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Priapism as the Presenting Feature of Renal Cell Carcinoma
429
ONCOLOGY At"'ID C}-LElvIOTI'iERAPY
mented in the absence of liver metastases or infiltration of the liver with tumor. This case demonstrates that dysfibrinogenemia can be part of a paraneoplastic syndrome and may be a sensitive marker for recurrent disease. D . .K Jl,f 2 figures, 1 table, 24 references
Priapism as the Presenting Feature of Renal Cell Caircinoma
D. P.
SARMA, A. MENDOZA AND
L. WOODS, III, F. H. RODRIGUEZ, JR., J. T. G. WEILBAECHER, Department of Pathology, Veterans Administration Medical Center and Louisiana State University Medical Center, New Orleans, and Department of Urology, Tulane University Medical School, New Orleans, Louisiana
J. Surg. Oncol., 28: 103-107 (Feb.) 1985 The authors present the seventh reported case of priapism as the first clinical manifestation of renal cell carcinoma. A review of the literature reveals that the average life expectancy of these patients can be measured in weeks. Of the 7 cases 5 were associated with left renal carcinoma. The preponderance of left renal cancer spreading to the penis might be explained by the fact that the left spermatic vein empties into the left renal vein, whereas the right spermatic vein empties into the inferior vena cava. Thus, renal cell carcinoma may metastasize to the penis via retrograde venous flow. 5 figures, l table, 7 references
Abstracter's comment. Leukemia is the most common cause of neoplastic priapism. The incidence of priapism in children with leukemia approaches 15 per cent. Compared to idiopathic priapism, malignancies may obstruct outflow from the corpus spongiosum as well as the glans penis. Shunting procedures may be of little value and the primary treatment should be radiation therapy or chemotherapy of the neoplastic disease. P. M. H.
Sarcomatoid Transitional Cell Carcinomas of the Renal Peivi§: An Ultirastructural and Immi.:uiohi:,_;toch.emical Study 1\/L R. WICK, T. L.
B. A. BURKE, Division of ,v1,,11n.ffUc,U, of ,r,h,'lrn,tn,'\! Medicine and of Minnesota School of Min-
PERRONE AND
Surgical ,-,,uuw,,,v Pathology, neapolis, Minnesota
Arch. Path. Lab. Med., 109: 55-58 (Jan.) 1985 The clinicopathological, immunocytochemical and ultrastructural aspects of 2 cases of sarcomatoid transitional cell carcinoma of the renal pelvis are discussed. Transitional cell carcinomas of the urinary tract occasionally may assume a partial or complete spindle cell pattern of growth, leading to the erroneous classification of some true carcinomas as sarcomas. Ultrastructural study in the 2 reported cases showed that the spindle cells retained features of epithelial differentiation. This conclusion was supported further by positive results of several immunohistochemical stains, using biotinylated peanut agglutinin and soybean agglutinin, and a rabbit antiserum directed against keratin proteins. In addition, both tumors manifested immunoreactivity for blood group antigens, using primary murine monoclonal antibodies. These results suggest that immunocytochemistry is a helpful diagnostic adjunct in
the proper classification of sarcomatoid urothelial neo" plasms. E. D. W. 4 figures, 34 1·eferences
Malignant Smooth Mi.rncle Tumors of the Retrope:rito~ neum an.d Me§entery: A Clini.copaH1.ologic Analysis of 44 Cases H. HASHIMOTO, M. TSUNEYOSm AND M. ENJOJI, Second
Department of Pathology, Faculty of Medicine, Kyushu University, Fukuoka, Japan J. Surg. Oncol., 28: 177-186 (Mar.) 1985 The authors analyzed clinicopathologically 44 cases of malignant smooth muscle tumors of the retroperitoneum and mesentery. There were 33 retroperitoneal and 11 mesenteric tumors. Classical leiomyosarcomas were found in 27 tumors, while 7 showed predominantly epithelioid cells and were classified as malignant leiomyoblastoma (epithelioid leiomyosarcoma). Dedifferentiated areas resembling malignant fibrous histiocytoma were noted in 3 cases. Mean patient age was 59 years. There were 