The postoperative irradiation of transitional cell carcinoma of the renal pelvis and ureter

The role of adjuvant irradiation in the treatment of transitional cell carcinoma of the renal pelvis and ureter was reviewed. Between June 1966 and March 1981, 41 patients underwent curative resections. A poor risk group was identified, with 23 patients demonstrating disease greater than grade 2 or stage B. Postoperative irradiation was administered to 11 of 23 patients. Median patient followup was 40 months. Two-thirds of all failures occurred within the first 12 months and no failure was seen beyond 35 months. Patients with poor prognostic features had a 60 per cent failure rate compared to 11.8 per cent of the patients with good risk factors (p equals 0.023). The median survival of the 2 groups was 28 and 99 months, respectively (p less than 0.001). Outcome of the poor risk patients was analyzed whether or not the patient received postoperative irradiation. None of the irradiated patients failed with local disease only, while there was 1 patient with local and distant recurrence. In contrast, the nonirradiated group had 5 local failures and twice the number of failures over-all. Median survival of the irradiated and nonirradiated patients was 35 and 26 months, respectively. The number of patients treated is too small to permit valid statistical conclusions and indicates the need for a multi-institutional study to determine if these suggestive findings of improved local control will be corroborated and translate into an improved survival rate.     

Treatment in 50 cases of transitional cell carcinoma in renal pelvis and ureter

A total of 50 cases of primary tumors in the renal pelvis and ureter were treated in Tokyo University Branch Hospital (20 cases in 1966-1982) and in Tranomon Hospital (30 cases in 1977-1987). They were composed of 42 men and 8 women (5.3:1) with a mean age of 61 years. 31 patients suffered from renal pelvic tumors, 15 ureteral tumors and 4 tumors in both sites. The tumors were located in the left side in 33 cases, right in 16, and both sides in 1.86% of patients showed gross hematuria. The findings on IVP were filling defect (42%) and nonvisualization (33%). Positive urine cytology was obtained in 12 of 25 cases (48%). Surgery was performed in 47 cases. The remaining 3 cases were with advanced diseases. The surgeries were total nephroureterectomy plus ipsilateral retroperitoneal lymph node dissection in 26 cases, total nephroureterectomy without node dissection in 7, total nephroureterectomy and total cystectomy in 3, nephrectomy in 9, partial nephrectomy in 1 and segmental excision of ureter with ureteroureterostomy in one. Histologically, all tumors were transitional cell carcinoma. Over-all survival rates (Kaplan-Meier's method) of the operated patients at 1, 3, 5 years were 84.2%, 73.1% and 69.4%, respectively. The stage and grade of the tumors affected the prognosis. N factor at lymph node dissection was the most determining factor of prognosis. 3 advanced cases who did not receive surgery for primary site were treated with 5FU in 2, and with CAP in 1.2 of them died of the disease within 1 year after diagnosis, one patient was lost in follow up.(ABSTRACT TRUNCATED AT 250 WORDS)     

A clinical study on transitional cell carcinoma of the renal pelvis and ureter

Thirty-three patients in which transitional cell carcinoma was histologically diagnosed in the upper urinary tracts were statistically analyzed. Clinical analysis was done according to a new TNM system proposed by Akaza. Tumor grade and stage well correlated with survival. TS and TE group showed 89.5 and 17.1% 3-year survival, respectively. The survival rates showed significant difference between grade, 1, 2 and 3. T category and grade were also significantly correlated. Furthermore, histology and cytology were well correlated. Finally, prognosis in our series was significantly influenced by stage and grade of the tumor. Prognosis is considered to be good for 1) grade 1, 2) grade 2, superficial tumors with negative cytology, and 3) No and M0 cases. We emphasize that the new classification proposed by Akaza correlates well to survival and adapts well to the definition of regional lymph nodes.     

Smad4在肾盂、输尿管移性细胞癌中的表达及在细胞凋亡中的作用

目的 探讨细胞凋亡及Smad4在肾盂、输尿管移行细胞癌中的表达及其作用。方法 凋亡的检测采用未端脱氧核苷酸转移酶介导生长素标记法（TUNEL法），Smad4检测采用免疫组织化学方法。结果 在肾盂、输尿管移行细胞癌中，细胞凋亡指数为1.10%－3.75%，平均为2.50%，细胞凋亡指数与肿瘤组织学分级有关，但与肿瘤病理分期无关。Smad4阳性表达占17.6%(6/34),Smad4阳性表达位于肿瘤胞浆、胞核内，Smad4表达与肿瘤的分期、分级无关。细胞凋亡指数和Smad4表达之间无明显相关。结论 细胞凋亡指数与肾盂、输尿管移行细胞癌分级有密切关素；Smad4与肾盂、输尿管癌分期分级无关；细胞凋亡指数与Smad4表达无关。     

