1/22. Ultrasonic assessment of renal transitional cell carcinoma: preliminary report.The value of ultrasound in determining the etiology of nonopaque filling defects seen in the renal pelvis at intravenous urography is under study. The ultrasound findings in three patients with proven transitional cell carcinoma of the kidney were similar and consisted of separation of the central renal echo complex by a region of low-intensity echoes. This pattern is distinct from characteristically echogenic nonopaque renal calculi and anechoic hydronephrosis. Renal collecting system blood clots may have an echo pattern similar to collecting system tumors, but can usually be distinguished by their mobility and transitory nature. Further investigation into the specificity and sensitivity of the ultrasonic diagnosis of renal collecting system masses is underway.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/22. carcinosarcoma of the urinary bladder--an aggressive tumor with diverse histogenesis. A clinicopathologic study of 4 cases and review of the literature.OBJECTIVE: Carcinosarcomas of urinary bladder are rare malignant neoplasms. Seventy-eight cases have been previously described. The histologic composition of these tumors is variable, but diagnosis requires the presence of both epithelial and mesenchymal malignant components. We report 4 additional cases, with an emphasis on unusual histologic features. methods: Histologic and immunohistochemical examinations were performed on bladder tumors from 4 patients. Clinicopathologic features of previously reported and current cases were reviewed and summarized. RESULTS: Four patients (3 men, 1 woman) age 54 to 77 years were found to have polypoid masses in the urinary bladder. In all cases, histologic examination showed biphasic neoplasms with distinct mesenchymal and epithelial components. The morphologic and immunohistochemical characteristics of the tumors varied. One of the cases was remarkable for the presence of liposarcoma, malignant peripheral nerve sheath tumor, and micropapillary urothelial carcinoma. Two of the patients died 2 years after diagnosis, which is consistent with the previously reported aggressive nature of urinary bladder carcinosarcomas. CONCLUSIONS: Carcinosarcomas of the urinary bladder are rare, aggressive malignant neoplasms. To our knowledge, a liposarcomatous component has been reported in only 1 case previously, and components of micropapillary urothelial carcinoma and malignant peripheral nerve sheath tumor have not been reported previously in carcinosarcomas of the urinary bladder. Because of the aggressive biologic behavior of these tumors, they should be identified promptly and treated appropriately.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/22. A micropapillary variant of transitional cell carcinoma arising in the ureter.A 79-year-old woman was evaluated for a ureteral stricture related to laser ablation of a tumor 6 months earlier at another institution. A ureteroscopic examination revealed an exophytic papillary tumor that was resected and examined histologically. The tumor was characterized by delicate papillae with thin stromal cores and numerous secondary micropapillae lined by small cuboidal to low columnar cells with uniform low-to-intermediate-grade nuclei, reminiscent of a serous borderline tumor of mullerian origin. The cell linings were 1 to 4 layers thick; mitotic figures were easily identified. The underlying stroma appeared edematous and contained scattered chronic inflammatory cells. No invasion was identified. After ascertaining that the patient had no known gynecologic neoplasm, the differential diagnoses considered included papillary nephrogenic adenoma, clear cell carcinoma, and the recently described entity of micropapillary transitional cell carcinoma. Because of the striking resemblance to serous carcinoma and the presence of significant mitotic activity, this case was felt to represent a case of micropapillary transitional cell carcinoma (world health organization grade 1 to 2) occurring in the ureter. To our knowledge, this tumor had some unique features (no areas of grade 3 nuclei or invasion) that have not been reported in tumors occurring in the urinary bladder. The transitional cell nature of the tumor cells was supported by the immunohistochemical staining pattern. The anatomic distribution of micropapillary transitional cell carcinoma is now expanded to include the ureter, and this tumor should be considered in the differential diagnosis for papillary lesions occurring in the ureter.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/22. Basaloid carcinoma of the colon arising at the splenic flexure.AIMS: Basaloid carcinomas typically arise in the anal canal and there are only three well-documented cases of this neoplasm reported outside the anal canal, none more proximally than the sigmoid colon. The first occurrence of a basaloid colonic carcinoma arising outside the sigmoid colon, at the splenic flexure, is presented. methods AND RESULTS: A splenic flexure mass was resected from a 54-year-old man with a 3-week history of abdominal discomfort, diarrhoea and weight loss. This tumour, like typical anal canal basaloid carcinomas, was composed of islands of basaloid cells with peripheral nuclear palisading; within many islands there was central necrosis and focal squamous differentiation. Ultrastructural and immunohistochemical studies confirmed the basaloid nature and focal squamous differentiation within this neoplasm. Basaloid carcinoma of the anal canal has been associated with human papilloma virus. Using in-situ hybridization, HPV dna was not detected in this case. CONCLUSIONS: Outside the anal canal, it has been postulated that basaloid colonic carcinomas may arise from cloacogenic embryologic rests, squamous metaplastic epithelium, or totipotential basal cells. The location and pathological findings of this tumour suggest that this rare colonic neoplasm arises from a totipotential basal cell.