Urothelial Inverted Papilloma of the Lower Urinary Tract—A Benign Lesion or a Precursor of Malignancy?

ObjectiveWe investigated the clinical characteristics and follow-up results of patients with a lower urinary tract inverted papilloma (IP) in our hospital, with the intention of clarifying whether certain groups require more aggressive surveillance.Materials and MethodsWe conducted a retrospective study of lower urinary tract IP, using the pathology database of Taipei Veterans General Hospital, from September 1992 to February 2008. In total, 67 patients were enrolled. Patients' clinical characteristics, symptoms, tumor locations, and follow-up data were analyzed.ResultsAmong the 67 patients diagnosed with IP, 59 were male and eight were female, with a mean age of 67.9 ± 12.4 years. Gross hematuria and lower-urinary-tract symptoms were the most common symptoms. All of the patients received transurethral resection as initial treatment. Thirty-eight of these patients were monitored for a median of 21 months (range: 3–168 months). Seven patients had synchronous urothelial malignancies, and one had recurrent IP during follow-up. No patient had subsequent urothelial carcinoma or IP recurrence without a synchronous or previous urothelial malignancy during follow-up.ConclusionThere is a low incidence of developing a subsequent malignancy with a simple IP lesion during follow-up. Rigorous surveillance may be unnecessary in IP patients without a synchronous or previous urothelial malignancy

Primary Urothelial Carcinoma of the Ureter: 11-Year Experience in Taipei Veterans General Hospital

BackgroundUrothelial carcinoma of the upper urinary tract is relatively rare, occurring in 5% of all urothelial tumors. Ureteral urothelial carcinoma is even less common than that of the renal pelvis, accounting for about 25% of all upper urinary tract tumors. The aim of this study was to evaluate the clinical behavior, survival, recurrence and prognostic information of primary ureteral urothelial carcinoma from our 11 years of experience at the Taipei Veterans General Hospital.MethodsWe retrospectively reviewed 111 patients with ureteral urothelial carcinoma who had been treated in our hospital between January 1993 and December 2003. Tumor staging was according to the 2002 AJCC TNM classification and stage groupings. Patients with stage 0a and stage 0is were categorized as stage 0a/is, and patients with pathologic T stage pTa and pTis were categorized as pTa/is for statistical analysis. The Kaplan-Meier method was used for survival analysis.ResultsThere were 69 males and 42 females, with a mean age of 70.5 ± 9.4 years at diagnosis. Of the 111 patients, 5 presented with stage 0a/is, 38 with stage I, 23 with stage II, 21 with stage III, and 24 with stage IV. Nephroureterectomy with bladder cuff excision was performed in 78 patients, 12 patients received segmental resection of the ureter, 4 received ureteroscopic laser coagulation, and 17 underwent chemotherapy or radiotherapy or both. Tumors were located on the left side in 53 patients, on the right in 53, and bilaterally in 5. The most frequent initial presenting symptom was gross hematuria (65%). The mean postoperative follow-up period was 49.3 months. Disease recurrence in the nephroureterectomy group occurred in 36 patients (46.2%), with 17 (21.8%) at the urinary bladder, 2 (2.6%) at the retroperitoneum, 1 (1.3%) at the contralateral ureter, 6 (7.7%) with distant metastases to the lung, bone, distant lymph nodes or liver, and 10 (12.8%) at multiple sites. The 5-year cancer-specific survival rate was 100% for pTa/is, 95.2% for pT1, 69.4% for pT2, and 43.8% for pT3. All 3 pT4 cases died of cancer in a median of 12 months. Significant prognostic factors for cancer-specific survival by univariate analysis were pT (p = 0.00001), stage (p = 0.00001), type of treatment (p = 0.00001) and grade (p = 0.0001). On multivariate analysis, only stage (p = 0.0001) and grade (p = 0.014) were significant for cancer-specific and overall survival. Stage (p = 0.0001), pT (p =0.0001) and grade (p = 0.026) were also significant prognostic factors of recurrence in multivariate analysis.ConclusionOur experience showed that patients with pTa/is and pT1 tumors treated with radical surgery have excellent prognoses. Tumor stage and grade are the only significant prognostic factors for both cancer-specific and overall survival

