Pure primary prostate transitional cell carcinoma. A review of our series

Primary prostate transitional cell carcinoma is a very uncommon tumor, that represents about 1% of all prostate tumours. In our institution, only six patients have been diagnosed with pure transitional cell prostate carcinoma until 2002. Bladder origin of the neplasic was ruled out in all cases. We report a study about the progression and survival of prostate transitional cell carcinoma. These prostatic tumours carry a poor prognostic (median survival is 4.6 months) with a strong tendency to metastatic spread. Therefore, we suggest a radical prostatectomy (without cystectomy) when it rules out bladder origin tumour.     

Magnetic resonance imaging in the staging of renal cell carcinoma

Correct diagnosis and accurate staging of renal cell carcinoma are critical in the evaluation of prognosis and subsequent treatment planning. Between October 1989 and April 1993, 25 patients with histologically proven renal cell carcinoma (RCC) were studied, comparing magnetic resonance imaging (MRI), computerized tomography (CT), operative findings and histopathological results. Two patients with pT3 tumours were understaged by both methods as T2. Three other patients staged as T4 by CT and T3 by MRI were actually pT3. N and V status were accurately detected by both imaging modalities. One patient with biopsy-proven liver metastasis missed by CT was correctly diagnosed by MRI. We conclude that MRI is complementary to CT and is especially helpful in patients with advanced stage and large sized tumours.     

Treatment of bladder carcinoma using a germ cell chemotherapy protocol.

Elevated levels of circulating beta-human chorionic gonadotrophin (beta-HCG) are commonly associated with a variety of tumours of germ cell origin. Other carcinomas may possess choriocarcinomatous elements but only rarely have there been reports of transitional cell carcinomas of the bladder associated with raised germ cell tumour markers, possibly because assays are not routinely performed. We present 3 patients with advanced transitional cell carcinoma of the bladder, 2 with metastatic and 1 with locally invasive disease, who had raised levels of germ cell tumour markers. These patients were therefore treated with combination chemotherapy appropriate to such tumours, with excellent results, as shown by clinical improvement and return to normal of tumour marker levels. Recent reports of the association between bladder carcinoma and ectopic synthesis of beta-HCG are reviewed. It was concluded that the production of beta-HCG is probably not rare, but that when it is found, the adoption of an appropriate chemotherapeutic regime may be successful.     

Primary malignant tumours associated with renal cell carcinoma.

Of 360 patients with primary renal cell carcinoma seen at the Vancouver General Hospital between 1957 and 1976, 33 had associated primary malignant lesions. A review of the 166 patients who had ablative surgery revealed that they were four times more likely to have a synchronous primary malignant tumour than the other patients. The incidence of asynchronous primary malignant tumours was not increased. This may be related to the fact that the patients' full life charts were not available. In 18 patients dying of other causes in whom an incidental renal cell carcinoma was found, 5 (28%) died of other malignant tumours. In a comparable age group from the general population, 19% are at risk of death from malignant disease. The frequency of synchronous contralateral renal cell carcinoma in our series was 50 times greater than the frequency of primary renal cell carcinoma in a corresponding sector of the general population.     

Renal cell carcinoma.

PURPOSE: The inactive form of pyruvatekinase could be established in different tumours. Purpose of this study was to demonstrate the presence or absence of the inactive form of pyruvatekinase in renal cell carcinoma, metastases and benign renal tissue by immunohistology. METHOD: After deparaffinization of formaline-fixed tissue (5 original tumours, 2 metastases and 5 benign renal tissues) cells were stained (APAAP-method) with Clon DF4 (ScheBo Tech). RESULTS: All malign tissue showed a positive reaction, inside benign tissue we saw a positive reaction of endothelial cells however we saw no reaction with benign renal cells. CONCLUSION: Renal cell carcinoma and metastatic cells show a strong immunohistological reaction against the inactive form of pyruvatekinase, no reaction of benign renal cells. It should be possible to develop a serological tumour marker for renal cell carcinoma.     

Combined imiquimod and acitretin for non-surgical treatment of basal cell carcinoma

We report the successful outcome of treatment of a basal cell carcinoma (BCC) with topical imiquimod and systemic acitretin in a 48-year-old woman. We think that this treatment is a possible option for management of these non-life-threatening tumours. Experimental evidence suggests that combination treatment with retinoids increase the effects of imiquimod and would therefore seem to be possible when treating superficial tumours in areas where the cosmetic outcome is particularly important.     

Merkel cell carcinoma in the orbitopalpebral region

Trabecular carcinoma is a rare cutaneous neuroendocrine carcinoma that probably originates from the Merkel cells that are usually found in the basal layer of the epidermis. The treatment of Merkel cell carcinoma is controversial and there is no specific therapeutic protocol because of the small number of cases that have been published. The procedures used to treat Merkel cell carcinoma must be tailored to minimise morbidity while maximising survival. Because the condition is so rare and difficult to diagnose and treat, we report three cases of orbitopalpebral tumours that confirm the local and regional aggressiveness and the high metastatic potential of this tumour.     

