Hong-Lin Cheng

Co-expression of RON and MET is a prognostic indicator for patients with transitional-cell carcinoma of the bladder

Recepteur dOrigine Nantais (RON) is a distinct receptor tyrosine kinase in the c-met proto-oncogene family. We examined the mutational and expression patterns of RON in eight human uroepithelial cell lines. Biological effects of RON overexpression on cancer cells were investigated in vitro, and the prognostic significance of RON and/or c-met protein (MET) expression was analysed in a bladder cancer cohort (n=183). There was no evidence of mutation in the kinase domain of RON. Overexpression of RON using an inducible Tet-off system induced increased cell proliferation, motility, and antiapoptosis. Immunohistochemical analysis showed that RON was overexpressed in 60 cases (32.8%) of primary tumours, with 14 (23.3%) showing a high level of expression. Recepteur dOrigine Nantais expression was positively associated with histological grading, larger size, nonpapillary contour, and tumour stage (all P<0.01). In addition, MET was overexpressed in 82 cases (44.8%). Co-expressed RON and MET was significantly associated with decreased overall survival (P=0.005) or metastasis-free survival (P=0.01) in 35 cases (19.1%). Recepteur dOrigine Nantais-associated signalling may play an important role in the progression of human bladder cancer. Evaluation of RON and MET expression status may identify a subset of bladder-cancer patients who require more intensive treatment.

Prognostic factors of primary transitional cell carcinoma of the upper urinary tract

OBJECTIVESnWe presented and analyzed our results in order to determine the relationship between patient survival and tumor grade and/or stage. In addition, a retrospective tumor DNA ploidy study was done to evaluate its possible role in predicting future tumor recurrence in the bladder.nnnMETHODSnA total of 112 patients with upper urinary tract transitional cell carcinomas (TCCs) were recorded at our hospital. Of these, 68 patients without concurrent bladder tumors (ages ranged from 36 to 80, mean 62.4 years; male:female = 1:1.2) were treated by nephroureterectomy and bladder cuff resection. They were followed up for 14-79 months (average 38.2 months). Eight (36.4%) of the 22 patients who had stage C or D tumors had received adjuvant systemic methotrexate, vinblastine, epirubicin, cisplatin chemotherapy after surgery. DNA flow cytometry using paraffin-blocked tumor specimens was performed on the tumors of 52 patients.nnnRESULTSnTheir pathologic stages and grades were 11 at stage 0, 15 at stage A, 20 at stage B, 14 at stage C, 8 at stage D; 9 of grade I, 41 of grade II, and 18 of grade III. Postoperatively, 13 patients (19.1%) subsequently developed bladder tumors with a latent period ranging from 2 to 37 months (average 14.9 months). The difference of the tumor DNA ploidy distribution pattern among tumors of high versus low stages and/or grades is not statistically significant (p > 0.05). Overall, the 5-year survival rates for patients with low- and high-stage tumors were 100 and 66.7%, respectively; for patients with grade I-II and III tumors they were 93.6 and 28.3%, respectively.nnnCONCLUSIONSnPatient survival was mainly related to both tumor stages (p = 0.0037) and grades (p = 0.0001), rather than to tumor DNA ploidy. For patients with grade II upper urinary tract tumors, tumor DNA ploidy seems to provide no additional predictive value on subsequent tumor recurrence in the bladder.

Spontaneous pyeloduodenal fistula: an unusual presentation in advanced renal transitional cell carcinoma

Spontaneous pyeloduodenal fistula is extremely rare. Most of the etiologies belong to chronic renal inflammatory disease, especially in patients with renal calculi. In published studies, only 2 cases have been reported in association with renal malignancy. We report a case of spontaneous pyeloduodenal fistula associated with transitional cell carcinoma, which has not been previously described in published reports.