副甲状腺機能亢進症を伴った両側副甲状腺嚢腫の1例

Cysts of the parathyroid glands are uncommon, and, moreover functioning parathyroid cysts that cause primary hyperparathyroidism are rare. Herein is reported a 53-year-old female with primary hyperparathyroidism accompanied by 2 parathyroid cysts, in one of which adenoma was noticed. Forty-two cases of parathyroid cysts were found in the Japanese literature. Twelve of them were in the hyperparathyroid state, but infarction of the adenoma lead to cystic degeneration in most of such cases and so the cyst wall were lined with adenoma cells. In only 2 cases including our case were the cyst walls lined with cuboid cells and the adenoma evident in the wall. The pathogenesis of our case seems to be a common embryonic defect or dilatation of vestigial remnants rather than a degenerative change of the adenoma

泌尿器科癌患者末梢血におけるInterleukin-1α, Interleukin-1β産生能の検討

対象は60例の泌尿器科癌患者.その内訳は膀胱癌30例, 腎癌12例, 前立腺癌18例であった.また, 対照群は健常者16例.測定方法はヘパリン採血した全血0.1mlずつを, 6段階(0, 0.1, 0.3, 1, 3, 5μg/ml)の濃度のリポポリサッカライド添加無血清培地にて24時間培養し, その上清をIL-1α, IL-1βに対するモノクローナル抗体を用いたELISA法にて測定した.リポポリサッカライドを含まない条件での全血1mlあたりのIL-1α, IL-1β産生量は, 膀胱癌患者, 腎癌患者, 前立腺癌患者では健常者と比較して有意差を認めなかった.次に5段階濃度のリポポリサッカライドを用いた場合, 膀胱癌患者, 腎癌患者, 前立腺癌患者, 健常者におけるIL-1α, IL-1β産生量はdose responseを示した.また, IL-1βの産生量はIL-1αより高値であった.しかし, 膀胱癌患者, 腎癌患者, 前立腺癌患者と対照群の間でのIL-1α, IL-1β産生量は有意差を認めなかったThe activities of interleukin-1 alpha (IL-1 alpha) and interleukin-1 beta) were investigated in peripheral whole blood from 30 patients with bladder cancer, 12 patients with renal cell carcinoma, 18 patients with prostatic cancer and 16 healthy subjects. Heparinized blood was cultured in the absence and presence of various concentrations of bacterial lipopolysaccharide (LPS). The culture supernatants were obtained and activities of IL-1 alpha and IL-1 beta were determined by enzyme-linked immunosorbent assay (ELISA). In the absence of LPS stimulation, neither IL-1 alpha nor IL-1 beta was spontaneously produced in blood cultures from patients with bladder cancer, renal cell carcinoma or prostatic cancer compared with control subjects. After stimulation with various concentrations of LPS, blood cultures from patients with bladder cancer, renal cell carcinoma, prostatic cancer, those from control subjects produced IL-1 alpha and IL-1 beta in a dose-dependent manner, and IL-1 beta was predominant in all supernatants. The activities of IL-1 alpha and IL-1 beta showed no significant differences between the patients with bladder cancer, renal cell carcinoma or prostatic cancer and control subjects. This study suggested that the patients with bladder cancer renal cell carcinoma and prostatic cancer did not spontaneously produce IL-1 alpha or IL-1 beta, but that the ability to produce IL-1 alpha and IL-1 beta in response to LPS stimulation was not significantly impaired

Prevalence and Clinical Characteristics of Simple Renal Cyst

We investigated simple renal cysts to understand the prevalence in healthy individuals and evaluate their clinical characteristics to determine whether or not there are any risk factors associated with simple renal cysts. Methods: Abdominal sonography was performed in 577 individuals (317 men, 260 women; mean age, 48.84 years; age range, 20–94 years) who received health check-up in January to February 2005. Data including age, sex, renal sonographic findings (cyst number, site, diameter, renal stones), values of serum cholesterol, glucose and creatinine, urine analysis (proteinuria, hematuria, pyuria), and smoking habit were analyzed. Results: The overall prevalence of simple renal cysts was 10.7%, ranging from 2.38% in the 2nd to 35.29% in the 7th or later decade of life. The prevalence increased with age (p < 0.001). The mean age of individuals with cysts was significantly older than those without cysts (57.65 ± 13.35 vs. 47.78 ± 12.40 years; p < 0.001). Male-to-female ratio was 2.81 (15.14% vs. 5.38%; p < 0.001). The majority of cysts were solitary (82.3%). Mean largest diameter of cysts was 20.89 ± 12.62 mm. The mean size of cysts in every age group was not statistically different. Factors significantly associated with simple renal cysts were age (odds ratio [OR], 4.37; p < 0.001), sex (OR, 0.32; p < 0.001), serum creatinine (OR, 11.77; p = 0.001), proteinuria (OR, 3.11; p = 0.004), renal stone (OR, 2.47; p = 0.006), and smoking (OR, 2.80; p < 0.001). However, in multivariate analysis, except proteinuria, all of the above factors were significantly related to the occurrence of simple renal cysts. Conclusion: The overall prevalence of simple renal cysts in healthy individuals was 10.7%. Age, sex, renal stone, serum creatinine, and smoking were found to be risk factors for the presence of simple renal cysts

