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Standard treatment modalities of caliceal diverticular calculi range from extracorporal shockwave lithotripsy (SWL) over retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PNL) and laparoscopic stone removal. A 55-year-old woman presented with a history of pyelonephritis based on a caliceal diverticular calculus. Due to the narrow infundibulum and anterior location, a robot-assisted laparoscopic calicotomy with extraction of the calculi and fulguration of the diverticulum was performed, with no specific perioperative problems and good stone-free results. This article shows technical feasibility with minimal morbidity of robot-assisted laparoscopic stone removal and obliteration of a caliceal diverticulum.

Background The mechanisms explaining the co-existence of asthma, eczema and rhinitis (allergic multimorbidity) are largely unknown. We investigated the mechanisms underlying multimorbidity between three main allergic diseases at a molecular level by identifying the proteins and cellular processes that are common to them. Methods An in silico study based on computational analysis of the topology of the protein interaction network was performed in order to characterize the molecular mechanisms of multimorbidity of asthma, eczema and rhinitis. As a first step, proteins associated to either disease were identified using data mining approaches, and their overlap was calculated. Secondly, a functional interaction network was built, allowing to identify cellular pathways involved in allergic multimorbidity. Finally, a network-based algorithm generated a ranked list of newly predicted multimorbidity-associated proteins. Results Asthma, eczema and rhinitis shared a larger number of associated proteins than expected by chance, and their associated proteins exhibited a significant degree of interconnectedness in the interaction network. There were 15 pathways involved in the multimorbidity of asthma, eczema and rhinitis, including IL4 signaling and GATA3-related pathways. A number of proteins potentially associated to these multimorbidity processes were also obtained. Conclusions These results strongly support the existence of an allergic multimorbidity cluster between asthma, eczema and rhinitis, and suggest that type 2 signaling pathways represent a relevant multimorbidity mechanism of allergic diseases. Furthermore, we identified new candidates contributing to multimorbidity that may assist in identifying new targets for multimorbid allergic diseases.

Study Type – Therapy (multi-centre cohort) Level of Evidence 2b OBJECTIVE To evaluate the early functional outcomes of transurethral plasma vaporization of the prostate (TUVis) in a multicentre study. PATIENTS AND METHODS A prospective multicentre observational study was conducted in eight urology departments. The inclusion criterion was benign prostatic hyperplasia (BPH) requiring surgical treatment. Patients on anti-coagulant therapy were not excluded. The TUVis procedure was performed according to a classic transurethral resection of the prostate (TURP) scheme following the manufacturer’s recommendations. We evaluated subjective functional outcome using self-questionnaires (International Prostate Symptom Score [IPSS] and five-item International Index of Erectile Function [IIEF-5]) and objective criteria (prostate volume, prostate-specific antigen [PSA], uroflowmetry, post residual volume) at baseline and at 1- and 3-month follow-ups. All types of complications were systematically recorded. RESULTS Despite 52% of patients receiving anticoagulant therapy before surgery, we reported only 3% with haemorrhagic complications, no blood transfusion, a mean catheterization time of 44 h and a mean postoperative stay of 2.9 nights. No significant change in irrigation time, catheter time or hospital stay was observed in patients with or without anticoagulant therapy. The IPSS and bother scores significantly decreased after the 3-month follow-up (57% and 59%, respectively), but the average remaining prostate volume was 29 cc and the tissue ablation rate was only 0.5 cc/min. Three major complications occurred, consisting of two urinary fistulas and one partial bladder coagulation. CONCLUSIONS The TUVis procedure has a proven fast postoperative recovery time, good short-term functional outcome and good haemostatic efficiency. However, the tissue ablation rate was lower than expected and we encountered three major complications, the mechanisms of which remain unclear. Considering the high energy level required to create the plasma effect, the generator, cable and resectoscope must be carefully checked before each procedure.

