The Natural History of Tumours of the Urinary Tract

Experimental and epidemiological evidence has implicated environmental factors in the increasing incidence of bladder cancer. Papillary tumours are less malignant than solid. Of 36 patients with papillary growths in the renal pelvis, 20 lived five years but 11 of 15 with solid tumours died within one year.Social and geographical influences have affected the incidence of adenocarcinoma of the kidney. Experimentally it has been produced by hormones, carcinogens, viruses and irradiation. Clinically the most adverse factor was histological anaplasia; renal vein invasion was three times as common in high-grade tumours. The postoperative five-year survival was 30 out of 42 patients with low-grade lesions but 12 out of 42 with high-grade lesions. In the case of low malignancy tumours without adverse factors, 25 out of 29 patients survived for five years. This unpredictable behaviour is characteristic of urinary tract tumours.     

Cytologic diagnosis of mesonephric adenocarcinoma of the urinary bladder

Mesonephric adenocarcinoma is a rare primary neoplasm of the urinary bladder, composed of papillary and glandular structures with clear-cell features. A case is reported in which cytologic examination of urine specimens showed the distinctive dimorphic cell population of small cells in papillary formations and larger cells with features of a clear-cell adenocarcinoma, permitting a specific diagnosis.     

Inverted papilloma of the renal pelvis. Cytologic features of ureteral washings

A case of rare inverted papilloma of the renal pelvis with cytologic study of ureteral washings is described. Cytologic findings included increased numbers of urothelial cell clusters with mild degenerative changes. Although cytology was helpful in establishing the presence of a papillary transitional-cell lesion, histologic analysis following resection was required to distinguish between the possibilities of transitional-cell carcinoma and inverted papilloma.     

Ciliated cells in papillary adenocarcinomas of Barrett's esophagus.

Eighteen surgical specimens having an adenocarcinoma arising in Barrett's esophagus were reviewed, and special attention was paid to the presence of ciliated cells. The tumors were classified as glandular (9), papillary (4), diffuse (3) and mixed (2) types. Ciliated cells were observed in one specimen, in cystically dilated glands in Barrett's mucosa adjacent to a papillary adenocarcinoma. Ciliated tumor cells were found in three of the four papillary adenocarcinomas. The fourth papillary tumor, 1 mixed papillary-diffuse adenocarcinoma and the remaining 13 adenocarcinomas had no ciliated cells. Thus, the presence of cilia in exfoliated tumor cells from the esophagus should raise the suspicion of a papillary adenocarcinoma arising in Barrett's mucosa.     

Aspiration cytology of the oncocytic variant of papillary adenocarcinoma of the thyroid gland

OBJECTIVE: To study the cytologic features of the oncocytic variant of papillary adenocarcinoma of the thyroid gland to distinguish this subtype from other oncocytic lesions of the thyroid. STUDY DESIGN: We reviewed the smears from aspiration biopsies of 6 proven cases of oncocytic variant of papillary adenocarcinoma and compared their cytologic features with smears from 19 oncocytic follicular neoplasms (11 adenocarcinomas and 8 adenomas). Smears were stained with a modified Giemsa stain (Diff-Quik). RESULTS: All smears were cellular. Colloid was variable but more abundant in cases of the oncocytic variant of papillary adenocarcinoma. The cells in papillary adenocarcinoma had round to ovoid, overlapped nuclei; prominent intranuclear inclusions; and "grooves." Nucleoli were generally absent. In oncocytic follicular neoplasms, the cells had round nuclei and prominent nucleoli. Nuclear inclusions and grooves were seen but were not as prevalent as in papillary adenocarcinomas. CONCLUSION: The oncocytic variant of papillary adenocarcinoma of the thyroid gland can be distinguished from other oncocytic lesions by fine needle aspiration biopsy, whereas the absence of prominent nucleoli in oncocytes favors the diagnosis of an oncocytic papillary adenocarcinoma.     

