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UP.10: Mineralocorticoid Expression is a Negative Prognostic Predictor in Patients with Renal Cell Carcinoma
UNMODERATED POSTER SESSIONS
(tumor markers were negative prior to and immediately after orchiectomy). No histologic risk factors for recurrence were present in either primary tumor. Both patients were effectively salvaged with chemotherapy, being alive and without evidence of disease at 2 and 3 years postsalvage therapy, respectively. Conclusion: Stage I, low-risk, malignant testicular GCTs can be managed effectively and safely with active surveillance. Salvage treatment of recurrent cancer provides an excellent chance of cure. However, strict adherence to surveillance protocols may be difficult to achieve. UP.07 20-Year Phase 1/2 Study of Single Agent Carboplatin in Metastatic Seminoma: Could it Have Been Accelerated By 72 Hr PET Scan Response? Oliver T, Powles T, Somasundram U, Shamash J Medical Oncology, School of Medicine and Dentistry, St Bartholomew’s and Royal London Hospitals, London, UK Introduction and Objectives: Samuels et al (1980 Proc ASCO 21 abst 415) observed 4 of 5 bulky seminomas achieved durable CR to single agent cisplatin and Oliver (1984 Proc ASCO 3 abst 636) reported 9 of 10 durable responses. Carboplatin proved less effective and in randomised trials involving 361 patients relapse free survival was 71% with Carbo and 91% with cisplatin-based combination. Prompted by successful dose escalation of carboplatin in ovarian cancer, the initial phase 1 study that preceded the UK randomised trial was reopened and dosage escalation to AUC 8 and then 10 was undertaken. This abstract updates this study with more prolonged follow up of the previous cases and new information on the higher dosages. Materials and Methods: Initially, patients received 450mg/m2 and subsequently the dose was increased to AUC 7, 8 and 10. The treatment was repeated q21 when possible and if delayed because of toxicity blood counts were repeated every 24 hours. Results: A total of 49 metastatic seminoma patients have been treated between 1983 and 2003. 79% of 19 receiving 450mg/m2, 88% of 17 receiving AUC 7 or 8 and 92% of 12 receiving AUC 10 are relapse free. As a pilot study 7 patients with a variety of metastatic germ cell cancers have had PET scan performed before and at 72 hours after treatment. Three achieved CR, 3 had greater than 40% re-
sponse and 1 after progressing after single agent carboplatin was in complete remission after one course of BEP. Conclusions: With late events increasingly a problem with more prolonged follow-up of testis cancer, minimizing treatment toxicity and finding a fast track approach to proving safety is an increasing need. The data presented demonstrates the potential of early PET scan as a surrogate marker to facilitate assessment of response and could have accelerated the phase 1/2 study reported. UP.08 Detection of Renal Disease in a Population Investigated for Microscopic Haematuria Cottrell A, Davies B, Gillatt D Bristol Urological Institute, Bristol, UK Introduction and Objectives: Patients ⬎ age of 50 with microscopic haematuria are currently referred to urological services to exclude urological cancer. Chronic Kidney Disease Guidelines recommend nephrology referral for all patients with eGFR⬍60ml/min/1.73m2. All patients with eGRF ⬎60 ml/min/1.73m2 and microscopic haematuria should be treated as Chronic Kidney disease stage 1/2. The presence of renal disease in a population undergoing urological investigation is investigated. Materials and Methods: The results of investigations of patients with microscopic haematuria referred to urological services under 2 week wait rules over a period of 16 months were reviewed. Patients underwent renal tract ultrasound, KUB X-ray, urine cytological investigation, flexible cystoscopy, urine culture and measurement of renal function including eGFR. Results: Three hundred and six patients were investigated, mean age 67 (range⫽20-91), 136 male, 169 female. Urological pathology was identified in 9% of patients (28/306) including: TCC bladder 3% (9/306), stone disease 2% (6/306), angiomyolipoma 0.7% (2/306) and carcinoma of prostate 1.6% (5/306). eGFR measurements were ⬎90 ml/min/1.73m2 in 18% (55/306), 60-89 ml/min/1.73m2 in 50% (154/306), 30-59 ml/min/1.73m2 in 18% (54/306), 15-29 ml/min/1.73m2 in 1% (2/306) and not measured in 15% (45/ 306). Only 2 patients were known to have renal disease with eGFR in range 60-89 ml/min/1.73m2. Conclusions: Following exclusion of urological malignancy, renal disease should be considered in all patients with microscopic haematuria and appropriate referral made to nephrology services where appropriate.