To evaluate blood loss during transurethral resection of the prostate (TURP), and its predictive factors, using the chromium 51 (51Cr) labeling method.From January to June 2008, 41 patients who underwent TURP for symptomatic benign prostatic hyperplasia (BPH) at four French urology centers were included in the analysis. Red cells volume was measured by the 51Cr method 1 day before TURP, and on postoperative day 3. Overall blood loss was estimated by multiplication of red cells volume loss and preoperative venous hematocrit value.Mean preoperative red cells volume was 1997 mL. Mean loss of red cells volume was 209 ml, which corresponds to an estimated blood loss of 507 mL. Mean delta of hematocrit and hemoglobin were 1.4% and 0.71 g/dL, respectively. In univariate analysis, prostate volume, weight of resected tissue, preoperative red cells volume, and resection time were significantly and directly associated with loss of red cells volume (P = 0.038, P = 0.004, P = 0.002, and P = 0.039, respectively). Bipolar and monopolar TURP did not lead to significant difference of red cells loss. In multivariate analysis, both preoperative red cells volume and weight of resected tissue were independent predictors of red cells loss (P = 0.017 and P = 0.048 respectively).We present the first study to measure blood loss secondary to TURP using the 51Cr method. This technique allowed evaluating blood loss not only during the surgical procedure but also during the postoperative period. We learned from this study that, on average, blood loss from the procedure until postoperative day 3 was more than 500 mL, which is larger than previously reported amounts as measured by other methods. Because significant blood loss might occur during the postoperative period, the 51Cr method should be used to measure blood loss when evaluating new emerging techniques to manage BPH.

Upper urinary tract urothelial cell carcinomas (UUT UCC) are rare sporadic tumors. Recent epidemiologic and molecular data have shown a singular susceptibility of UUT UCCs for specific risk factors. The main exogenic factors involved in UUT UCCs carcinogenesis remain tobacco and occupational exposure (aromatic amines, polycyclic hydrocarbures and chlored solvents). Enzymatic variants of detoxification system may be responsible of carcinogenesis with these toxics. Tumors induced by phenacetine consumption are decreasing since it was banned in the 1970s. Also, acid aristolochic exposure (Balkan nephropathy, Chinese Herb nephropathy) has been demonstrated to specifically induce UUT UCCs. Familial genic polymorphism of detoxification system would explain geographic distribution in endemic areas. In Taiwan, chronic arsenic exposition would constitute the main risk factor of UUT UCC. However, theses mechanisms of carcinogenesis remain unclear. The knowledge of UUT UCC development mechanisms implying toxic detoxification systems is still incomplete. To date, there is a growing body of evidence supporting that the interaction between individual genetic susceptibilities and environmental toxic exposure is a key to explain carcinogenesis in the majority of sporadic UUT UCC occurrence.

Plusieurs interventions en urologie se pretent a une pratique en chirurgie ambulatoire. Le but de cet article est de revoir l’organisation necessaire et les cadres legislatifs. Le CHRU de Lille developpe depuis plusieurs annees la chirurgie ambulatoire et son exemple est repris afin d’illustrer les propos.

Purpose Given that postprostatectomy recurrence of prostate cancer occurs in 10–40% of patients, the best use of immediate postoperative radiotherapy (RT) in high-risk patients and salvage RT for biochemical recurrence remains a topic of debate. We assessed the levels of evidence (in terms of efficacy, prognostic factors, and toxicity) for the following treatment strategies: immediate postoperative RT alone, salvage RT alone, and the addition of androgen deprivation therapy to the two RT strategies. Methods and Materials A systematic literature search for controlled randomized trials, noncontrolled trials, and retrospective studies between 1990 and 2008 was performed on PubMed, CancerLit, and MEDLINE. Only relevant articles that had appeared in peer-reviewed journals were selected. We report on the levels of evidence (according to the National Cancer Institute guidelines) supporting the various treatment strategies. Results Immediate postoperative RT improves biochemical and clinical progression-free survival (Level of evidence, 1.ii) but has no significant effect on metastasis-free survival or overall survival. A pathologic review is of particular importance for correctly analyzing the treatment strategies. Low-grade morbidity has been significantly greater in the postoperative groups, but no severe toxicity has been observed. The influence of immediate postoperative RT on postprostatectomy continence appears to be slight; therefore, immediate postoperative RT should be considered in patients with major risk factors for local relapse (Level of evidence, 1.ii). On the basis of extensive retrospective data, salvage RT is effective in biochemical relapse after prostatectomy; some patients with few adverse prognostic factors might also benefit from salvage RT (Level of evidence, 3.ii). The addition of androgen deprivation therapy to immediate postoperative or salvage RT has only been supported by weak, retrospective data (Level of evidence, 3.ii). Conclusion Prospective randomized trials are needed to compare immediate postoperative RT with salvage RT and to assess the value of androgen deprivation therapy in this setting.