Prognostic variables in patients with transitional cell carcinoma of the renal pelvis and proximal ureter

Recent technological advances in urological endoscopic surgery of the renal pelvis and proximal ureter via ureteroscopy or percutaneous nephroscopy have made it possible to consider parenchymal-sparing procedures in patients with transitional cell carcinoma. To define the role of these procedures in the management of renal pelvic or proximal ureteral transitional cell carcinoma we analyzed retrospectively 31 patients who underwent nephroureterectomy for transitional cell carcinoma of the renal pelvis and/or proximal ureter. High grade upper urinary tract transitional cell carcinoma and a history of metachronous or synchronous bladder transitional cell carcinoma were independent adverse prognostic factors. However, patients with low grade upper urinary tract transitional cell carcinoma and no evidence of a urothelial field change had a 100 per cent 5-year survival rate. It would appear that parenchymal-sparing endoscopic techniques should be regarded with caution in patients with either high grade transitional cell carcinoma of the renal pelvis and proximal ureter or a history of bladder cancer.     

Apoptotic cell death and Smad4 expression in transitional cell carcinoma of the renal pelvis and ureter

PURPOSE: To investigate the frequency of apoptosis and the expression of Smad4 protein as well as their roles in transitional cell carcinoma (TCC) of the renal pelvis and ureter. METHODS: Apoptosis was detected by using terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) technique in 34 formalin-fixed and paraffin-embedded specimens of renal pelvic and ureteral TCC. The expression of Smad4 was immunohistochemically studied. RESULTS: The incidence of apoptosis ranged from 1.10 to 3.75% with a median of 2.50% in TCC of the renal pelvis and ureter. The incidence of apoptosis was noted to be closely related to histologic grade but not to pathologic stage of the cancer. The expression of Smad4 was detected in six of 34 cases (17.6%). Regarding subcellular distribution, Smad4 protein was localized both in cytoplasm and nucleus of the cancer cells. In comparing the incidence of apoptosis with the expression of Smad4, no significant associations were seen between them. The expression of Smad4 was not related to the tumor grade nor stage of the cancer. CONCLUSIONS: The present study demonstrated close association of the incidence of apoptosis with the tumor grade of TCC of the renal pelvis and ureter. Significance of Smad4 expression was not noted in the study. It suggests that apoptotic cell death may play an important role in the tumor progression of renal pelvic and ureteral TCC.     

Transitional cell carcinoma of the renal pelvis and ureter

In a retrospective study of 185 patients with transitional cell carcinoma of the renal pelvis and ureter, of whom 127 were treated by total nephroureterectomy and 58 by conservative resection, the survival of those with superficial well differentiated tumours was greater than 90% in each group. When urothelium was left behind after conservative resection, there was a 22% rate of recurrence on the same side but this almost only occurred when the original tumour had been multifocal. Post-operative radiotherapy did not improve survival.     

Bilateral renal cell carcinoma and synchronous occurrence of transitional cell carcinoma of renal pelvis

A case is reported of the unusual occurrence of a primary bilateral renal cell carcinoma and synchronous occurrence of a papillary transitional cell carcinoma of the renal pelvis in one kidney. The literature is reviewed.     

肾原发性上皮样血管肉瘤伴肾盂移行细胞癌

作者报道应用临床病理学、免疫组织化学和电子显微镜检查，发现１例左肾原发性上皮样血管肉瘤伴肾盂移行细胞癌。该病例第八因子相关抗原、荆豆凝集素、内皮细胞抗体、波形蛋白、细胞角蛋白和上皮膜抗原（ＦⅧＲＡ、ＵＥＡ、ＣＤ３１、Ｖｉｍｅｎｔｉｎ、Ｃｙｔｏｋｅｒｅｔｉｎ和ＥＭＡ）阳性，电镜查见Ｗ－Ｐ小体。作者认为该病是一种罕见肿瘤，预后差，其形态学和免疫组织化学类似于上皮性肿瘤，易导致误诊。电镜和内皮性标志物ＦⅧＲＡ、ＣＤ３１、ＵＥＡ的联合应用可确诊本瘤。     

Conservative surgery for transitional cell carcinoma of the renal pelvis

From 1972 to 1986, 14 patients underwent a conservative operation for transitional cell carcinoma of the renal pelvis. Most of these patients had low grade (12), noninvasive (10) tumors involving a solitary functioning kidney (12). The operations performed were open pyelotomy with tumor excision and fulguration (8 patients), partial nephrectomy (5) and percutaneous nephroscopic fulguration (1). There was 1 operative death. Of the 13 surviving patients 8 (62 per cent) remained free of transitional cell carcinoma postoperatively, while 5 (38 per cent) had recurrent disease. Six patients (46 per cent) presently are free of tumor 6 months to 5 years postoperatively. Conservative surgical techniques can provide satisfactory treatment for selected patients with renal pelvic transitional cell carcinoma when preservation of functioning renal parenchyma is necessary to avoid kidney failure.     

