[Possibilities of molecular diagnosis of renal cell carcinoma]

Histologically defined subtypes of renal cell tumors (clear cell, papillary, chromophobe, oncocytoma) have to be accepted as distinct tumor entities based on specific and distinct molecular alterations and different prognosis. Immunochemistry and genetic analysis can be used for diagnosis in uncertain cases and are more and more important for individual therapy selection. Differentiation of prognosis in each subtype seems possible by using molecular signatures of primary tumors allowing individual assessment of aggressiveness and metastatic potential. Molecular markers from blood as well as from tumor tissues can predict therapy response in the future. In order to transfer these promising data into clinical practice it is mandatory to develop validation studies which have to be performed based on defined criteria similar to those for therapeutic clinical trials.

Trichosomoides nasalis (Nematoda: Trichinelloidea) in the murid host Arvicanthis niloticus: migration to the epithelium of the nasal mucosa after intramuscular development

Knowledge of the biology of the trichinelloid subfamily Trichosomoidinae is poor. Trichosomoides nasalis is a common parasite of Arvicanthis niloticus (Muridae) in Senegal, and a procedure for experimental infections has been established. It has been demonstrated that larvae develop in striated muscle fibres, similar to Trichinella spp., but they are not arrested in the first stage, and they reach the adult stage within three weeks. In the present histological study it is shown that T. nasalis females and dwarf males migrate from the abdomen and thorax to the host's muzzle, moving through connective tissues and between muscles. A few migrating specimens were also found in the blood vessels of the nasal mucosa. While sexes were still separated in the lamina propria of the mucosa, females recovered from the epithelium contained intra-uterine males. Worms were found between the incisors in the mucosa of the anterior and median conchae which are rich in mucous cells. Only the pseudostratified epithelium was parasitized. Under natural conditions, the inflammation of the nasal mucosa that is induced by the parasites might reduce the competitiveness of infected rodents when foraging or looking for potential mates.

[Prognostic and predictive molecular markers for urologic cancers]

Molecular prognostic factors and genetic alterations as predictive markers for cancer-specific targeted therapies are used today in the clinic for many malignancies. In recent years, many molecular markers for urogenital cancers have also been identified. However, these markers are not clinically used yet. In prostate cancer, novel next-generation sequencing methods revealed a detailed picture of the molecular changes. There is growing evidence that a combination of classical histopathological and validated molecular markers could lead to a more precise estimation of prognosis, thus, resulting in an increasing number of patients with active surveillance as a possible treatment option. In patients with urothelial carcinoma, histopathological factors but also the proliferation of the tumor, mutations in oncogenes leading to an increasing proliferation rate and changes in genes responsible for invasion and metastasis are important. In addition, gene expression profiles which could distinguish aggressive tumors with high risk of metastasis from nonmetastasizing tumors have been recently identified. In the future, this could potentially allow better selection of patients needing systemic perioperative treatment. In renal cell carcinoma, many molecular markers that are associated with metastasis and survival have been identified. Some of these markers were also validated as independent prognostic markers. Selection of patients with primarily organ-confined tumors and increased risk of metastasis for adjuvant systemic therapy could be clinically relevant in the future.

[Current issues in pulmonary pathology. Report of the working group on pulmonary pathology of the German Society of Pathology]

The working group on pulmonary pathology of the German Society of Pathology (Deutsche Gesellschaft für Pathologie, DGP) developed very actively in the last year. Apart from the autumn meeting in Heidelberg in 2011 and the sessions at the annual DGP meeting in Berlin it was possible to realize a first publication with support and coauthorship of several members of the working group dealing with the classification of lung adenocarcinoma. In this report the key aspects of the activity related to the following issues are summarized including non-small cell lung carcinoma, neuroendocrine tumors of the lungs, interstitial pulmonary diseases, cell blocks in cytology and banking in thoracic pathology.

Limits and chances in an unfortunate course of recurrent orbital rhabdomyosarcoma

BACKGROUND

Orbital rhabdomyosarcoma (RMS) in childhood has an excellent survival rate after chemotherapy and radiation, and mutilating surgery can often be avoided.

CASE REPORT

As a rarity we present an unfortunate disease course in a child suffering from orbital embryonal RMS which did not enduringly respond to multimodal therapy including local excision and exenteration orbitae. After short intervals and despite tumor-free margins, orbital RMS recurred twice and led to an extended exenteration orbitae including the bony margins. Because of the lack of standards for adjuvant therapy in cases of recurrences after exenteration orbitae, therapy had to be restricted to a wait- and- see strategy as the only chance of tumor control.