17 men (39 per cent) and 27 women (61 per cent). Most of the tumors were large (more than 10 cm. in greatest diameter). A total of 29 retroperitoneal and 8 mesenteric tumors showed classical leiomyosarcomas characterized by interlacing bundles of spindle cells with fibrillated, acidophilic cytoplasm and elongated, blunt or cigar-shaped nuclei. Electron microfindings in 4 tumors revealed smooth muscle cells with a spectrum of differentiation of varying degrees. Initial operative treatment in 30 patients consisted of simple local excision in 23, removal of the tumor plus the adjacent kidney in 3 and biopsy only in 4, since the tumor was unresectable. Followup in the 42 patients showed that 33 (79 per cent) died within the first 5 years and 23 (55 per cent) died within the first 2 years, whereas only 7 (17 per cent) were well 3.2 to 15.3 years after the initial treatment. The 5-year survival rate was 21 per cent. The average number of mitoses per 10 high power fields was 10.4. Of the 15 patients with leiomyosarcoma and l to 4 mitotic counts per 10 power fields 10 died of tumor. F. T. A. 12 figures, 3 tables, 14 references
Invasive Potential of Supe:rficial Bladder Cance:1:, A of the Relative Me:dts of P:redictive Pmrameters
Engiand
Brit. J.
57: 32-36
1985
The indirect immunoperoxidase test to detect urothelial cell surface blood group antigens was performed in an attempt to assess the loss of these antigens as a prognostic predictor. In their technique A, B and O(H) blood group specific monoclonal antibodies were used. It was possible to perform the test satisfactorily on histological material from 55 cases that were superficial on presentation; 15 subsequently became invasive. The loss of surface antigens correlated well with histological grade44.4 per cent of grade 1, 87.2 per cent of grade 2 and 94.1 per cent of grade 3 tumors were negative. The blood group phenotype in 114 patients was studied. Of 26 patients who subsequently had invasive cancer 14 (54 per cent) were of blood group A phenotype compared to 37 of 88 (42 per cent) in the noninvasive category. Acetylation studies
ONCOLOGY At"'ID C}-LElvIOTI'iERAPY
mented in the absence of liver metastases or infiltration of the liver with tumor. This case demonstrates that dysfibrinogenemia can be part of a paraneoplastic syndrome and may be a sensitive marker for recurrent disease. D . .K Jl,f 2 figures, 1 table, 24 references
Priapism as the Presenting Feature of Renal Cell Caircinoma
D. P.
SARMA, A. MENDOZA AND
L. WOODS, III, F. H. RODRIGUEZ, JR., J. T. G. WEILBAECHER, Department of Pathology, Veterans Administration Medical Center and Louisiana State University Medical Center, New Orleans, and Department of Urology, Tulane University Medical School, New Orleans, Louisiana
J. Surg. Oncol., 28: 103-107 (Feb.) 1985 The authors present the seventh reported case of priapism as the first clinical manifestation of renal cell carcinoma. A review of the literature reveals that the average life expectancy of these patients can be measured in weeks. Of the 7 cases 5 were associated with left renal carcinoma. The preponderance of left renal cancer spreading to the penis might be explained by the fact that the left spermatic vein empties into the left renal vein, whereas the right spermatic vein empties into the inferior vena cava. Thus, renal cell carcinoma may metastasize to the penis via retrograde venous flow. 5 figures, l table, 7 references
Abstracter's comment. Leukemia is the most common cause of neoplastic priapism. The incidence of priapism in children with leukemia approaches 15 per cent. Compared to idiopathic priapism, malignancies may obstruct outflow from the corpus spongiosum as well as the glans penis. Shunting procedures may be of little value and the primary treatment should be radiation therapy or chemotherapy of the neoplastic disease. P. M. H.
Sarcomatoid Transitional Cell Carcinomas of the Renal Peivi§: An Ultirastructural and Immi.:uiohi:,_;toch.emical Study 1\/L R. WICK, T. L.
