Fine-needle aspiration of metastatic lesions and regional lymph nodes in genitourinary cancer

A percutaneous fine-needle aspiration biopsy of metastatic tumor and/or retroperitoneal, pelvic, or abdominal lymph nodes was accomplished in 101 patients. A diagnosis of metastatic disease was confirmed by this method in 49 patients. In 26 patients, surgical excisional biopsy or exploratory laparotomy was avoided. An unknown pelvic mass causation was diagnosed in 3 patients. In 15 of 57 patients with localized bladder, prostate, or testis cancer, involvement of regional lymph nodes was confirmed by transabdominal fine-needle aspiration. All 57 transabdominal aspirations were performed without complications. The method is inexpensive, safe, and can have a high accuracy in diagnosing a local tumor spread or distant metastases.     

Serum prostate-specific antigen value adjusted for non-cancerous prostate tissue volume in patients undergoing radical prostatectomy: a new predictor of biochemical recurrence in localized or locally advanced prostate cancer

The aim of this study was to investigate the significance of serum prostate-specific antigen (PSA) value adjusted for total tumor volume (PSA/tumor volume) and serum PSA value adjusted for non-cancerous prostate tissue volume (NCPV) (PSA/NCPV) as a predictor of pathological findings and clinical outcome after radical prostatectomy. Clinical and pathological data of 407 patients (median age: 66.5 years; range: 41.8-85.7 years) were reviewed retrospectively. The median follow-up period was 18.1 months (range: 1.0-107.8 months). Biochemical recurrence was defined as detectable PSA levels (greater than 0.2 ng ml(-1)) and the time of biochemical recurrence was taken to be the first time PSA became detectable. In the multivariate model, PSA/NCPV was an independent predictor of extracapsular extension and positive surgical margin (P<0.05), but PSA/tumor volume was not. Kaplan-Meier curves revealed that PSA/NCPV correlated with biochemical recurrence-free survival (P<0.001; log-rank test) but PSA/tumor volume did not (P=0.275; log-rank test). PSA/NCPV was also a significant independent prognostic factor for biochemical recurrence-free survival on multivariate Cox proportional hazard analysis (P=0.004, relative risk=2.42). Our findings suggest that PSA/NCPV is associated independently with extracapsular extension and surgical margin status and may be an independent prognostic variable of PSA recurrence after radical prostatectomy.     

Radiofrequency Ablation for Metachronous Liver Metastasis from Colorectal Cancer after Curative Surgery

Background We compared outcomes of surgery and radiofrequency thermal ablation (RFA) in patients with metachronous liver metastases. Methods Between October 1995 and December 2005, 59 patients underwent hepatic resection and 30 underwent RFA for metachronous liver metastases. Patients with extra-hepatic metastases, those who underwent both types of treatment, and those with synchronous hepatic metastasis were excluded. Results The two groups had similar mean age, sex ratio, comorbid medical conditions, primary disease stage, and frequency of solitary metastases. Preoperative mean serum carcinoembryonic antigen (CEA) level was significantly higher in the RFA group (13.4 ng/mL vs. 7.7 ng/mL; p = 0.02). Mean diameter of hepatic metastases was significantly greater in the resection than in the RFA group (3.1 cm vs. 2.0 cm; p = 0.001). Recurrence after treatment of metastasis was observed in 18 of 30 (60.0%) RFA and 33 of 59 (56%) resection patients. Local recurrence at the RFA site was observed in 7 of 30 (23%) patients. Time to recurrence (15 vs. 8 months, p = 0.02) and overall survival (56 vs. 36 months, p = 0.005) were significantly longer in the resection than in the RFA group. In the 69 patients with solitary metastases of diameter ≤3 cm, time to recurrence (p = 0.004) and overall survival were significantly greater in the resection group. Conclusions Compared with hepatic resection, RFA for metachronous hepatic metastases from colorectal cancer was associated with higher local recurrence and shorter recurrence-free and overall survival rates, even in patients with solitary, small (≤3 cm) lesions.     

Evidence of the immunomodulatory role of dual PI3K/mTOR inhibitors in transplantation: an experimental study in mice

The PI3K/mTOR signaling cascade is fundamental in T‐cell activation and fate decisions. We showed the distinct regulation of PI3K/mTOR in regulatory and effector T‐cells and proposed the potential therapeutic benefit of targeting this pathway to control the balance between effector and regulatory T‐cell activities. Substantial adverse effects in long‐term clinical usage of rapamycin suggest the use of alternative treatments in restraining effector T‐cell function in transplant patients. We hypothesize that dual PI3K/mTOR inhibitors may represent an immunosuppressant alternative. Here we show that dual PI3K/mTOR PI‐103 and PKI‐587 inhibitors interfered IL‐2‐dependent responses in T‐cells. However, in contrast to the inhibitory effects in non‐Treg T‐cell proliferation and effector functions, dual inhibitors increased the differentiation, preferential expansion, and suppressor activity of iTregs. Rapamycin, PI‐103, and PKI‐587 targeted different signaling events and induced different metabolic patterns in primary T‐cells. Similar to rapamycin, in vivo administration of PI‐103 and PKI‐587 controlled effectively the immunological response against allogeneic skin graft. These results characterize specific regulatory mechanisms of dual PI3K/mTOR inhibitors in T‐cells and support their potential as a novel therapeutic option in transplantation.     

The expression of redox proteins in phyllodes tumor

This study aimed to investigate the associations between the expression of redox-related proteins which regulate reactive oxygen species (ROS) production and the histologic factors in phyllodes tumor (PT). We used tissue microarrays to analyze 193 PTs and performed immunohistochemical staining against five redox-related proteins including catalase, thioredoxin reductase (TxNR), glutathione S-transferase π (GST π), thioredoxin interacting protein (TxNIP), and manganese superoxide dismutase (MnSOD). We then compared the immunohistochemical results and histologic parameters. The 193 PTs were classified as benign (n = 145, 75.1 %), borderline (n = 33, 17.1 %), and malignant (n = 15, 7.8 %). With worsening histologic grade, the expression of catalase, TxNR, TxNIP, and MnSOD in the stromal component increased (P < 0.001), and GST π and MnSOD expression in the epithelial component increased (P = 0.014, and 0.038). Significant associations were found between the expression of catalse–TxNR, catalase–TxNIP, catalase–MnSOD, TxNR–TxNIP, TxNR–MnSOD, and TxNIP–MnSOD in both the epithelial and stromal components (P < 0.05). This study confirmed that the stromal expression of catalase, TxNR, TxNIP, and MnSOD increased with worsening histologic grade in PT, reflecting the change in ROS production during the malignant transformation of PT.     

Transitional Cell Carcinoma in a Remnant Ureter after Retroperitoneoscopic Simple Nephrectomy for Benign Renal Disease

A 70-yr-old man presented with painless gross hematuria. He underwent right nephrectomy for benign disease 9 yr ago. Computed tomography and cystoscopy showed a mass in the distal region of the right ureteral stump. He underwent right ureterectomy and bladder cuff resection. Pathological examination showed T1 and WHO grade 2 transitional cell carcinoma. At 6 months postoperatively, the patient is alive without any evidence of recurrence.