George M. Farrow

CHROMOPHOBE CELL RENAL CARCINOMA: CLINICOPATHOLOGICAL FEATURES OF 50 CASES

PURPOSE We review the clinicopathological features of chromophobe cell renal carcinoma. MATERIALS AND METHODS Cases were identified by reviewing the histology of all renal neoplasms resected between 1977 and 1990. Clinical data were obtained by chart review. RESULTS Of 50 cases a majority (53%) were discovered incidentally and most (86%) were stage I. Typical pathological findings included the presence of 2 cell types (pale and eosinophilic), reactivity for Hales colloidal iron, ultrastructural cytoplasmic vesicles and deoxyribonucleic acid aneuploidy. At last followup 47 patients (94%) were tumor-free or dead of unrelated causes. Survival was similar in patients with clear cell carcinoma of similar grade and stage. CONCLUSIONS Chromophobe cell carcinoma is a morphologically distinctive neoplasm with a favorable prognosis. Distinction from renal oncocytoma is important.

Prospective Analysis of Computerized Tomography and Needle Biopsy With Permanent Sectioning to Determine the Nature of Solid Renal Masses in Adults

ABSTRACTPurpose: We prospectively determined the accuracy of computerized tomography (CT) and needle biopsy of solid renal masses.Materials and Methods: A total of 100 patients with a solid renal mass who were scheduled for operation were prospectively evaluated. CT was performed before radical or partial nephrectomy. Biopsy of the surgical specimens was done twice through the tumor using an 18 gauge biopsy gun. Specimens were sent for permanent section and review by 2 pathologists blinded to each other and to the whole tissue specimens. Images were reviewed by 2 radiologists blinded to each other and to the results of pathological analysis. Results of CT and permanent biopsy were compared with the results of whole tissue specimen analysis.Results: Specimens were obtained from 59 radical and 41 partial nephrectomies. Malignant neoplasms were present in 85 patients (85%). Overall accuracy was 77% and 72%, the nondiagnostic rate was 20% and 21%, sensitivity was 81% and 83%, and specificity was 60% and 33%. ...

Low-grade collecting duct carcinoma of the kidney: report of 13 cases of low-grade mucinous tubulocystic renal carcinoma of possible collecting duct origin

OBJECTIVES To assess the nature of a series of unusual low-grade mucin-producing tubulocystic renal cancers diagnosed at the Mayo Clinic since 1985. METHODS We reviewed the clinical, radiologic, and pathologic features of 13 unusual low-grade renal carcinomas with features most suggestive of collecting duct origin. RESULTS In 8 cases, the tumor was discovered incidentally. Presenting symptoms in the other 5 patients were similar to those of typical renal carcinoma. Imaging studies and angiography disclosed solid, cystic, or complex masses that were relatively avascular. Pathologic assessment revealed good circumscription, minimal hemorrhage and/or necrosis, minimal tendency to extend beyond the kidney, tubulocystic architecture, a fibrotic interface with adjacent normal renal parenchyma, low nuclear grade, and minimal mitotic activity. Mucin production was noted in all evaluable cases. All tumors expressed keratins AE1/AE3 and/or Cam 5.2. The tumors showed immunoreactivity to antibodies directed against keratin 34 beta E12 (8 of 13 cases), and Ulex Europeus antigen 1 (6 of 10 cases). Follow-up ranged from 12 to 114 months (mean 62). No metastases occurred in 12 patients. One patient died of metastatic carcinoma morphologically identical to the primary renal neoplasm 46 months after his tumor had been misinterpreted as a benign condition. CONCLUSIONS We believe the tumors described in this article may be of collecting duct origin, representing the low-grade end of a spectrum of cancers arising in collecting duct epithelium.

Stage D1 Prostatic Adenocarcinoma: Significance of Nuclear DNA Ploidy Patterns Studied by Flow Cytometry

Flow cytometric analysis of nuclear DNA ploidy pattern was performed on 91 samples of prostatic adenocarcinoma from patients with stage D1 disease (metastatic deposits in pelvic lymph nodes). All patients had undergone radical retropubic prostatectomy and bilateral pelvic lymphadenectomy. Clinical follow-up ranged from 5 to 19 years. Nuclei were extracted from paraffin-embedded archival material. Isolated nuclei were stained with propidium iodide. The DNA ploidy pattern was diploid (normal) in 42% of tumors, tetraploid in 45%, and distinctly aneuploid in 13%. Only 15% of DNA diploid tumors progressed locally or systemically, whereas 75% of tumors with an abnormal DNA ploidy pattern (tetraploid or aneuploid) subsequently progressed ( P P

Small Cell Anaplastic Carcinoma of the Prostate: A Clinical, Pathological and Immunohistological Study of 27 Patients

Because small cell anaplastic carcinoma of the prostate is an uncommon tumor, it has remained a poorly defined entity. To elucidate further the clinical, pathological and immunohistochemical characteristics of this cancer the 27 patients who presented to the Mayo Clinic from 1960 to 1990 were reviewed. Of these patients 18 (67%) presented with pure small cell anaplastic carcinoma, and 9 (33%) were diagnosed with small cell anaplastic carcinoma and adenocarcinoma of the prostate. Twenty-six patients (96%) had either stage C or D disease at the time of diagnosis. Two patients presented with a paraneoplastic syndrome, including 1 man with inappropriate antidiuretic hormone secretion and 1 who suffered from thyroxine intoxication. Of 24 men with long-term followup 22 (92%) died of small cell anaplastic carcinoma of the prostate despite antiandrogen therapy and the remaining 2 are alive with active, progressive disease. The median survival time following diagnosis was 17.1 months (range 2 to 90 months). All tumors with tissue available for immunohistochemical staining reacted positive for neuron-specific enolase, indicating that small cell anaplastic carcinoma of the prostate is most likely a neuroendocrine neoplasm. No tumor stained positive for either prostatic acid phosphatase or prostate specific antigen. Pathologically, small cell anaplastic carcinoma of the prostate appears to be similar to oat cell carcinoma of the lung. This series of 27 patients emphasizes that small cell anaplastic carcinoma of the prostate is highly malignant, is frequently of advanced stage at presentation, responds poorly to antiandrogen therapy and has a poor prognosis.

