The determination of stage in nonmuscle urothelial carcinoma: Staining pattern of caspase-8

Context

Urothelial carcinoma (UC) is one of the most frequent epithelial tumors worldwide.

Aims

We aimed to investigate the protein expressions of caspase-8, p53, murine double minute 2 (mdm2), and p14^ARF in nonmuscle UCs and to correlate the findings with clinicopathological characteristics.

Settings and Design:

A total of 50 patients who had pTa and pT1 tumors were analyzed.

Subjects and Methods

The protein expressions of caspase-8, p53, mdm2, and p14^ARF were analyzed by immunohistochemistry.

Statistical Analysis Used

Chi-square test was done using SPSS version 16.0 (SPSS, Inc., Chicago, IL, USA).

Results

Cytoplasmic caspase-8 expression was significantly higher in pT1 UCs while nuclear caspase-8 expression was significantly higher in pTa UCs (P = 0.005 and P = 0.011, respectively). Cytoplasmic caspase-8 expression was also higher in high-grade UCs (P = 0.035). The expression of p53, mdm2, and p14^ARF was not also related with pathological stage or grade (P > 0.05 for all). The p14^ARF expression was related with nuclear caspase-8 expression in most of the patients. Complete agreement among nonmuscle UCs for immunohistochemical expression of p14 and nuclear caspase-8 was seen in 41 cases, and the pairwise kappa agreement value was substantial (κ =0.614). The patients who had recurrence were positive for both p53 and mdm2 or either p53 or mdm2 (P = 0.025).

Conclusions

These results suggested that the staining pattern of caspase-8 might be helpful for determining of the stages in nonmuscle UC. It was also showed that the expression status of p53 and mdm2 were related with the recurrence.

A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours

OBJECTIVES

To report the results of a novel surveillance policy for stage I nonseminomatous germ cell tumours (NSGCTs).

PATIENTS AND METHODS

Between 1978 and 2000, 132 patients (median age 28 years, range 16-52) who were regularly followed were included in a new surveillance policy. All pathology specimens were studied retrospectively by the same pathologist for embryonal carcinoma, yolk sac tumour and lymphovascular invasion components. A loose surveillance protocol was designed in which computed tomography (CT) was used only for the first year.

RESULTS

The median (range) follow-up was 38 (6-265) months; the relapse rate was 24% and all occurred before 23 months, with 87% diagnosed within the first year. Platinum-based chemotherapy was given to patients with relapse, and surgery used after chemotherapy in seven. Among all the risk factors, an embryonal carcinoma component was the only significant predictor of relapse. The overall survival rate was 99%.

CONCLUSION

The presence of embryonal carcinoma in the primary pathology is the only risk factor determining the relapse rate of the present surveillance policy for stage I NSGCTs. The overall survival was no different from those reported for retroperitoneal lymph node dissection and primary chemotherapy. Decreasing the frequency of CT in the first year and totally eliminating it after 1 year reduces the cost of surveillance. The possible compliance problems of patients are also minimized, without changing the overall survival. This surveillance protocol for patients with stage I NSGCT has reduced costs and provided a better quality of life for the patients, without jeopardizing the final outcome.

Bilateral supernumerary kidney: imaging findings

Supernumerary kidney is a rare urogenital anomaly with less than 100 cases reported. Bilateral supernumerary kidney is even more rare and to our knowledge there are three cases reported in the literature. Herein we present the computed tomography (CT), excretory urography (IVP), and CT angiography (CTA) findings in a patient with bilateral supernumerary kidneys.