4%) had metastatic disease and no local recurrence was seen. Immunohistochemistry showed that 26 tumours (27.4%) expressed CD44s, but none expressed CD44v6. Statistical analysis showed that CD44s expression was correlated with tumour size (p=0.006) and Fuhrman grading (p<10−4). Among the various parameters tested for the multivariate analysis, CD44s expression correlated only with disease‐free survival (p=0.04). It is concluded that CD44s expression, but not CD44v6, is of potential prognostic interest in patients with localized T1–T2 conventional renal cell carcinomas. Copyright

Transurethral Ureterorenolithotripsy Using New Automated Irrigation/Suction System Controlling Pressure and Flow Compared with Standard Irrigation: A Randomized Pilot Study

PURPOSE To compare in a random fashion an automated irrigation/suction pump system with the standard pressurized technique during transurethral ureterorenolithotripsy. PATIENTS AND METHODS Between July 2001 and December 2001, 47 patients were prospectively included. Prior to randomization, rigid instruments were allocated to 25 patients (group R) and flexible instruments to 22 patients (group F) according to stone location. The groups R and F were then randomized separately, and the pressurized technique was employed in groups R1 and F1, while the automated system was employed in groups R2 and F2. Operative time, amount of liquid consumed, and stone-free rate at the end of the procedure were analyzed. RESULTS For the entire series, ureteroscopy time using the automated system (mean 42 +/- 17[SD] minutes; range 15-90 minutes) was 35% less than with the pressurized technique (mean 65 +/- 25 minutes; range 20-135 minutes) (P = 0.04 Wilcoxon score). The stone-free rate was significantly higher in groups R2 + F2 (92%) than in groups R1 + F1 (69%) (P = 0.048). CONCLUSION With the ENDO FMS UROLOGY system, there was a significant reduction in the mean ureteroscopy time: 32% less with the rigid instrument and 53% less with the flexible instrument. This seems to be attributable to a wider working space and highly improved visibility. The integrated suction at constant flow allows efficient evacuation of stone fragments while limiting cavity pressure. These results, obtained on 47 patients, should be confirmed by larger randomized studies.

Molecular cytogenetics of t(X;1)(p11.2;q21) with complex rearrangements in a renal cell carcinoma

We report a new case of renal cell carcinoma with the translocation (X;1)(p11;q21) and complex structural rearrangements in a female patient of 64 years of age. We analyzed abnormalities using FISH to identify chromosomal rearrangements, and wonder whether the translocation (X;1) could represent a particular subentity in renal cell carcinoma with distinct histologic features.