Prospective analysis of intraoperative frozen needle biopsy of solid renal masses in adults.

PURPOSE We prospectively determined the accuracy of intraoperative needle biopsy of solid renal masses. MATERIALS AND METHODS A total of 103 patients diagnosed with a solid renal mass and scheduled for surgery were prospectively evaluated. Radical or partial nephrectomy was performed, and biopsy of the surgical specimen was done twice through the tumor using an 18 gauge biopsy gun. Biopsy specimens of 106 tumors were sent for frozen sectioning, stained with hematoxylin and eosin, and reviewed by 2 independent pathologists blinded to each other and whole tissue specimens. Biopsy results were compared to whole tissue specimens. RESULTS Specimens were obtained from 60 radical and 46 partial nephrectomy cases. Malignant neoplasms were present in 91 cases (86%). Overall, 15 cases (14%) were benign, of which 11 were oncocytomas. If lesions 4 cm. or less only were included in analysis, the incidence of benign lesions increased to 22%. Overall accuracy of the 2 pathologists was 76 and 80%. Nondiagnostic rates were 11 and 17%. Both observers incorrectly diagnosed 4 malignant lesions (5%) as benign, and incorrectly diagnosed 3 and 5 benign lesions (21 and 36%), respectively, as malignant. Analysis of values for both observers yielded a sensitivity of 77 and 84%, specificity 60 and 73%, positive predictive value 94 and 96%, and negative predictive value 69 and 73%. CONCLUSIONS Overall frozen needle biopsy was accurate in more than 75% of cases and showed an excellent positive predictive value for carcinoma of more than 94%. Unfortunately, there was a large degree of inaccuracy for benign lesions and we do not recommend the routine use of intraoperative frozen needle biopsy to guide surgical decision making.

Calcified Renal Masses: A Review of Ten Years Experience at the Mayo Clinic

Of 2,709 renal masses seen in a 10-year period, 111 contained roentgenographically visible calcium. This was found in 1 to 2% of the simple cysts and in 10% of renal-cell carcinomas. Calcium located non peripherally (within the mass) indicated a malignant lesion in 87% of cases. In another 8%, the masses were indistinguishable from renal-cell carcinoma on vascular studies, and this type of calcification required surgery; only 5% were benign cysts while peripheral eggshell calcification without calcium in the mass was usually associated with benign simple cysts, the risk of malignancy was still about 20%.

Long-Term Followup of Young Patients with Stage a Adenocarcinoma of the Prostate

A total of 23 men less than 60 years old with stage A adenocarcinoma of the prostate who were managed expectantly (that is untreated) and were at risk for 10 to 25 years form the basis of this study. The original amount of tissue obtained at transurethral resection, number of chips involved and examined, and tumor grade (Mayo grades 1 to 4) were recorded and compared in an in-depth analysis whereby the entire tissue removed was examined without knowledge of previous grading attempts. On the basis of volume estimation of the amount of cancer present 8 patients were reclassified as having stage A2 disease. Of these 8 patients 2 had disease progression and 1 died of metastatic adenocarcinoma of the prostate. At review 15 patients remained with stage A1 disease and 4 had disease progression (3 systemically and 1 locally) an average of 10.2 years after diagnosis. Because of longer life expectancy the young patient with stage A1 disease is at increased risk for local and/or systemic disease progression. Therefore, when incidental adenocarcinoma of the prostate is found in young patients consideration should be given to examination of all tissue resected, and to repeat transurethral resection and biopsy to ensure accurate staging. Lifelong careful followup is mandatory not only to detect local recurrence owing to heterogeneous adenocarcinoma of the prostate but also to detect a possible secondary clinical lesion.

Stage D1 prostate cancer treated by radical prostatectomy and adjuvant hormonal treatment. Evidence for favorable survival in patients with DNA diploid tumors

Background. Stage Dl disease is found in at least every sixth patient undergoing bilateral pelvic lymphadenectomy and radical retropubic prostatectomy (RRP) for clinically localized prostate cancer (PC). Previous recommendations for monotherapy using surgery, radiation, or systemic therapy alone for Stage Dl disease have usually been associated with a poor outcome in regard to progression and survival. Unlike other pathologic stages, D1 disease treated with RRP is mainly related to DNA ploidy pattern in regard to all end points (progression and survival) and immediate adjuvant hormonal treatment (AHT) rather than to the usual pathologic variables, including the number of positive nodes.

Renal angiomyolipoma. A clinicopathologic study of 32 cases

The data from 32 cases of angiomyolipoma (renal hamartoma) are presented: 23 of the tumors were removed at surgery and nine at autopsy. The histopathologic findings are reviewed and the spectrum of gross renal involvement is emphasized. On the basis of the duration of symptoms and findings and the subsequent course of patients subjected to surgical resection, the clinical behavior of the tumor is assessed. Of particular interest is the relationship of this tumor to the tuberous sclerosis complex. Data presented indicate that many of the patients have various components of the syndrome, which in some patients have familial manifestations. It is inferred from this study that the tuberous sclerosis complex may vary in expression from a solitary renal tumor to the fully developed clinical syndrome.