UROLOGY 72 (Supplement 5A), November 2008
UP.09 Extra Adrenal Pheochromomocytoma of Urinary Bladder: A Case Report and Review of Literature Sharma P, Sharma P, Saraswat B Dr SN Medical and Attached Hospitals, Jodhpur, India Introduction and Objectives: Pheochromocytoma of urinary bladder is rare disease causing a hypertension, palpitation, throbbing headache & haemorrhage induced by voiding. Materials and Methods: This case is reported because of rarity of this disease in urinary bladder. Life-long follow up is required because of late endocrinal manifestations and metastasis in this tumor. Results: Extra adrenal Pheochromocytomas are more likely to recur and metastasize than their adrenal counterparts making lifetime follow up with annual determination of catecholamine production essential. Conclusions: This case is reported because of rarity of this disease in urinary bladder. UP.10 Mineralocorticoid Expression is a Negative Prognostic Predictor in Patients with Renal Cell Carcinoma Ogushi T, Fujimura T, Kumagai J, Kitamura T, Urano T, Inoue S, Takahashi S Tokyo University, Tokyo, Japan Introduction and Objectives: Mineralocorticoid receptors (MR) bind both mineralocorticoids and glucocorticoids and mediate diverse functions in multiple normal tissues. Less is known about MR regulation and function in neoplasms. To investigate the clinical significance of MR in renal cell carcinoma, we examined MR expression in human renal cell carcionoma specimens by immunohistochemical analysis. Materials and Methods: MR expression was evaluated immunohistochemically in 69 human renal cell carcinoma specimens using an immunoreactivity (IR) scoring system (0 to 3⫹) that corresponded to the sum of the percentage of positive cells. Subsequently, the correlation between MR status and clinicopathological characteristics was statistically analyzed. Results: MR expression was evaluated immunohistochemically in 69 human renal cell carcinoma specimens using an immunoreactivity (IR) scoring system (0 to 3⫹) that corresponded to the sum of the percentage of positive cells. Subsequently, the correlation between MR status and clinicopathological characteristics was statistically analyzed.
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UNMODERATED POSTER SESSIONS
Conclusions: MR is expressed in the majority of human renal cell carcinomas and high MR immunoreactivity is associated with tumor aggressiveness and unfavorable prognosis. UP.11 Renal Cell Carcinoma: Atypical Clinical Manifestation Ilievski A1, Ilievski P2, Nakovski R3, Jankovski V3, Jovanovski S3, Batandzioski T3, Popovski Z3 1 University Clinics, Skopje, Macedonia; 2 Mahaska Hospital, Oskaloosa, USA; 3 Urology Department, Clinical Hospital, Bitola, Macedonia Introduction and Objectives: Classical triad of symptoms: haematuria, abdominal or flank pain and palpable abdominal mass occur in 10 to 15 of patients and present advanced disease. Symptoms as a dyspnea, headache, seizure, and bone pain are symptoms for metastatic disease and are found in 30% of patients. This cancer is associated with wide spectrum of paraneoplastic syndromes in many varieties in 10 to 40% of the patients. Materials and Methods: We did a statistical work-up of cancer in our department from January 2000 to April 2008. Most were diagnosed in early stage with ultrasound and CT scan, but many of them were in advanced stage with lungs metastasis and surrounding organs. The total number of 58 cases radical nephrectomy was done with abdominal or thoracoabdominal approach. They were 43 or 74% male and 15 or 26% female. The age of the patient was 60.4 (range⫽38-76 ) for male and 57.9 (range⫽31-81) for female patients. The ratio male to female was 2.8:1. The atypical clinical manifestations were found in two cases both from right kidney. Results: From 53 cases, two were atypical: one with atypical manifestation of metastasis and tje other one as a paraneoplastic syndrome. Metastases from right kidney to the pleura on the same side were manifested with pleural exudation which at the beginning pathology report was endothelioma but the later pathology report was adenocarcinoma. Primary carcinoma on ultrasound and CT scan was found renal carcinoma. The patient died 3 months after radical nephrectomy. The second case was also from right kidney and manifested with microhaematuria, hypertension and hypercalcemia with calcium 12.2 mg. This patient was sent for endocrinological investigation for hyperparathyroidisam and after 6 months on ultrasound and CT scan found renal cell
