Genitourinary tumors and HIV1 infection

4 patients with solid genitourinary tumors and HIV1 infection have been treated in our institution over the last 2 years. Two patients had seminoma, 1 renal adenocarcinoma and 1 renal angiosarcoma. All had deeply impaired immunity with a low CD4 level. 3 had or developed a true AIDS syndrome according to the WHO and CDC criterias of 1988. The remaining patient was seropositive and died less than 3 months following the diagnosis of renal angiosarcoma. He is the first reported case of renal sarcoma in a patient infected with HIV1. 2 patients were homosexuals, and the 2 others were drug addicts. Along with other reported cases, our cases underline the association between the depression of immunity due to HIV and the onset of solid genitourinary tumors.     

Surgical treatment of intracardiac tumors in 25 patients

For most intracardiac tumors, operation is the only means of therapy. In our institute, we have aggressively performed operation for intracardiac tumors regardless of histological type because resection for tumor had a beneficial effect on the hemodynamics with congestive heart failure. Twenty-five cases of cardiac tumors were operated upon from 1980 through 1998. The follow-up period ranged from 2 months to 19 years. The histological diagnoses of the tumors were as follows: benign tumors 24 (myxoma 21, papillary fibroelastoma 1, fibroma 1, angiomyolipoma 1) and malignant tumor (angiosarcoma 1). There was one hospital death in this series. In the New York Heart Association classification, the cardiac performances of intracardiac benign tumors after operation were Class I or II. The results of surgical treatment of intracardiac benign tumors were satisfactory both in short-term and in long-term. On the other hand the long term result of malignant tumor was extremely poor. A patient with angiosarcoma died 8 months later due to bone metastasis.     

Laparoscopic partial nephrectomy for cystic masses

PURPOSE: Although laparoscopic partial nephrectomy (LPN) has emerged as an effective treatment option in select patients with a solid renal tumor, scant data are available on cystic renal tumors. We report our experience with LPN in 50 patients with a cystic renal lesion. MATERIALS AND METHODS: Of 284 patients undergoing LPN at our institution since August 1999 preoperative computerized tomography identified a suspicious cystic lesion in 50 (17.6%) (group 1). Data were retrospectively compared with those on 50 matched, consecutive patients undergoing LPN for a solid renal mass (group 2). All patients with Bosniak II/IIF cysts were advised to undergo watchful waiting. Surgery was offered if the cyst changed in character or if that was the patient preference. RESULTS: Median tumor size was 3 cm in group 1 and 2.6 cm in group 2 (p = 0.07). Groups 1 and 2 were comparable in regard to perioperative parameters. In patients with Bosniak II (9), IIF (4), III (12) and IV (21) cysts final histopathology revealed renal cell carcinoma in 22%, 25%, 50% and 90%, respectively. All 100 patients had a negative surgical margin. No patient in group 1 had intraoperative puncture/spillage of the cystic tumor. In group 1 during a mean followup of 14 months (range 1 month to 3 years) 1 patient had retroperitoneal recurrence at 1 year despite negative surgical margins during initial LPN. CONCLUSIONS: Surgical outcomes of LPN for suspicious cystic masses are similar to those of LPN for solid tumors. However, extreme caution and refined laparoscopic technique must be exercised to avoid cyst rupture and local spillage.     

Bilateral renal oncocytoma: report of 2 cases and literature review

We report on 2 patients with bilateral renal oncocytoma treated in the last 5 years. One patient underwent bilateral partial nephrectomy for a solitary tumor in each kidney. Both tumors were confirmed to be renal oncocytomas by light and electron microscopic examination. After 4 years this patient had no evidence of local recurrence or distal metastasis. The second patient presented with bilateral multiple renal oncocytomas. Transabdominal bilateral renal exploration revealed 2 tumors in the right kidney and 3 tumors in the left kidney. Right radical nephrectomy and enucleation of the left renal tumors were performed. Examination by light and electron microscopy confirmed that all tumors from both kidneys were oncocytomas. Only 8 cases of bilateral renal oncocytoma have been reported in the literature, including our 2 cases. In 6 of these 8 cases the tumors were multicentric, which may be a characteristic of bilateral renal oncocytoma. Recognizing the coexistence of multicentricity and bilaterality is important because more conservative treatment is required. However, a favorable prognosis may still be anticipated.     

