Transitional Cell Carcinoma Of Renal Pelvis Research Articles

CARCINOGENICITY STUDY OF GLYCINE IN FISCHER 344 RATS

The carcinogenicity of commercial glycine (GL) was assessed in groups of 50 male and 50 female F344 DuCrj rats by application in the drinking water at levels of 0. 2.5 or 5.0% for 108 wk. A dose-dependent reduction in the mean final body weights of rats was observed with GL, the incidences of necrosis in the renal papillae also being increased by the treatment. Thus while the controls were negative, necrosis was observed in 3 of 40 males and 10 of 31 females given 5.0% GL, and 2 of 45 males and 14 of 46 females receiving 2.5% GL. Incidences of urinary bladder papilloma were 2 in 31 females (6%) given 5.0% GL and 4 in 46 female (8%) given 2.5% GL. One renal cell tumor was noted in a male receiving 5.0% GL, but no precancerous renal cell lesions. One pelvic transitional cell carcinoma was also found in a control male.

Incision of the Ureterovesical Junction for Endoscopic Surveillance of Transitional Cell Cancer of the Upper Urinary Tract

Ureteroscopy for treatment of upper tract transitional cell cancer is complicated by the need for subsequent outpatient, anesthesia-based, surveillance ureteroscopy to detect recurrent tumors. We report on 2 patients with ureteroscopically treated renal pelvic transitional cell carcinoma in whom the ureteral tunnel was incised. By rendering the ureterovesical junction incompetent, we created a widely patent refluxing ureteral orifice. During the last 2 years we have been able to perform repeatedly office-based flexible surveillance ureteroscopy without fluoroscopy and without oral or parenteral analgesics in both patients.

Pyelovenous Lymphatic Migration of Transitional Cell Carcinoma Following Flexible Ureterorenoscopy

Ureterorenoscopy has enhanced the diagnosis and treatment of upper urinary tract disorders. However, the irrigation necessary for visualization and distention of the lumen may increase renal pelvic pressure, resulting in pyelovenous lymphatic backflow. We report a case of renal pelvic transitional cell carcinoma that may have migrated to submucosal venous and lymphatic spaces during flexible ureterorenoscopy.

Renal pelvic cancer: A review of 611 patients treated in Illinois 1975–1985

Renal pelvic transitional cell carcinoma constitutes about 7 percent of all kidney cancer. This report is a summary of 611 Illinois patients with this tumor treated between 1975 and 1985. Overall, the five-year relative survival rate was 62 percent and the observed five-year rate was 48 percent. Stage was a major determinant of survival, as expected, in these cancer patients. The Illinois experience is reviewed and compared with the accumulated literature experience with renal pelvic cancers since 1944.

Spontaneous neoplasms in aged Sprague-Dawley rats.

Incidence of neoplastic lesions in untreated Sprague-Dawley rats (1340 males and 1329 females) used as controls in 17 carcinogenicity studies are tabulated and evaluated. In male rats, the most common neoplasms were benign pheochromocytomas and keratoacanthomas (4.0% in each case) followed by pancreatic islet cell adenomas (3.7%), thyroid parafollicular cell adenomas (3.6%), fibromas and squamous cell papillomas of the skin and hepatocellular adenomas (2.0% in each), malignant lymphoma lymphocytic (1.9%), histiocytic sarcomas (1.4%), and adrenal cortical adenomas (1.2%). In female rats, the most common neoplasms were of mammary gland origin (31.3%: fibroadenoma 19.0%, adenocarcinomas 8.8%, and adenomas 3.5%) followed by thyroid parafollicular cell adenomas (2.9%), uterine endometrial stromal polyps (2.6%), adrenal cortical adenomas (1.9%), malignant lymphoma lymphocytic (1.6%), fibromas in the skin (1.3%), and pancreatic islet cell adenoma (1.1%). Metastases were observed from pheochromocytomas, hepatocellular carcinomas, nephroblastomas, renal pelvis transitional cell carcinoma, interstitial cell tumor and seminoma of the testes, Zymbal's gland adenocarcinomas, and mammary adenocarcinomas.

Renal pelvic transitional cell carcinoma. The role of the kidney in tumor-node-metastasis staging.