Resume Recemment, de nouvelles voies therapeutiques ont ete explorees afin d’ameliorer les troubles mictionnels des patients presentant des troubles urinaires du bas appareil lies a une hyperplasie benigne de la prostate. L’objectif de cet article est de realiser une mise au point sur ces traitements : anti-inflammatoire, antidiuretique, anticholinergique et toxine botulinique. Les anticholinergiques, associes au risque de retention urinaire se revelent efficaces pour les troubles irritatifs en association a un alpha-bloquant. Les antidiuretiques peuvent etre proposes chez les patients de moins de 65 ans presentant une polyurie confirmee par un calendrier mictionnel, invalidante, liee a une HBP et refractaire au traitement classique de I’HBP. L’interaction entre l’inflammation et HBP n’est pas encore clarifiee. Les anti-inflammatoires semblant ameliorer les symptomes trouveraient peut etre une place dans un traitement ponctuel de 1’HBP car leur utilisation au long cours n’est pas recommandee. Les inhibiteurs de cox-2 ont ete retires du marche. Enfm, la toxine botulinique pourrait avoir une place dans le traitement des troubles lies a I’HBP si les etudes cliniques confirment les resultats prometteurs recemment publies. Ces nouvelles approches seront probablement a integrer dans les recommandations et les arbres decisionnels du traitement des troubles mictionnels lies a I’HBP.

We externally validated a previously designed neural network model to predict outcome and duration of passage for ureteral/renal calculi. The model was also evaluated using a 6 mm largest stone dimension cutoff in predicting stone outcome.The model was previously designed on 301 patients at Albany Medical Center (free shareware from www.uroengineering.com). The model had a prediction accuracy of 86% for passage outcome and 87% for passage duration. In this study we tested the model on a separate 384 patients from 6 different external institutions to assess the prediction accuracy. All patients had a single renal/ureteral calculus by evaluation in an emergency room setting or by primary physicians and were then referred for further treatment. Model accuracy was also compared to using a 6 mm largest stone dimension cutoff in predicting the need for intervention.Testing on the 384 patients from all 6 external institutions revealed an outcome prediction accuracy of 88%. The area under the ROC curve was 0.9. Using a 6 mm stone size cutoff provided 79% (ROC 0.8) accuracy. The model duration of passage prediction accuracy was 80% (133 patients passed the stone, area under ROC of 0.8).The model provided high stone outcome prediction accuracy (ROC of 0.9 and 0.8) at the 6 external institutions, comparable to that of the design institution. The model provided higher accuracy than using only the largest stone dimension as a cutoff. Increasing experience will further assess the model's accuracy.

Objectifs Les objectifs sont de decrire les caracteristiques anatomocytopathologiques des tumeurs de vessie incidentes en population generale, dans la zone de proximite de Lille et la prise en charge therapeutique initiale des personnes atteintes de tumeur de vessie non infiltrant le muscle (TVNIM) a risque fort de progression/recurrence et des personnes ayant une tumeur de vessie infiltrant le muscle (TVIM) au moment du diagnostic. Methodes La ZL (780 000 habitants) est couverte par le registre general des cancers de Lille et de sa region. Les tumeurs y sont enregistrees et codees selon les standards internationaux et nationaux. Les tumeurs de vessie incidentes en 2011 et 2012 sont analysees a l’exception des tumeurs benignes et des carcinomes de l’ouraque (N = 517). Resultats Une analyse anatomopathologique a ete effectuee pour 510 tumeurs. Vingt-trois pour cent des tumeurs etaient des TVNIM a faible risque de recurrence/progression, 30,8 % des TVNIM a risque intermediaire, 17,4 % des TVNIM a haut risque et 27,5 % des TVIM. Pour les 90 tumeurs a haut risque, l’âge median de survenue etait 74 ans ; 61 cas ont ete presentes en reunion de concertation multidisciplinaire (RCP) ; 49 personnes ont beneficie d’instillations endovesicales, 9 d’une chirurgie d’emblee ; pour 90,2 %, la prise en charge initiale correspondait a la recommandation de la reunion. Pour les 142 TVIM, l’âge median de survenue etait 72 ans ; 131 cas ont ete presentes en RPC ; 65 personnes ont beneficie d’une cystectomie initiale, 32 n’ont recu aucun traitement specifique ; 81,5 % des personnes ont recu le traitement preconise. Conclusion Cette description est l’une des rares etudes realisees en France permettant de faire un etat des lieux des tumeurs de vessie en population generale et de leur prise en charge, etape achevee par l’analyse du bilan realise et du timing de la prise en charge.