Primary renal angiosarcoma

Primary renal Angiosarcoma is a rare neoplasm and only 24 cases have been reported in specialized literature. We describe a case of primary renal angiosarcoma in a patient presenting with hematuria, palpable abdominal mass, left flank pain and anemia. A computerized tomography of the abdomen with contrast medium showed a tumor with 15 cm diameter, in the upper pole of the left kidney, with a low-density central area, suggesting necrosis or hemorrhage. Diagnosis was given in a morphologic base and proven by an immunohistochemical study. Primary renal angiosarcoma should be included among differential diagnosis of retroperitoneal hematoma and hemorrhagic renal tumors.     

Enucleation of renal tumor using a microwave tissue coagulator]

We report our clinical findings on 7 tumors in 5 patients who underwent successful enucleation of renal tumor with a microwave tissue coagulator. All patients presented with incidentally-found renal tumor on ultrasonography or computed tomography. One patient had bilateral renal tumors. The mean size of the renal tumor was 2.5 cm (Range 1.0-5.2 cm). One patient had a tumor larger than 5 cm, and was found to have renal insufficiency preoperatively. Four cases were clinically diagnosed as T1aN0M0. In all patients, the renal tumor was enucleated with a microwave tissue coagulator successfully without renal pedicle clamping. The mean operative time and blood loss were 241 minutes and 788 ml, respectively. The pathological diagnosis was renal cell carcinoma in all cases. Although 2 patients had preoperative renal insufficiency, there were no serious postoperative complications and no evidence of loss of renal function as a result of this operation. Our findings suggest that renal tumors can be enucleated with a microwave tissue coagulator safely and successfully without damaging renal function.     

Vascular tumors of the breast. IV. The venous hemangioma

Recent studies have documented the diversity of vascular tumors of the breast. In addition to angiosarcoma, it has been possible to define several categories of benign lesions. This report describes four patients whose vascular tumor consisted of a circumscribed disorderly vascular proliferation composed largely of venous channels. These vascular tumors of the breast correspond most closely to soft-tissue lesions that have been classified as venous hemangiomas. The patients ranged in age from 24 to 59 years. Each presented with a mass; the tumors measured 1.0-5 cm in diameter. Three were treated by excisional biopsy and one by mastectomy. All have remained well. The patient with the longest follow-up (11 years) reported that her tumor had been present for 13 years before diagnosis. A 38-year-old woman had coexistent lobular carcinoma in situ. She remains well less than 1 year after excisional biopsy. Thus far there is no evidence that this apparently benign lesion is likely to develop into angiosarcoma. Based on the information at hand, complete local excision appears to be adequate treatment. Longer follow-up and the study of other cases will provide a more complete assessment of the clinical course of this vascular tumor.     

Spontaneous rupture of a renal angiosarcoma.

Here we describe the clinical, radiologic, histopathological and immunohistochemical features of a rare spontaneous rupture of renal angiosarcoma detected in the left kidney of a 55-year-old male. Due to the rarity of this neoplasm (less than 15 cases have been reported), there is no unanimous consensus for therapy following radical nephrectomy. In our case there was no flank trauma and retroperitoneal haematoma around the left kidney was seen on computed tomography. The patient underwent left radical nephrectomy and died about 3 months after operation due to multiple bone and liver metastases. To our knowledge, this is the first report of spontaneous rupture of renal angiosarcoma and we suggest that it should be borne in mind that renal angiosarcoma may be a cause of retroperitoneal haematomas.     

Renal oncocytoma. Review of our 22 patients

SummaryRenal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported.Materials and methodsBetween 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%.ResultsWe found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria.ConclusionsThe rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution.     

