Synchronus renal cell carcinoma and Bellini duct carcinoma: a case report on a rare coincidence

Bellini duct carcinoma or collecting duct carcinoma (CDC) is a rare but aggressive primary renal neoplasm. The coexistence of two synchronous neoplasms in the same kidney is highly infrequent. As a result, it is hardly surprising that there are no references to renal cell carcinoma (RCC) combined with CDC of the same kidney in the literature. Histology and immunohistochemistry are important tools for differentiating between the two types of tumors involved. We present the first case of a synchronous occurrence of RCC and CDC of the same kidney.     

川芎的适宜采收期和加工方法

目的研究不同采收期和不同加工方法对川芎有效成分含量的影响。方法按《中国药典》2000年版方法分别测定了不同产地、3个采收期和6种干燥加工方法川芎中水分、挥发油的含量,HPLC法测定了阿魏酸的含量,酸性染料比色法测定了总生物碱的含量。结果5月10日~30日,挥发油的含量随采收期的延迟而降低,阿魏酸含量则明显增加;总生物碱含量显著增加。挥发油的含量以水洗后晒干法损失最大,其他方法差异不明显;阿魏酸以微波干燥的含量最高,远红外干燥法的次之;总生物碱以远红外和农户烘干法的含量最高。结论川芎最适宜的采收期以每年5月20日(约农历小满)后10 d为宜;加工方法以产地农户烘干法为宜。     

不同来源红花的质量研究

目的:对红花药材进行全面的质量评价.方法:应用高效液相色谱法及其他方法测定红花黄素、红素、腺苷等,比较不同产地红花化学成分的含量.结论:为建立红花化学成分红花黄素、红花红素及腺苷的测定方法及质量评价提供了依据.     

肾集合管癌的临床病理特点

目的 观察肾集合管癌的临床病理特点.方法 调研病人临床资料,记录肿瘤大体、光镜及电镜下的形态,运用免疫组化检测CK34βE12、CK19、CK13、vimentin、S-100、CEA、Ki-67,并对4例患者进行随访.结果 4例肿瘤主体位于肾髓质,其中2例累及肾周脂肪囊;1例大部分突入肾盂（镜下肿瘤表面尚被覆移行上皮黏膜）;肾集合管癌细胞中等大小,部分胞质嗜酸,部分透亮,部分核呈空泡状,有小核仁,组织结构呈小的腺管状、实片状、乳头状,癌组织间纤维组织增生明显,其中2例伴片状坏死,1例伴大量中性粒细胞浸润;瘤细胞CK34βE12和CK19（＋）,CK13、vimentin、S-100（-）、Ki-67 10%～15%;2例患者术后死亡,2例存活.结论 肾集合管癌是具有特殊形态和免疫表型、预后较差的肿瘤,应通过组织学改变和免疫组化等方法与其他胃肿瘤鉴别.     

肾集合管癌3例临床病理分析

目的探讨肾集合管癌的临床病理特征。方法对3例外科治疗的肾集合管癌进行临床、组织学、免疫组化及超微结构观察，并结合文献复习。结果本病发病年龄35～42岁，临床无特殊症状，影像学检查提示肾细胞癌。病理上肿瘤主要位于肾髓质内，组织学瘤细胞呈管状、管状乳头状结构，胞质透明或颗粒状，核大，核仁清晰，典型的肿瘤细胞呈靴钉样，间质纤维增生，多量淋巴细胞浸润并有肿瘤旁集合管上皮细胞的异型增生。免疫组化显示CK(AE3)、EMA和vimentin( )，CD10、CEA、CK7和CK20(-)。结论肾集合管癌是一种少见的起源于集合管上皮的恶性肿瘤，肿瘤呈管状、乳头状排列，细胞呈靴钉状伴间质的纤维增生和炎细胞反应，确诊本病时应与肾乳头状癌和肾髓质癌鉴别。     