Objectives: To determine the value of frozen section examination for the management of small incidental testis tumors. Methods: We reviewed all cases of incidental nonpalpable testis tumors that have been examined in frozen section during the period 1996–2002. For each case, frozen section and definitive histological slides were available and were reviewed. Results: Fifteen cases were retrieved in the files of the Department of Pathology. Nine cases were discovered by ultrasonography examination in patients presenting with infertility. Six cases were discovered incidentally by sonography for testis trauma or scrotal pain. The patients were aged from 18 to 43 years. The tumors measured from 4 to 16mm. Frozen section examination concluded in 9 cases to a benign lesion "Leydig cell nodule", in four cases a diagnosis of malignancy was retained and the last two cases were inconclusive. The standard microscopic examination confirmed the 9 cases of Leydig cell tumors; malignancy was confirmed in the 4 cases (3 seminomas and one teratoma) and the uncertain cases were benign Sertoli cells tumors. Benign lesions were treated by a conservative approach. Conclusion: Frozen section examination is a useful method for the management of small incidental masses of the testis.

To compare postoperative outcomes of patients on oral anticoagulation (OA) treated with transurethral plasma vaporization of the prostate in saline water (TUVis) and transurethral resection of the prostate (TURP).Between January and December 2009, 111 patients on OA therapy were treated with either TURP or TUVis in eight centers. Types of OA and perioperative management were collected. Postoperative outcomes were statistically compared between the two groups.A total of 57 (51%) and 54 (49%) patients were treated with TURP and TUVis, respectively. Types of OA were not significantly different between the two groups, but bladder catheterization prior to surgery was more frequently observed in the TUVis group. Before surgery, 28 patients were treated with warfarin alone, 74 with a platelet aggregation inhibitor (PAI) alone, and 9 with a combination of both. PAI was withdrawn preoperatively in 50 patients. All treatments with warfarin were switched for heparin. Comparison of the two groups showed significantly less hemorrhagic complications after TUVis. Patients treated with TUVis experienced less bladder washouts (2% versus 18%, p = 0.008), less late hematuria (4% versus 19%, p = 0.02), and lower decrease of serum hemoglobin (mean decrease of 0.66 versus 1.47 g/dL, p = 0.02). Postoperative bladder catheterization and hospital stay were significantly shorter, whereas the rate of urinary retention was significantly higher. Three months after surgery, functional results were not significantly different between the two groups.In patients on OA, TUVis led to significantly less bleeding, as well as shorter bladder catheterization and hospital stay than TURP.

Study Type - Therapy (multi-centre cohort). Level of Evidence 2b.To evaluate the early functional outcomes of transurethral plasma vaporization of the prostate (TUVis) in a multicentre study.A prospective multicentre observational study was conducted in eight urology departments. The inclusion criterion was benign prostatic hyperplasia (BPH) requiring surgical treatment. Patients on anti-coagulant therapy were not excluded. The TUVis procedure was performed according to a classic transurethral resection of the prostate (TURP) scheme following the manufacturer's recommendations. We evaluated subjective functional outcome using self-questionnaires (International Prostate Symptom Score [IPSS] and five-item International Index of Erectile Function [IIEF-5]) and objective criteria (prostate volume, prostate-specific antigen [PSA], uroflowmetry, post residual volume) at baseline and at 1- and 3-month follow-ups. All types of complications were systematically recorded.Despite 52% of patients receiving anticoagulant therapy before surgery, we reported only 3% with haemorrhagic complications, no blood transfusion, a mean catheterization time of 44 h and a mean postoperative stay of 2.9 nights. No significant change in irrigation time, catheter time or hospital stay was observed in patients with or without anticoagulant therapy. The IPSS and bother scores significantly decreased after the 3-month follow-up (57% and 59%, respectively), but the average remaining prostate volume was 29 cc and the tissue ablation rate was only 0.5 cc/min. Three major complications occurred, consisting of two urinary fistulas and one partial bladder coagulation.The TUVis procedure has a proven fast postoperative recovery time, good short-term functional outcome and good haemostatic efficiency. However, the tissue ablation rate was lower than expected and we encountered three major complications, the mechanisms of which remain unclear. Considering the high energy level required to create the plasma effect, the generator, cable and resectoscope must be carefully checked before each procedure.