Clinical study on incidental renal cell carcinoma]

Of 93 patients with renal cell carcinoma treated at our hospital between January 1974 and December 1990, thirty-two cases with incidentally detected cancer were evaluated clinically and pathologically. The average age of the patients was 61 years old ranging from 39 to 84 years. There were 25 men and 7 women with a sex ratio of 3.6:1. Fourteen tumors had developed in the right kidney and 17 in the left kidney. One patient had bilateral tumors synchronously and was treated by radical nephrectomy with contralateral enucleation of the tumor. The proportion of incidental renal carcinoma has been increasing steadily; 87.5% of the cases was found by either abdominal ultrasonography or CT scan. Nineteen patients (59.4%) had a tumor smaller than 5 cm in diameter. There were 29 cases with G1 or G2 renal cancer and twenty with pT2. The five-year survival rate in the incidental cases was 52.2% with significantly better survival than in cases when metastasis was initially suspected, but there was no significant difference in survival between the incidentally found cases and the cases of symptomatic renal cancer.     

Angiosarcoma of kidney

We describe a forty-six-year-old man who died of disseminated angiosarcoma ten months after a radical nephrectomy and postoperative radiation therapy for a renal angiosarcoma. We found 3 other well-documented reports of renal angiosarcoma, all in men. Two of the 3 cases previously reported also had a rapidly fatal course with hematogenous spread of the neoplasm following nephrectomy. Angiosarcoma of the kidney, although rare, is apparently a highly malignant fatal neoplasm, and effective therapy remains unknown.     

Bilateral renal cell carcinoma in a patient receiving long-term dialysis

Bilateral renal cell carcinoma developing in a 55-year-old male receiving long-term dialysis is reported. The patient, who had undergone maintenance hemodialysis for 12 years, was admitted in July, 1986 for the purpose of extensive examination of a right renal mass. CT scan and ultrasonography demonstrated an enlarged bilateral kidney associated with multiple cysts, containing a solid mass in the right upper pole. The patients underwent right nephrectomy under the diagnosis of right renal tumor. The solid tumor 4 x 3 cm in size revealed a grade 1 to 2 renal cell carcinoma pathologically. Two small tumors were recognized in other portions of the kidney. Multiple cysts of varying sizes, the largest 2 cm in diameter, replaced the renal parenchyma. The cyst walls frequently contained hyperplastic changes. The patient has been subsequently followed up for 2 years and 9 months and underwent left nephrectomy for suspected left renal tumor. The surface of the left kidney was covered by numerous cysts. The result of pathological examination was renal cell carcinoma, which was recognized in a total of 7 regions of the left kidney. The patient remains well on hemodialysis, with no evidence of recurrence or metastasis.     

Colorectal malignancies in HIV-positive patients

Due to the development of more effective medications, those infected with HIV are living longer. Consequently, more tumors and infections have been added to the AIDS-defining criteria in the last decade. Our aim was to review the occurrence and clinical course of colorectal (CR) malignancies in HIV infected/AIDS patients from a single institution. A retrospective review of HIV/AIDS patients with colorectal malignant tumors was undertaken. We included adult patients, with ELISA and Western blot test positive for HIV, and primary malignant tumors located in the colon or rectum. Malignant neoplasms of the anus were excluded for the purposes of this study. Twelve patients (9 males and 3 females), mean age 41 years, were identified with the following neoplasm: 6 adenocarcinomas (ACA), 5 non-Hodgkin lymphomas (NHL), and 1 small-cell carcinoma. Intravenous drug abuse was the main risk factor for HIV. No patient had identified risk factors for colorectal neoplasm. Five out of six patients with ACA had metastatic disease at the time of diagnosis. One patient with stage II ACA developed early liver metastases after colonic resection. Seven out of 12 patients underwent surgery. Six (85.7%) of these sustained postoperative complications, primarily wound infection. The overall survival in our series was dismal, averaging 20 months. For NHL average survival was 29 months, and 12 months for CR-ACA. This is the largest series of cases of colorectal cancer in the HIV/AIDS patient population published in the English language and the largest number of colorectal ACA reported in this unique population. Early in our experience, tumors frequently found in immunoincompetent patients were detected (NHL). More recently, we have only treated patients with colorectal ACA; none of them had no risk factors for colorectal cancer (family history, IBD, FAP, HNPCC). These patients developed tumors at earlier ages and were diagnosed at an advanced stage. Therefore, these tumors may be associated with the grade of immunosuppression induced during the course of the HIV infection and with a tumorigenic effect of the HIV on the colonic epithelium. Consequently, a high index of suspicion when evaluating chronic abdominal complaints in such patients is warranted. The use of the new antiretroviral therapy regimens should be further evaluated to know its impact in the survival.     

