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Reports on advances in kidney cancer and metastatic disease. Genetics; Classification; Premalignant lesions; Imaging; Prognostic factors; Surgical treatment of localized disease; Treatment of metastatic disease.

Proper treatment of resection specimens by the urologist and pathologist is critical in accurately reporting tumors and tumor-like nodules of the adrenal gland. Clinically inapparent adrenal masses are discovered, with increasing frequency, in the course of diagnostic testing or treatment for conditions that are not related to adrenal diseases. As a consequence an increasing number of relatively small tumors lacking the characteristic gross features of malignancy is detected. There is a need for identification of pathological findings that can improve the diagnostic accuracy and predict patient outcome.The aim of this paper is to review the handling and pathology reporting of adrenal gland specimens in the light of recent advances in this field of pathology. [Copyright &y& Elsevier]

Prostate carcinoma infiltrating around ganglion cells is claimed to be diagnostic of extracapsular extension because ganglion cells are only found in periprostatic soft tissue. However, the presence of autonomic ganglion cells in the fibrous capsule of the prostate has been reported. In this study, we aimed to define the exact localization of the ganglion cells in radical prostatectomy specimens. Slides of 64 totally embedded radical prostatectomies were reviewed. The ganglion cells were noted as outside the gland if no relation could be defined with prostate capsule or prostatic glands. They were noted as in the capsule when ganglion cells were observed inside the capsule, which was easily and definitely discerned. Ganglion cells were noted as in the prostate when ganglion cells were observed beneath the capsule and in close proximity to the prostatic glands. Also, the ganglion cells were noted as in the capsule if they were observed inside the capsule but not adjacent to the prostatic glands, and as outside the prostate when the capsule could not be easily defined and distant from the prostatic glands. Ganglion cells were observed in the prostate in 12 cases (18.75%). There was no relationship of these ganglion cells with the tumor in the prostatectomy specimens. Ganglion cells were located in the capsule in 14 cases (21.9%). The ganglion cells were observed outside the prostate in the other 38 cases (59.4%). These results show that there may be ganglion cells in the prostate. Therefore, defining ganglion cell invasion by the tumor as extracapsular invasion may lead to staging error and cause erroneous management of the disease. Presence of carcinoma in ganglion cells should be recorded by defining whether these structures are within or outside the prostate gland. Prostate Cancer and Prostatic diseases (2000) 3, 34–36 [ABSTRACT FROM AUTHOR]

Renal cell carcinoma (RCC) is the most common malignancy of the kidney. Since RCC is curable when it is confined to the renal capsule, early diagnosis is extremely important. Promoter hypermethylation is the most common mechanism for the inactivation of the tumor suppressor genes (TSG) in the development of human cancer. This study aimed to investigate the methylation profiles of 7 TSG (RASSF1A, ECAD, TIMP3, APC, MGMT, p16 and RARβ2) in 3 different tissue samples (normal, premalign, malign) of patients with RCC. Twenty-one patients diagnosed with RCC were included in the study. Methylation-specific polymerase chain reaction was performed to detect the methylation patterns of the 7 TSG. High methylation rates for the genes RASSF1A (76%), p16 (80%), ECAD (42%), TIMP3 (33%) and MGMT (33%) were observed in the patients with RCC. The APC (14%) and RARβ2 (19%) genes showed low methylation rates. In conclusion, 5 TSG (RASSF1A, ECAD, TIMP3, MGMT and p16) showed high methylation rates in RCC patients. A methylation-based gene test including these genes may be useful in the early detection of RCC. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: To investigate heat shock protein (HSP)-27 expression in patients with renal cell carcinoma (RCC) and examine its biologic significance. HSPs were first defined as proteins induced by heat shock and other environmental and pathophysiologic stresses. They are implicated in protein-protein interactions and are thought to play an important role in cancer. The expression of HSP-27 has been demonstrated in some human tumors.Methods: The expression of HSP-27 was studied in tumor and normal parenchyma tissue specimens from 76 patients with RCC by immunohistochemistry. The findings were correlated with clinical stage, lymph node metastasis, histologic grade, and survival.Results: Of the 76 RCC tissue specimens studied, the presence of HSP-27 was demonstrated in 73 (96%). The expression was low in 10 patients (14%), intermediate in 38 (50%), and high in 25 (33%). HSP-27 expression was greater in RCC tissue compared with adjacent noncancerous renal tissue (P <0.001). An inverse relationship was found between tumor stage and HSP-27 expression (r = -0.281, P = 0.016). However, no statistically significant difference was observed in progression-free survival with respect to HSP-27 expression. No relationship was found between HSP-27 expression and tumor grade, lymph node metastasis, distant metastasis, or cause-specific survival.Conclusions: Our data suggest that HSP-27 expression is not a powerful and statistically significant prognostic indicator for disease-free survival for patients with RCC. [Copyright &y& Elsevier]

