Selwyn Z. Freed

Idiopathic Regression of Metastases from Renal Cell Carcinoma

Herein we review 48 acceptable cases of idiopathic regression of metastases from renal cell carcinoma culled from the literature and present 3 additional cases. The data are analyzed and the issue of organ specificity in coping with metastases is discussed.

The Prevalence and Significance of Brunn’s Nests, Cystitis Cystica and Squamous Metaplasia in Normal Bladders

The frequency of Brunns nests, cystitis cystica and squamous metaplasia was studied by multiple histologic sections in 100 grossly normal bladders obtained at postmortem examination. Of the 100 bladders 93 per cent had at least 1 of the 3 proliferative changes. Brunns nests and cystitis cystica were seen in 89 and 60 per cent of the bladders, respectively, most often at the bladder neck and trigone. Non-keratinizing squamous metaplasia of the vaginal type was seen almost exclusively on the trigone and bladder neck in 46 per cent of the premenopausal and postmenopausal women but in only 7 per cent of the men. There was no satisfactory evidence that inflammation was casually associated with these changes. These findings suggest that Brunns nests, cystitis cystica and squamous metaplasia of the vaginal type in women are normal variants of bladder urothelium and have no precancerous potential.

Nonpapillary carcinoma in situ and atypical hyperplasia in cancerous bladders: Further studies of surgically removed bladders by mapping

Complete mapping of epithelium has been performed in 10 bladders surigcally removed for cancer. In all cases, in areas adjacent to or distant from the visible tumors, nonpapillary carcinoma in situ and related lesions such as atypical hyperplasia could be demonstrated. More importantly, in 5 of the 10 bladders, areas of occult invasive carcinoma derived from such abnormal epithelia have been recorded. These findings fully confirm prior observations and raise the number of totally mapped bladders to 20. The histologic findings in the entire series of 20 cases are discussed and the distribution of cancer and precancerous lesions tabulated. It is suggested that the areas of the bladder most frequently affected by precancerous lesions are the left and right lateral walls and the posterior wall. The trigone and the dome are less frequently involved. The need for aggressive assessment of bladder epithelium in patients with tumors of the bladder and/or early radical treatment for patients with non papillary carcinoma in situ is discussed in light of these observations.

Xanthogranulomatous Pyelonephritis: Detailed Analysis of 29 Cases and a Brief Discussion of Atypical Presentations

AbstractA detailed review of 29 cases of xanthogranulomatous pyelonephritis is presented. Focal involvement of the kidney was noted in 5 instances. An accurate preoperative diagnosis of xanthogranulomatous pyelonephritis is difficult because of its clinical and radiological similarities to various other renal lesions. Bilateral xanthogranulomatous pyelonephritis is extremely rare and segmental excision of the kidney, when technically feasible, may be curative.

Predictive value of DNA measurements in bladder washings. Comparison of flow cytometry, image cytophotometry, and cytology in patients with a past history of urothelial tumors

Comparative DNA ploidy measurements were carried out by flow cytometry and by image analysis on cells in 71 bladder washing specimens from 50 patients with past histories of bladder tumors. Among the specimens classified as diploid or questionable by flow cytometry, 14 showed the presence of aneuploid DNA values documented by image analysis. In 18 of the 50 patients, recurrent tumors were observed during a relatively brief period of follow‐up. In 15 of them the DNA pattern was aneuploid and in three it was questionable. In nine of the 15 patients, both methods of DNA analysis disclosed aneuploidy, but in six patients aneuploidy was detected by image analysis only. A combination of DNA aneuploidy, whether observed by flow cytometry, image analysis, or both, and of positive or suspicious urine cytology is highly predictive of recurrence of high grade bladder tumors. Image analysis of DNA content in bladder washings adds information of clinical value above and beyond that obtained by flow cytometry.

The Removal of Renal Carcinoma Thrombus Extending into the Right Atrium

A relatively simple technique is described for removal of intra-atrial extension of renal cell carcinoma. A balloon catheter is inserted through an incision in the inferior vena cava and inflated in the atrium. Coupled with an elevation of venous pressure this procedure provides control beyond the tumor and a mechanism for withdrawal of the tumor to the abdominal venotomy for extraction. Radical nephrectomy and resection of directly invaded cava complete a definitive surgical procedure. The technique has proved satisfactory in 2 patients.

Pancreatic duct to ureter anastomosis for exocrine drainage in pancreatic transplantation

Abstract 1. 1. Four cases of segmental pancreatic transplantation are reported. 2. 2. Experimental studies of pancreatic duct to ureter anastomosis in the dog are summarized. 3. 3. The technic of segmental pancreatic transplantation and of pancreatic duct to ureter anastomosis is described. 4. 4. The pancreatic duct to ureter anastomosis, both experimentally and clinically, is a simple, effective technic for providing exocrine drainage of the transplanted pancreatic segment. 5. 5. The three patients receiving segmental pancreatic transplants are alive. Two have functioning pancreatic grafts, one beyond six months. This last patient also has a functioning kidney transplant.

Detection of tumor angiogenesis factor in adenocarcinoma of kidney.

Implantation of human renal adenocarcinoma in the rabbit cornea has resulted in new vascular growth from the limbus toward the tumor implant. This suggests that renal adenocarcinoma elaborates tumor angiogenesis factor (TAF) which stimulates endothelial cell growth. Such a substance could conceivably be responsible for the luxuriant vascularity of most renal adenocarcinomas. Conversely, absence or diminished secretion of TAF may be responsible for the hypovascular papillary renal adenocarcinomas and their recognized relatively benign clinical behavior.

Nephrectomy for renal cell carcinoma with metastases

The percentage of patients with renal cell carcinoma who also have identifiable metastases when first seen is increasing. In the past metastases were considered justification for excluding nephrectomy in the management of the patient. However, numerous opportunities for therapy which are abetted by removal of the primary tumor are presented. It is concluded, depending on several variables, that the advantages of nephrectomy usually justify the procedure.

Androgen receptors in bladder tumors

Cytosol androgen receptor content of transitional cell bladder cancer tissue was found to be substantially higher than its content in normal bladder mucosa and lower than in control benign prostatic hypertrophy tissue. Tumors arising in female patients had a lower androgen receptor content than those arising in male patients. High-grade tumors had a lower androgen receptor content than low-grade tumors.