Small cell carcinoma of the urinary tract

Small cell carcinomas of the urinary tract are rare, but lethal. We report 3 cases of primary small cell carcinoma of the kidney, urinary bladder and prostate with light microscopic, immunohistochemical and electron microscopic findings. One patient with small cell carcinoma of the prostate died of disseminated disease 2 years after diagnosis and another patient with small cell carcinoma of the urinary bladder was free of tumour after 6 months. A partial remission was induced in the third patient with distant metastases of small cell carcinoma of the kidney by using chemotherapy protocols similar to the drug regimens for small cell carcinomas of the lung; the patient survived for 5 months. Immunohistochemical studies revealed the absence of argyrophilic immunostaining of tumour cells in all 3 cases, positive staining for keratin in 2 and staining for neuron-specific enolase in all 3. In the third patient, reactivity for prostate-specific antigen was negative. Dense-core, membrane-bound granules were identified in the cytoplasm of 2 patients. The paraneoplastic syndrome was not found, indicating that in considering the occurrence of ectopic hormones, specific cytoplasmic granules of origin need not be implicated. Recognition of this distinct entity requires full consideration of morphological, immunohistological, ultrastructural and biological features. In order to define the origin of this tumour more clearly and to evaluate the effectiveness of chemotherapy, larger series of patients are needed.     

Primary sarcomas of the gastrointestinal tract (author's transl)

From 1952 to 1976 2203 malignant tumours of the gastrointestinal tract were seen at the Surgical Clinic of the M.H.L., 18 of them were sarcomas. There was a predominance of carcinomas of the stomach (Sa: Ca = 1:229) and of the colon (1:162), whereas sarcomas of the small intestine were found in a relation of 1:0,9. X-ray diagnosis of the gastric sarcomas is difficult, only those with endogastric growth can be recognized by gastroscopy. The postoperative prognosis of gastric sarcomas is better than that of gastric carcinomas. Sarcomas of the small intestine have a high mortality rate because of a high rate of ileus and perforation. Sarcomas of the colon - normally localized in the caecum or rectum - have a better prognosis, seldom stenosis can be seen.     

Fuso-cellular carcinoma of the esophagus with aspects of microcytoma (oat cell)

A case of polypoid carcinoma of the lower oesophagus in a 52 yr old man is reported. The tumour presented the histological features of spindle-cell squamous carcinoma and oat-cell carcinoma. The histogenesis of these tumours is considered.     

Small bowel obstruction due to phytobezoars in the intact gastrointestinal tract

We present a series of cases of small bowel obstruction due to an intraluminal phytobezoar concretion. This rare cause of obstruction should not be forgotten as the recent literature has concentrated more on those patients with a past history of gastrointestinal surgery. None of our cases had had previous surgery, highlighting the point that an intact gastrointestinal tract does not exclude phytobezoars as a cause of obstruction.