Postoperative Adjuvant Intravesical Instillation Therapy with BCG, Epirubicin and Thiotepa in Superficial Transitional Cell Carcinoma of Urinary Bladder

From December, 1993 to June 1995, a total of 65 patients (40 male and 25 female; age range from 38 to 81 years old, mean 64) with urinary bladder transitional cell carcinoma (13 stage T0, 43 stage T1, 6 stage T2, 3 stage T3a) received adjuvant intravesical instillation therapy after TURBT (transurethral resection of bladder tumor). Among them, 22 were treated with epirubicin, 28 with thiotepa and 15 with BCG (Bacillus Calmette-Guerin, Caunnaught strain, Canada). They were followed with cystoscopy and urine cytology at regular therr-month intervals. The overall local recurrence rates were 27.2%, 28.5%, and 13.3% in the epirubicin, thiotepa and BCG groups, respectively (p＞0.05). Only one patient, in the BCG group, dropped out of therapy because of urosepsis. Complicatoins were more severe and common in the BCG group, including dysuria (93.3%), hematuria (60%), frequency (46.7%) and fever with chills (40%). Patients who had failed previous intravesical chemotherapy recurred equally in the therapeutic groups of epirubicin (40%) and thiotepa (30.8%), but were not found in the BCG group, while the tumor recurrence rate for patients with fresh bladder tumor were 26.7%, 16.7%, and 13.3% among the groups given thiotepa, epirubicin and BCG, respectively. The preliminary result, with limited short-term follow-up, implied that BCG may provide the lowest recurrence rate among the three therapeutic groups at the expense of relatively severe, but self-limiting, side effects on the urinary bladder.

Incidental Renal Cell Carcinoma：Experience at National Cheng Kung University Hospital

OBJECTIVES: As ultrasonography and computed tomography have become commonplace, renal rumors are increasingly being detected incidentally. To assess the characteristics of incidentally discovered renal cell carcinoma, we retrospectively reviewed 92 cases of pathologically proven disease. nMATERIALS AND METHODS: From June1998 to January 2001, totally 90 cases of pathologically proven renal cell carcinoma (RCC) were reviewed at NCKUH. Charts were analyzed to record the presenting symptoms, image modality used, tumor stage, tumor size, local tumor recurrence or distant metastasis, and outcome. nRESULTS: Of the 92 patients, there were 61 males and 1 females with a male to female ratio of 1.97. Patients’ ages ranged from 19 to 87 with a mean of 57.8 years. Sixty-three patients (68.5%) presented with clinical symptoms and/or signs related to renal pathology. Twenty-nine patients (31.5%) were incidentally diagnosed during image studies for non-renal symptoms or routine health examinations. The overall detection of organ-confined disease (stages I and II) was 72.4% of the ”incidental” and 30.1% of the “symptomatic” group. Smaller tumor size was also found in the “incidental” group (5.17 vs. 8.72 cm). The overall 5-year survival rate for patients with incidentally detected RCC was 92.3%, and was 52.5% in those with symptomatic tumors. Postoperatively, there was local tumor recurrence or distal metastasis in 6.9% of patients with incidental RCC and 30.2% of symptomatic patients. nCONCLUSIONS: With the widespread use of non-invasive image modalities, the detection of smaller, lower-stage renal tumors will significantly improve the outcome of this disease.

Efficacy of Combined Finasteride and α1-blocker Treatment for Benign Prostatic Hyperplasia after Initial Unsatisfactory Response to α1-blocker

OBJECTIVE: The purpose of our study was to assess the efficacy of a combination of finasteride and alphal-adrenergic antagonist(α1-blocker)for treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Charts of 69 patients with symptoms of BPH treated at our department from January 1995 to December 1998 with α1-blocker first then in combination with finasteride (ProscarR 5 mg/day) owing to the unsatisfactory subjective response to the initial α1-blocker were retrospectively reviewed. Data were collected with regards to prostate volume, uroflow rate, and PSA levels before and after finasteride. Changes in prostate volume, PSA level, and maximum uroflow rate were recorded and analyzed for each patient RESULTS: There was a statistically significant decrease in prostate volume and prostate specific antigen level after combination therapy. A mean decrease in prostate volume of 20%±14% was achieved in the first year and 17%±17% in the second year of combination therapy. Mean reductions of 47%± 48% and 57%±34% in serum PSA levels were achieved in the first and second years, respectively. For maximal uroflow rate (Qmax), a significant increase from combination therapy was observed only in patients with baseline PSA values greater than 4 ng/ml and prostate volumes greater than 35cm3 in the first year of treatment (mean 1.1±3.0 and 1.8±3.3ml/s increase, respectively). However, all patients showed improvement in symptoms and quality of life. CONCLUSIONS: Based on our observations, patients with higher baseline PSA levels and larger prostate volumes benefited the most from a combination of finasteride and α1-blocker for treatment of BPH.