肾集合管癌合并肾囊性透明细胞癌1例报告及文献复习

目的：探讨肾集合管癌（CDC）合并肾囊性透明细胞癌的临床病理特征及其诊断、鉴别诊断方法。方法：分析1例CDC合并肾囊性透明细胞癌患者的临床表现、组织形态学和免疫表型特征,并复习相关文献。结果：患者,男性,70岁,临床表现为无痛性血尿。影像学检查提示左肾占位。组织学示肾上极的肿瘤组织排列成不规则腺管状、乳头状,部分肿瘤细胞呈靴钉状突向腺腔内,间质纤维结缔组织明显增生,大量淋巴细胞浸润,肿瘤周围部分集合管腺上皮见异型增生。瘤细胞阳性表达波形蛋白（vimentin）、角蛋白7（CK7）、角蛋白19（CK19）、上皮膜抗原（EMA）、转录因子E3（TFE3）和E-钙黏素（E-cad）,而角蛋白20（CK20）、CD31、CD34、CD10、CD117、肾脏特异性钙黏蛋白（ksp-cad）和α-甲基酰基辅酶A消旋酶（AMACR）表达则呈阴性。肾中部囊性肿瘤组织学表现为典型的肾囊性透明细胞癌,癌细胞阳性表达CD10、波形蛋白和CK19,而CK7、CD117表达则呈阴性。结论：CDC是一种少见的高度恶性肿瘤,其诊断依赖组织病理学和免疫组化标记。由于组织起源不同,CDC合并肾透明细胞癌的概率更小,但这种合并存在的情况仍有可能。     

24小时尿标本留取方法的改进

目的:减少影响24h尿标本检测结果的因素,探索一种简单科学的24h尿标本留取方法. 方法:将73例住院患者的24h尿标本分为4组,进行自身对照,测定其尿糖、尿蛋白、尿酸、内生肌酐清除率、尿电解质值. 结果:4组测定值差别均无统计学意义(P>0.05),证明改进法完全可以替代传统法留取24h尿标本.     

Arachidonic acid as a second messenger for hypotonicity-induced calcium transients in rat IMCD cells

 In rat inner medullary collecting duct (IMCD) cells in primary culture, hypotonic stress induces Ca²⁺ transients consisting of an early peak phase caused by a Ca²⁺ release from intracellular stores and a subsequent plateau phase that involves Ca²⁺ entry from the extracellular milieu. In the present study, the mechanisms by which cell swelling is transduced into the Ca²⁺ release were investigated. The free intracellular Ca²⁺ concentration ([Ca²⁺]_i) was measured using the fluorescent dye fura-2 and cell volume using a confocal laser scanning microscope. In control experiments, after reduction of extracellular osmolarity from 600 to 300 mosmol/l, by omission of sucrose, [Ca²⁺]_i rapidly increased from 106 ± 9 nmol/l to a peak value of 405 ± 22 nmol/l (P≤ 0.05) and thereafter reached a steady-state of 230 ± 23 nmol/l. In low-Ca²⁺ conditions (10 nmol/l), the reduction of osmolarity evoked only a transient increase of [Ca²⁺]_i by 182 ± 11 nmol/l (P≤ 0.05), which reflected Ca²⁺ release from intracellular stores. Hyposmotic stress had no effect on inositol 1,4,5-triphosphate (IP₃) production measured by a [³H]IP₃ radioreceptor assay. Preincubation with 100 μmol/l ETYA (a non-metabolisible derivative of arachidonic acid) reduced the Ca²⁺ response to hyposmotic stress under high and low Ca²⁺ conditions (87 and 85% inhibition respectively) as well as the regulatory volume decrease (RVD). Extracellular application of arachidonic acid in isotonic medium led to an increase in [Ca²⁺]_i under high and low Ca²⁺ conditions. Pretreatment of IMCD cells with 50 μg/ml D609 (a phosphatidylcholine-directed phospholipase C inhibitor) or with 200 μmol/l propranolol (a phosphatidate phosphohydrolase inhibitor) reduced the hypotonic Ca²⁺ response more strongly than pretreatment with 5 μmol/l BPhB (a phospholipase A₂ inhibitor). The Ca²⁺ response was also suppressed after preincubation with 200 μmol/l RHC 80267 (a diacylglycerol lipase inhibitor). Preincubation with 50 ng/ml pertussis toxin (a G-protein inhibitor) reduced the transient component of the Ca²⁺ response partially. We conclude that G-proteins, phosphatidylcholine-directed phospholipase C, phospholipase A₂, diacylglycerol lipase and arachidonic acid, but not IP₃, are involved in the mechanisms by which Ca²⁺ is released from the intracellular stores during RVD in IMCD cells. Received: 13 May 1996 / Received after revision: 16 September 1996 / Accepted: 19 September 1996     