CONCLUSION

Although survival rates of orbital RMS are high, the possibility of recurrence should not be underestimated. In cases of refractory RMS, new concepts are needed to offer further chances for survival.

[Nephron-sparing surgery 2012]

Nephron-sparing surgery is considered to be the standard surgery for small renal masses. There is a large socioeconomic and oncological relevance in such a decision, especially since tumour incidence as well as average life expectancy increases, also triggered by better diagnostic quality. The present review highlights the current state of nephron sparing-surgery, evaluates different surgical approaches and gives perspectives on the future developments and scientific investigations required. In conclusion, nephron-sparing surgery has been well studied and different approaches have shown high safety profiles with oncological results comparable to those of radical nephrectomy. Nephron -sparing surgery provides decisive advantages in long-term survival and patient morbidity, especially concerning chronic renal failure rates. Therefore, whenever feasible, a renal mass should be considered for nephron-sparing surgery.

Monanema joopi n. sp. (Nematoda, Onchocercidae) from Acomys (Acomys) spinosissimus Peters, 1852 (Muridae) in South Africa, with comments on the filarial genus

Monanema joopi n. sp. is described from blood drawn from the heart of the murid Acomys (Acomys) spinosissimus in South Africa. It is characterised by a non-bulbous cephalic extremity, shared with only one of its five congeners, and a cylindrical tail with caudal alae and a spicular ratio of 2.7 in the male. As is typical for the genus, microfilariae are skin-dwelling. They are 185 to 215 micrometres long and have no refractory granules beneath their sheath. A key to the species of Monanema is presented and an amended generic description, based on the six currently known species, is proposed. Species of Monanema are primarily lymphatic and the low intensity of infection with M. joopi n. sp. in blood from the heart, might suggest that not all adults settle in the heart cavities. One might also consider that other, more susceptible rodents serve as hosts for this parasite as well. To date, the geographic range of Monanema includes North America, Africa and Australia, each with representatives of a different lineage. Given the present hypotheses on the evolutionary origin and subsequent migrations of rodents, we expect the origin of Monanema to be in the Palearctic-Oriental region.

A multivariate Baltic Sea environmental index

Since 2001/2002, the correlation between North Atlantic Oscillation index and biological variables in the North Sea and Baltic Sea fails, which might be addressed to a global climate regime shift. To understand inter-annual and inter-decadal variability in environmental variables, a new multivariate index for the Baltic Sea is developed and presented here. The multivariate Baltic Sea Environmental (BSE) index is defined as the 1st principal component score of four z-transformed time series: the Arctic Oscillation index, the salinity between 120 and 200 m in the Gotland Sea, the integrated river runoff of all rivers draining into the Baltic Sea, and the relative vorticity of geostrophic wind over the Baltic Sea area. A statistical downscaling technique has been applied to project different climate indices to the sea surface temperature in the Gotland, to the Landsort gauge, and the sea ice extent. The new BSE index shows a better performance than all other climate indices and is equivalent to the Chen index for physical properties. An application of the new index to zooplankton time series from the central Baltic Sea (Latvian EEZ) shows an excellent skill in potential predictability of environmental time series.

Telomerase activity and telomere length in different areas of renal cell carcinoma

Telomerase activity and telomere length were analyzed in a total of 59 surgically removed primary renal cell carcinoma (RCC). The study includes tissue from the centre of the tumor, several different peripheral tumor areas, metastases and secondary tumors. None of the normal renal cortex tissues used as control exhibited telomerase activity. In contrast, telomerase activity was detected in 55 out df 59 (=93%) tested primary RCC. There was no case with intratumoral heterogeneity concerning the telomerase activity status. All metastases and secondary tumors were telomerase-positive. In the four telomerase deficient tumors all measured telomeric repeat fragments were shortened in comparison to the normal tissue. As these patients exhibit no metastases or secondary tumors a less malignant variant of RCC is supposed. There was no correlation between telomerase activity and specific histopathological subtypes of RCC or specific chromosomal aberrations. As telomerase activity is not associated with advanced stages of tumors it may be an important early event in the development of RCC. Thus, telomerase activity may be a prevalent marker for early and late stages of all subtypes of RCC.