Renal epithelial proliferation and its clinical expression in Brown Norway (BN) rats

Renal epithelial proliferation has previously been found to be a common condition in a colony of Lewis x Brown Norway (BN) F2 hybrid rats. The aim of this study was to investigate the prevalence and clinical consequences of this condition in pure inbred BN and Lewis rats. Renal epithelial proliferation was found in 29 of 49 BN rats (59%) examined and in four of 50 Lewis rats (8%) examined. Serum creatinine and serum corticosterone was not influenced by the condition. Haematuria was more common in BN rats with (74%) than without renal papillary proliferation (35%, P < 0.05), but it may not be used to diagnose renal epithelial proliferation, as we found rats having renal epithelial proliferation without showing haematuria and rats showing haematuria without having renal epithelial proliferation. Haematuria was also common in Lewis rats (16-56% dependent of age and gender), in which renal epithelial proliferation were found in only 8%. Fluctuating asymmetry, which was used as a measure of developmental instability, was found to be increased in rats with renal epithelial proliferation (P < 0.05). Haematuria was also found to be related to the degree of fluctuating asymmetry (P < 0.01). Although the prevalence of renal epithelial proliferation is clearly higher in BN rats than in Lewis rats (P < 0.01), and although in previous reports the condition was found in F2 BN x Lewis hybrids and not in F1 BN x Lewis hybrids it cannot clearly be defined as having been caused by a single Mendelian gene, as we found it in both inbred strains. Futhermore, we found that morphologically the proliferations could be placed on the papillary as well as the medullary wall of the renal pelvis, while previously it has only been described on the papillary wall.     

Gene expression in the normal adult human kidney assessed by complementary DNA microarray

The kidney is a highly specialized organ with a complex, stereotyped architecture and a great diversity of functions and cell types. Because the microscopic organization of the nephron, the functional unit of the kidney, has a consistent relationship to the macroscopic anatomy of the kidney, knowledge of the characteristic patterns of gene expression in different compartments of the kidney could provide insight into the functions and functional organization of the normal nephron. We studied gene expression in dissected renal lobes of five adult human kidneys using cDNA microarrays representing approximately 30,000 different human genes. Total RNA was isolated from sections of the inner and outer cortex, inner and outer medulla, papillary tips, and renal pelvis and from glomeruli isolated by sieving. The results revealed unique and highly distinctive patterns of gene expression for glomeruli, cortex, medulla, papillary tips, and pelvic samples. Immunohistochemical staining using selected antisera confirmed differential expression of several cognate proteins and provided histological localization of expression within the nephron. The distinctive patterns of gene expression in discrete portions of the kidney may serve as a resource for further understanding of renal physiology and the molecular and cellular organization of the nephron.     

A morphometric study of primary adenocarcinoma of the vagina

Primary adenocarcinoma of the vagina accounts for approximately 1% of all invasive carcinomas of the female genital tract. This paper reports on a study of four cases of primary adenocarcinoma (including one with in utero diethylstilbestrol exposure) of the vagina from the files of the Medical University of South Carolina. Both tissue sections and cytologic preparations from each case were evaluated in order to delineate the morphologic characteristics of the cells that compose the lesions. Histologically, the lesions primarily presented the tubular cystic pattern; solid and papillary growth patterns were also seen in one case. The constituent cells included clear cells, hobnail cells and secretory and nonsecretory tubular cystic cells. All specimens were examined for the following parameters: cell population, nuclear area, cytoplasmic area, nuclear/cytoplasmic (N/C) proportions, nuclear and cytoplasmic characteristics. While a fairly detailed profile of the morphologic criteria for hobnail cells was developed, the cellular profiles of the other malignant glandular cells originating in primary vaginal adenocarcinoma remain less certain.     

Catheterized urine cytology of mucinous carcinoma arising in the renal pelvis. A case report

BACKGROUND: Primary mucinous carcinoma of the renal pelvis is a rare tumor; therefore, criteria for cytologic diagnosis of this tumor have not been established. CASE: An 81-year-old woman suffered from macrohematuria for six months and was found to have a tumor in the right kidney by radiographic examination. Catheterized urine obtained from the right renal ureter was viscous and contained spherical clusters of cells with occasionally vacuolated, lacy and basophilic cytoplasm. In the small to medium-sized nuclei, chromatin was coarse and granular, and the nuclear membrane was thin and nearly smooth. Large nucleoli were evident in some of the nuclei. These findings were consistent with adenocarcinoma possibly of mucinous type. CONCLUSION: Preoperative diagnosis of mucinous carcinoma is possible by cytologic findings of catheterized urine together with clinical data.     