Background/Aims: There are only a few surveys on the prevalence of lower urinary tract symptoms (LUTS) among the general population. The aim of this survey was to assess the prevalence of LUTS and their impact on discomfort in men. Methods: A questionnaire was mailed to 3,877 men aged 50–80 years, which included questions on their medical history, demographic and sociological status, and also the International Prostate Symptom Score (IPSS) with additional questions on discomfort related to urinary symptoms. Results: The response rate was 81.5%. Prevalence of mild and severe IPSS was 89.2%. Specific bother for each urinary symptom depended on symptom frequency: urgency, frequency, weak stream, nocturia, incomplete emptying, intermittency and straining 1 time out of 5 were responsible for discomfort in respectively 4.9, 6.1, 7.1, 7.5, 8.7 and 9.9%; the same symptoms more than half of the time were responsible for discomfort in respectively 32.8, 38, 45.3, 45.6, 53.2 and 58.7%. Urgency was much more deeply implicated in discomfort than frequency of nocturia. Conclusions: Urinary symptoms in men are very common. Nocturia is the most frequent but has a low impact on discomfort. Urgency has a higher impact on discomfort and should therefore be considered in treatment decision-making.

We report a case of an elderly man with bladder cancer, in whom the first manifestation of Erdheim-Chester disease was retroperitoneal infiltration detected during routine follow-up. The disease was diagnosed on the basis of histology and immunochemistry findings (presence of histiocytes) and of imaging findings (plain radiography, computed tomography, magnetic resonance imaging, and bone scintigraphy). The differential diagnosis with respect to other causes of retroperitoneal infiltration is discussed.

New therapeutic approaches have recently been investigated in order to improve the voiding disorders of patient with lower urinary tract symptoms related to benign prostatic hyperplasia. The purpose of this article is to provide a review of these treatments: anti-inflammatory, antidiuretic, anticholinergic and botulinum toxin. Anticholinergic drugs associated with a risk of urinary retention, appear to be effective for irritative disorders in combination with an alpha-blocker. Antidiuretics can be proposed in patients younger than 65 with disabling polyuria confirmed by a voiding diary, related to BPH and refractory to conventional treatment of BPH. The interaction between inflammation and BPH has not yet been clarified, but anti-inflammatory drugs appear to improve symptoms and may have a place in short-term treatment of BPH, as their long-term use is not recommended and COX-2 inhibitors have been withdrawn from the market. Finally, botulinum toxin could have a place in the treatment of disorders related to BPH if clinical studies confirm the recently published promising results. These new approaches will probably be integrated into guidelines and flow-charts for the treatment of voiding disorders related to BPH.

Prostatic stents and microwave thermotherapy are minimally invasive techniques for the treatment of voiding disorders related to benign prostatic hyperplasia. A review of the literature evaluates the place of these treatments in 2006. Permanent prostatic stenting is rarely used, but remains a treatment option for patients with obstructive disorders and a formal anaesthetic contraindication. Temporary stenting can be used to predict the effect of resection in selected patients. Finally, microwave thermotherapy, not widely used in France, has a promising clinical efficacy and occupies a place between medical treatment and surgery.

To analyse the value of an introduction to urology session to recruit interns following the Examen National Classant (ENC) (National Entrance Examination).Over a 2-year period, interns appointed to surgery in Paris participated in a one-day introduction to urology session before starting work as surgical interns. A questionnaire at the beginning of internship recorded: age, gender, teaching hospital, student attachment in urology and desired specialization as a function of the surgical training programmes proposed by the ENC. Items concerning the desired specialization were resubmitted to the interns at the end of the session.Population. 166 interns, 98 females (59%) and 68 males (41%) with a mean age of 24.8 +/- 5 years (range: 22-31) participated in this study. 110 interns had trained at a Parisian teaching hospital (66.2%) and 56 (33.8%) had trained at a provincial teaching hospital. 31 interns (18.7%) had completed at least one urology attachment during their medical training. Desired specialization: Orthopaedics was the discipline most frequently cited (n=48; 28.9%). Urology was selected by 19 interns (11.4%), 17 of whom had completed an urology attachment during their medical training. At the end of the introduction to urology session, another 15 interns initially oriented towards other specializations were interested in urology training.Specialization of certain surgical disciplines during internship could become inevitable in the medium term. In this case, the organization of national introduction to urology sessions in each ENC allocation region would be a solution to encourage motivated interns to immediately choose urology as their surgical speciality by preference rather than by default.

