Stephen C. Jacobs

Spread of prostatic cancer to bone

Selective metastasis is the formation of secondary tumors in an organ pattern that is peculiar. The reason for specific organ localization has not been established. I Clearly, prostatic carcinoma selectively spreads to bone. The predilection of prostatic cancer to metastasize to bone has been recognized since Thompson’ reported the very first case. In this review., the mechanisms of this metastasis to bone and the response within bone will be emphasized. Staging of carcinoma of the prostate is difficult because of a lack of absoluteness in clinical, surgical, and autopsy staging. Still, the concept is widespread that prostatic carcinoma begins as a small focus (Stage A) which, after some dormant period, enlarges to a palpable nodule (Stage B). After growing through the prostatic capsule (Stage C), the tumor spreads in an orderly manner through the pelvic lymph nodes (Stage :Dl), up the periaortic nodes, and then to bone. Whitmore, however, has pointed out that the natural history of prostatic carcinoma is unpredictable, which certainly confounds treatment regimens. Approximately 40 per cent of patients, hoveever, do present with Stage D disease with most of these having bone metastases. Metastases to bone occurs late in the natural history of each particular tumor, and patients with bone metastases are not expected to survive five years. Yet, 20 per cent of cases of Stage D carcinoma of the prostate do survive five yearse4 Patients with prostatic carcinoma die of their tumor,4.s but it takes them a long time to do so compared with other tumors. This might account for some of the increase in the number of bone metasases; that is patients with other carcinomas may die before clinical bone metastases become apparent. However, prostatic cancer not only metastasizes to and flourishes in bone, but also seems to exclude other sites, at least clinically.

Synchronous bilateral renal cell carcinoma: Total surgical excision

Sixty‐one patients with bilateral synchronous renal cell carcinoma have undergone total excision of their neoplastic disease. True follow‐up of the patients has been obtained from the surgeons or the patients themselves. Fifty‐one patients underwent renal parenchymal‐sparing procedures in one‐ or two‐stage operations. Successful extracorporeal tumor resection was performed on 17 kidneys. The local tumor recurrence rate is 10%. Ten patients underwent bilateral nephrectomy with maintenance hemodialysis, and 4 of these underwent renal transplantation. The 69% survival rate of the group at five years is better than that of unilateral renal cell carcinoma.

Amino-terminal sequence of a large form of basic fibroblast growth factor isolated from human benign prostatic hyperplastic tissue

Homogenization of human benign prostatic hyperplastic tissue in high ionic strength alkaline buffer containing protease inhibitors resulted in the isolation of a 17,400 molecular weight growth factor. When tissue was homogenized in ammonium sulfate at pH 4.5 without protease inhibitors a smaller, 16,600 dalton, growth factor was isolated. Both growth factors reacted with antisera against synthetic peptides whose sequences corresponded to the amino-terminal (1-12), Internal (33-43) and carboxyl-terminal (135-145) portions of basic fibroblast growth factor (bFGF). This suggested that the smaller growth factor was not a truncated form of (1-146) bFGF and that the larger growth factor may contain additional sequences. Amino-terminal sequencing showed the larger growth factor to have the sequence: Ala-Ala-Gly-Ser-Ile-Thr-Thr-Leu-Pro-Ala-Leu-Pro-Glu-Asp-Gly-Gly-Ser-Gly- Ala-Phe-Pro-. These results show that the larger growth factor is an 8 amino acid extended from of (1-146) bFGF and it is likely that the smaller growth factor is a proteolytic cleavage product of the larger growth factor produced during the extraction procedure.

Renal oncocytoma. A clinicopathologic study

Seven cases of renal oncocytomas are described. Two cases were from recent surgical and autopsy material seen within a period of ten months. Four cases were reclassified as renal oncocytomas from a 20 year review of 63 renal cell carcinomas removed operatively. One case was identified from a nine year review of 31 renal cell carcinomas coded in our autopsy files. All patients were males; mean age was 69 years. The smallest tumor measuring 0.3 × 0.3 × 0.3 cm represents the smallest renal oncocytoma reported. The largest tumor weighed 2350 g. It is the largest renal oncocytoma so far reported in the literature. Two of the cases were found in polycystic kidneys. None of the seven patients presented with symptoms related to the tumors and the subsequent clinical course was benign in all cases. Differential diagnosis from renal cell carcinoma is discussed in terms of light and electron microscopic and radiologic aspects. The previously reported cases in the literature are reviewed.