Sarcomatoid carcinoma of transitional cell origin confined to renal pelvis

Thirteen reported cases of renal pelvic sarcomatoid carcinoma have been documented since 1961, and all patients presented with metastatic disease or advanced renal parenchyma involvement. The mean survival was shorter than 9 months, and adjuvant therapy appeared to offer no benefit. We present the case of a 61-year-old man with gross hematuria and a large filling defect on computed tomography excretory urography. Surgical pathologic examination after laparoscopic nephroureterectomy was consistent with renal pelvis-confined sarcomatoid carcinoma of transitional cell origin. Adjuvant therapy was not given secondary to the organ-confined nature of disease. The patient was without recurrence for more than 1 year.     

非气腹手助腹腔镜肾盂癌根治术(附4例报告)

目的　探索非气腹手助腹腔镜肾、输尿管、部分膀胱切除术治疗肾盂癌的方法。　方法　自 2 0 0 1年 7月至 2 0 0 1年 11月使用自制非气腹装置实施非气腹手助腹腔镜治疗肾盂癌 4例。　结果　手术时间平均 170分钟 ,失血量 195ml。术后未使用镇痛剂 ,平均恢复进食时间 2 8天。术后随访 1～ 4个月 ,未见肿瘤复发。　结论　手助非气腹腹腔镜肾输尿管膀胱部分切除术治疗肾盂癌具有手术时间短、对病人心肺功能损害小、出血少、病人术后恢复快、操作简单易学等优点     

Sarcomatoid transitional cell carcinoma originating from a duplicated renal pelvis

A case of sarcomatoid transitional cell carcinoma of the renal pelvis is reported. It was distinguished from carcinosarcoma by immunohistochemical study. The tumor was difficult to distinguish from a renal parenchymal tumor in imaging studies because it originated from a duplicated renal pelvis.     

Micropapillary carcinoma of the renal pelvis and ureter

PURPOSE: MPC located in the upper urinary tract is rare with only 2 cases reported to date. We report clinical and histopathological data on 26 patients to increase the knowledge of this rare entity. MATERIALS AND METHODS: A clinical and histopathological review was performed in 943 patients with a neoplasm in the renal pelvis or ureter, diagnosed between 1971 and 1998. We identified 26 patients with MPC. No patients were alive at the end of the study. RESULTS: Of the patients 11 had greater than 50% MPC and 15 had focal MPC (at least 10%). The incidence was 2.8%. Median patient age at diagnosis was 69 years (range 54 to 88) and the male-to-female ratio was 17:9. All except 4 patients had stage T3 disease or higher. Carcinoma in situ was identified in 64% of cases and vascular invasion was present in 81%. A total of 20 patients (77%) died of disease and only 7 survived longer than 5 years. CONCLUSIONS: The prognosis is poor since most patients with MPC of the renal pelvis and ureter initially present with advanced disease. Stage for stage the prognosis is not different from that in nonMPC urothelial cell carcinoma. Surgery is curative in less advanced cases. However, radiotherapy and systemic chemotherapy appear to be ineffective.     

Cytologic diagnostic value of voided urine in 60 cases of primary transitional cell carcinoma of the renal pelvis and ureter

Exfoliative urinary cytology was performed on 60 cases of histologically proven TCC (Transitional cells carcinoma) of the renal pelvis and ureter. There were 39 cases of TCC of the renal pelvis. Urine cytology was positive in 27 cases (69.2%); suspicious in 5 cases (12.8%) and negative in 7 cases (17.9%). Significant correlation was found in the frequency of diagnosis and the histological grade of carcinoma. The cytological positive rate in G1 carcinoma was 40%; 71% in G2; 100% in G3. It is considered that the location of tumor in the renal pelvis predominates the urinary cytological positive rate. Urine cytology was positive in 3 cases (33.3%) out of 9 cases of the carcinoma seated in the inferior renal calix, whereas 19 cases (86.4%) from 22 cases in other sites of the renal pelvis (P less than 0.05). The positive rate of urine cytology for 21 cases of TCC of the ureter was 42.9%. The results showed that the secondary ureteric obstruction was an influence on the cytological positive rate.     

A mixture of transitional cell carcinoma and adenocarcinoma of the renal pelvis

An 85-year-old male was admitted to our hospital with the chief complaint of a left hydronephrosis. Computed tomography (CT) revealed left hydronephrosis and a left ureteral tumor. We performed left nephroureterectomy. Microscopically, the neoplasm was composed of a mixture of transitional cell carcinoma and adenocarcinoma. To our knowledge, this case is the 14th report of mixed carcinoma of the upper urinary tract.