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/22. The treatment of bilateral synchronous renal pelvic tumors with Bench surgery.Bilateral nephrectomy, renal perfusion and bench surgery have been used in the management of synchronous bilateral renal pelvic tumors in a 35-year-old man. The possibility of bilateral nephrectomy followed by hemodialysis and eventual transplantation was considered but was not done because we believe for the present time that the nature of the immune response and its importance in the pathogenesis of cancer are complicated and poorly defined. It is likely that immunosuppression may tip the balance toward the tumor. Bench surgery allowed us to perform radical resection of these urothelial tumors yet preserve enough renal tissue to sustain life. This patient is now enjoying an active life and has a blood urea nitrogen of 30 mg. per cent and a serum creatinine of 1.2 mg. per cent from the functioning third of the former right kidney.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/22. Benign ectopic prostatic glands in subvesical skeletal muscle. A lesion resembling carcinoma.In physiological instances, the prostatic acini may be intermingled with striated muscle fibers in the apex and in the anterolateral subcapsular areas of the prostate. We report an unusual lesion composed of benign prostatic glands, which were scattered between skeletal muscle fibers beneath the bladder submucosa. A 55-year-old man underwent four transurethral resections and radiation therapy for a urothelial carcinoma of the urinary bladder. Subsequently a cystectomy was performed. In the resection specimen, the prostate specific antigen-positive glands were found among the skeletal muscle bundles close to the bladder submucosa. They were seen as small groups of haphazardly scattered or isolated glands mimicking an infiltrative pattern of a prostatic adenocarcinoma. Prominent nucleoli in some glands further contributed to the worrisome appearance of the lesion. However, the high molecular weight cytokeratin 34 beta E12 exhibited basal cell layers of the glands, and the subsequent course of disease confirmed the benign nature of the lesion. The juxtaposition of the prostatic acini with the skeletal muscle out of the apex and the anterolateral subcapsular areas of the prostate should be included in the differential diagnosis of prostatic carcinoma in urinary bladder and prostate biopsies.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/22. brenner tumor of the ovary with striking microcystic change.An ovarian brenner tumor from a 39-year-old woman exhibited striking microcystic change that was so extensive it largely obscured the nature of the tumor, causing initial diagnostic difficulty. The patient presented with symptoms related to a pelvic mass and had a unilateral, 24 cm in maximal dimension, stage I tumor that was solid and cystic. Microscopic examination revealed extensive microcystic change within the epithelial nests in large areas of the tumor such that transitional-type epithelium was only recognized very focally. The tumor had minor areas (<5%) that showed marked cytological atypia and mitotic activity, interpreted as microscopic foci of intraepithelial carcinoma, but was predominantly benign. The presence of characteristic fibromatous stroma and mucinous metaplasia within the epithelial nests provided important clues to the correct diagnosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/22. Papillary clusters as a diagnostic pitfall in urinary cytology of pseudosarcomatous fibromyxoid tumor of the bladder. A case report.BACKGROUND: Pseudosarcomatous fibromyxoid tumor (PFT) of the urinary bladder is an uncommon benign lesion that can involve any site in the bladder. Cellular features of PFT of the bladder are exceedingly rare. We describe the urinary cytology in a PFT patient who displayed numerous papillary fragments that suggested a malignant tumor. CASE: A 52-year-old man was seen at the hospital for evaluation of gross hematuria. At cystoscopy, the urologist observed a 3-cm, smooth, polypoid and ulcerated mass extending from the trigone to the bladder neck. Urinary cytology showed many papillary clusters with irregular nuclear margins in the bloody cell background. No spindle cells were noted. Cytology was interpreted as papillary growth, factor transitional cell carcinoma, grade 2-3. A laparotomy with partial resection of the urinary bladder was carried out, and histologically the tumor was composed of spindle, stellate, fibroblastic cells embedded in myxoid stroma with little collagen. Immunohistochemical and ultrastructural studies revealed the fibroblastic nature of the lesion. The final diagnosis was PFT of the bladder on the basis of histologic examination of the resected material. CONCLUSION: Papillary fragments are a diagnostic pitfall in urinary cytology of PFT lesions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/22. Mucinous adenocarcinoma of the renal pelvis associated with transitional cell carcinoma in the renal pelvis and the bladder.We report a case of mucinous adenocarcinoma of the renal pelvis associated with bladder carcinoma in situ (CIS). Transitional cell carcinoma (TCC) of the renal pelvis and CIS were also observed adjacent to the adenocarcinoma. Immunohistochemical assessment of the pelvic adenocarcinoma revealed positive expressions for mucin, epithelial membrane antigen, cytokeratin 7, cytokeratin 19 and carcinoembryonal antigen, but not vimentin or chromogranin. Based on the histopathological examinations, the adenocarcinoma of the renal pelvis in the present case may have a similar biological nature to conventional TCC and probably originated by development of pre-existing TCC of the renal pelvis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/22. Case report: microcystic transitional cell carcinoma of the urinary bladder.We report a rare case of microcystic transitional cell carcinoma involving the urinary bladder, in a 38-year-old man, and we add our experience in the treatment of this neoplasm. The tumor was muscle invasive, and a radical cystectomy was performed. The patient received no postoperative chemotherapy or radiotherapy, and he has not signs of local recurrence or distal metastasis after 3 years of intense follow up. Even though the number of cases documented so far, is insufficient to draw safe conclusions regarding the optimal treatment of the microcystic variant of transitional cell carcinoma. Our case indicates that even in cases of microcystic transitional cell carcinoma with infiltrative nature, aggressive therapy is associated with good control of the disease locally and distally.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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