Traumatic renal pelvis rupture associated with previously unknown stenosis at the renal pelvis junction

Traumatic rupture of the renal pelvis junction has been reported only rarely in the literature. Surgical exploration of the right kidney in a young man with blunt abdominal trauma showed a formerly unknown stenosis at the renal pelvis junction with hydronephrosis. Rupture of the renal pelvis by blunt abdominal trauma was related to obstruction of the ureteropelvic junction. Routine ultrasound examinations could show this pathological findings and help the patient to undergo early urological treatment.     

Deletion of epithelial ABH isoantigens in primary gastric neoplasms and in metastatic cancer

A, B and H isoantigens, demonstrable in human gastric and small intestinal mucosae, using the mixed cell agglutination reaction, were diminished or absent in eight of nine gastric epithelial malignancies. In all metastases, there was complete absence of isoantigenic activity, even though in three of the corresponding primary gastric tumors, there was some residual activity. The loss of isoantigenicity noted in tumors paralleled that seen in the intestinalized metaplastic epithelium accompanying such tumors. In 2 patients with pernicious anemia, there was partial retention of such isoantigenicity in tumor tissue. Although it is not known whether they cause or result from malignant change, these findings suggest that an alteration of blood-group substance synthesis occurs in malignant epithelium. It is conceivable that such alterations may contribute to the potential of malignant cells to metastasize.Supportéd by Grants CA-04486 and CA 02090 from the National Cancer Institute; and TI AM 5320 from the National Institute of Arthritis and Metabolic Diseases, National Institutes of Health, Bethesda, Md.The authors wish to thank Dr. Israel Davidsohn for his advice and help.Senior Clinical Traineeship (Cancer Control) CST-529 A 67 from US Public Health Service; present address: Division of Experimental Pathology, Walter Reed Army Institute of Research, Washington, DC 20012.     

Unusual primary lung neoplasms

Bronchial carcinoids and hamartomas are, respectively, the most common malignant and benign unusual primary lung neoplasms. These tumors are often asymptomatic but can cause central airway obstruction. Helical computed tomographic and radionuclide scintigraphic advances in their detection and evolution, together with newer interventional bronchoscopy techniques such as neodymium:yttrium-aluminum-garnet laser phototherapy and cryotherapy, represent important improvements in the diagnosis and management of patients with such tumors.     

Transitional cell carcinoma of the ureter and renal pelvis

Transitional cell carcinoma (TCC) of ureter and renal pelvis is relatively uncommon. Smoking, occupational carcinogens, analgesic abuse, Balkan nephropathy are the risk factors. Cytogenetic studies revealed that the most frequent aberration is the partial or complete loss of chromosome 9. Approximately 20-50% of patients with upper urinary tract (UUT) TCC have bladder cancer at some point on their course, whereas the incidence of UUT TCC after primary bladder cancer is 0.7-4%. Excretory urography and retrograde pyelography are the conventional diagnostic tools; however, ureteropyeloscopy combined with cytology and biopsy is more accurate. Grade and stage of the disease have the most significant impact on survival. Nephroureterectomy with bladder cuff excision has been the mainstay of treatment. Local resection may be appropriate for distal ureteral lesions especially when the disease is low grade and stage. Advances in endourology have made it possible to treat many tumors conservatively. Ureteroscopic and to a certain extent percutaneous surgical approaches are widely used today especially in patients with low grade, low stage disease. Endoscopic close surveillance is mandatory for these patients. Adjuvant topical therapies appear to be safe but confirmation of any benefits awaits the results of further large studies. More recently, laparoscopic techniques have become a viable alternative to open surgery, but long term cancer control data are lacking. Aggressive surgical resection does not affect the outcome of patients with advanced disease. Adjuvant radiotherapy is ineffective, and systemic chemotherapy results in a low complete response rate for patients with metastases.     

Stromal eosinophilia in colonic epithelial neoplasms

OBJECTIVE: The purpose of this retrospective study was to determine the frequency and intensity of eosinophilic infiltration (or tissue eosinophilia) in the stroma of colonic adenomas, hyperplastic polyps, and colorectal adenocarcinomas. Eosinophilic infiltration in various malignancies has been reported but has not been evaluated in benign colorectal adenomas and hyperplastic polyps. METHODS: We analyzed 488 colonic neoplasms: 176 tubular adenomas, 55 tubulovillous adenomas, 82 villous adenomas, 15 early carcinomas in polyps, 95 invasive adenocarcinomas, and 65 hyperplastic polyps for the presence of eosinophilic infiltration. The eosinophilic infiltration was graded as negative (< or =5%), mild to moderate (>5-40%), or marked (>40%), depending on the percentage of eosinophils relative to total inflammatory cells in the stroma. RESULTS: Mild to moderate eosinophilia was noted in 75% of all adenomas. The transitional zone in all cases of invasive adenocarcinoma (zone between normal tissue and adenocarcinoma) revealed a high percentage of tissue eosinophilia. There was a striking absence of TE in the stroma of invasive adenocarcinomas. Only 5% of hyperplastic polyps had any eosinophilic infiltration. CONCLUSIONS: These data suggest that, in the spectrum of colonic neoplasms, stromal eosinophilia is most prominent in adenomas and seems to decrease with progression through the adenoma-carcinoma sequence. The ramifications of this study may alter management plans and provide some prognostic information for clinical evaluation.     

Cells of origin of primary pulmonary neoplasms in mice: morphologic and histochemical studies

Urethane-induced pulmonary adenomas in mice have two distinct histologic growth patterns--solid and papillary. The development of these tumors between 14 and 56 weeks was investigated in A/J mice. Solid tumor multiplicity remained constant from 14 to 56 weeks, whereas papillary and total tumor multiplicities increased in parallel between 14 and 28 weeks and remained constant through 56 weeks. The simplest explanation of these results is that solid and papillary adenomas arise independently, possibly from different cell types. The cell type of origin of these primary mouse lung tumors was investigated histochemically. Succinate dehydrogenase (SDH) histochemistry readily stained bronchiolar epithelial cells, but alveolar epithelial cells exhibited only slight enzymatic activity. Urethane-induced papillary adenomas exhibited intense SDH staining, whereas solid adenomas stained very lightly. Since Clara cells and type II pneumocytes are the only cells capable of proliferation in the bronchiolar and alveolar epithelia, respectively, the relative SDH activities of these adenomas is consistent with a hypothesis that solid tumors arise from type II pneumocytes and papillary tumors arise from Clara cells.