S114
carcinoma with metastasis in both adrenal glands. Radical nephrectomy and bilateral adrenalectomy was done by thoracoabdominal approach. Conclusions: Our presentation of atypical cases with their clinical manifestations and metastases are very important in practice and indicative of endemic nephropathy. Practitioner physicians should think of the possibility of this cancer with many varieties of paraneoplastic syndromes, which can be diagnosed with ultrasound and CT scan. UP.12 Renal Cell Carcinoma, Sarcomatoid Variant: Our Experience of 10 Years at the Clinical Hospital of the University of Chile Cuevas M, Fulla´ J, Igor M, Diaz P, Storme O Universidad De Chile, Departamento De Urologı´a, Santiago, Chile Introduction and Objectives: Sarcomatoid variant can be found in 1 to 5% of the renal cell carcinomas, taking the poorest prognosis in this cancer. We evaluated our experience in the last 10 years at the Clinical Hospital of the University of Chile. Materials and Methods: A retrospective study was performed between 1997 and 2007. A total of 27 patients were studied. Characteristics such as age, sex, histology, and global survival rate were evaluated in all the cases. Results: The series consisted of 27 patients, 16 men (59.3 %) and 11 women (40.7%), with a mean age of 60.3⫹/4.7 years (range⫽18 to 85 years). The mean of long-term survival was 29.5 (0.5-87) months. A 5-year mortality of 66.7% was found. There were not statistical significance at comparing the diferents grades of cell-atipia (p⫽ 0.957). A positive statistical significance was found when we compared the differents cancer stages (IIV) (p: 0.001). Conclusions: Sarcomatoid variant, associated to a major stage, has a poor prognosis of long-term survival. In this series, we can’t evaluate a major association with cell-atipia. UP.13 Renal Cell Carcinoma with SarcoidLike Stromal Reaction Ibarra A1, Campero J1, Matamala P2 1 Clinica Las Condes, Santiago, Chile; 2 Hospital San Juan de Dios, Santiago, Chile Introduction and Objectives: Tisular reactions related to tumors, with forma-
tion of epithelial granulomas, are known from approximately one century. Such sarcoid-like reactions can happen in lymph nodes of drainage zones, in relation to the tumor itself and even in non-regional tissues. It has been described in nearly 14% of Hodgkin lymphomas, 7% of non Hodgkin lymphomas and 4% of epithelial neoplasias (more frequent in seminomas and similar ones). They can be difficult or delay a correct diagnosis. In renal tumors, these reactions are exceptional. Materials and Methods: A 32-year-old man was featured in the study for hypertension. Abdominal ultrasound detects right solid renal mass of 2 cm in diameter in anterior aspect. The CT scan demonstrated solid lesion with contrast. The study of dissemination was negative. In December 2007, there was a laparoscopic partial nephrectomy, whose intraoperatory biopsy reported carcinoma of renal cell, without surgical margin compromise. Images controlled at a month revealed post-surgical alterations. At present, he does not present evidence of disease. Results: A round mass of 2.4 ⫻ 2 x 1.8 cm was observed: well defined, soft, yellowish. It was a prominent sarcoid like reaction in its stroma with granulomas of epithelial histiocytes without necrosis and lymphocytes. Ziehl Neelsen’s stain and the PCR for tuberculosis complex were negative. Conclusions: We present a very infrequent case of renal cell carcinoma with sarcoidlike stromal reaction. This special guest response usually does not change the prognosis, but it can be a powerful distracting element, avoiding or delaying the correct diagnosis, especially in partial biopsies or cytology obtained by fine needle aspiration. UP.14 Malignant Renal Mesenchymoma Ibarra A1, Matamala P2,3, Urrutia J2, Alcalde E3 1 Clinica Las Condes, Santiago, Chile; 2 Hospital San Juan de Dios, Santiago, Chile; 3Universidad De Chile, Santiago, Chile Introduction and Objectives: Malignant mesenchymoma is the term used to define a neoplasia constituted by 2 or more differentiated sarcomatous tissues not related, besides undifferentiated or fibrosarcomatous components. It is very infrequent, and in the kidney, only about 5 cases have been described. Its prognosis would depend on predominant components and grade of differentiation. Materials and Methods: A 54-year-old woman, hypertense in treatment. The pa-
UROLOGY 72 (Supplement 5A), November 2008
