Study of allelic losses on 3p, 6q, and 17p in human urothelial cancer

Forty-eight transitional cell carcinomas of the bladder and three transitional cell carcinomas of the renal pelvis were examined for loss of heterozygosity (LOH) on chromosomes 3p, 6q, and 17p. The most frequent allelic loss was seen on 17p (18/36, 50%) followed by 6q (6/22, 27%), and 3p (5/22, 23%). In cases with LOH at more than one locus, the same DNA sample often varied in degree of signal reduction for missing alleles. This observation indicates that LOH studies can serve to detect intratumor heterogeneity. No correlation was found between allelic losses at these chromosome arms and tumor grade and stage. Allelic losses on 6q were associated with tumors having a solid growth pattern; in this kind of tumors, allelic losses on 3p were associated with invasion.

Restriction fragment length polymorphism of the L-myc gene is not a prognostic factor in bladder cancer patients

The L-myc restriction fragment length polymorphism has been suggested to be of prognostic significance in some types of primary tumours. We examined the prognostic and susceptibility significance of the L-myc genotype in a group of 98 bladder cancer patients. The L-myc genotype did not correlate with any pathologic parameter and does not offer any clinical utility in patients with bladder cancer.

Analysis of 3p allelic losses in renal cell carcinomas: comparison with cytogenetic results

We performed a study of loss of heterozygosity (LOH) at 3p by restriction fragment length polymorphism analysis in a series of 22 renal tumors. In 11 cases, molecular results could be compared with those of cytogenetic studies. The highest frequency of allelic losses at 3p was seen in clear cell non-papillary renal tumors, whereas none of the papillary renal cell carcinomas showed LOH at 3p. Allelic losses on 3p were found to be independent of tumor grade or stage or both. One case analyzed showed a discrepancy between cytogenetic and LOH studies. This tumor displayed rearrangements of chromosome 3 and no LOH at the c-RAF-1 (close to the Von Hippel Lindau gene) locus.

Grade, local stage and growth pattern as prognostic factors in carcinoma of the penis

OBJECTIVES

To assess the management of adenopathies and the determination of prognostic factors in the treatment of squamous carcinoma of the penis.

MATERIALS AND METHODS

We reviewed 81 cases treated at our Institution between 1980 and 1994. In 62 cases, we review the pathologic samples according to the growth patterns proposed by Cubilla et al.

RESULTS

We find that both the grade of cellular differentiation and the local stage of the tumor are statistically significant with respect to the presence of positive adenopathies. We obtain results similar to Cubilla's work and different survival rates for the patterns of tumor growth.

CONCLUSIONS

On the basis of our results, we propose 3 differentiated follow-up and treatment groups. We suggest that the new growth pattern classification is useful as prognostic factor in carcinoma of the penis. We corroborate that prophylactic lymphadenectomy is indicated in tumors of vertical growth, while a conservative management should be considered in tumors of verrucous growth.

[Squamous cell carcinoma of the penis: treatment protocol according to our 14 years of experience]

OBJECTIVE

The management of lymph nodes and the determination of prognostic factors are matters of controversy in the treatment of squamous cell carcinoma of the penis. We attempted to establish an approach based on the different types of lymphadenectomies and biopsies we have performed and to evaluate local stage and grade of cellular differentiation as prognostic factors.

METHODS

81 cases treated at our institution between 1980 and 1994 were reviewed. The results of the different lymphadenectomies and biopsies performed were analyzed. Tumors were staged according to the Jackson and TNM classifications; in 62 cases the pathological samples were reexamined by the same pathologist to determine the grade of cellular differentiation according to the Broders classification. A p value of < 0.05 was considered significant.

RESULTS

We did not obtain reliable results with the biopsies done and variable results in the lymphadenectomies performed. The grade of cellular differentiation and local stage were both statistically significant with respect to the presence of positive lymph nodes. We found statistically significant differences for survival according to the stage of the positive lymph nodes.

CONCLUSION

We have established three approaches in management of squamous cell carcinoma of the penis according to the local stage and grade of cellular differentiation.