肾移植受者并发恶性肿瘤34例临床分析

目的分析总结肾移植受者并发恶性肿瘤的发生情况、治疗措施及转归。方法回顾性分析1983—2011年温州医学院附属第一医院肾移植中心规范随访、接受免疫抑制治疗半年以上的1400例肾移植受者发生恶性肿瘤的临床资料,诊断均经组织病理学检查证实,采用手术治疗、免疫抑制剂调整等综合治疗。结果发生恶性肿瘤34例(2.43%),患者发生恶性肿瘤时平均年龄为(52±10)岁,中位诊断时间为移植术后74(8～325)个月。其中泌尿系统肿瘤18例(Ⅰ～Ⅱ期12例,Ⅲ～Ⅳ期6例),并发两个以上部位肿瘤15例;消化系统肿瘤6例,血液系统肿瘤2例,其他肿瘤8例。治疗实体肿瘤患者手术为主,并减少1/3～1/2免疫抑制剂剂量(有些患者用西罗莫司替换他克莫司或环孢素),辅以化疗、放疗和免疫治疗等综合治疗。34例恶性肿瘤患者除3例失访,至今存活22例,肿瘤术后中位生存时间37(4～67)个月,其中肾功能正常15例、血清肌酐轻度升高6例、移植肾切除后返回血液透析治疗1例;9例死亡患者肿瘤切除术后中位生存时间32(3～100)个月,死因多为肿瘤广泛转移。结论肾移植受者术后肿瘤发生率较高,尤以泌尿系统肿瘤多见,其特点为多部位、易复发。肿瘤发生后根据病理分级分期积极手术治疗并调整免疫抑制方案,配合其他方法综合治疗可以提高患者存活率。     

肾嫌色细胞癌影像学特点与外科治疗选择

目的 提高肾嫌色细胞癌的临床诊治水平. 方法 回顾性分析25例肾嫌色细胞癌患者临床资料.男13例、女12例,平均年龄51岁.左侧13例,右侧12例.无症状肾癌16例,有腰部不适、发热、肉眼血尿等症状9例.实验室检查发现肝功能异常1例、红细胞沉降率加快1例.结合文献复习讨论肾嫌色细胞癌的影像学特点与外科治疗选择. 结果 B超检查肿瘤主要表现为低回声、有包膜、血流信号不明显.CT及MRI扫描肿瘤特征为边界清楚、质地均匀(CT平扫为70%、MR为73%),出血、坏死和囊性变少见,增强扫描多为均匀强化(CT为65%、MR为67%)及轻度强化(CT为65%、MR为93%).肿瘤直径＞4.0 cm的22例患者行根治性肾切除术、≤4.0 cm且位于肾周边的3例行肾部分切除术.肿瘤平均直径7.6 cm,剖面质地多均匀、呈灰白色或暗红色,光镜下癌细胞呈板状或条索状排列、胞质苍白或呈嗜酸性,免疫组化染色Vimentin阴性、CK18阳性.TNM分期pT1a 8例、pT1b 9例、pT2 6例、pT3a 2例.23例获随访,平均随访28个月,无瘤生存22例,1例于术后58个月发现肺转移,经干扰素-α治疗、吉西他滨及氟尿嘧啶化疗3个月后死亡. 结论 肾嫌色纽胞癌患者多无症状、分期较早.MR和CT主要表现为边界清楚、质地均匀、强化不明显.手术方式选择应遵循肾癌的外科治疗原则.患者预后多良好,手术至出现转移的时间间隔较长,建议延长术后随访时间.     