Development of Trichosomoides nasalis (Nematoda: Trichinelloidea) in the murid host: evidence for larval growth in striated muscle fibres

Trichosomoides nasalis (Trichinelloidea) is a parasite of Arvicanthis niloticus (Muridae) in Senegal. Female worms that harbour dwarf males in their uteri, occur in the epithelium of the nasal mucosa. Young laboratory-bred A. niloticus were either fed females containing larvated eggs or intraperitoneally injected with motile first-stage larvae recovered from female uteri. Both resulted in successful infection. Organs examined during rodent necropsy were blood and lymphatic circulatory systems (heart, large vessels, lymphnodes), lungs, liver, kidneys, thoracic and abdominal cavities, thoracic and abdominal muscular walls, diaphragm, tongue, and nasal mucosa. Development to adult nasal stages took three weeks. Recovery of newly hatched larvae from the peritoneal fluid at four-eight hours after oral infection suggests a direct passage from the stomach or intestinal wall to the musculature. However, dissemination through the blood, as observed with Trichinella spiralis, cannot be excluded even though newly hatched larvae of T. nasalis are twice as thick (15 μm). Developing larvae were found in histological sections of the striated muscle of the abdominal and thoracic walls, and larvae in fourth moult were dissected from these sites. Adult females were found in the deep nasal mucosa where mating occurred prior to worms settling in the nasal epithelium. The present study shows a remarkable similarity between T. nasalis and Trichinella species regarding muscle tropism, but the development of T. nasalis is not arrested at the late first-larval stage and does not induce transformation of infected fibres into nurse cells. T. nasalis seems a potential model to study molecular relations between trichinelloid larvae and infected muscle fibres.

[Therapy selection in patients with advanced bladder cancer. Is molecular biology helpful?]

The prognosis of patients with advanced bladder cancer is still limited by a high rate of systemic progression. In addition to extended lymph node dissection, perioperative chemotherapy has been shown to improve the outcome after cystectomy. The role of neoadjuvant and adjuvant therapies are still a matter of controversial debate: there is an overtreatment of patients on the one hand but other patients are undertreated and do not receive chemotherapy because the progression risk may be underestimated on the basis of clinical and histopathological parameters. Improved cure rates can be achieved by new biomarkers defining the individual risk of systemic progression and predicting the response probability of the individual patient.A number of recent publications demonstrated that molecular signatures of the primary tumor can define the metastatic risk or correlate with chemotherapy response. Furthermore, it is essential to understand resistance mechanisms and to develop new targeted therapies based on knowledge of bladder tumor biology. This paper gives an overview concerning the role of molecular biology for therapy decision-making.

B domain containing Tenascin-C: a new urine marker for surveillance of patients with urothelial carcinoma of the urinary bladder?

BACKGROUND

ECM remodelling during tumorigenesis entails the re-occurrence of different Tn-C(L) splicing variants. In patients with urothelial carcinoma of the urinary bladder (UBC), B and C domain containing Tenascin-C (B(+) and C(+) Tn-C) urine levels were shown to be increased in case of muscle invasiveness. Thus, the present study was aimed at examining the ability of B(+) and C(+) Tn-C as potential urinary surveillance markers of UBC patients.

METHODS

Urine levels of B(+) and C(+) Tn-C were determined by ELISA in 35 UBC patients during a 2 year follow-up period after therapy and related to clinical diagnosis and histological stage in 4 defined groups representing typical courses of disease.

RESULTS

B(+) Tn-C levels showed significant differences between cases of tumour progression or regression. The urine levels of B(+) Tn-C could be used to discriminate between cases without tumour recurrence and such with tumour existence (cut-off value: 0.8 ng/ml) or between non-muscle invasive and muscle invasive tumour growth (cut-off value: 3.5 ng/ml).

CONCLUSIONS

Progression of UBC with time is accompanied by significant changes in urinary levels of B(+) Tn-C. Urinary B(+) Tn-C can therefore be suggested as a valuable urine surveillance marker in UBC follow-up care.

[Securing the future through research - light on the horizon?]

Research is more important than ever for urology as a clinical specialty. The enormous advances being achieved in molecular medicine should not develop outside the realm of urology. In fact, implementing them in urology serves to guarantee the further existence of our specialty with its current clinical scope. If drug therapy for cancer is to remain an enduring part of urology or if kidney transplantation is to continue to be an integral part of urology and not belong to transplant surgery, then the expertise in these clinical entities and understanding of their pathogenetic relationships must be found in urology. As a result, research must be an essential part of our specialty on the one hand and the results of research must be applied to the whole extent of urology on the other hand.