Involvement of prostatic urethra and ducts in bladder cancer. A report of 40 cases of prostate mapping.
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Biomedical subjects
Publications and source records attributed to F L Gu.
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It has been recognized in recent years that renal cell carcinoma possesses a proximal convoluted tubules origin. In an attempt of further intensive evaluation we assayed 51 renal cell carcinomas and 38 additional normal kidney specimens with 4 kidney segment-specific antibodies (Uro-2/S4, Uro-5/T16, Uro-10/T43, Anti Tamm-Horsfall Protein) directed against the nephrotic cells by indirect immunohistological techniques. Consistently stable staining was developed in the tests. The results showed that the majority of renal clear cell carcinomas expressed nephrogenous properties of proximal convoluted tubules but in part also of distal tubules and collecting ducts. Granular cell carcinoma mostly demonstrated histogenic appearance of distal convoluted tubules.
In 1960, there were 26 eunuchs from the palace of the Qing Dynasty still living in Beijing. The authors took that unique opportunity of carrying out a general physical examination, including palpation of the prostate, for every one of them. Their average age then was 72 years (59-83 years). They became eunuchs at the age of 10-26 years. The prostate was impalpable in 26 (81%) and 1-2 cm in width rectally in five, with a flat surface. At the time of the examination they had been eunuchs on the average for 54 years (41-65 years). This is probably the largest series of human beings followed for such a long period of time to confirm that testicular hormone is essential for the development and preservation of the prostate. The type of operation, the traditional way of carrying out the operation and the usual complications are presented.
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The present study covers 1213 patients with urothelial tumours, of whom 113 have been affected by multi-organ malignancies. The disease was found to spread mostly in direction of the urine flow. Bladder was the most frequently affected organ. The incidence of pelvic cancer in China is higher than in Western countries.
Following the use of rigid ureteroscopic lithotripsy (URS) in 1984 and extracorporeal shock wave lithotripsy (ESWL) in 1987, the treatment for ureteral stones has undergone significant changes. Our experience showed that the successful rate of URS for 132 patients was 89.4% and for the upper third was rather low, percutaneous antegrade URS should be considered. 376 patients treated with ESWL in prone position with a successful rate of 96.8%. The applicability of open surgery was reduced to 17.8% in 1987 and 14.5% in 1988.
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In recent years, diagnostic imaging techniques, especially ultrasonography (US) and CT scanning, have been widely adopted in clinical practice, making early accurate diagnosis of renal tumors possible. A total of 452 cases of renal tumors have been admitted to the institute since 1951, of which 220 were seen from 1951 to 1979 and 232 in the past 9 years (1980-1988). The frequency of renal parenchymal tumors was obviously higher in the latter group, including asymptomatic renal carcinoma in 20.2% and hamartoma in 38.1%. All these were discovered on routine physical check-up by ultrasonography and/or CT scanning and would otherwise have gone undiagnosed on conventional urography. Ultrasonography and CT can also reveal the nature and the extent of the tumor. The idea that "a renal tumor should be considered malignant unless pathologically proven otherwise" is no longer valid. However, general manifestations of renal carcinoma, such as elevated erythrocyte sedimentation rate (ESR), hypertension, malaise, anemia, fever and hypercalcemia, still deserve proper attention. We suggest that ultrasonography of both kidneys should be mandatory in routine physical check-up, as far as the urinary system is concerned, in order to discover asymptomatic renal tumors.
The results of multiple random biopsies from apparently non-tumor bearing mucosa were analyzed in 117 cases with bladder cancer. Of the 687 evaluable specimens, 26.5% showed abnormalities including hyperplasia (12.4%), atypical hyperplasia (5.8%), flat carcinoma in situ (6.0%) and even occult carcinoma (2.3%). The frequency of mucosal lesions increased with advancing histologic grade of visible tumors. The frequency of occult cancerous or precancerous lesions in cases with visible tumors was significantly higher than that of cases with invisible tumors. Undoubtedly the existing of occult cancerous or precancerous lesions is one of the important factors of high recurrence rate after local resection of the bladder tumors. Patients with occult cancerous or precancerous lesions should be given intensive follow-up and intravesical prophylactic therapy.
In a retrospective investigation we found that the endogenous creatinine clearance (Ccr) of 35 nephrectomized patients was lower than that of normal people of comparable age with two intact kidneys. The Ccr level in the post-nephrectomy patients appeared to correlate with the age of the patients at the time of nephrectomy. The average Ccr value was 99.2 ml/min in the younger group, and 54.9 ml/min in the older group. Furthermore, we also found that the measurement of the remaining kidney in the younger group was larger than that of the matched control group, but no difference was found between the measurement of the remaining kidney in the older group and that of the matched control group. Therefore, we suggest that the remaining kidney in patients over 50 years of age may be described as "a low compensatory kidney". The results from an experimental study of Wistar rats indicated that the dry and wet weights of the remaining kidneys of the younger rats which had undergone neptrectomy were 1.53 X 10(-3) g/gwt, and 5.89 X 10(-3) g/gwt respectively, vs 1.05 X 10 g/gwt and 3.82 X 10(-3) g/gwt in older ones. In tissue culture using serum of younger nephrectomized rats, the amount of 3H-TdR incorporation into the monolayer cells of renal cortex was 1,405.4 CPM, whereas it was 1,025.4 CPM by using serum of older nephrectomized rats. In addition, the cells of renal cortices from both younger and older rats had a similar response to the same serum from nephrectomized rats.(ABSTRACT TRUNCATED AT 250 WORDS)
Attention has long been drawn on the multi-organ involvement of urothelial malignancies both by urologists and pathologists. Urothelial malignancies did occur occasionally in several urinary organs within the same patient. From 1951 to 1986, 12,553 patients were admitted to our urological department, among them 1,213 had urothelial tumors. There were renal pelvic tumors in 130, ureteral in 93, bladder in 925 and urethral in 65. We measured any single individual of the paired-organ, the pelvis or ureter as a single organ. Thus, of the total 1,213 tumors 113 were found to have multi-organ involvement. Long term follow-up rate was 93.6%. In the present study, we noted that the malignant appearance of urothelium involving in multi-organ has generally been with a trend toward urinary flow. i.e. from the proximal to the distal site of urinary tract. One hundred and four patients (92%) had tumors developed the urinary flow direction while only 9 patients (8%) were of refluent direction. Renal pelvis, ureter and urethra showed to be at high preference of multi-organ involvement, accounting for 53.8%, 58.1% and 46.2% respectively, whereas bladder tumor only showing 10.5%, predominated in single organ involvement.
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