Primary signet-ring cell carcinoma of the urinary bladder

Sixty‐one cases of adenocarcinoma of the urinary bladder presenting between 1966 and 1981 were reviewed. Among the only seven cases of primary adenocarcinoma of the urinary bladder, three were classified as primary signet‐ring cell carcinoma. These 3 cases were reviewed with the 11 previously reported cases in the literature. Primary signet‐ring cell carcinoma of the urinary bladder occurs predominately in men (12 men, 2 women) with age ranging from 38 to 83 years. It usually runs a rapidly fatal course despite therapy. The characteristic clinical, gross, and histomorphologic findings and pathogenesis of this rare bladder malignancy are discussed.

Use of a Prototype 3F Electrohydraulic Electrode with Ureteroscopy for Treatment of Ureteral Calculous Disease

A 3F electrohydraulic electrode was used with flexible ureteroscopy to treat upper urinary tract calculi in 18 patients. Of 21 procedures performed 10 involved retrograde passage of the ureteroscope and 11 consisted of antegrade procedures with percutaneous nephrostomy access. Complete fragmentation was achieved in 19 of the 21 procedures. In 1 patient bilateral renal caliceal diverticular calculi were treated with the electrohydraulic electrode used to open initially the diverticular orifice. Minor complications included retained stone fragments and small ureteral perforations. No serious complications resulted from the lithotripsy and no patient required an open operation. Flexible ureteroscopy, retrograde or antegrade, appears to offer access to upper tract stones not treated reliably with rigid ureteroscopy. Electrohydraulic lithotripsy with this small 3F probe appears to be a safe and effective means to treat upper urinary tract stones.

Epidermal Growth Factor is not the Major Growth-Promoting Agent in Extracts of Prostatic Tissue

Extracts of benign prostatic hyperplasia (BPH) contain a factor which is mitogenic for human foreskin fibroblasts in culture. Because of the similarity of BPH extract and epidermal growth factor (EGF) in stimulating quiescent fibroblasts to divide, it was of interest to determine if the prostate-associated growth factor competes for EGF receptor binding. BPH extract was found to compete poorly for 125I-EGF-receptor binding, did not influence the dissociation of cell-bound 125I-EGF and caused only a slight down-regulation of the EGF receptor. These findings indicate that EGF and BPH extract do not recognize the same receptor and that the major growth stimulating activity of BPH extract is not due to EGF.

Primary renal carcinoid tumor.

A case of primary renal carcinoid tumor in a sixty-seven-year-old man is presented. Radical nephrectomy removed the primary disease, but hepatic metastases developed and the patient subsequently died. Review of the literature disclosed 8 other cases of primary renal carcinoid. Three of these had metastatic spread.

CONGENITAL RENAL ARTERIOVENOUS MALFORMATIONS

Congenital renal arteriovenous malformations are rare, but their incidence are frequency of recognition are rising. Six cases of both cirsoid and idiopathic varieties are described. Patients were either asymptomatic or presented with gross hematuria and flank pain. Physical findings included hypertension, cardiomegaly, flank tenderness, and an abdominal bruit. IVP findings included filling defects in the renal pelvis from blood clots, irregular mucosal pattersn, or mass effect. Angiography demonstrated either single, simple, vascular channels or multiple, complex, varix-like communications. In both there was early filling of the renal vein, a normal caliber to the feeding artery and draining vein, and no displacement of parenchymal vessles. Asymptomatic patients required no treatment. Surgical procedures that spare renal parenchyma are preferred.

Erosion of an Inflatable Penile Prosthesis Reservoir into an Ileal Conduit

We report an unusual complication of an inflatable penile prosthesis. The penile prosthesis reservoir had been placed intra-abdominally and it eroded into an ileal conduit. The reservoir was removed endoscopically but the patient ultimately required creation of a new ileal conduit. Placement of reservoirs intraperitoneally risks erosion into the bowel.