This study investigated the frequency of allelic imbalance (AI) in particular loci in conventional renal cell carcinoma tissue and premalignant lesions of the kidney. DNA from the tumor tissue, premalignant lesions and normal kidney tissue of radical nephrectomy specimens from 33 patients was obtained. It was amplified with a set of eight microsatellite markers, which are located on chromosomes 2, 3, 5, 8, 9, 11, 16, 17. AI in DNA samples was determined by analysis of the alteration in (CA)n repeats. The rates of AI in tumor tissue were found to be between 22.2% and 53.3% and in premalignant lesions between 11.1% and 40.0%. Premalignant lesions and tumor tissues in conventional renal cell carcinoma have the same genotypic changes in 50.0–87.8% (informative cases). These results suggest that the progressive accumulation of AI in areas of premalignant lesions may contribute to the development of renal cell carcinoma, representing an important molecular event in the multistep renal carcinogenesis cascade. [ABSTRACT FROM AUTHOR]

The gold standard in the treatment of renal tumors is radical or partial nephrectomy. The surgical specimen handling is important since the pathologic features result in clinico-pathologic knowledge that determines prognosis, additional treatment and scientific studies. The correct handling of the specimen by urologists and pathologists becomes very basic in order to enable retrieval of a maximum of information. This protocol aims at standardization of the minimal criteria for handling, cellular subtyping, grading, staging and margin evaluation that must allow the comparison among the different scientific groups. [Copyright &y& Elsevier]

Discusses the preliminary findings of several clinical trials on the use of androgen deprivation to treat advanced prostate cancer. Efficacy of hormone suppression therapy; Impact of androgen therapy on the quality of life of cancer patients; Side effects of androgen suppression therapy.

Objective To assess nuclear morphometry as a predictor of prognosis in patients with renal cell carcinoma (RCC). Patients and methods The study included 65 consecutive patients with RCC who underwent radical nephrectomy and were followed up for a median (range) of 80 (27–138) months. Nuclear morphometry was assessed using a computer-assisted image analysis system on histological sections and characterized by five nuclear variables (area, perimeter, major and minor diameter, and form factor). From the patients' records and pathology specimens, the clinicopathological prognostic variables (histological type, Fuhrman grade and pathological stage) were recorded. The proliferative activity was assessed using immunohistochemical staining with Ki-67 antibody. Results Higher values of mean nuclear area, perimeter, and major and minor diameter were significantly related to higher nuclear grade, proliferative activity and advanced tumour stage. They were significant predictors of disease progression and survival, together with grade, stage, sarcomatoid histology and proliferative activity. Of all significant prognostic factors predicting progression-free survival, only stage was independent (T4 vs T1, hazard ratio 6.55, 95% CI 1.63–26.13, P =0.008). Conclusion Although the significance of these preliminary results must not be overstated, nuclear morphometry might provide significant prognostic information in predicting survival and tumours at high risk of progression in RCC. [ABSTRACT FROM AUTHOR]

Prescribing of BPH medications increases with patient age. As part of the Urologic Diseases in America (UDA) project, two insurance claims databases were used: CMS 5% Sample (Medicare beneficiaries age >=65) and Optum Clinformatics Data Mart (CDM, privately insured adults <65). [Extracted from the article]

Per-BPH-patient-per-year costs for HBO care rose and exceeded POBO costs from 2007 onward for private insurance, and from 2010 onward for Medicare. The distribution of healthcare expenditures for BPH management evolved from 2004-2013, with increasing outpatient costs relative to inpatient costs. [Extracted from the article]