Context.—Adult renal cell carcinoma (RCC) with rhabdoid features is a recently recognized morphologic variant of kidney carcinoma. To date, only very few studies have been published on this subject and p53 was not previously studied. Objective.—To evaluate clinical attributes, morphology, and immunohistochemistry in RCC with rhabdoid component. Design.—Reviewing a consecutive series of 310 RCCs, we identified 14 cases of RCC with rhabdoid features. All cases were reviewed and subjected to detailed clinical and pathologic studies with immunohistochemical evaluation of p53. Results.—All tumors were clear RCCs with rhabdoid component representing from 5% to 50% of the tumor volume. Rhabdoid cells were large with a central eosinophilic intracytoplasmic inclusion and an eccentric atypical nucleus. Tumor necrosis was common (13/14) and sometimes extensive. Nine of 14 tumors were staged pT3, 4 of 14 were pT2, and only 1 tumor was pT1. On immunohistochemistry, rhabdoid cells were positive for vimentin (14/ 14), epithelial membrane antigen (11/14), and cytokeratin (9/14). Desmin and smooth muscle actin were always negative. p53 was positive in 10 of 14 tumors in the rhabdoid areas (5%–50% of tumor cells stained) but only in 5 of 14 cases in usual clear renal cell areas. In the follow-up, 10 of 14 patients developed metastases and 6 of 14 died of the disease. The median of survival was 8 months. Conclusions.—We showed that RCC with rhabdoid features is a very aggressive neoplasm with a poor prognosis. We observed an overexpression of p53 in the rhabdoid component that may be implicated in the tumor dedifferentiation.

To analyse the value of an urology initiation session proposed to young interns to improve recruitment of the discipline since the introduction of the new National-Ranking Exam (NRE).In October 2004, the 77 interns appointed to surgery in Paris on the basis of the ENC participated in a one-day urology initiation session organized by the AFUF, at the AP-HP School of Surgery. All interns were given a questionnaire at the beginning of the session to record the following data: age, gender, teaching hospital, a student attachment in urology and desired specialization as a function of the surgical training programmes proposed by the ENC. Items concerning the desired specialization were resubmitted to the interns at the end of the session.Population. 77 interns, 48 females (62.3%) and 29 males (37.7%) with a mean age of 25.2 +/- 5 years (range: 23-31). 55 interns had trained at a Parisian teaching hospital (67%) and 22 (28.6%) had trained at a provincial teaching hospital. 16 interns (20.8%) had completed at least one urology attachment during their medical training. Desired specialization. Orthopaedics was the discipline most frequently cited (n = 20; 26%). Urology was chosen by 8 interns (10.40%), who had all completed an urology attachment during their medical training. At the end of the urology initiation session, another 8 interns expressed the desire to specialize in urology. Of the 16 potential urology interns, 9 (56.2%) confirmed that their decision was final.Urology occupies a special place and remains a popular surgical speciality among students. Organization of practical sessions constitutes a solution to inform, create an emulation and motivate surgery interns to choose urology.

We assessed the value of pelvic phased array dynamic contrast enhanced magnetic resonance imaging for predicting the intraprostatic location and volume of clinically localized prostate cancers.Suspicious areas on prospective pre-biopsy magnetic resonance imaging in 24 patients were assigned a magnetic resonance imaging malignancy score and located with respect to anatomical features, gland side, and transition and peripheral zone boundaries. The largest surface area and volume were measured. These magnetic resonance imaging findings were compared with radical prostatectomy specimen histopathology findings.Histopathology maps detected 56 separate cancer foci. The largest tumor focus was located in the peripheral zone in 14 patients and in the transition zone in 10. T1-weighted dynamic contrast enhanced magnetic resonance imaging identified 30 of the 39 tumor foci greater than 0.2 cc and 27 of the 30 greater than 0.5 cc. T2-weighted sequences were suspicious in 22 of 30 foci greater than 0.2 cc that were identified by T1-weighted dynamic contrast enhanced magnetic resonance imaging sequences. Sensitivity, specificity, and positive and negative predictive values for cancer detection by magnetic resonance imaging were 77%, 91%, 86% and 85% for foci greater than 0.2 cc, and 90%, 88%, 77% and 95% for foci greater than 0.5 cc, respectively. Median focus volume was 1.37 cc (range 0.338 to 6.32) for foci greater than 0.2 cc detected by magnetic resonance imaging in the peripheral zone and 0.503 cc (range 0.337 to 1.345) for those not detected by magnetic resonance imaging (p0.05). Corresponding median values for transition zone foci were 2.54 (range 0.75 to 16.87) and 0.435 (range 0.26 to 0.58).Pre-biopsy pelvic phased array dynamic contrast enhanced magnetic resonance imaging is an accurate technique for detecting and quantifying intracapsular transition or peripheral zone tumor foci greater than 0.2 cc. It has promising implications for cancer detection, prognosis and treatment.

