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We report two patients with renal primitive neuroectodermal tumor (PNET) in whom the diagnosis was established by both a cytogenetic and a molecular analysis. Histologically, both renal tumors were composed of uniform immature round cells with a positive immunoreactivity for 013 (p30/32 MIC2). The cytogenetic analysis with in situ hybridization (chromosome painting) demonstrated reciprocal translocation t(11;22)(q24;q12) specific to PNET in the cultured cells derived from each tumor. The reverse transcriptase-polymerase chain reaction (RT-PCR) in both tumors demonstrated EWS/ FLI-1 fusion transcripts, representing the molecular equivalent of t(11; 22). A Southern blot analysis also confirmed EWS gene rearrangement in both renal tumors. In addition, the authors also established two new cell lines (designated as FU-RPNT-1 and FU-RPNT-2) from renal PNETs. When transplanted into athymic mice, FU-RPNT-1 and FU-RPNT-2 reproduced and maintained the morphologic and molecular characteristics of the original tumors. In conclusion, the detection of t(11; 22) and EWS/FLI-1 fusion transcripts is considered to provide a novel adjunctive method for diagnosing renal PNET. These newly established cell lines thus may be used to investigate the biologic behavior related to renal PNETs.

We clarified the risk of elevated creatine kinase (CK) and myoglobulinemia during incised muscle urological operations.We retrospectively reviewed 58 consecutive cases of radical nephrectomy with muscle incision and 89 consecutive radical prostatectomies or radical cystectomies without muscle incision. Operations with or without muscle incision were divided into 2 groups depending on operative time (200 minutes or less and 201 to 400). Increases in CK and myoglobin were compared between the 2 groups, and between muscle incision and no muscle incision at each operative time.CK and myoglobin were proportionally increased according to operative time in operations without muscle incision but not in muscle incision operations, in which high CK and myoglobin were seen even with short operative times. CK and myoglobin were more increased in muscle incision operations than in those without incision with significance at each operative time. However, maximum CK and myoglobin were 2,220 IU/L and 3,600 ng/ml, respectively, in muscle incision operations.Even with short operative times surgeries with muscle incision are associated with a marked increase in CK and myoglobulinemia. However, CK and myoglobin are not sufficiently high for rhabdomyolysis with acute renal failure to develop.

Invasive bulbomembranous urethral carcinoma appears highly aggressive and requires radical local excision to cure. The standard surgical therapy for this tumor includes en bloc resection of the penis, urethra, scrotum and pubic bone with radical cystoprostatectomy.1 However, recently it has become increasingly important to also consider quality of life.2,3 We report on a patient with invasive bulbous urethral carcinoma, who has been satisfied 5 years after surgery with the surgical and cosmetic results of the methods used for penis and bladder preservation.

A 64-year-old man presented with a 1-month history of increasing bladder irritability and dysuria in December 1998. Digital rectal examination revealed an enlarged prostate with an irregular surface but without a pulsatile mass. There was no history of pelvic trauma or surgery. Serum prostate specific antigen (PSA) was 56.0 ng./ml. Transrectal ultrasound demonstrated a tubular and tortuous hypoechoic lesion along the left side of the prostate, which was suspicious for vascular abnormality (fig. 1). Systematic sextant prostate biopsy was performed under transrectal ultrasound guidance, avoiding the hypoechoic mass, and bleeding was minimal after the biopsy. A poorly differentiated adenocarcinoma was detected in all of the 6 biopsy specimens obtained. Pelvic CT demonstrated a large dilated and tortuous vascular system adjacent to the left side of the prostate (fig. 2). Digital subtraction angiography confirmed the presence of a large arteriovenous malformation in the left pelvis, fed by the left superior gluteal artery and draining into the left external iliac vein. During a 4-month period 6 courses of transarterial embolization of the left superior gluteal artery with metal coils were performed. Digital subtraction angiography showed a decrease in the size of the arteriovenous malformation.

A 73-year-old woman presented with gross hematuria and slight lumbago in June 1998. She had been on oral warfarin potassium for 4 years because of a permanent pacemaker implantation for the sick sinus syndrome. IVP revealed irregular right caliceal and pelvic defects, and narrowing of the infundibula. The left kidney was slightly hydronephrotic due to ureteropelvic junction stenosis. Abdominal computerized tomography (CT) showed thickening of the bilateral renal pelvic wall and the vestibule in the stomach with a slight homogeneous enhancement, which was considered suspiciously similar to bilateral renal pelvic and gastric tumors, or a malignant lymphoma (part A of figure). However, photogastroscopy did not reveal a stomach tumor. Repeat abdominal CT failed to show bilateral renal pelvic or gastric tumor. However, a hematoma was evident between the left gluteus medius and gluteus minimus (part B of figure). A thrombotest revealed less than 10% of normal value (normal during therapy 10% to 20%). We concluded that bilateral renal pelvic wall thickening was allowing hemorrhaging into the submucosa.