(tumor markers were negative prior to and immediately after orchiectomy). No histologic risk factors for recurrence were present in either primary tumor. Both patients were effectively salvaged with chemotherapy, being alive and without evidence of disease at 2 and 3 years postsalvage therapy, respectively. Conclusion: Stage I, low-risk, malignant testicular GCTs can be managed effectively and safely with active surveillance. Salvage treatment of recurrent cancer provides an excellent chance of cure. However, strict adherence to surveillance protocols may be difficult to achieve. UP.07 20-Year Phase 1/2 Study of Single Agent Carboplatin in Metastatic Seminoma: Could it Have Been Accelerated By 72 Hr PET Scan Response? Oliver T, Powles T, Somasundram U, Shamash J Medical Oncology, School of Medicine and Dentistry, St Bartholomew’s and Royal London Hospitals, London, UK Introduction and Objectives: Samuels et al (1980 Proc ASCO 21 abst 415) observed 4 of 5 bulky seminomas achieved durable CR to single agent cisplatin and Oliver (1984 Proc ASCO 3 abst 636) reported 9 of 10 durable responses. Carboplatin proved less effective and in randomised trials involving 361 patients relapse free survival was 71% with Carbo and 91% with cisplatin-based combination. Prompted by successful dose escalation of carboplatin in ovarian cancer, the initial phase 1 study that preceded the UK randomised trial was reopened and dosage escalation to AUC 8 and then 10 was undertaken. This abstract updates this study with more prolonged follow up of the previous cases and new information on the higher dosages. Materials and Methods: Initially, patients received 450mg/m2 and subsequently the dose was increased to AUC 7, 8 and 10. The treatment was repeated q21 when possible and if delayed because of toxicity blood counts were repeated every 24 hours. Results: A total of 49 metastatic seminoma patients have been treated between 1983 and 2003. 79% of 19 receiving 450mg/m2, 88% of 17 receiving AUC 7 or 8 and 92% of 12 receiving AUC 10 are relapse free. As a pilot study 7 patients with a variety of metastatic germ cell cancers have had PET scan performed before and at 72 hours after treatment. Three achieved CR, 3 had greater than 40% re-
sponse and 1 after progressing after single agent carboplatin was in complete remission after one course of BEP. Conclusions: With late events increasingly a problem with more prolonged follow-up of testis cancer, minimizing treatment toxicity and finding a fast track approach to proving safety is an increasing need. The data presented demonstrates the potential of early PET scan as a surrogate marker to facilitate assessment of response and could have accelerated the phase 1/2 study reported. UP.08 Detection of Renal Disease in a Population Investigated for Microscopic Haematuria Cottrell A, Davies B, Gillatt D Bristol Urological Institute, Bristol, UK Introduction and Objectives: Patients ⬎ age of 50 with microscopic haematuria are currently referred to urological services to exclude urological cancer. Chronic Kidney Disease Guidelines recommend nephrology referral for all patients with eGFR⬍60ml/min/1.73m2. All patients with eGRF ⬎60 ml/min/1.73m2 and microscopic haematuria should be treated as Chronic Kidney disease stage 1/2. The presence of renal disease in a population undergoing urological investigation is investigated. Materials and Methods: The results of investigations of patients with microscopic haematuria referred to urological services under 2 week wait rules over a period of 16 months were reviewed. Patients underwent renal tract ultrasound, KUB X-ray, urine cytological investigation, flexible cystoscopy, urine culture and measurement of renal function including eGFR. Results: Three hundred and six patients were investigated, mean age 67 (range⫽20-91), 136 male, 169 female. Urological pathology was identified in 9% of patients (28/306) including: TCC bladder 3% (9/306), stone disease 2% (6/306), angiomyolipoma 0.7% (2/306) and carcinoma of prostate 1.6% (5/306). eGFR measurements were ⬎90 ml/min/1.73m2 in 18% (55/306), 60-89 ml/min/1.73m2 in 50% (154/306), 30-59 ml/min/1.73m2 in 18% (54/306), 15-29 ml/min/1.73m2 in 1% (2/306) and not measured in 15% (45/ 306). Only 2 patients were known to have renal disease with eGFR in range 60-89 ml/min/1.73m2. Conclusions: Following exclusion of urological malignancy, renal disease should be considered in all patients with microscopic haematuria and appropriate referral made to nephrology services where appropriate.