Benign Prostatic Epithelial Polyp of the Urethra in Adult: A Case Report and Review of the Literature

Epithelial polyps of the urethra in adults are uncommon lesions. We reported a case with a solitary long and pedunculated polyp of prostatic urethra with intermittent urinary leakage in whom transurethral resection was done successfully. The symptoms improved after removal of the polyp. Cystourethroscopy done three months later found no evidence of recurrence.

Pediatric Epididymitis and Orchitis：An Age Consideration

Epididymitis and orchitis are more common in adults than in children and adolescents. Previous studies suggested that epididymitis is nearly as frequent as torsion of the spermatic cord or torsion of the appendix of testes. In this study, we present our experience with 35 patients with diagnosis of epididymitis or orchitis during an eight-year period.n Our data showed a significantly higher incidence (p＜0.05) of epididymitis and orchitis in infants younger than year old (8 of 35 patients, 22.9%), and a less significant peak falls among boys aged 9 years old (5 of 35 patients, 14.2%). The seasonal distribution showed a significantly higher incidence (p＜0.005) in May (7 cases of 35 patients, 20%).n According to the age group of the patient, there may be various etiologies and approaches. For young children under two years old, an underlying anatomical pathology should be ruled out. In older boys (between five years old and puberty) dysfunctional voiding should also be taken into consideration. For adolescents with sexual exposure, sexually transmitted diseases should be screened.

Near-diploid transitional cell carcinoma: A preliminary report

DNA ploidy analysis has been accepted as an important prognostic factor for patients with transitional cell carcinoma (TCC). However, there was few information dealing with the clinical relevance of slightly aberrant DNA content by flow cytometry (FCM). Here we present five cases of near-diploid (ND) tumours, with DNA index (DI) varying from 0.92 to 1.14, obtained from a prospective study of fifty-one cases (9.8%). The frequency of ND tumours showed a tendency to decrease with increasing tumour stage. Higher fraction of tumour proliferation, defined by Ki-67 index, showed a steady increment from 3.4 to 23.5% with occurrence of gross chromosomal changes. In contrast, the expression of epidermal growth factor receptor (EGFR) decreased from 48.3 to 35.3% for diploid (n=29) through aneuploid (n=17) tumours. All three ND bladder cancers had recurrence of one to three times with median follow-up of 36 months. The incidences of tumour recurrence (60%) and cancer death (20%) in ND tumours were intermediate between the aneuploid and diploid TCCs. But, flow DNA analysis of paraffin-embedded ND tumours revealed wide and symmetrical G0/G1 peak with DI varying from 5.6 to 13.0. Our limited experience suggests the necessity of special treatment for G0/G1 peaks having CV values greater than 5.5% from paraffin-embedded urothelial carcinomas.

Neurilemoma in the Urinary Tract-Two Cases Report and a Review of the Literature

Neurilemoma is a neoplasm of Schwann cells origin. It occurs rarely in the uri-nary tract. Although neurilemoma arising from perineum, penis, and tunica vaginalis of the testicle has been reported, there are only six cases of renal neurilemoma reported in the English literatures to date. Herein, we repored two additional cases, one in the renal parenchyma and the other in the urinary bladder. They were treated with radical nephrectomy and transurethral resection respectively. No evidence of local recurrence or distant metastasis occurred after 13 months and 4 months followup.