后腹腔镜下肾输尿管全长及膀胱袖状切除术35例报告

目的 介绍后腹腔镜下行肾、输尿管全长及膀胱袖状切除的体会。方法 经后腹腔镜施行肾输尿管全长及袖状膀胱切除术35例。男14例，女21例。年龄49～82岁，平均67岁。输尿管肿瘤20例，肾盂肿瘤15例。肿瘤位于右侧19例，左侧16例。其中输尿管肿瘤合并膀胱肿瘤者2例，先后发生双侧输尿管肿瘤并膀胱肿瘤者1例。经尿道用针状电极距输尿管口约0．5am环行切透膀胱。采用腰部3个穿刺套管针入路，行根治性肾切除，输尿管尽量向下游离，下腹部行5～9cm切口，取出肾标本，然后行下段输尿管及部分膀胱袖状切除。结果 35例手术顺利，手术时间1．5～6．0h，平均3．1h。出血量20～1600ml，平均166ml。4例需输血。术后20～32h下床活动。术后病理报告为移行细胞癌30例，输尿管低分化腺癌2例，输尿管鳞状细胞癌1例，输尿管平滑肌肉瘤1例，黄色肉芽肿性肾盂肾炎1例。1例术前为尿毒症透析患者，术后并发十二指肠漏，术后第3天放置引流管引流十二指肠漏出液，术后2个月死于心力衰竭。术后常规行膀胱灌注，预防肿瘤复发。平均住院时间11d。随访1～32个月，平均14个月，33例患者无瘤生存，1例术后3个月发生盆腔转移，目前带瘤存活。膀胱肿瘤均未见复发。结论 经后腹腔镜手术治疗肾盂和输尿管肿瘤，切口明显小于开放手术，术后恢复快。用电切镜环状切除输尿管末端可完整切除输尿管。     

成人肾母细胞瘤的临床特点

目的 探讨成人肾母细胞瘤的临床特点.方法肾母细胞瘤患者6例.男4例,女2例.年龄21～58岁,平均31岁.临床表现为腰腹痛4例,其中伴肉眼血尿1例,伴发热1例;腰腹部肿块2例.查体腹部能触及肿块者4例,有肾区叩击痛5例,下腹部压痛1例.6例尿常规检查2例红细胞(++).6例B超检查发现5.0 cm×5.0 cm～22.0 cm×25.0 cm的低回声团块,边界尚清.4例CT检查均发现密度不均、边界不清的实质性肿块,其中1例增强后肿物不均匀强化,中心有出血坏死;CT值11～40 HU,平均22.5 HU,增强后CT值35～78 HU,平均63.5 HU.2例MRI检查,提示实性占位性病变.3例IVU检查提示肾影增大,肾盏受压变细,肾盂积水1例.术前诊断肾肿瘤5例、盆腔包块1例.6例均手术治疗.根治性肾切除术5例,卵巢切除术1例,均同时行腹膜后淋巴结清扫术.术中见肿瘤侵犯胰尾1例,侵犯侧腹壁1例,侵犯下腔静脉1例;2例肾门淋巴结＞1.5 cm×1.5 cm.剖开肿物见切面灰黄或灰白色,4例包膜完整,3例肿瘤中心出血坏死.术后接受化疗加放疗4例,单纯化疗2例.结果 按美国国家肾母细胞瘤研究组(NWTS)分期:Ⅰ期1例、Ⅱ期2例、Ⅲ期2例、Ⅳ期1例.6例均顺利手术切除肿瘤.肿瘤直径4.5 cm～25.0 cm,平均11.8 cm.术后病理确诊,其中组织学分型显示分化良好型5例,分化不良型1例.有淋巴结转移者2例,局部浸润者3例,肺转移者1例(同时存在局部浸润).术后随访1～7年,平均3.5年.5例无瘤生存,1例术后2年死于肺转移. 结论 成人肾母细胞瘤患者就诊时大多已有肿瘤转移或浸润,发生血行转移者也明显多于其他肾肿瘤,早期诊断、根治性手术及术后放化疗可提高生存率.     

