Immunohistological detection of T antigen and ABH blood group antigens in upper urinary tract tumours

Transitional cell carcinoma of the ureter and renal pelvis

Transitional cell carcinoma (TCC) of ureter and renal pelvis is relatively uncommon. Smoking, occupational carcinogens, analgesic abuse, Balkan nephropathy are the risk factors. Cytogenetic studies revealed that the most frequent aberration is the partial or complete loss of chromosome 9. Approximately 20-50% of patients with upper urinary tract (UUT) TCC have bladder cancer at some point on their course, whereas the incidence of UUT TCC after primary bladder cancer is 0.7-4%. Excretory urography and retrograde pyelography are the conventional diagnostic tools; however, ureteropyeloscopy combined with cytology and biopsy is more accurate. Grade and stage of the disease have the most significant impact on survival. Nephroureterectomy with bladder cuff excision has been the mainstay of treatment. Local resection may be appropriate for distal ureteral lesions especially when the disease is low grade and stage. Advances in endourology have made it possible to treat many tumors conservatively. Ureteroscopic and to a certain extent percutaneous surgical approaches are widely used today especially in patients with low grade, low stage disease. Endoscopic close surveillance is mandatory for these patients. Adjuvant topical therapies appear to be safe but confirmation of any benefits awaits the results of further large studies. More recently, laparoscopic techniques have become a viable alternative to open surgery, but long term cancer control data are lacking. Aggressive surgical resection does not affect the outcome of patients with advanced disease. Adjuvant radiotherapy is ineffective, and systemic chemotherapy results in a low complete response rate for patients with metastases.

Postoperative cytology in relation to recurrences of superficial bladder tumours

TNM classification allows only a partial estimation of future tumour behaviour after surgery. More knowledge on malignant potential is needed. Spreading of viable tumour cells during transurethral resection (TUR) and their possible subsequent implantation in the bladder mucosa should be an important factor influencing duration of the tumour-free interval (TFI). A total of 1384 fresh urine samples sequentially taken after surgery from 356 patients were examined in a cytological laboratory. Data analysis confirmed significant differences in TFI between the groups with negative, suspicious and positive cytology. The higher the cytological abnormalities the shorter was TFI, regardless of which histopathological tumour grade has been verified.