Nuclear grooves. How specific are they?

OBJECTIVE: To study the significance of nuclear grooves in thyroid and extrathyroid benign and malignant lesions. STUDY DESIGN: In this retrospective study, 26 cases were selected randomly, consisting of papillary carcinoma of the thyroid (7), papillary adenocarcinoma (9), normal cervical smear (5) and benign bronchioalveolar lavage (BAL) (5). In all cases hematoxylin and eosin- and Papanicolaou-stained smears were studied for nuclear grooves. RESULTS: Except for one case of papillary adenocarcinoma, nuclear grooves were discernible in all cases. The highest number of nuclear grooves was seen in normal cervical smears, followed by papillary carcinoma of the thyroid, papillary adenocarcinoma and BAL smears. CONCLUSION: The number of grooves did not correlate with either benign or malignant conditions. These findings cast serious doubt about the diagnostic significance of nuclear grooves. Probably nuclear grooves are nonspecific findings and should be considered only in association with other diagnostic features.     

Fine needle aspiration study of metastatic mixed adenosquamous carcinoma of the renal pelvis. A case report

The findings in a fine needle aspirate of a psoas area metastasis from a mixed adenosquamous carcinoma of the renal pelvis are presented. The primary renal tumor is apparently the fourth such case reported in the literature; the pathogenesis of such tumors is briefly reviewed. The value of fine needle aspiration in excluding a clinically suspected abscess and in allowing a specific diagnosis of malignancy is emphasized.     

Renal cell carcinoma metastatic to follicular adenoma of the thyroid gland. A case report

BACKGROUND: Renal cell carcinoma is an unpredictable tumor that can recur many years after the original diagnosis and metastasize to uncommon sites, including the thyroid gland. Differential diagnosis from primary thyroid tumor is often difficult both clinically and pathologically. We report a case of metastatic renal cell carcinoma in follicular adenoma of the thyroid gland. CASE: A 48-year-old woman presented with a 3-cm-diameter, palpable mass in the left lobe of the thyroid gland. The patient's history included removal of a left renal mass, which was conventional renal cell carcinoma. Fine needle aspiration cytology smears contained a few small clusters of polygonal cells with abundant, clear cytoplasm and irregular, hyperchromatic nuclei as well as bland-looking thyroid follicle cells and stromal cells. A papillary or follicular growth pattern was not detected. A cell block made from the aspirated sample was composed mainly of clear cells. By immunohistochemical stains, the clear cells were completely negative for TTF-1, thyroglobulin, calcitonin and inhibin while equivocally staining for cytokeratin, CD10 and galectin-3. The histologic diagnosis was renal cell carcinoma metastatic to follicular adenoma of the thyroid gland. CONCLUSION: Renal cell carcinoma metastatic to the thyroid may masquerade as a primary thyroid neoplasm. A history of prior nephrectomy, the presence of unremarkable thyroid follicle cells, the absence of a papillary or follicular growth pattern and immunohistochemical study can help differentiating metastatic renal cell carcinoma from a primary thyroid lesion with clear cell change.     

Papillary carcinoma of the common bile duct. Diagnosis by bile drainage cytology

A 54-year-old man with clinical and radiologic findings suggestive of pancreatic carcinoma had cytologic examination of bile drainage fluid specimens prepared by membrane filtration and cytocentrifugation. Examination showed clumps of malignant cells with features most consistent with a well-differentiated papillary neoplasm of bile duct origin, rather than a primary pancreatic carcinoma. Partial pancreatoduodenectomy with resection of the proximal common bile duct confirmed the presence of a small, well-differentiated but invasive papillary bile duct carcinoma. Pancreatic carcinoma and papillary carcinoma of the bile duct are anatomically and biologically different lesions that should be distinguished, when possible, by cytologic examination. In this case, surgical treatment was planned on the assumption that cytologic examination could distinguish a papillary carcinoma of the bile duct from the clinically suspected pancreatic adenocarcinoma.     