[The IPPS questionnaire in patients and controls. Psychometric validation]

The translation into Spanish of the AUA/International Prostatic Symptom (AUA/IPS) Score hadn't been validated in spanish. METHODS. AUA/IPS questionnaire was self administered by 103 consecutive patients and by 24 healthy volunteers. An alternative formulation to question 4 (ALT-4) was added. RESULTS. 51 patients (49%) and 17 controls (79%) completed al questions (Feasibility). Reliability was measured by: a) Crohnbach's alpha (0.68 and 0.70 with ALT-4) b) Kendall's coefficient of concordance (0.097, significance < 0.001) and c) retesting 17 patients within 2 months. The relation of the AUA/IPS scores with quality of life (Construct validity) showed a Spearman's correlation coefficient of 0.57 (confidence = 0.0001), and 0.52/0.0004 with ALT-4. The relation with uroflowmetry (Concurrent empirical validity) was poor as shown in ROC curves. CONCLUSIONS. The Spanish version of the AUA/IPS questionnaire given in an easy format improves feasibility without alteration of reliability or validity. The relation of the AUA/IPS score with uroflowmetry is poor, although the questionnaire can be considered valid and reliable.

Renal abscess due to Aspergillus fumigatus in a patient with the acquired immunodeficiency syndrome

Disseminated aspergillosis is a systemic fungal infection that may occur in previously healthy or immunocompromised patients. The condition, although rare, is being recognized with increasing frequency in persons with the human immunodeficiency virus. Clinical genitourinary involvement is unusual. We present a case of renal abscess for Aspergillus fumigatus in a patient with acquired immunodeficiency syndrome who complained of flank pain and fever.

[Cytogenetic characteristics and of primary culture in multiple renal tumors]

The incidence of multiple tumours in renal cancer ranges between 1 and 30%. In these cases, it becomes very difficult to differentiate between adenoma and carcinoma just by using conventional methods, particularly in borderline cases. We carried out primary cultures and subsequent cytogenetic studies in 2 patients with multiple renal cancer. Clonal numerical changes in the first case were: 3, 7, 16 and 17 trisomies, chromosome loss; and structural changes, del(1) (p34), del(2) (p16, p22). In the second case, clonal numerical changes were 7 trisomy and tetrasomy and loss of the Y chromosome. Both tumours were cytogenetically characterized as papillary renal tumours. The diagnostic approaches are discussed and the prognosis possibilities evaluated, using this method to evaluate them in multiple renal tumours.

[The urologist's language: a survey on symptoms]

The definition of urologic symptoms varies depending on the source. Some symptoms are particularly vague and their clinical usefulness is doubtful. A survey was sent to 500 spanish urologists, asking about terminology and normality limits. There were 17 items, most of them as multiple choice questions, and all of them with the possibility of an open answer. The response rate, two months after the mailing was 12% (60 physicians). The variability of the answers was high for most of the items. In most questions over half of the respondents (between 50 and 70%, depending on the question) agreed, whereas the rest gave different answers. The free answers given were also different. This discrepancy affected all of the questions. The low response rate can be attributed to the scare tradition of this kind of survey in our country. The disparity in the definitions urges a unification of them, or at least that authors explain what they understand when they mention any symptom or syndrome.

Carcinoma in situ as a prognostic factor for G3pT1 bladder tumours

G3pT1 bladder cancer has traditionally been regarded as a superficial tumour with a high risk of progression. We have studied 37 patients with initial G3pT1 bladder tumours treated between January 1981 and December 1985. They were divided into 2 groups according to the association with carcinoma in situ (Cis) at the time of diagnosis. Clinical behaviour was analysed at 5 years. The first group (without Cis) showed progression and recurrence rates similar to those of low grade, low stage bladder tumours. The second group (with Cis) had a similar rate of recurrence but their progression rate was 65%.

[Simultaneous homolateral renal and adrenal carcinoma]

A case of renal cancer associated with simultaneous, homolateral adrenal carcinoma is described. This rare association and the diagnostic value of ultrasound and CT are discussed.

Treatment of transitional cell carcinoma of the ureter: is the controversy justified?

