M. Ugur Mungan

Prognostic significance of angiogenesis and immunoreactivity of cathepsin d and type IV collagen in high-grade stage T1 primary bladder cancer

OBJECTIVES To assess the prognostic significance of biologic parameters such as angiogenesis, expression of cathepsin D (a lysosomal protease), and degradation of type IV collagen (a basement membrane protein), we studied 20 patients with primary grade III Stage T1 transitional cell carcinoma of the bladder. METHODS Endothelial cells were labeled immunohistochemically using factor VIII-related antigen. The vascular surface density (VSD) and the microvessel number (NVES) were assessed by means of stereology. The tumor tissues were also analyzed by immunohistochemical methods for the expression of cathepsin D and the staining pattern of type IV collagen. RESULTS Eight patients (40%) having either recurrence or progressive disease showed greater NVES and VSD values (P = 0.002 and P = 0.01, respectively) than patients without. The significance of vascular parameters was found to be statistically independent from coexisting carcinoma in situ, bacille Calmette-Guerin (BCG) treatment, tumor size, and number. Additionally, these parameters did not show statistical significance between progressive and recurrent tumors. However, tumors with solid morphologic features had higher VSD values and a significantly greater rate of recurrence or progression (P = 0.01 and P = 0.07, respectively). Tissue from 17 (85%) of 20 tumors showed absent or patchy basement membrane staining for type IV collagen, and 12 (60%) showed strong immunoreactivity for cathepsin D antibody. There were no differences for either molecule with either BCG treatment or other parameters related to prognosis. CONCLUSIONS Angiogenesis may have an independent role in predicting prognosis in grade III Stage T1 bladder carcinoma. Grade III Stage pT1 tumors with solid morphologic features have higher angiogenetic activity and a worse prognosis. Cathepsin D and type IV collagen do not seem to play a role in predicting biologic behavior.

Primary renal lymphoma of mucosa-associated lymphoid tissue

Mucosa-associated lymphoid tissue-type lymphomas have recently been recognized as a distinctive form of B-cell malignant lymphoma. In contrast to other types of low-grade lymphomas, these tumors have a tendency to be localized at diagnosis and to be curable with local therapy. We report an unusual case of primary localized low-grade lymphoma of mucosa-associated lymphoid tissue arising in the kidney. The patient underwent radical nephrectomy and was free of disease at 28 months of follow-up without additional treatment. Once properly staged and classified, lymphoma of mucosa-associated lymphoid tissue involving the kidney can be managed by radical nephrectomy and follow-up.

Tubular dysplasia and carcinoma in situ: precursors of renal cell carcinoma

OBJECTIVES To identify the dysplastic changes in tubules adjacent to or remote from renal cell carcinoma (RCC) and to assess proliferating cell nuclear antigen (PCNA) expression of normal tubule and carcinoma cells. METHODS The study analyzed 62 kidneys with RCC that were removed by radical nephrectomy. Pathologic sections were stained with hematoxylin-eosin and evaluated for the presence of dysplasia. Sections that contained dysplasia were then stained by the avidin-biotin immunoperoxidase technique after epitope retrieval for PCNA. RESULTS Dysplastic changes in normal kidney were identified in 14 cases (23%). Dysplastic changes were adjacent to the tumor in 10 cases. Dysplasia was adjacent to the tumor and diffuse in 6 cases (3 clear cell [CRCC], 2 chromophobe [ChRCC], 1 sarcomatoid RCC [SRCC]), adjacent to the tumor and focal in 4 cases (2 CRCC, 1 papillary RCC, 1 SRCC), remote and focal in 3 cases (1 granular RCC, 1 ChRCC, 1 SRCC), and remote and diffuse in 1 case (CRCC). The lesions represented a focus that could be defined as carcinoma in situ in 3 cases. PCNA immunostaining in dysplastic epithelia was more intense than that in normal tubules and was as intense or even more intense than that in carcinoma cells. CONCLUSIONS Dysplasia of tubular epithelium is probably a biologic precursor of at least some RCC. Tubular dysplasia warrants further study as an important phase that will provide new insights into the pathogenesis, biologic behavior, and natural history of RCC. Its impact on the surgical management of small unilateral RCC needs to be investigated.

Effects of finasteride on the vascular surface density, number of microvessels and vascular endothelial growth factor expression of the rat prostate

AbstractIntroduction: Finasteride is a 5-alpha-reductase inhibitor used in the medical treatment of benign prostatic hyperplasia (BPH) and appears to be effective in treating prostatic bleeding secondary to BPH. The exact mechanism of this effect is not known. The aim of this study was to evaluate the effects of finasteride on the vascular surface density (VSD), number of microvessels (NVES) and vascular endothelial growth factor (VEGF) expression of the rat prostate. Materials and methods: Nineteen adult male rats were used. Finasteride was given to 14, and there were 5 in the control group. Finasteride 80 mg/kg was administered daily via orogastric tube as a suspension for three months. Rats were sacrificed and vascular structures of the prostates were labelled immunohistochemically using CD31 antibodies. VSD and NVES of the prostates were assessed by means of a peroxidase labeled streptavidin-biotin method. VEGF expression was examined by immunohistochemistry using VEGF monoclonal antibody. Results: Mean prostatic weights were decreased significantly in rats given finasteride (p=0.0001). Although an increase in VSD was detected in the finasteride group it was not significant (p=0.26). NVES was significantly increased in the finasteride group (p=0.033). No significant difference was detected between the two groups in terms of VEGF expression (p=0.48). Conclusion: Finasteride does not seem to decrease VSD, NVES and VEGF expression at the level of the rat prostate. The effect of reduction of bleeding in BPH is likely to be due to its effect on shrinking glandular hyperplasia which might enhance vessel wall stability rather than decreasing overall vascularity.

Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor.

Abstract Standard therapy of sequential bilateral testis cancer is generally considered to be orchiectomy. We present a case of sequential bilateral testicular germ cell tumor treated with testis sparing surgery. The patient was disease free 50 months after surgery without local recurrence or distant metastases. Testis sparing surgery provides a better quality of life and may be considered a safe, feasible alternative in the treatment of carefully selected patients with bilateral testicular germ cell tumor.

Vertebral Fracture Associated with Shockwave Lithotripsy in a Patient with Granulomatous Spondylitis

Extracorporeal shockwave lithotripsy (SWL) is an accepted treatment modality in the treatment of urinary stone disease. Many complications have been reported secondary to high-energy shockwaves, but the effects of SWL on the skeletal system have rarely been investigated. We represent the first case of a burst-type vertebral fracture after SWL in an elderly osteoporotic patient with granulomatous spondylitis.