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Angiomyolipoma of the kidney is a clonal neoplasm, apparently part of a family of neoplasms derived from perivascular epithelial cells. A 40-year-old woman presented with right flank pain and an otherwise non-significant medical history. An abdominal computed tomography scan revealed an 18 cm solid mass in the mid-portion of the right kidney and multiple perihilar lymph nodes. Presumptive diagnosis was renal cell carcinoma. Right radical nephrectomy and a perihilar lymph node dissection was performed through a Chevron incision for the anticipated diagnosis of renal adenocarcinoma. The renal tumor was diagnosed as angiomyolipoma and a component was identified pathologically in a dissected lymph node. There was no evidence of tumor recurrence in the follow-up period of eight years. The consensus from other studies suggests that this phenomenon is a manifestation of the multicentric nature of angiomyolipoma, rather than due to metastasis. Genetic studies may resolve this question in the future.

Objective To determine the level of malondialdehyde (MDA), an indirect indicator of lipid peroxidation-induced injury by reactive oxygen species, in testicular biopsy specimens from infertile patients with and without varicocele. Patients and methods Levels of MDA were measured in the testicular biopsy specimens from 25 infertile men (15 with varicocele, mean age 30.0 years, sd 5.7, range 23–45, and 10 without, mean age 28.7 years, sd 4.2, range 21–34). All patients were evaluated by a detailed history, physical examination, semen analysis (at least twice), serum follicle-stimulating hormone and free testosterone levels, testicular biopsy and contact imprint. Scrotal colour Doppler ultrasonography was used to confirm suspected varicocele. The level of MDA in testicular biopsy specimens was measured using the thiobarbituric acid test and the results expressed per unit tissue weight. Results As a causal factor for infertility, varicocele was identified in 15 men (60%), testicular failure in four (16%), idiopathic infertility in four (16%) and obstruction in two (8%). Of the 15 patients with varicocele, eight had bilateral varicocele and it was subclinical in three; the varicocele was grade I in four, grade II in six and grade III in two. The mean ( sd) MDA level in the men with a subclinical varicocele was 15.7 (3.1) pmol/mg tissue, while in those with grade I–III varicocele it was 32.9 (12.25), 37.1 (12.25) and 86.9 (2.89) pmol/mg tissue, respectively. The levels in patients with grade III varicocele were significantly greater than in the other groups (P 0.05). Conclusion These results suggest that increasing levels of MDA are associated with higher grades of varicocele and support a possible rationale for controlled trials in infertile men with varicocele.

Objective: The aim of this study was to assess the impact of a 12–month treatment period with alfuzosin, 2.5 mg t.i.d, on symptomatic patients with BPH (n = 355) by means of the Int

The grade of the prostate cancer is an important factor in defining prognosis and deciding on treatment. In this study, we compared the Gleason score determined by 18-gauge core needle biopsies with both the Gleason score and pathological staging of the radical prostatectomy specimens.Between July 1992 and September 1998, we performed 144 radical retropubic prostatectomies for clinically localized prostatic carcinoma, after a negative frozen section in bilateral pelvic lymphadenectomy in all cases. Ten patients with pathologic stage T1a and T1b were excluded. The final study group consisted of 134 patients, all of whom had been diagnosed with adenocarcinoma by transrectal needle biopsies with an 18-gauge automated spring-loaded biopsy gun. No patients received neoadjuvant therapy, including androgen deprivation and radiation therapy. All patients had a designated Gleason score on the needle biopsy and prostatectomy specimens.We found that grading error was greatest with well-differentiated (Gleason score 2-4) tumors, The accuracy was 15% for Gleason score 2-4 on needle biopsy. Of the 113 evaluable patients with Gleason score 5-7 on needle biopsy, 110 (97%) were graded correctly. All of the Gleason score 8-10 on needle biopsy was graded correctly. But only 1 patient in our series had Gleason score 8 on needle biopsy. Twenty-seven (25%) of 110 patients with a biopsy grade of Gleason score7 had the cancer upgraded to 7. Of patients with both Gleason score7 in the needle biopsy and Gleason score 7 in the prostatectomy specimen, only 3 (11%) had tumor confined to the prostate.The potential for grading error is greatest with well-differentiated tumors and of patients with both Gleason scores7 in the needle biopsy and Gleason score 7 in the prostatectomy specimen, only 11% had tumor confined to the prostate. This effects treatment policy, especially for watchful waiting criteria.

Summary Aims E-cadherin has been studied recently as a potential marker for tumour progression. The present study aimed to assess the expression of E-cadherin in formalin-fixed and paraffin-embedded radical prostatectomy specimens and to compare its expression with the pathological stage and Gleason score. Methods This study comprised a total of 58 men who were selected on the basis of the negative surgical margins of surgical specimens from radical retropubic prostatectomies and concomitant pelvic lymph node dissections. Indirect immunoperoxidase staining was performed as described previously using HECD-1 monoclonal antibody with the retrieval of antigen by treatment of the paraffin-embedded tissue with microwaves in citrate buffer. Results Aberrant staining patterns of E-cadherin were observed in 18 (64%) and in 25 (83%) of cases with pathological stages pT2 and pT3a, respectively ( P > 0.05). Immunohistochemical examination also revealed aberrant staining patterns of E-cadherin in 16 (89%) of specimens with Gleason score ≥7 and in 27 (68%) of specimens with Gleason score P > 0.05). Biochemical recurrence was identified in three (5%) patients and immunohistochemical examination of their specimens revealed aberrant staining patterns of E-cadherin molecule in all of them. Conclusion Our preliminary results indicate that, even though we could not demonstrate any significant correlation between E-cadherin staining pattern and tumour invasion and Gleason scores, aberrant staining patterns of E-cadherin may be a significant predictor for disease recurrence following radical prostatectomies if supported by large scale studies.