Diclehan Orhan

Influence of tumor stage, size, grade, vascular involvement, histological cell type and histological pattern on multifocality of renal cell carcinoma.

PURPOSE We assessed the influence of clinical and pathological factors on multifocality of renal cell carcinoma. MATERIALS AND METHODS Between June 1995 and September 1999 radical nephrectomy was performed in 71 men and 32 women with a mean age of 56.5 years. The 103 removed kidneys with renal cell carcinoma were sectioned at 3 mm. intervals and inspected microscopically for satellite carcinomas. We evaluated pathological stage, grade, cell type, histological pattern, vascular involvement, tumor size and the incidence of multifocality. To determine cell type we used several classification systems. RESULTS The primary tumor was 2 to 20 cm. (mean plus or minus standard deviation 7.10 +/- 3.48). Overall satellite carcinomas were present in 22 of the 103 cases (21.4%). When the predominant lesion was 5 cm. or smaller, the incidence of multifocality was 19%. The incidence of multifocality was statistically higher in patients with stage pT3 than in those with stage pT1 or pT2 disease (p = 0.022). Multiple logistic regression analysis demonstrated that only primary tumor pathological stage was a significant predictor of renal cell carcinoma multifocality in stages T3 versus T1 and T3 versus T2 cancer (odds ratio 3.45, 95% confidence interval 1.15 to 10.39 and 5.75, 1.31 to 25.29, respectively). Other parameters, such as tumor size, grade, vascular invasion, cell type and histological pattern, did not correlate with multifocality. CONCLUSIONS Our results imply that primary tumor stage is a significant factor for multifocal disease. Therefore, more precise preoperative staging of the primary lesion is required if nephron sparing surgery is indicated.

Inducible nitric oxide synthase expression in benign prostatic hyperplasia, low- and high-grade prostatic intraepithelial neoplasia and prostatic carcinoma

Objective To elucidate the incidence of inducible nitric oxide synthase (iNOS) expression in benign prostatic hyperplasia (BPH), low‐ and high‐grade prostatic intraepithelial neoplasia (PIN) and prostatic carcinoma lesions, and to explore the role of iNOS in prostate tumorigenesis.

Microvessel density as a prognostic marker in bladder carcinoma: correlation with tumor grade, stage and prognosis.

Introduction: The aim of our study was toevaluate tumor angiogenesis as a prognosticmarker of transitional cell carcinoma of thebladder and to asses its relationship toestablished variables for survival and responseto therapy.Patients and method: Microvessel density(MVD), a measure of tumor angiogenesis, wereevaluated in 77 primary bladder cancers.Forty-three superficial carcinomas and 34invasive carcinomas were analysed. Tumorspecimens of all patients were obtained bytransurethral resection (TUR) and all thetumors were transitional cell carcinomas.Twenty-two patients with invasive bladdercancer have undergone M-VEC chemotheraphy. Thecorrelation between MVD and histopathologicalgrade, tumor stage and prognosis was evaluated.MVD was identified by immunostaining ofendothelial cells using anti-CD34 antibody. Forstatistical analysis Kruskal-Vallis,Mann-Whitney U and Fisher’s exact tests were used.Results: MVD was correlated with tumorgrade, stage and prognosis. Significantlyhigher MVD was determined in invasive tumorsthan superficial tumors (p < 0.05). MVDincreased with tumor grade and stage(p < 0.05). High MVD was correlated with therisk of clinical progression in bothsuperficial and invasive bladder carcinomas(p < 0.05, p < 0.001 respectively). Invasivetumors with remission after M-VEC chemotheraphyhad lower MVD than tumors with progressionafter M-VEC.Conclusion: These data demonstrate thatMVD in bladder carcinoma correlates with grade,stage and malignant potential of the tumor.Quantification of tumor angiogenesis may allowselection of the type of treatment for bladdercancer patients.

Remission of nephrotic syndrome after removal of localized castleman's disease

Renal complications of Castlemans disease are uncommon. Among the various renal disorders, including mesangial proliferative glomerulonephritis, membranous glomerulonephritis, and minimal change disease, nephrotic syndrome attributable to renal amyloidosis is very rarely reported. We report a case of mixed type of localized Castlemans disease complicated with nephrotic syndrome. Renal biopsy was performed. The deposition of AA amyloidosis was shown. After the removal of two mesenteric lymphoid masses, the proteinuria was gradually decreased and disappeared. Renal biopsy was repeated after 14 months, and, despite complete remission of nephrotic syndrome, no regression in amyloid deposition was found.

P53, bcl-2 and bax immunoreactivity as predictors of response and outcome after chemotherapy for metastatic germ cell testicular tumours.

Objective To evaluate the roles of p53, bcl‐2 and bax as determinants of chemosensitivity in testicular cancers and to assess whether immunohistochemical expression of these proteins in testicular germ cell tumours (GCTs) could be used to predict the outcome in patients with metastatic testicular GCTs.

Changing patterns of lung cancer; (3/4 in.) 1.9 cm; still a safe length for bronchial resection margin?