Androgen receptors in transitional cell carcinoma

Androgen receptors were measured in transitional cell carcinoma tissues obtained from 13 patients with bladder tumours and 3 patients with ureteric tumours. Scatchard analysis of binding of mibolerone, a synthetic androgen, was used for receptor measurement. None of the patients were receptor positive. This study suggest that human male hormones do not play any direct role in the malignant transformation of human transitional cell epithelium.     

Small cell carcinoma of skin: a report of two cases

We present two cases of small cell carcinoma of skin and review the evidence for the origin of these tumours from Merkel cells situated in the basal layers of the epidermis. The aggressive behaviour of these tumours makes their initial histological diagnosis important if careful follow-up is to be instituted and we suggest that more radical primary treatment might improve results. We emphasise the need to exclude an origin from other sites apart from skin and the role of electron microscopy and immunohistochemistry in identifying these tumours as being distinct from other poorly differentiated carcinomas.     

Squamous cell carcinoma of the lateral nail fold

The digital nail complex is occasionally involved by squamous cell carcinoma. The published literature has either been indiscriminating of the site of origin of this tumour within the nail complex or has concentrated attention on the nail bed as the site of pathology. Tumours originating in the lateral nail fold can be clearly differentiated from those of the nail bed itself. This study identifies six cases of squamous cell carcinoma arising in the lateral nail fold. While surgical convention remains to amputate the digital tip for squamous cell carcinoma of any part of the nail complex, the dermatological literature identifies that local surgery can be curative for these tumours, when presenting early and without bone involvement, although offering no discussion of reconstruction. Reconstruction is desirable and methods of achieving this following local excision of lateral nail fold tumours are illustrated in this series.     

Merkel cell carcinoma in the orbitopalpebral region.

Trabecular carcinoma is a rare cutaneous neuroendocrine carcinoma that probably originates from the Merkel cells that are usually found in the basal layer of the epidermis. The treatment of Merkel cell carcinoma is controversial and there is no specific therapeutic protocol because of the small number of cases that have been published. The procedures used to treat Merkel cell carcinoma must be tailored to minimise morbidity while maximising survival. Because the condition is so rare and difficult to diagnose and treat, we report three cases of orbitopalpebral tumours that confirm the local and regional aggressiveness and the high metastatic potential of this tumour.     

Localized renal cell carcinoma of an unusually large size: case report

Renal cell carcinoma has a variable clinical course. Size is a prognostic factor correlated with venous invasion, lymph node or distant metastases. These are more often encountered when the size exceeds 10 cm. For 20 years, incidental renal tumours have represented the majority of diagnosed cases, as a result of more common use of imaging techniques. We report a case of renal cell carcinoma of an unusually large size, without metastatic or locally advanced disease. Histology revealed a pT2 clear cell renal cell carcinoma of 31 x 31 x 10 cm, which was totally resected. It is the first case reported of localized conventional renal cell carcinoma reaching such a size.     

Primary adenosquamous and squamous cell carcinoma of the upper urinary tract. Report on three cases

Three cases of adenosquamous cell carcinoma and squamous cell carcinoma of the upper urinary tract are presented. The fact that the urothelium normally has no glandular or squamous structures renders the pathogenesis of these tumours interesting. The process is assumed to begin with an urothelial metaplasia resulting from a reaction to chronic irritation, leading to dedifferentiation, dysplasias and, in the end, to a squamous cell carcinoma or adenocarcinoma. The relevant medical histories include chronic episodes of pyelonephritis or nephrolithiasis. Diagnosis, therapeutic approaches and prognosis of these rare tumours are discussed.     

Synchronous basal cell carcinoma and meningioma following cranial irradiation for a pilocytic astrocytoma

We report a case of synchronous radiation-induced meningioma and basal cell carcinoma in a 48-year-old man who presented to the plastic surgeons with a fixed scalp lesion sited over a craniotomy scar. Synchronous radiation-induced tumours are a rare occurrence.     

Squamous cell carcinoma of the renal pelvis. A clinical case

Squamous cell carcinoma of the renal pelvis is uncommon, accounting for approximately 10% of all renal pelvic tumours. It's often associated with chronic renal calculi or infection and it usually presents at an advanced stage with pain or a palpable mass. We report an incidental case of squamous cell carcinoma of the renal pelvis, associated with chronic renal calculi and infection, and weight loss. The prognosis of patients with advanced squamous cell carcinoma of genitourinary origin is poor. In patients with chronic stones or infection squamous cell carcinoma of renal pelvis must be suspected if survival is to be affected.     

