Collecting duct carcinoma of the kidney: an immunohistochemical study of 11 cases

BACKGROUND: Collecting duct carcinoma (CDC) is a rare but very aggressive variant of kidney carcinoma that arises from the epithelium of Bellini's ducts, in the distal portion of the nephron. In order to gain an insight into the biology of this tumor we evaluated the expression of five genes involved in the development of renal cancer (FEZ1/LZTS1, FHIT, TP53, P27(kip1), and BCL2). METHODS: We studied eleven patients who underwent radical nephrectomy for primary CDC. All patients had an adequate clinical follow-up and none of them received any systemic therapy before surgery. The expression of the five markers for tumor initiation and/or progression were assessed by immunohistochemistry and correlated to the clinicopathological parameters, and survival by univariate analysis. RESULTS: Results showed that Fez1 protein expression was undetectable or substantially reduced in 7 of the 11 (64%) cases. Fhit protein was absent in three cases (27%). The overexpression of p53 protein was predominantly nuclear and detected in 4 of 11 cases (36%). Immunostaining for p27 was absent in 5 of 11 cases (45.5%). Five of the six remaining cases (90%) showed exclusively cytoplasmic protein expression, where, in the last case, p27 protein was detected in both nucleus and cytoplasm. Bcl2 expression with 100% of the tumor cells positive was observed in 4 of 11 (36%) cases. Statistical analysis showed a statistical trend (P = 0.06) between loss and reduction of Fez1 and presence of lymph node metastases. CONCLUSIONS: These findings suggest that Fez1 may represent not only a molecular diagnostic marker but also a prognostic marker in CDC

Is there a role for chemotherapy in prostate cancer?

There is evidence from randomised-controlled trials that patients with symptomatic hormone-refractory prostate cancer may experience palliative benefit from chemotherapy with mitoxantrone and prednisone. This treatment is well tolerated, even by elderly patients, although the cumulative dose of mitoxantrone is limited by cardiotoxicity. Treatment with docetaxel or paclitaxel, with or without estramustine, appears to convey higher rates of prostate-specific antigen response in phase II trials, but is more toxic. Large phase III trials comparing docetaxel with mitoxantrone have completed accrual. There is no role for chemotherapy in earlier stages of disease except in the context of a well-designed clinical trial

Preventive bilateral pulmonary irradiation in renal neoplasms.

The aim of the study was to evaluate the role of bilateral lung radiotherapy in the prevention of lung metastases from renal cell carcinoma. The preliminary results are presented. Between 1981-1984, 38 patients with renal cell carcinoma with no evident lung metastases and with normal respiratory function (confirmed by gas analysis, spirometry, diffusion test) were submitted to radical nephrectomy with regional lymphadenectomy. The patients were randomly assigned to two groups. 19 patients were treated with lung radiotherapy (1,500 rad in 5 times with overlap on the mediastinum--3,000 rad) two weeks after surgery, 19 patients did not undergo further treatment after surgery. Chest X-rays and functional lung evaluation were performed at 3.6 and 12 months, and then every six months. Results in the first group (lung radiotherapy) showed no cases of lung fibrosis; 15 patients are disease-free (follow-up: 3-36 months); 4 patients died from cancer, only 1 of whom with lung metastases. In the second group (no lung Radiotherapy) 14 patients are disease-free whilst 5 patients died with lung metastases