Total hip arthroplasty in patients with human immunodeficiency virus infection: pathologic findings and surgical outcomes

BACKGROUND: An increased incidence of osteonecrosis of the femoral head has been reported in patients infected with human immunodeficiency virus (HIV). The purpose of this study was to review the pathologic specimens of HIV-positive patients who had undergone total hip arthroplasty (THA) and compare them with those of THA patients who were HIV-negative. The surgical outcomes of these HIV-positive patients were also reviewed. METHODS: 40 HIV-positive patients who underwent 54 THAs at our institution were identified. The primary pathologic diagnosis for the femoral heads of these patients was osteonecrosis in 35 cases, degenerative joint disease in 11 cases, and other diagnoses in 8 cases. RESULTS: There was a higher incidence of osteonecrosis in HIV-positive patients. At the most recent follow-up, 4 patients had died and 1 patient had a significant Staphylococcus aureus infection of the hip. INTERPRETATION: There was a significant difference in the pathologic diagnoses of the HIV-positive group and the HIV-negative group, implicating HIV infection as a risk factor for osteonecrosis. Also, the risk of infectious complications is lower in our study than previously reported in other studies of HIV-positive patients who have undergone THA.     

Urgent superselective segmental renal artery embolization in the treatment of life-threatening renal hemorrhage

INTRODUCTION: Renal hemorrhage is a major life-threatening condition that can be caused by trauma, operation, biopsy, as well as sudden spontaneous rupture of renal tumors or aneurysms. We report our experience with superselective segmental renal artery catheterization and embolization as therapeutic options for such cases. PATIENTS AND METHODS: Over the last 8 years, 28 patients with severe renal hemorrhage were admitted for evaluation and possible further treatment. Twenty of them had a history of previous biopsy (6 of them one of a transplanted kidney), 1 patient had a recent percutaneous nephrostomy, 4 patients presented with renal mass ruptures (2 patients renal cell carcinoma, 1 patient angiomyolipoma, 1 patient hemorrhagic cysts), 1 patient had rupture of a renal aneurysm during delivery, 1 patient suffered bleeding after partial nephrectomy, and 1 patient was hospitalized after a car accident. They all presented with clinical signs of hemodynamic instability. Angiographic investigation of the kidneys preceded further intervention in all cases. 26 out of the 28 patients underwent superselective embolization of the specific bleeding vessel with the use of microcoils and/or Gelfoam particles. RESULTS: All patients treated by superselective segmental renal artery embolization had a successful outcome, including a steady renal function and a stable clinical course. No complications occurred. CONCLUSION: Superselective segmental renal artery catheterization and embolization is a safe and efficient method for the treatment of patients with severe renal hemorrhage, preserving healthy renal parenchyma and renal function.     

A clinical study of associated bladder cancer in patients with renal pelvic and ureteral cancer

We reviewed 76 cases of renal pelvic and ureteral cancer, admitted to our hospital between January, 1975 and December, 1988, with special reference to the occurrence of bladder cancer. Bladder cancer was associated with an upper urinary tract neoplasm in 35 of the 76 cases (46.1%), 7 with a preceding bladder cancer, 17 with a coexistent one and 11 with a subsequent one. In case of renal pelvic and upper ureteral cancer the incidence of coexistent or subsequent tumors of the bladder was 28.7% (16 of 56 patients). However, in the cases of lower ureteral cancer the incidence of these tumors was 82.4% (14 of 17 patients). This incidence was significantly higher than that in renal pelvic and upper ureteral cancer. The subsequent bladder cancer was observed in 19 patients including 8 patients who had a recurrence of the bladder cancer after the treatment for a preceding and coexistent bladder cancer. The cancer in most cases occurred within 2 years after the treatment of the upper urinary tract neoplasm. Of 19 patients who had subsequent bladder cancer 11 had primary sites in the renal pelvis and upper ureter. Another 8 patient had primary sites in the lower ureter. Four of the 8 subsequent bladder cancers in patients with lower ureteral cancer occurred just on and around the affected ureteral orifice. All these 4 tumors were high grade and high stage tumors. On the other hand, another 15 patients developed subsequent bladder cancer in a place other than the affected ureteral orifice. Of these 15 patients, 13 cases showed a low grade and low stage tumor.(ABSTRACT TRUNCATED AT 250 WORDS)