Renal pelvic carcinoma is a rare tumor. There are several staging systems currently in use based on a bladder cancer staging model. An analysis of the American Cancer Society, Illinois Division, experience with 611 cases of renal pelvic transitional cell carcinoma suggested that the kidney parenchyma may be a determinant in the anatomic spread of disease. A tumor-node-metastasis system for renal pelvic (separate from ureteral) cancer is recommended.

Treatment of primary squamous cell carcinoma of the upper urinary tract

Forty-six patients with primary squamous cell carcinoma of the upper urinary tract treated over a 44-year period were studied. The lack of characteristic presentation caused delay in diagnosis. Associated urinary calculi were found in only five (11%) of the patients. Almost all of the tumors were histologically high grade; at surgery, 84% of the tumors were locally advanced or metastatic. Prognosis is poor independent of treatment; the overall 24-month survival rate was 22%. Comparison with a previous study of renal pelvic transitional cell carcinoma indicates that these two forms of urothelial neoplasm are biologically different.

Incidence and Pathology of Spontaneous Renal Pelvis Transitional Cell Carcinomas in Rats

Spontaneous transitional cell carcinoma (TCC) originating from renal pelvis is very rare. Metastasis from this tumor having been reported only once previously. Data from control groups of 17 carcinogenicity studies in Sprague-Dawley and 10 carcinogenicity studies in Fischer 344 (F-344) rats were reviewed and evaluated to determine the incidence and pathology of TCC. Renal pelvis TCC were observed in 1 male and 1 female Sprague-Dawley rat and in 1 male F-344 rat. Metastasis from TCC to the lung was observed in 1 male Sprague-Dawley rat. Detailed histopathological features of this tumor are described and discussed.

Radiological and cytological detection of renal pelvic transitionalcell carcinoma : Paivansalo M, Merikanto J, Myllyla V, et al. (Department of Diagnostic Radiology, Oulo University Central Hospital, Kajaanintie 50, SF 90220 Oulu, Finland). RöFo 1990;153:266–270

Radiological and cytological detection of renal pelvic transitionalcell carcinoma : Paivansalo M, Merikanto J, Myllyla V, et al. (Department of Diagnostic Radiology, Oulo University Central Hospital, Kajaanintie 50, SF 90220 Oulu, Finland). RöFo 1990;153:266–270

Magnetic Resonance Imaging for Assessment of Vena Caval Tumor Thrombi: A Comparative Study with Venacavography and Computerized Tomography Scanning

We assessed the accuracy of magnetic resonance imaging in demonstrating the presence and extent of vena caval tumor thrombi. The study group included 20 patients with vena caval thrombi from renal cell carcinoma (18), renal pelvic transitional cell carcinoma (1) and adrenal pheochromocytoma (1). Preoperative diagnostic studies included magnetic resonance imaging in all patients, inferior venacavography in 16 and computerized tomography scanning in 15. All patients underwent an operation in which the presence and extent of the vena caval thrombus were confirmed. Magnetic resonance imaging accurately delineated the presence and extent of the thrombus in all 20 patients (100%). Venacavography was accurate in 15 patients (94%) but 8 (50%) required a retrograde and antegrade study. Computerized tomography scanning demonstrated the presence of a tumor thrombus in all 15 patients but accurately delineated the cephalad extent of the thrombus in only 5 (33%). In patients with vena caval tumor thrombi magnetic resonance imaging can provide accurate information regarding the extent of vena caval involvement while avoiding the need for an invasive contrast imaging study. (J. Urol., 144: 1100–1104, 1990)

Experience with Cardiopulmonary Bypass and Deep Hypothermic Circulatory Arrest in the Management of Retroperitoneal Tumors with Large Vena Caval Thrombi