Between 1938 and 1985, 73 patients with ureteral tumors underwent surgery at Puigvert Foundation (1 case with bilateral synchronous tumors). Sixty-three patients were males and 10 females. Ages ranged between 49 and 78 (mean of 62) years. Tumoral stages were: pTa 5 cases; pT1 56 cases; pT2 10 cases, and pT3 2 cases. Radical treatment was performed in 38 cases and conservative treatment in 35 cases. Follow-up ranged between 2 and 20 (mean of 7) years. The overall survival rate at 5 years was 100, 82 and 50% for stages pTa, pT1 and pT2-3, respectively (p less than 0.05). Analyzed together, the actuarial survival at 5 years was 90.3% with conservative surgery and 67.8% with radical surgery (p not significant). The survival by stages for the patients treated with radical surgery was: 100% in pTa; 69.6% in pT1, and 57.1% in pT2-3. For those treated conservatively, survival was 100% in pTa, 95.8% in pT1 and 33.3% in pT2. Thus patients presenting with infiltrating tumors should not be treated conservatively, while patients with superficial lesions had a similar evolution whether treated by conservative or radical surgery.

Spiral urethral prosthesis as an alternative to surgery in high risk patients with benign prostatic hyperplasia: prospective study

A spiral urethral prosthesis was inserted with use of local anesthesia in 22 patients with benign prostatic hyperplasia who had long-term indwelling bladder catheters (mean 13 months) and anesthetic contraindications to an operation (American Society of Anesthesiologists rating of 4 in 86% of the patients). Of the 22 patients 7 (31.8%) did not reach 12 months of followup for different reasons. The remaining 15 patients were followed with clinical evaluations, urine cultures, transrectal ultrasound, voiding urethrography and urine flow rates at 3, 6 and 12 months. Final evaluation at 12 months showed normal voiding in 74% of the patients with an absence of significant post-void residual in all. In 10 patients (67%) urinary flow rates varied between 6 and 14 cc per second and in the remaining it was less than 6 cc per second. In 60% of the patients urine culture was negative. Our results suggest that a spiral urethral prosthesis, placed with the patient under local anesthesia, is an excellent substitute for long-term, indwelling, bladder catheterization, and is a useful alternative to an operation in patients with an increased surgical risk.

The role of repeat transurethral resection in stage A1 carcinoma of the prostate

Between 1983 and 1987 repeat transurethral resection (TUR) was performed in 20 patients with a diagnosis of stage A1 prostatic carcinoma. The average weight of the resected tissue in the repeat TUR was 8.81 g (range 3-20 g). In 5 of 20 cases (25%) residual prostatic cancer was identified. By adding the number of foci with cancer obtained at the initial operation with the repeat TUR, 16 cases (80%) remained as A1 and 4 cases (20%) were reclassified (upstaged) to A2. The usefulness of this technique in the restaging of patients with incidental carcinoma of the prostate is analyzed.

Inside-out kidney: unilateral herniation. Complication of cutaneous pyelostomy

A case of unilateral kidney herniation through a cutaneous pyelostomy stoma is reported. Our purpose is to point out the likely causes of this complication and its correction.

Correlation between tissular levels of prostatic acid phosphatase and prostate-specific antigen and hormonal response of metastatic prostatic cancer

A correlation between the serum levels of testosterone and the tissular intensity of prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA) in normal prostates has been demonstrated. In prostatic cancer patients, we studied the correlation between the percentage of neoplastic cells secreting PAP and PSA and the response to androgen deprivation, and found no relationship between them. Therefore it is not possible to predict the response to hormone therapy through the grade of tissular PAP or PSA.

Value of radical cystectomy in bladder cancer with pelvic node involvement

Of the 241 patients with bladder cancer treated with cystectomy and urinary diversion between January, 1978, and May, 1985, pelvic lymphadenectomy was performed in 150. In 41 of the 150 patients, pelvic node involvement was shown in the pathology study (27%). The preoperative clinical stages showed bladder muscle invasion in all 41 cases. Node invasion was found in 16/77 cases with radiation therapy and in 25/73 cases without radiation therapy (p less than 0.05). Operative mortality was 3 cases (7.3%). Of the 38 patients who survived the operation, 35 (94%) died of cancer within an average of 8 months. Twenty-seven showed 1-3 pelvic nodes involved, 7 showed 4-6, and 4 patients had more than 6 nodes involved. These differences between survival rates are not statistically significant (p = 0.35). Two patients died of a disease not related to the tumor, and only 1 is alive 4 years after operation (2%).

Tumor recurrence in prostatic urethra following simultaneous resection of bladder tumor and prostate

A comparative retrospective study was performed on 100 patients who had undergone transurethral resection of a superficial bladder tumor (Ta-Tl) with no associated carcinoma in situ (group 1) and 100 patients who had undergone simultaneous transurethral resection of a superficial bladder tumor (Ta-Tl), with no associated carcinoma in situ, and benign prostatic hyperplasia (group II). Evaluation of the recurrences of prostatic urethral tumors in both groups showed that they appeared in 10 patients (12 recurrences) in group I and 10 patients (14 recurrences) in group II (p = not significant). These data enabled us to rule out the influence of simultaneous transurethral resection in cases of recurrences of prostatic urethral tumors.