Osmotic work across inner medullary collecting duct accomplished by difference in reflection coefficients for urea and NaCl

To demonstrate that osmotic work can be accomplished across the inner medullary collecting duct (IMCD) by the difference in refelection coefficients for urea and NaCl, phenomenological coefficients for urea and NaCl transport were determined in isolated segments of the hamster IMCD perfused in vitro. Arginine vasopressin at 100 U/ml increased urea permeability from 11.5±2.9 to 31.7±4.2×10^–7 cm² s^–1 in the middle IMCD but not in the upper IMCD. Urea transport in the middle IMCD consisted of two components, transport with saturable kinetics and simple passive diffusion. Permeability to Na⁺ was very low (2×10^–7 cm² s^–1). Reflection coefficients as measured by the equiosmolality method, with raffinose being a reference solute, were 0.87±0.05 and 0.71±0.04 for urea and 1.03±0.07 and 0.91±0.04 for NaCl in the upper and the middle IMCD, respectively. Reflection coefficient for urea in the middle IMCD was 0.68 when determined by the zero volume flux method. When the middle IMCD was perfused with bicarbonate Krebs-Ringer (BKR) solution containing 200 mmol/l urea, the replacement of urea in the bathing fluid with equiosmolal NaCl caused large volume flux (3.81±0.45 nl mm^–1 min^–1) associated with dilatation of intercellular space. The existence of vasopressin in the bath was essential for this phenomenon. This effect was inhibited by 5×10^–4 M phloretin in the bath, suggesting that the vasoressin-stimulated urea transport is responsible for this phenomenon. From these observations, we conclude that transport parameters of the middle IMCD are appropriate for accomplishment of osmotic work across this segment in the absence of physicochemical osmotic gradients.     

Developmental expression of acid-base-related proteins in the rabbit kidney

The newborn is limited in its ability to respond to acid-base perturbations. To investigate the development of renal H⁺/HCO₃-transport mechanisms, we probed acid-base-related epitopes in the mesonephric and developing metanephric kidneys of rabbits. Using immunofluo-rescence with monoclonal antibodies to the vacuolar H⁺ATPase, band 3-like Cl^–/HCO₃-exchanger, and apical surface of fully differentiated -intercalated cells, and peanut lectin cytochemistry (another marker of -intercalated cells), we found that these epitopes were poorly expressed in the nephrogenic zone of the newborn kidney cortex. Deeper in the cortex, collecting ducts showed weak apical staining with -intercalated cell antibodies and two patterns of staining with the H⁺ATPase and band 3 antibodies: polar and circumferential or diffuse. Some cells showed apical staining with H⁺ATPase while others showed diffuse staining, similar to that observed in the mature cortical collecting duct. Band 3 labeling was basolateral, as observed in the adult, and diffuse, which was rarely seen in mature kidney sections. Newborn outer medullary collecting ducts showed apical labeling with H⁺ATPase and basolateral staining with band 3 antibodies, similar to the mature outer medulla. Surprisingly, the mesonephric collecting tubule showed cells with apical H⁺ATPase staining or basolateral band 3 labeling and, less frequently, cells with positive staining for -intercalated cells. The relative maturity of the mesonephric collecting tubule and similarity to what is observed in mature metanephric collecting ducts indicates that intercalated cells may be present and functioning in both organs. Thus, the lineage of intercalated cells may be more intricate than previously believed.