小熊猫肾脏和输尿管的组织学研究

小熊猫的肾脏呈蚕豆形,表面光滑不分叶,只有1个肾锥体和1个肾盏,无肾盂。肾脏皮质内可见皮质迷路和髓放线。皮质迷路内有近曲小管、远曲小管和肾小体等结构。髓放线内有近端小管直部和远端小管直部。髓质可分为外髓和内髓两个区域。外髓有较多的集合管断面,少量的远端小管直部和细段,较多的直小血管束。内髓部位有大量的细段和乳头管。各种泌尿小管之间有少量的疏松结缔组织构成的间质,间质内有丰富的毛细血管。输尿管横切面呈圆形或卵圆形,管腔呈不规则的裂隙状。管壁由粘膜、肌肉层和外膜组成。并与大熊猫肾脏和输尿管的组织结构作了比较研究。     

Cytoplasmic microtubules of normal and tumor cells of the leopard frog. Temperature effects

The cytoplasmic microtubule complex (CMTC) was examined in monolayer cultures of normal tadpole mesonephros, primary renal adenocarcinoma, and an established cell line derived from a pronephric renal adenocarcinoma (PNKT-4B) of the leopard frog, Rana pipiens. Immunocytochemistry revealed typical arrays of microtubules extending from the cytocentrum to the cell periphery in all three cell types when cultured at 28 degrees C; similar results were obtained at 20 degrees C. However, the CMTC was disorganized in both tumor types, in contrast to the retention of a typical CMTC in normal tissue cultured at 7 degrees C. The response of PNKT-4B cells differed from that of normal tadpole mesonephros when treated with the microtubule inhibitor drug nocodazole. At 28 degrees C, PNKT-4B and tadpole mesonephros cells lost their CMTC with nocodazole treatment, and both were able to reconstitute CMTC when nocodazole was removed. Similarly, both lost CMTC organization with nocodazole and culture at 70 degrees C. However, while normal cells could effect a recovery at 7 degrees C after the removal of nocodazole, PONKT-4B cells were unable to restructure CMTC under the same conditions. Metastasis in the frog renal adenocarcinoma is temperature-dependent, with an elevated prevalence of metastasis in tumor-bearing frogs maintained at 28 degrees C. Few metastatic colonies are detected in tumor-bearing frogs maintained at a low temperature (7 degrees C). Other studies have indicated that microtubules, which are essential for cell motility, play an important role in the invasion by tumor cells of normal tissue fragments in vitro. The effects of temperature on metastasis of the Lucke renal adenocarcinoma are consistent with temperature-mediated changes in tumor-cell CMTC.     

Bradykinin-induced changes in myo-inositol 1,2-(cyclic)phosphate in rabbit papillary collecting tubule cells

Rabbit renal papillary collecting tubule cells were harvested and grown in primary cultures. When labeled with myo-[2-3H]inositol and extracted under neutral conditions, a metabolite undetected under acidic extraction was observed on resolution by anion-exchange chromatography and which eluted under similar conditions with authentic DL-myo-inositol 1,2-(cyclic)phosphate; the mass spectrum of its pentakis(trimethylsilyl) derivative contains an identical ratio of selected ion fragments to the authentic standard. Bradykinin, demonstrated previously to increase labeling of free inositol polyphosphates, increases labeling of inositol 1,2 cyclic phosphate but over a time course subsequent to the formation of inositol trisphosphate. These observations are consistent with the model that bradykinin induces hydrolysis of phosphatidylinositol 4,5-bisphosphate which precedes hydrolysis of phosphatidylinositol in renal papillary collecting tubule cells.     

Papillary adenoma of the kidney with mucinous secretion

Although infrequently, mucin secretion has previously been reported in papillary renal cell carcinoma. We here investigate the presence of mucin in a series of 93 renal papillary adenomas in 58 patients. Acid mucin was present in four cases (4.3% of the tumors; 6.9% of the patients), in which basophilic mucin secretion was evident with hematoxylin-eosin. To the best of our knowledge mucin secretion has not been reported in renal papillary adenoma. We describe two different types of mucin secretion: intracytoplasmic and luminal. The secretion was intracellular in numerous scattered tumor cells in two cases, focal luminal in one case, and mixed intracellular and luminal in another case. Mucin production, despite its low frequency, can be considered as an additional feature of renal papillary adenoma. Mucin production suggests that renal papillary adenoma and papillary renal cell carcinoma are actually not two independent biological processes, but a continuum of one biological process.     