Place of cystectomy in superficial bladder cancer

Between January 1978 and June 1985, 44 patients underwent cystectomy for clinically diagnosed superficial bladder cancer. Operative mortality was 13.6%. Early and late complications were observed in 34 and 55% patients, respectively. Clinical understaging was seen in 23%, and stage reduction in 18% of the patients. Clinical staging was correct in 59% of the patients. The mean follow-up was 40 months (range, 24-84 months). Five patients presented local recurrence (13%) of the tumor and 10 patients showed distant metastases (26%). Urethral and upper urinary tract recurrences were observed in 7 and 4 patients, respectively. Fourteen patients (39%) died of cancer after a mean follow-up of 24 months. The actuarial 5-year survival was achieved by 77% of the patients with PTo-PTa-PTis and by 67% of the patients with PT1 (p, not significant).

Balanitis xerotica obliterans: surgical treatment

A case of BXO treated with complete surgical removal of the mucosal lesion and skin flap meatoplasty with excellent results 26th months later is reported.

Value of in vivo mucosa-staining test with methylene blue in the diagnosis of pretumoral and tumoral lesions of the bladder

An in vivo staining test, methylene blue was applied to 50 patients with bladder tumor. 378 biopsies were performed in 85 areas stained with methylene blue and in 293 random biopsy areas. Of these samples, 56 had carcinoma in situ: 38 of these were not stained (68% false-negative) and the remaining 18 took up the stain. In the latter corresponding to 11 patients, carcinoma in situ was also shown in unstained areas examined by random biopsies. In 37 areas with urothelial dysplasia, 31 were not stained (84% false-negatives) while 6 cases (16%) took up the stain. Bladder tumors were stained in an irregular way but the intensity of the stain was related to the tumor grade. According to our experience the in vivo staining test with methylene blue cannot be used as a marker for pretumoral and tumoral lesions of the bladder.

Value of random endoscopic biopsy in the diagnosis of bladder carcinoma in situ

The data obtained from 2,272 random biopsies performed on cystocopically normal mucosa in 457 cases of primary bladder tumors, that did not undergo any previous treatment, are present. Dysplasia was found in 119 cases (26.04%) and carcinoma in situ in 100 cases (21.88%). The relationship between cancer in situ and tumoral grade was: G1, 4 of 76 (5.26%); G2, 33 of 225 (14.66%), and G3, 58 of 152 (38.16%). The relationship between cancer in situ and tumoral stage for superficial tumors (pTa-pT1) was 52 of 314 (16.56%), and for deep tumors (pT2, pT3, pT4), 42 of 109 (38.53%). In this least group of 109 cases, 53 cystectomies were performed and the diagnosis obtained by random biopsy and mapping of the surgical sample were correlated. A coincidence in both techniques was found in 77.36% of the cases.

Balanitis xerotica obliterans in children

This report is based on 7 children with balanitis xerotica obliterans. Of these patients 5 had stenosis of the urethral meatus that required meatotomy and the postoperative results were good. The frequency of balanitis xerotica obliterans in children at our center, as well as the findings of other authors, suggests that possibly more cases would be diagnosed during infancy if all dried foreskin were examined systematically.

Nuclear magnetic resonance in advanced prostate cancer (stage D)

Nuclear Magnetic Resonance (NMR), a recently developed diagnostic method, has proved to be useful in the study of patients with prostatic disease. The authors report their experience with this technique in 10 cases of advanced prostate cancer (stage D) treated with LH-RH agonists (HOE 766-Buserelin). NMR provided information on the size of the prostate, the invasion of the vesical floor and seminal vesicles and the involvement of the pelvic and retroperitoneal nodes. It was also useful for ruling out metastases in the pelvis and spinal column, and showed an excellent correlation with the bone scan. In 2 untreated cases, NMR was sufficient by itself to diagnose metastatic prostate cancer. However, given the current lack of experience, it is not yet possible to draw conclusions concerning the superiority of this technique over other methods in the diagnosis and staging of prostatic carcinoma.