Cystic prostate cancer is a rare entity. Ductal adenocarcinoma, formerly known as endometrioid adenocarcinoma, is a clinical and histological variant of prostatic carcinoma. The authors report two cases of cystic prostate cancer, in which histological examination demonstrated the predominance of a ductal carcinoma contingent. A review of the literature revealed 8 cases of cystic prostate cancer, including 3 cases that also presented a ductal contingent. The cystic appearance of the peripheral prostatic zone appears to be a distinct clinical and morphological entity of ductal carcinomas. This entity has never been previously reported.

To investigate, by real-time quantitative reverse transcriptase-polymerase chain reaction, the expression of MUC3 and vascular endothelial growth factor (VEGF) to correlate them with histologic parameters and with prognosis. Human mucins are large O-glycoproteins expressed in epithelial tissues. Deregulation of mucin genes has been demonstrated in several epithelial neoplasms. In the kidney, MUC3 is expressed in normal convoluted tubules and in renal clear cell carcinoma.Twenty-six renal clear cell carcinoma specimens were studied. For all tumors, samples of normal and tumor kidney were frozen. After RNA extraction, using ultracentrifugation through a cesium chloride cushion, VEGF and MUC3 mRNA were analyzed by real-time quantitative reverse transcriptase-polymerase chain reaction. The pathologic parameters included Fuhrman nuclear grade and TNM stage. All follow-up data were available.The median level of MUC3 and VEGF expression was greater in tumor areas compared with normal areas (P0.002 and P0.001, respectively). The MUC3 tumor/normal tissue expression ratio was greater in nuclear grade 3 tumor than in low grades (grade 1-2; P0.005). No statistically significant relationship was found with the prognosis for MUC3 and VEGF in our study.The results of this study demonstrate that MUC3 and VEGF are overexpressed in renal clear cell carcinoma, and the MUC3 expression ratio is greater in nuclear grade 3 than in grades 1 and 2 (low grades) tumor. These findings suggest the implication of MUC3 in renal carcinogenesis.

To evaluate the risk of local recurrence and metastatic spread of renal cancer treated by conservative surgery with a minimum follow-up of 5 years.All patients operated for renal cancer by conservative surgery in our department between November 1989 and March 1997 were included in this retrospective study and were submitted to annual follow-up. These patients presented conventional indications (solitary T1N0M0 tumours4 cm) or indications of necessity (all stages).The minimum follow-up was 5 years (range: 63-143 months; median: 90 months). This series comprised 30 partial nephrectomies, 15 performed for solitary T1N0M0 tumours4 cm, and conservative surgery was performed by necessity in 15 patients (10 patients with T1N0M0 tumours, 5 patients with T2 or M+ tumours). All tumours less than 4 cm on imaging were less than 4 cm on the operative specimen. In stage T1N0M0 tumours, the prediction of pathological stage by preoperative imaging was accurate in 24 out of 25 cases, with 24 pT1N0M0 and 1 pT3aN0M0 on final histology. The resection margins were negative in 29 out of 30 patients. One patients with a stage T2N0M+ tumour (7.5 cm in diameter) had a positive resection margin. Two out of 30 patients developed impaired renal function after surgery to a solitary kidney. Renal function at 3 months remained identical to preoperative renal function in all other patients. For 24 patients with pT1N0M0 tumours4 cm, the specific recurrence-free survival was 100% (median follow-up: 90 months; range: 63 to 143 months). Among the 6 patients with T2 or M+ tumours, 5 patients (84%) died from metastatic disease at 18, 22, 24, 28 and 54 months, while 1 patient (16%) was still alive without recurrence at 119 months.The indication for conservative surgery for T1N0M0 renal tumours4 cm is a validated treatment option for unifocal renal cancer. This series confirms the data reported in the literature with a minimum follow-up of 5 years. Stage pT3a tumours on postoperative diagnosis have a high risk of recurrence and metastatic spread, which may constitute an indication for secondary radical nephrectomy. Annual surveillance by imaging is essential.