Prepubertal Testicular Germ Cell Tumors: 25-year Experience in Taipei Veterans General Hospital

Due to the rarity of testicular tumors in the prepubertal population, adequate information about their biological course is difficult to document well in a single institution. The purpose of this study was to focus on prepubertal males in an attempt to evaluate clinical features and optimal management among various testicular germ cell tumors with long-term follow-up. Methods: We retrospectively reviewed the records of children younger than 12 years of age with primary testicular germ cell tumors between February 1981 and December 2005 at Taipei Veterans General Hospital. Thirty-four children were diagnosed with adequate clinical and pathologic data. The stage of the disease was determined according to the staging system used by the Children's Oncology Group. Mean follow-up time was 139 months (range, 2–283 months). Results: All of the 34 prepubertal patients were diagnosed initially with a painless scrotal mass. The mean age of the patients at diagnosis ranged from 6 months to 84 months (mean, 20.5 months). All patients underwent radical orchiectomy as an initial treatment. Twenty-nine (85.3%) patients had yolk sac tumors, and 5 (14.7%) had mature teratomas. Of the 29 patients with yolk sac tumor, 26 (89.7%) were diagnosed as stage I, 1 (3.4%) as stage III, and 2 (7.0%) as stage IV. Five (19.2%) of the 26 stage I yolk sac tumors progressed to metastasis after radical orchiectomy, and all of these 5 patients later received chemotherapy. One patient initially with stage III yolk sac tumor and 2 patients with stage IV yolk sac tumor were also treated with chemotherapy. Eventually, 1 patient with stage IV yolk sac tumor died due to tumor pro-gression; the remaining 28 patients with yolk sac tumor all survived without tumor relapse after appropriate treatment. In the 5 patients with teratomas, there was no tumor relapse after radical orchiectomy with a mean follow-up time of 139.1 months. The 5-year survival rates for yolk sac tumor and teratomas were 96.5% and 100%, respectively. Conclusion: The most common prepubertal malignant testicular tumor is yolk sac tumor, and the most common benign testicular tumor is teratoma. Children with testicular germ cell tumors have excellent long-term survival rates after appropriate treatment

Urothelial Carcinoma of the Urinary Bladder in Young Adults — Clinical Experience at Taipei Veterans General Hospital

The clinical behavior and prognosis of bladder cancer in young patients is not well defined. The aim of this study was, therefore, to evaluate the clinical behavior, pathologic characteristics and prognosis of urothelial carcinoma of the urinary bladder in young adults. Methods: We retrospectively reviewed records from 30 young patients (23 males, 7 females; age = 40 years) with urothelial carcinoma of the urinary bladder who had been treated in our hospital between May 1990 and October 2003. Data were analyzed by the Kaplan-Meier method to assess disease recurrence and survival. Results: The mean age at diagnosis was 34.3 ± 5 years (range, 22–40 years). Fifteen patients presented with pTa, 9 with pT1, 4 with pT2, 1 with pT3, and 1 with pT4. Twenty-six patients (87.2%) had low-grade bladder cancer, and the other 4 had high-grade disease. The most frequent initial presenting symptom was gross hematuria. The mean postoperative follow-up period was 72.8 months (range, 4–149 months). Fifty percent of superficial bladder cancers recurred a mean of 10.7 months (range, 3–68 months) after operation. One patient died from invasive bladder cancer after radical cystectomy, and 1 died from superficial bladder cancer due to tumor progression. The 5-year cancer-specific survival rate was 95.2% for superficial cancer and 83.3% for invasive cancer. The overall survival rate was 93.3%. Conclusion: Urothelial carcinoma of the urinary bladder in young adults is usually associated with low grade and low stage. Invasive bladder cancer had no worse a survival rate than superficial bladder cancer