Review of Topical Treatment of Upper Tract Urothelial Carcinoma

A select group of patients with upper tract urothelial carcinoma may be appropriate candidates for minimally invasive management. Organ-preserving endoscopic procedures may be appropriate for patients with an inability to tolerate major surgery, solitary kidney, bilateral disease, poor renal function, small tumor burden, low-grade disease, or carcinoma in situ. We review the published literature on the use of topical treatment for upper tract urothelial carcinoma and provide our approach to treatment in the office setting

Surgically Discovered Xanthogranulomatous Pyelonephritis Invading Inferior Vena Cava with Coexisting Renal Cell Carcinoma

Xanthogranulomatous pyelonephritis (XGP) is a chronic inflammatory process that results in replacement of renal and/or perirenal tissue with a diffuse infiltrate of inflammatory cells referred to as xanthoma cells. We present a case of a 49-year-old man with an incidentally discovered renal mass with inferior vena cava (IVC) thrombus, who was found intraoperatively to have a significant inflammatory process involving the posterior wall of his IVC and right renal vein consistent with XGP surrounding a focus of clear cell renal cell carcinoma in the midportion of his right kidney

Gleason score and laterality concordance between prostate biopsy and prostatectomy specimens

Objectives: Prostate biopsy involvement and Gleason score guide treatment decisions in prostate cancer. We evaluated concordance in Gleason score and laterality between biopsy and radical retropubic prostatectomy (RRP) specimens and factors that influenced this relationship. Material and Methods: We reviewed 538 prostate cancer diagnoses at a Veterans Affairs medical center (2000-2005) to identify men with prostate biopsy and RRP specimens. During this time there was a move from limited (6 core) to extended (12 core) biopsy schemes. Discordance in Gleason score was defined as any change in Gleason score. Results: 152 men underwent RRP with biopsy showing Gleason < 7 in 56%, 7 in 36%, and > 7 in 8%. Biopsy involvement was unilateral in 59% and bilateral in 41%. Compared to the biopsy, RRP Gleason score was concordant in 76 (50%), higher in 51 (34%), and lower in 25 (16%). Bilateral involvement was concordant in 97%, while unilateral involvement was concordant in only 20%. Both Gleason score and laterality were concordant in only 26%. Gleason concordance was higher in those with 8 or more cores compared to < 8 cores taken (54% vs. 34%, p = 0.046), but concordance was not affected by age, PSA, prostate volume, or length of time from biopsy to RRP. During later years, concordance did not improve despite taking more cores. Conclusions: Prostate biopsy underestimated prostatectomy Gleason score in 34% of men and bilateral involvement in 80% of those with unilateral disease on biopsy. Taking at least eight cores improves the accuracy of the prostate biopsy