BACKGROUND Surgical resection is the best treatment modality in non-small cell lung cancer (NSCLC). As a guideline, it is suggested that at least a bronchial resection margin of 1.9 cm from the macroscopic tumor might provide a tumor-free margin in lung cancer. In some recent reports, there is great emphasis on the changing histopathological patterns of lung cancer, but no concern for the proximal extension of lung cancer. The aim of this study was to determine the validity of this guideline in the current time. METHODS Surgically resected specimens of NSCLC cases (n = 70) were examined. The bronchial tree including tumor was dissected and beginning from the edge of the visible tumor, the bronchus were cut into serials in its transverse plane, 5 mm apart from each other. Cut sections were examined for proximal extension of tumor at different levels. RESULTS Microscopic proximal extension was observed in 24.2% (n = 17/70) of all the cases. Peribronchial extension (n = 9/17) (52.9%) was more predominant compared with bronchial extension (n = 8/17) (47.0%). Squamous cell carcinoma (n = 11/38) (28.9%) showed proximal extension more than adenocarcinoma (n = 5/23) (21.7%). Adenocarcinoma showed more peribronchial extension (n = 4/5) (80.0%) whereas squamous cell carcinoma (n = 7/11) (63.6%) showed more bronchial extension. The farthest extension was 3.0 cm for adenocarcinoma and 2.0 cm for squamous cell carcinoma. Excluding tumor positive specimens beyond 1.5 cm level to the bronchial resection margin, all tumors accounted for 96% of the whole series. CONCLUSIONS Microscopic proximal extension of lung cancer occurs in 24.2% of NSCLC cases. Squamous cell carcinoma extends more proximally compared with adenocarcinoma in ratio whereas adenocarcinoma extends more in length. A bronchial resection of 1.5 cm in length from the macroscopic tumor will provide clear margins in 93% of NSCLC cases.

Thrombospondin-1, Vascular Endothelial Growth Factor Expression and Microvessel Density in Renal Cell Carcinoma and Their Relationship with Multifocality

OBJECTIVE To evaluate the relevance of microvessel density (MVD) and the angiogenic factors, vascular endothelial growth factor (VEGF, an important angiogenic factor in solid tumors) and thrombospondin-1 (TSP-1, a potent inhibitor of angiogenesis), to multifocality of renal cell carcinoma (RCC). PATIENTS AND METHODS Using immunohistochemistry the expression of CD34, TSP-1 and VEGF was assessed in 38 archival tissue specimens from 19 patients with unifocal RCC and 19 with multifocal RCC. Immunostaining results for VEGF was scored for the appropriate percentage of positive tumor cells and relative immunostaining intensity (score range 0-12). Only extracellular immunoreactivity was considered positive for TSP-1 and the same method was used to score the stromal staining. The microvessel density was measured by immunohistochemical staining with anti-CD34 monoclonal antibody. RESULTS VEGF immunoreactivity> or =1% was detectable in all unifocal and multifocal tumors. TSP-1 immunoreactivity was detected in 14 (73.7%) of 19 unifocal RCCs and in 16 (84.2%) of 19 multifocal RCC specimens (p=0.69). There were no statistically significant differences in the immunostaining intensity, percentage of immunopositive cells and the staining scores of VEGF and TSP-1 among the two groups. Additionally, there was no difference in MVD in multifocal and unifocal tumors. CONCLUSION As there is no difference in MVD count, and expression of angiogenic factors (VEGF and TSP-1) in multifocal and unifocal tumors, multifocality of RCC is not determined by VEGF/TSP-1 expression.

The prognostic value of proliferating cell nuclear antigen, Ki-67 and nucleolar organizer region in transitional cell carcinoma of the bladder

Objectives: To investigate the value of proliferating cell nuclear antigen(PCNA), Ki-67 antigen labelling indices and nucleolar organizer region(NOR) score in relation to histological grade, stage, recurrence andprogression of the bladder tumor.Materials and methods: Tissue specimens from 77 bladder cancer patients(43 superficial, 34 invasive) were immunostained with PCNA and Ki-67 andstained with AgNOR. Thirteen specimens of normal bladder mucosa servedas controls.Results: In comparison to normal bladder mucosa the values of the threeindicators were significantly greater (p < 0.001). There was a significantrelationship between PCNA, Ki-67 indices, AgNOR scores and grade andstage of the tumor (p < 0.001). All indicators also correlated with each other(p < 0.001). The Kaplan-Meier curves for recurrence-progression freesurvival revealed that patients with a PCNA labelling index >36.22%, Ki-67labelling index >29.68% and AgNOR score > 3.34 had a worse prognosis thanthose with <36.22%, <29.68% and <3.34, respectively.Conclusions: PCNA, Ki-67 indices and AgNOR scores correlated with eachother and with tumor grade and stage. These proliferation markers maygive objective and accurate information about the biological behavior ofbladder transitional cell carcinoma.

Carcinosarcoma of the Prostate

A case of prostatic carcinosarcoma is presented with histopathologic and immunohistochemical characteristics. A 70-year-old man presented with a history of anti-androgen (cyproterone acetate) therapy for prostatic adenocarcinoma. Diffuse and strong staining for progesterone receptor was observed in the carcinosarcoma specimen although it was completely negative in the previous adenocarcinoma specimen. It may be speculated that hormonal therapy might have facilitated the selection of a progesterone-dependent subclone of tumor cells with the ability of mesenchymal differentiation and that genetic instability due to p53 inactivation might have played a role in this process.

Collecting duct carcinoma.

Collecting duct carcinoma of the kidney is a rare variant of renal cell carcinoma. Hematuria is the most common presenting symptom. This tubulopapillary tumor arises from or differentiates forward to medullary collecting tubules. It is typically centered on the medulla of the kidney and extends into the cortex with a desmoplastic reaction. There are few reports documenting the clinical presentation and long-term prognosis. We describe a case of this uncommon tumor with clinical, histological and immunohistochemical features and review the literature.