Serum levels and thyroid tissue expression of CA50 and CA 19-9 in patients with thyroid tumor.

A 77-year-old man was admitted to the hospital with a thyroid nodule. The levels of serum tumor-associated carbohydrate antigens (CA 50, CA 19-9) and thyroglobulin (HTG) were markedly increased. We performed total thyroidectomy and right neck lymph node dissection. After treatment, the serum CA 50, CA 19-9 and HTG levels were markedly decreased. Histological examination of the thyroid tumor showed papillary adenocarcinoma and the dissected neck lymph nodes contained metastatic adenocarcinoma. The expression of CA 50 and CA 19-9 (defined by the monoclonal antibodies) was studied by immunoperoxidase staining from the normal and carcinomatous thyroid tissues and the dissected neck lymph node. CA 50 was expressed more strongly by the carcinoma cells than CA 19-9. The positive rates for serum CA 50 and CA 19-9 levels in other patients with papillary adenocarcinoma were not significantly higher compared with patients with benign nodules and normal subjects. But a significant positive correlation was found between the diameter of the carcinoma and the serum levels of CA 50 and CA 19-9. These results suggest that the serum levels of CA 50 and CA 19-9 might not become useful markers for diagnosing carcinoma of the thyroid, but might be useful markers for monitoring the growth or recurrence of papillary adenocarcinoma of the thyroid in patients with high serum levels of CA 50 and CA 19-9.     

钠／碘同向转运体在人不同组织学分型胃癌中的表达

目的研究钠／碘同向转运体（sodium-iodide symporter,NIS）在人不同组织学分型胃癌组织中的表达,分析NIS表达与胃癌组织学分型的关系。方法选取于中国医科大学附属第一医院肿瘤外科行手术治疗的180例患者的胃癌组织为研究对象。依据胃癌的组织学分型分为6组,其中乳头状腺癌30例,管状腺癌30例,低分化腺癌30例,黏液腺癌30例,印戒细胞癌30例,未分化癌30例。选取上述180例患者的癌旁组织及30例慢性胃炎患者的胃组织作为对照。采取免疫组织化学SP法对上述组织的石蜡切片进行染色。结果在人胃癌组织、人胃癌旁组织及人慢性胃炎组织中,NIS阳性细胞率分别为10．6％（19／180）、28．3％（51／180）和90％（27／30）。人胃癌组织与人胃癌旁组织相比（P〈0．01）、人胃癌组织与人慢性胃炎组织相比（P〈0．01）、人胃癌旁组织与人慢性胃炎组织相比（P〈0．01）,NIS阳性细胞率均具有显著统计学差异。在人乳头状腺癌、管状腺癌、低分化腺癌、黏液腺癌、印戒细胞癌及未分化癌中,NIS阳性细胞率分别为30％（9／30）、10％（3／30）、13．3％（4／30）、6．7％（2／30）、3．3％（1／30）和0（0／30）。人乳头状腺癌与人黏液腺癌相比（P〈0．05）、人乳头状腺癌与人印戒细胞癌相比（PGO．01）以及人乳头状腺癌与人未分化癌相比（P〈0．01）,NIS阳性细胞率均具有统计学差异。在人慢性胃炎组织及人胃癌旁组织中,NIS仅表达于胃黏膜细胞的细胞膜上,而在人胃癌组织中,NIS在癌细胞膜有表达,在细胞质也有较明显的表达。结论在人胃癌组织、癌旁组织、慢性胃炎组织中,NIS阳性细胞率依次增高。在本研究人各种组织学分型的胃癌中,随着胃癌恶性程度的增高,NIS表达呈现出减少的趋势。人胃癌组织NIS在癌细胞的细胞膜和细胞质均有表达,而?     

Spontaneous pulmonary adenocarcinoma and subcutaneous cavernous hemangiomas arising in a squirrel monkey (Saimiri sciureus)

Benign and malignant pulmonary tumors have been reported in both Old World and New World monkeys but are uncommon. Hemangiomas are also rarely reported in nonhuman primates. Here we present a case of two primary neoplasms (a papillary adenocarcinoma of bronchioloalveolar origin and multiple cavernous subcutaneous hemangiomas) arising in an aged squirrel monkey (Saimiri sciureus).