1/77. Chromosome instability in lymphocytes from two patients affected by three sequential primary cancers: the role of fragile sites. The chromosomal aberration rate and the expression of fragile sites induced by aphidicolin were evaluated in metaphase chromosomes obtained from peripheral blood lymphocytes of two untreated patients with multiple primary cancers. Spontaneous aberrations of chromosome number and structure and chromosome fragility were compared with controls with the use of the same methods. Chromosomal aberration rates and expression frequencies of fragile sites were significantly higher in the patients than in normal control subjects. In the patients, all but one structural chromosome aberration involved at least one fragile site. Our results suggest that fragile sites may be unstable regions of the human genome, which might play an important role in the genetic instability associated with cancer predisposition. ( info) |
2/77. Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder: ultrasound and CT findings. We report the imaging findings in a case of Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder. Ultrasound and CT demonstrated multiple nodular masses in the pelvis of the transplanted kidney, ureter and bladder. The masses enhanced well on CT following i.v. contrast medium. ( info) |
| Nephrogenic adenoma (NA), a rare benign lesion of the urinary tract, is widely accepted to be a metaplastic reaction due to urothelial injury. It mainly occurs in the urinary bladder and rarely in the ureter. Renal transplant recipients are prone to the development of NA. However in those patients, NA was diagnosed exclusively in the bladder. Herein, we present the--to our knowledge--first case of NA involving a transplanted ureter. A 42-year-old female kidney transplant recipient suffered hematuria, oliguria, and acute renal failure and presented with ureteral obstruction and hydronephrosis of the renal transplant. To our surprise, evidence of cytomegalovirus (CMV) infection of the NA was demonstrated using special immunohistochemical staining. The findings in this case raise the possibility that CMV infection, as an irritant of the ureteral epithelium, may be an etiological factor of NA. ( info) |
4/77. Urachal carcinoma with metastasis to the maxilla: the first reported case. A case is reported for the first time of a urachal carcinoma with metastasis to the maxilla. The patient presented with a hard swelling along the left upper jaw in the region of 24-27. At the time of onset there were skin changes and signs of metastasis to the brain. The patient died 13 months after the onset of symptoms. ( info) |
5/77. leiomyoma of the genitourinary tract. OBJECTIVE: To review our experience and the literature with respect to leiomyomas of the genitourinary tract with special emphasis on the role of the clinical presentation and imaging studies in the differential diagnosis. MATERIAL AND methods: During a period of 35 years in our department, five patients were treated with symptomatic leiomyomas, originating from the renal pelvis, bladder, urethra and epididymis. All the cases were diagnosed after exploration, excision and histological examination of the specimen. Following the presentation of the five cases of leiomyomas of the genitourinary tract, we reviewed the literature with special emphasis on the modern imaging techniques, differential diagnosis and treatment approach. CONCLUSION: Complete excision followed by histological examination is the most reliable means of distinguishing leiomyoma from other more common and usually malignant tumors of the genitourinary tract. ( info) |
6/77. Multiple primary malignant neoplasms: case report and a comprehensive review of the literature. A case is presented of an elderly patient with synchronous ureteral/bladder/urethral transitional cell carcinoma and prostatic adenocarcinoma. In a subsequent review of 1,104,269 cancer patients in the literature, the reported prevalence of multiple primary malignant neoplasms (MPMN) varies between 0.734% and 11.7%. It appears that MPMN might occur more frequently than can be explained on the basis of random chance. As expected, the incidence of developing MPMN is noted to rise with increasing age. In addition, the preponderance of men with MPMN is caused primarily by the high frequency of prostatic cancer. Current studies and research need to address the potential of older cancer patients being at higher risk of second primaries. ( info) |
7/77. Case report: metastatic transitional cell carcinoma presenting in a urinoma. We describe a case of transitional cell carcinoma (TCC) metastasising into a urinoma cavity in a patient where the primary tumour arose at the ipsilateral ureterovesical junction. Seeding of transitional cell carcinoma into contiguous structures following surgical intervention has been reported, but to our knowledge, this is the first report of spread into a distant urinoma. ( info) |
8/77. Is cytology required for a hematuria evaluation? PURPOSE: The value of urine cytology in evaluating patients with hematuria remains controversial. The American Urological association Best Practice policy on Asymptomatic Microscopic hematuria recommends cytology only in patients with risk factors for transitional cell carcinoma (TCC). This study evaluated how often urine cytology yielded supportive or unique information that led to the diagnosis of transitional cell carcinoma, the cost of that information and whether it would have been obtained using the current best practice policy. MATERIALS AND methods: Between March 1976 and June 1985, 1,000 sequential patients with 1 episode of gross hematuria or microscopic hematuria, defined as greater than 3 red blood cells per high power field on 2 of 3 properly collected urinalyses, were evaluated according to a standard protocol in a closed panel health care system in the state of hawaii. These records were reviewed to determine if urine cytology yielded supportive or unique information that led to the diagnosis of TCC. RESULTS: In 4 patients positive urine cytology was the sole finding supporting a TCC diagnosis. urine cytology had a sensitivity of 55% and a specificity of 99.3%. The cost of a cytology result that yielded unique information was 8,367 US dollars using the 2002 medicare reimbursement schedule. CONCLUSIONS: urine cytology can have an important role in the evaluation of hematuria. The current American Urological Society Best Practice policy using risk factors to select patients for urine cytology would have captured the 4 patients for whom cytology was the key to diagnosis. urine cytology was comparable to excretory urography, creatinine and cystoscopy in terms of cost analysis. ( info) |
9/77. The nested variant of transitional cell carcinoma: a neoplasm resembling proliferation of Brunn's nests. This report describes four cases in which a malignant transitional cell neoplasm initially manifested as small nests and abortive tubules infiltrating the lamina propria. Many of the tumor cells were only slightly atypical but careful examination revealed at least some significantly anaplastic cells in every case, the degree of cellular atypia tending to parallel the depth of invasion. Despite the initial impression of a benign lesion resembling a proliferation of Brunn's nests, these carcinomas tended to be persistent and aggressive. ( info) |
10/77. Retroperitoneal lymph node dissection in patients with interaortocaval lymph node metastases of transitional cell carcinoma of the urinary tract. Three patients suffered from renal pelvic, ureteral and bladder cancers that were treated with both standard surgical treatments and two adjuvant cycles of cisplatin-based combination chemotherapy. Metastases of interaortocaval lymph nodes were detected in all patients between 9 and 33 months from the surgery for primary lesions. All patients received three cycles of cisplatin-based combination chemotherapy and retroperitoneal lymph node dissection (RPLND). The chemotherapy achieved partial response (62-98%). Two patients with viable cancer cells died with hepatic metastases; the first 15 months and the second 25 months from the date of diagnosis of distant lymph node metastasis. The third patient, who had no viable cancer cells, remains alive and disease-free 36 months later. Therefore, RPLND after chemotherapy provides prognostic information that helps to define patients who might benefit from additional systemic chemotherapy. ( info) |