From June 1984 to September 1989, 43 patients with large vena caval tumor thrombi from retroperitoneal malignancies underwent surgical treatment with cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). The primary malignancies were renal cell carcinoma (RCC) (n = 39), renal pelvic transitional cell carcinoma (n = 1), adrenal pheochromocytoma (n = 1), and renal (n = 1) or retroperitoneal (n = 1) sarcoma. The level of the caval thrombus was either suprahepatic (n = 27), intrahepatic (n = 14), or subhepatic (n = 2). In all cases the primary tumor and caval thrombus were completely removed. Concomitant procedures included coronary artery bypass grafting (n = 5), pulmonary resection (n = 2), and hepatic lobectomy (n = 1). The time of circulatory arrest ranged from 10 to 44 minutes (mean, 23.5 minutes). There were two operative deaths (4.7%), neither of them due to to the use of DHCA. Major postoperative complications occurred in 13 patients (30.2%). There were no ischemic or neurologic complications and no cases of perioperative tumor embolization. The median postoperative hospital stay was 9 days. Twenty-two patients (51%) are alive and enjoying a good quality of life. The 3-year patient survival rates in patients with localized (n = 24) versus metastatic (n = 15) RCC are 63.9% and 10.9%, respectively (p = 0.02). We conclude that CPB with DHCA facilities excision of retroperitoneal malignancies with large caval thrombi and provides the potential for cure with low morbidity and mortality rates.

Radiological and cytological detection of renal pelvic transitional-cell Carcinoma

We evaluated US, CT, intravenous urography, arteriography, retrograde pyelography and urine cytology results in a series of 23 patients with renal pelvic transitional-cell carcinomas, 14 of whom underwent US, 17 i.v. urography, 8 CT, 15 arteriography, 9 retrograde pyelography, and 17 patients urine cytology. A tumour was identified in 5 patients (36%) at US, in 11 patients (61%) at urography, in 7 (88%) at CT, in 10 patients (67%) at arteriography, and in 8 (89%) at retrograde pyelography. Urine cytology was assessed as showing changes consistent with Papanicolaou class III-V in 15 (88%) of 17 patients. When renal pelvic cancer is suspected, intravenous urography should be performed as the initial radiological examination and followed by CT, which may also identify tumour spread. Arteriography and retrograde pyelography are sometimes complementary investigations. Repeated urinary cytology is mandatory. Our results show that US alone is unreliable in detecting renal pelvic cancer.

Percutaneous Treatment of Transitional Cell Carcinoma of the Upper Urinary Tract

Fourteen selected patients with renal pelvic transitional cell carcinoma were managed percutaneously in our institution between March 1984 and April 1987. With a mean follow-up of 19 months, and excluding those patients who underwent immediate nephroureterectomy, six patients remain free of recurrent disease, which is similar to the results obtained with open parenchyma-sparing conservative operations. Our results suggest that percutaneous operations can provide cure in selected patients, including those with a normal contralateral kidney and with small (no more than 2-cm), single, low-grade, papillary tumors that are confined to the mucosa who, in addition, have negative cytology, negative random biopsies of contiguous mucosa, and no history of or concurrent transitional cell carcinoma elsewhere in the urinary tract. Further, our results suggest that second-look procedures with resection of suspicious residual disease, Nd:YAG laser irradiation of the tumor bed, and intracavitary administration of BCG all appear to help prevent recurrences.

Conservative Surgery for Transitional Cell Carcinoma of the Renal Pelvis

From 1972 to 1986, 14 patients underwent a conservative operation for transitional cell carcinoma of the renal pelvis. Most of these patients had low grade (12), noninvasive (10) tumors involving a solitary functioning kidney (12). The operations performed were open pyelotomy with tumor excision and fulguration (8 patients), partial nephrectomy (5) and percutaneous nephroscopic fulguration (1). There was 1 operative death. Of the 13 surviving patients 8 (62 per cent) remained free of transitional cell carcinoma postoperatively, while 5 (38 per cent) had recurrent disease. Six patients (46 per cent) presently are free of tumor 6 months to 5 years postoperatively. Conservative surgical techniques can provide satisfactory treatment for selected patients with renal pelvic transitional cell carcinoma when preservation of functioning renal parenchyma is necessary to avoid kidney failure.

Percutaneous renal surgery and local radiotherapy in the management of renal pelvic transitional cell carcinoma.