UROLOGY 72 (Supplement 5A), November 2008
UP.09 Extra Adrenal Pheochromomocytoma of Urinary Bladder: A Case Report and Review of Literature Sharma P, Sharma P, Saraswat B Dr SN Medical and Attached Hospitals, Jodhpur, India Introduction and Objectives: Pheochromocytoma of urinary bladder is rare disease causing a hypertension, palpitation, throbbing headache & haemorrhage induced by voiding. Materials and Methods: This case is reported because of rarity of this disease in urinary bladder. Life-long follow up is required because of late endocrinal manifestations and metastasis in this tumor. Results: Extra adrenal Pheochromocytomas are more likely to recur and metastasize than their adrenal counterparts making lifetime follow up with annual determination of catecholamine production essential. Conclusions: This case is reported because of rarity of this disease in urinary bladder. UP.10 Mineralocorticoid Expression is a Negative Prognostic Predictor in Patients with Renal Cell Carcinoma Ogushi T, Fujimura T, Kumagai J, Kitamura T, Urano T, Inoue S, Takahashi S Tokyo University, Tokyo, Japan Introduction and Objectives: Mineralocorticoid receptors (MR) bind both mineralocorticoids and glucocorticoids and mediate diverse functions in multiple normal tissues. Less is known about MR regulation and function in neoplasms. To investigate the clinical significance of MR in renal cell carcinoma, we examined MR expression in human renal cell carcionoma specimens by immunohistochemical analysis. Materials and Methods: MR expression was evaluated immunohistochemically in 69 human renal cell carcinoma specimens using an immunoreactivity (IR) scoring system (0 to 3⫹) that corresponded to the sum of the percentage of positive cells. Subsequently, the correlation between MR status and clinicopathological characteristics was statistically analyzed. Results: MR expression was evaluated immunohistochemically in 69 human renal cell carcinoma specimens using an immunoreactivity (IR) scoring system (0 to 3⫹) that corresponded to the sum of the percentage of positive cells. Subsequently, the correlation between MR status and clinicopathological characteristics was statistically analyzed.
S113
UNMODERATED POSTER SESSIONS
Conclusions: MR is expressed in the majority of human renal cell carcinomas and high MR immunoreactivity is associated with tumor aggressiveness and unfavorable prognosis. UP.11 Renal Cell Carcinoma: Atypical Clinical Manifestation Ilievski A1, Ilievski P2, Nakovski R3, Jankovski V3, Jovanovski S3, Batandzioski T3, Popovski Z3 1 University Clinics, Skopje, Macedonia; 2 Mahaska Hospital, Oskaloosa, USA; 3 Urology Department, Clinical Hospital, Bitola, Macedonia Introduction and Objectives: Classical triad of symptoms: haematuria, abdominal or flank pain and palpable abdominal mass occur in 10 to 15 of patients and present advanced disease. Symptoms as a dyspnea, headache, seizure, and bone pain are symptoms for metastatic disease and are found in 30% of patients. This cancer is associated with wide spectrum of paraneoplastic syndromes in many varieties in 10 to 40% of the patients. Materials and Methods: We did a statistical work-up of cancer in our department from January 2000 to April 2008. Most were diagnosed in early stage with ultrasound and CT scan, but many of them were in advanced stage with lungs metastasis and surrounding organs. The total number of 58 cases radical nephrectomy was done with abdominal or thoracoabdominal approach. They were 43 or 74% male and 15 or 26% female. The age of the patient was 60.4 (range⫽38-76 ) for male and 57.9 (range⫽31-81) for female patients. The ratio male to female was 2.8:1. The atypical clinical manifestations were found in two cases both from right kidney. Results: From 53 cases, two were atypical: one with atypical manifestation of metastasis and tje other one as a paraneoplastic syndrome. Metastases from right kidney to the pleura on the same side were manifested with pleural exudation which at the beginning pathology report was endothelioma but the later pathology report was adenocarcinoma. Primary carcinoma on ultrasound and CT scan was found renal carcinoma. The patient died 3 months after radical nephrectomy. The second case was also from right kidney and manifested with microhaematuria, hypertension and hypercalcemia with calcium 12.2 mg. This patient was sent for endocrinological investigation for hyperparathyroidisam and after 6 months on ultrasound and CT scan found renal cell