Aims: To establish the clinicopathological features of minimal volume prostate adenocarcinoma on prostate biopsy. Methods: Twenty four cases of minimal adenocarcinoma diagnosed on prostate biopsy and treated by radical prostatectomy were reviewed. Results: The major microscopic criteria were nuclear enlargement (22 of 24), infiltrative pattern (19 of 24), prominent nucleoli (19 of 24), intraluminal eosinophilic secretions (15 of 24), and high grade intraepithelial neoplasia associated (11 of 24). Sixteen of 24 cases were assigned a Gleason score 6 on biopsy. When the whole gland was assessed, 22 of these tumours were localised to the prostate (stage pT2), and only two cases were stage pT3. Conclusions: Minimal focus of adenocarcinoma on prostate biopsy is not an uncommon finding. It is usually an intermediate grade and localised stage neoplasm.

We report a case of an elderly man with bladder cancer, in whom the first manifestation of Erdheim-Chester disease was retroperitoneal infiltration detected during routine follow-up. The disease was diagnosed on the basis of histology and immunochemistry findings (presence of histiocytes) and of imaging findings (plain radiography, computed tomography, magnetic resonance imaging, and bone scintigraphy). The differential diagnosis with respect to other causes of retroperitoneal infiltration is discussed.

Primary testicular lymphomas account for less than 5% of all testicular neoplasms. Testicular natural killer (NK)/T-cell lymphomas are exceptional and have a very poor prognosis. We report the case of a 30-year-old French Caucasian man with testicular NK/T-cell lymphoma of the following immunophenotype: CD2+, CD3ɛ+ and CD56+. Despite intensive chemotherapy, the disease progressed rapidly, with death occurring 2 months after diagnosis.

Buts du travail La carcinome renal a cellules claires (CRCC) est un cancer resistant aux therapeutiques conventionnelles (chimio-radiotherapie) en cas de diffusion metastatique. La recherche de nouvelles cibles therapeutiques est un challenge dans ce domaine. MUC1 et de la E-cadherine sont frequemment dysregules dans les carcinomes. Le but de ce travail est d’evaluer leur expression dans les metastases de CRCC. Materiel et methodes 22 metastases de CRCC et 10 tumeurs renales primitives correspondantes ont ete incluses dans l’etude. MUC1 et la E-cadherine ont ete evalues de facon semi-quantitative par immunohistochimie sur coupes en paraffine avec des anticorps monoclonaux diriges contre MUC1 (M8, 1/50, Consortium Europeen) et la E-cadherine (Clone 4A2C7, Zymed, 1/100). Resultats – 86 % (19/22) des metastases etaient marquees avec l’anticorps anti MUC1 dans plus de 50 % des cellules tumorales. Le marquage etait membranaire circonferentiel et/ou cytoplasmique en rapport avec une perte de la polarite apicale observee dans les cellules renales tubulaires normales. Dans 10 cas, au sein des tissus metastatiques, il existait une repartition preferentielle peri-vasculaire des cellules tumorales immunomarquees par MUC1. – 27 % des metastases etaient marquees par l’anticorps anti E-cadherine sous la forme d’un marquage baso-lateral interessant en moyenne 20 % de cellules tumorales avec dans un unique cas, un marquage delocalise cytoplasmique intense. Conclusions MUC1 est fortement exprime dans les metastases de CRCC avec un marquage membranaire circonferentiel et/ou cytoplasmique comme observe dans les cancers du sein a evolution metastatique. La sur-expression de MUC1 s’accompagne d’une faible expression de la E-cadherine. La repartition preferentielle des cellules tumorales MUC1 positives autour des vaisseaux fait suspecter un role possible dans la dissemination metastatique. Enfin la sur-expression de MUC1 dans les metastases de CRCC permet egalement d’envisager de l’etudier comme une cible therapeutique potentielle.