Six patients with a history of bladder carcinoma and a radiographic filling defect of the pelvicaliceal system have been investigated or treated percutaneously. In two cases of doubtful diagnosis, percutaneous pyeloscopy showed that no pelvicaliceal tumour was present. In four patients with multifocal or recurrent transitional cell carcinoma and difficult clinical problems, intrarenal tumours were cauterised or resected percutaneously. Radioactive iridium wire (192Ir) was inserted into the surgical track to deliver prophylactic irradiation (4500 cGy) to prevent tumour seeding. Follow-up was from 7 to 36 months. One operated patient developed early wide-spread multifocal disease throughout the urothelium, including the operated kidney, and died of uraemia. The other three patients have shown no recurrence in the operated kidney, though two have developed recurrences in the bladder or ureter. There have been no track recurrences.

Tumor production in germ-free rats fed 5-nitrofurans

Weanling female germ-free Sprague-Dawley rats were divided into 3 groups: the control group rats were fed an autoclaved 5010C diet for 2 years; the nitrofurantoin (NF) group rats were fed this diet supplemented with 0.188% NF for 2 years; and the N-[4-(5-nitro-2-furyl)-2-thiazolyl]-formamide (FANFT) group rats were fed this diet supplemented with 0.188% FANFT for 20 weeks followed by 20 additional weeks of the control diet. The FANFT-group rats were killed following the early appearance of bladder tumors. Six of 11 control rats had tumors: 2 with mammary fibroadenomas, 1 with adrenal adenoma, 1 with leukemic spleen, and 2 with mesenchymal sarcoma of the colon. Ten of 12 NF-group rats had tumors: 9 with mammary fibroadenomas, 1 with adrenal adenoma, and 1 each with leukemic spleen and cervical squamous cell carcinoma. Eight of 12 FANFT-group rats had tumors: 7 with bladder and 1 with renal pelvis transitional cell carcinoma. The incidences of mammary fibroadenoma in the NF group and of lower urinary tract tumors in the FANFT group were significantly greater ( P < 0.01) than those of these tumors in the control group.

Transitional cell carcinoma of renal pelvis in horseshoe kidney

A case is reported of renal pelvic transitional cell carcinoma in a horseshoe kidney. The incidence, etiologic considerations, and operative approach are presented.

Diagnosis of Renal Tumors by the Percutaneous Aspiration Cytology

Aspiration cytology was performed in ten patientsof renal tumors, consisting of seven patients of renalcell carcinoma and three of pelvic transitional cellcarcinoma.Specimens from8of them (80%) were adequate forcytological diagnosis.Because these two tumor groupshad specific cytological features, respectively, therenal tumors were easily differentiated. Cytologicalspecimens obtained by open aspiration biopsy and bydirect stamping of the tumors further verified thesefindings.Urinary sediments were examined cytologically in13patients of renal tumors, comprising nine patientsof renal cell carcinoma and four of pelvic transitionalcell carcinoma. Atypical cells were detected only in6of them (46%).In this study, percutaneous aspiration cytodiagnosiswas proved to be a valuable method to differentiaterenal malignancies preoperatively.Fat stain with Oil Red-O was applied to the cytological specimens obtained by aspiration biopsy andurinary sediments.Oil Red-O positive cytoplasmicgranules were observed in 10 of 17 specimens fromthe patients of renal cell carcinoma and 1 of 11 specimens from the patients of pelvic transitional cellcarcinoma.The positive specimen from the lattergroup was a smear of urinary sediment from a patient of renal pelvic tumor.This fact suggests that thefat stain is not specific for renal cell carcinoma only.

Transitional-cell carcinoma of renal pelvis and ureter Retrospective review of 40 patients

The symptoms, physical, radiographic, and pathologic findings, and the survival rate in 40 patients with transitional-cell carcinoma of the renal pelvis and ureter were studied. The incidence of these tumors was found to be increasing, with the peak in the seventh decade. The sex ratio was 2.3:1, male to female. Most of the tumors occurred in the lower third of the ureter. Hematuria was the most common presenting symptom. Diagnosis was evident in 69.5 per cent of patients with ureteral carcinoma and 82 per cent with renal pelvic carcinoma by retrograde ureteropyelography. Total nephroureterectomy with excision of the vesical cuff was the surgical procedure of choice. However, in selected cases a conservative procedure is indicated. The over-all five-year survival rate for all grades of tumor was 48 per cent, 52 per cent for ureteral and 44 per cent for pelvic tumors.