S114
carcinoma with metastasis in both adrenal glands. Radical nephrectomy and bilateral adrenalectomy was done by thoracoabdominal approach. Conclusions: Our presentation of atypical cases with their clinical manifestations and metastases are very important in practice and indicative of endemic nephropathy. Practitioner physicians should think of the possibility of this cancer with many varieties of paraneoplastic syndromes, which can be diagnosed with ultrasound and CT scan. UP.12 Renal Cell Carcinoma, Sarcomatoid Variant: Our Experience of 10 Years at the Clinical Hospital of the University of Chile Cuevas M, Fulla´ J, Igor M, Diaz P, Storme O Universidad De Chile, Departamento De Urologı´a, Santiago, Chile Introduction and Objectives: Sarcomatoid variant can be found in 1 to 5% of the renal cell carcinomas, taking the poorest prognosis in this cancer. We evaluated our experience in the last 10 years at the Clinical Hospital of the University of Chile. Materials and Methods: A retrospective study was performed between 1997 and 2007. A total of 27 patients were studied. Characteristics such as age, sex, histology, and global survival rate were evaluated in all the cases. Results: The series consisted of 27 patients, 16 men (59.3 %) and 11 women (40.7%), with a mean age of 60.3⫹/4.7 years (range⫽18 to 85 years). The mean of long-term survival was 29.5 (0.5-87) months. A 5-year mortality of 66.7% was found. There were not statistical significance at comparing the diferents grades of cell-atipia (p⫽ 0.957). A positive statistical significance was found when we compared the differents cancer stages (IIV) (p: 0.001). Conclusions: Sarcomatoid variant, associated to a major stage, has a poor prognosis of long-term survival. In this series, we can’t evaluate a major association with cell-atipia. UP.13 Renal Cell Carcinoma with SarcoidLike Stromal Reaction Ibarra A1, Campero J1, Matamala P2 1 Clinica Las Condes, Santiago, Chile; 2 Hospital San Juan de Dios, Santiago, Chile Introduction and Objectives: Tisular reactions related to tumors, with forma-
tion of epithelial granulomas, are known from approximately one century. Such sarcoid-like reactions can happen in lymph nodes of drainage zones, in relation to the tumor itself and even in non-regional tissues. It has been described in nearly 14% of Hodgkin lymphomas, 7% of non Hodgkin lymphomas and 4% of epithelial neoplasias (more frequent in seminomas and similar ones). They can be difficult or delay a correct diagnosis. In renal tumors, these reactions are exceptional. Materials and Methods: A 32-year-old man was featured in the study for hypertension. Abdominal ultrasound detects right solid renal mass of 2 cm in diameter in anterior aspect. The CT scan demonstrated solid lesion with contrast. The study of dissemination was negative. In December 2007, there was a laparoscopic partial nephrectomy, whose intraoperatory biopsy reported carcinoma of renal cell, without surgical margin compromise. Images controlled at a month revealed post-surgical alterations. At present, he does not present evidence of disease. Results: A round mass of 2.4 ⫻ 2 x 1.8 cm was observed: well defined, soft, yellowish. It was a prominent sarcoid like reaction in its stroma with granulomas of epithelial histiocytes without necrosis and lymphocytes. Ziehl Neelsen’s stain and the PCR for tuberculosis complex were negative. Conclusions: We present a very infrequent case of renal cell carcinoma with sarcoidlike stromal reaction. This special guest response usually does not change the prognosis, but it can be a powerful distracting element, avoiding or delaying the correct diagnosis, especially in partial biopsies or cytology obtained by fine needle aspiration. UP.14 Malignant Renal Mesenchymoma Ibarra A1, Matamala P2,3, Urrutia J2, Alcalde E3 1 Clinica Las Condes, Santiago, Chile; 2 Hospital San Juan de Dios, Santiago, Chile; 3Universidad De Chile, Santiago, Chile Introduction and Objectives: Malignant mesenchymoma is the term used to define a neoplasia constituted by 2 or more differentiated sarcomatous tissues not related, besides undifferentiated or fibrosarcomatous components. It is very infrequent, and in the kidney, only about 5 cases have been described. Its prognosis would depend on predominant components and grade of differentiation. Materials and Methods: A 54-year-old woman, hypertense in treatment. The pa-
UROLOGY 72 (Supplement 5A), November 2008