B. A. BURKE, Division of ,v1,,11n.ffUc,U, of ,r,h,'lrn,tn,'\! Medicine and of Minnesota School of Min-
PERRONE AND
Surgical ,-,,uuw,,,v Pathology, neapolis, Minnesota
Arch. Path. Lab. Med., 109: 55-58 (Jan.) 1985 The clinicopathological, immunocytochemical and ultrastructural aspects of 2 cases of sarcomatoid transitional cell carcinoma of the renal pelvis are discussed. Transitional cell carcinomas of the urinary tract occasionally may assume a partial or complete spindle cell pattern of growth, leading to the erroneous classification of some true carcinomas as sarcomas. Ultrastructural study in the 2 reported cases showed that the spindle cells retained features of epithelial differentiation. This conclusion was supported further by positive results of several immunohistochemical stains, using biotinylated peanut agglutinin and soybean agglutinin, and a rabbit antiserum directed against keratin proteins. In addition, both tumors manifested immunoreactivity for blood group antigens, using primary murine monoclonal antibodies. These results suggest that immunocytochemistry is a helpful diagnostic adjunct in
the proper classification of sarcomatoid urothelial neo" plasms. E. D. W. 4 figures, 34 1·eferences
Malignant Smooth Mi.rncle Tumors of the Retrope:rito~ neum an.d Me§entery: A Clini.copaH1.ologic Analysis of 44 Cases H. HASHIMOTO, M. TSUNEYOSm AND M. ENJOJI, Second
Department of Pathology, Faculty of Medicine, Kyushu University, Fukuoka, Japan J. Surg. Oncol., 28: 177-186 (Mar.) 1985 The authors analyzed clinicopathologically 44 cases of malignant smooth muscle tumors of the retroperitoneum and mesentery. There were 33 retroperitoneal and 11 mesenteric tumors. Classical leiomyosarcomas were found in 27 tumors, while 7 showed predominantly epithelioid cells and were classified as malignant leiomyoblastoma (epithelioid leiomyosarcoma). Dedifferentiated areas resembling malignant fibrous histiocytoma were noted in 3 cases. Mean patient age was 59 years. There were 17 men (39 per cent) and 27 women (61 per cent). Most of the tumors were large (more than 10 cm. in greatest diameter). A total of 29 retroperitoneal and 8 mesenteric tumors showed classical leiomyosarcomas characterized by interlacing bundles of spindle cells with fibrillated, acidophilic cytoplasm and elongated, blunt or cigar-shaped nuclei. Electron microfindings in 4 tumors revealed smooth muscle cells with a spectrum of differentiation of varying degrees. Initial operative treatment in 30 patients consisted of simple local excision in 23, removal of the tumor plus the adjacent kidney in 3 and biopsy only in 4, since the tumor was unresectable. Followup in the 42 patients showed that 33 (79 per cent) died within the first 5 years and 23 (55 per cent) died within the first 2 years, whereas only 7 (17 per cent) were well 3.2 to 15.3 years after the initial treatment. The 5-year survival rate was 21 per cent. The average number of mitoses per 10 high power fields was 10.4. Of the 15 patients with leiomyosarcoma and l to 4 mitotic counts per 10 power fields 10 died of tumor. F. T. A. 12 figures, 3 tables, 14 references
Invasive Potential of Supe:rficial Bladder Cance:1:, A of the Relative Me:dts of P:redictive Pmrameters
Engiand
Brit. J.
57: 32-36
1985
The indirect immunoperoxidase test to detect urothelial cell surface blood group antigens was performed in an attempt to assess the loss of these antigens as a prognostic predictor. In their technique A, B and O(H) blood group specific monoclonal antibodies were used. It was possible to perform the test satisfactorily on histological material from 55 cases that were superficial on presentation; 15 subsequently became invasive. The loss of surface antigens correlated well with histological grade44.4 per cent of grade 1, 87.2 per cent of grade 2 and 94.1 per cent of grade 3 tumors were negative. The blood group phenotype in 114 patients was studied. Of 26 patients who subsequently had invasive cancer 14 (54 per cent) were of blood group A phenotype compared to 37 of 88 (42 per cent) in the noninvasive category. Acetylation studies