Prognostic factors and the role of neprectomy in metastatic renal cell carcinoma

The objective of this study was to evaluate the prognostic factors and role of nephrectomy in metastatic renal cell carcinoma. We reviewed 62 cases of metastatic renal cell carcinoma (RCC) at presentation to document the factors influencing the survival and to evaluate the role of nephrectomy. Sex and age of the patients, size of the primary tumour, site and number of the metastases, nephrectomy, cell type and grade of the tumour and type of the medical treatment were analyzed as prognostic factors. The age and sex of the patients, cell type and type of the medical treatment did not appear to be significant predictors of prognosis. However, improved survival was correlated with tumours ≤7 cm in diameter, low grade tumours, metastasis limited to single organ and removal of the primary tumour. When these parameters were analyzed in a combined manner patients who had undergone nephrectomy showed consistently longer survival. We suggest that nephrectomy should be considered in all patients with metastatic RCC, as long as the morbidity of the operation is predicted to be acceptable.     

Does the immunophenotype of renal cell carcinoma correlate with its clinical stage?

The following comparative study is an analysis of the clinical data, morphology and immunophenotype of 93 patients who have been operated on for renal cell carcinoma. We were able to show a close link between the histological grade and the occurrence of distant metastases: 33% of the patients with grade III tumours versus 11.5% of the patients with grade I tumours had developed metastasis by the time of the surgery. Histological subtyping per se did not give prognostic hints. Immunohistochemistry has revealed an inconsistent reaction pattern for the cytokeratin marker K11 (18/22). For proper diagnosis a panel of cytokeratin markers should be employed. The reaction patterns of monoclonal antibodies against the epidermal growth factor receptor (EGFR) and against myelomonocytic antigens in normal renal tissue (positive for the tubulus system) and in renal carcinoma indicate that renal cell carcinoma derive from the tubulus system. The proliferation marker Ki-67 correlates well with the histological grading. Although only a limited number of snap-frozen tumours have been investigated, this study indicates that EGFR is expressed by normal and by malignant renal tissue and that Ki-67 may serve as a prognostic marker.     

The role of arterial embolization in renal cell carcinoma.

Twenty-five years ago arterial embolization was introduced to facilitate the surgical excision of the carcinomatous kidney or to palliate symptoms, such as haemorrhage from non-resectable tumours. The role of this technique in the therapeutic armamentarium has been a source of debate in the literature. We reviewed all the available literature. A total of 389 papers were evaluated. Fifty-one publications and 3225 case histories met explicit entry criteria for inclusion. Until now no prospective randomized study of this approach to the management of renal carcinoma has been published. In the majority of studies the patients are grouped together irrespective of indication, i.e. pre-operative or palliative. Few articles are prospective or contain clear information regarding tumour stage, indication and adequate follow-up. Although we are not able to distinguish with certainty the effect of embolization on the course of the disease, it seems that complete pre-operative renal artery embolization facilitates the excision of large vein-invading tumours. The optimal delay between embolization and operation is probably one day. The embolization material of choice is ethanol. Palliative embolization in non-operable tumours with serious haemorrhage seems to have been successful in most cases. The scientific basis for the implementation of renal artery embolization in renal cell carcinoma is weak. We believe that either controlled trials or parallel prospective cohort studies should be undertaken to compare treatment of selected locally advanced renal carcinomas with and without embolization.     

Basal cell carcinoma of the external auditory canal

Carcinomas of the external auditory canal are rare, nevertheless they are associated with a relatively poor prognosis. Among these tumours, basal cell carcinomas are less frequent than squamous cell carcinomas. Anyway, it is difficult to determine if their prognosis is better, as in other localizations on the body. We reviewed six patients, presenting locally advanced basal cell carcinomas of the external auditory canal and considered the history of their disease, the treatment procedures and final oncological outcome. Four of the patients died of the disease within five years from surgery. They presented local recurrences even after radical surgical excision in free tissue margins. From these findings we have the impression that basal cell carcinoma of the external auditory canal behave, even after radical surgery, as an aggressive tumour associated with a really poor prognosis.     

DCC protein expression in clear cell renal cell carcinoma

OBJECTIVES: To investigate whether the expression of protein from the "deleted in colorectal cancer" (DCC) gene, which predicts a poor outcome for patients with colorectal carcinoma, can also serve as a prognostic factor in renal cell carcinoma (RCC). PATIENTS AND METHODS: The expression of DCC was evaluated immunohistochemically in 94 paraffin-embedded tumour samples from patients with stage T1, T2, and T3 clear cell RCC. The mean follow-up was 52.3 months. The endpoints of the study were recurrence of disease and death from disease. RESULTS: The under-expression of DCC protein was detected in 63% of patients who died from the disease and in 36% with no evidence of disease. DCC protein under-expression was detected in all patients with T1 tumours who died from the disease, in half the T2 tumours and in two-thirds of T3 tumours. CONCLUSION: DCC protein under-expression correlated with more aggressive tumour behaviour and a greater risk of death from RCC. However, a larger cohort of patients should be assessed before drawing definitive conclusions.