[Nephrectomy by transperitoneal abdominal route. Its value in difficult cases: kidney cancer and pyonephrosis].
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In this study special interest was given to trace elements recognized as to be carcinogenic to humans. The kidney tissue sections were analyzed in order to determine the concentrations of elements present in the sample. The Synchrotron Radiation Induced X-ray Emission (SRIXE) technique was applied using a white photon microbeam. The results from cancerous parts of the kidney tissues were compared to non-cancerous parts and to the control group. In addition the iron concentration level was determined in the serum of those patients. Two-dimensional scans are presented to illustrate the differences between perfused and not-perfused tissues. According to this study there is no significant difference in the Mn concentration between cancerous and non-cancerous parts of the kidney, but the concentrations of Cd, Cr, Ti, V, Cu, Se, and Zn are at a lower concentration level in the cancerous parts than in the non-cancerous parts. A converse observation has been made for Fe. This may be associated with different metabolism and dynamics of the cancer process and both higher vascularization and need of higher blood supply in the cancerous tissue. The two-dimensional scanning of thin kidney sections showed differences in the trace element distributions depending on the analyzed samples: perfused and non-perfused. Perfusion removed blood mostly from the peritubular capillaries while in the glomerulus some capillaries had a relatively high Fe content. A low Fe concentration was observed in nephron tubules while a converse observation has been made for Cd. This may indicate that Cd is localized in the cells but not in the blood.
The authors compared the histologic changes in 12 kidneys removed due to renal carcinoma with the changes in 12 other kidneys in which before nephrectomy an embolization of the renal artery with Spongostan had been performed. The results achieved show that the embolization of the renal artery may intensify the lymphocytic macrophagal and fibroplastic interstice of the tumour and according to this may represent a factor which is able to activate the cellular effector mechanism of the antineoplastic immunity of the organism.
The recent technical developments in magnetic resonance imaging (MRI) and the use of paramagnetic contrast media (gadolinium compounds) have considerably improved the performances of MRI for the detection and characterization of renal tumors. MRI does not have specific merits for the diagnosis of the typical form of cancer, nor for the detection of small kidney tumors, both being mainly based on computed tomography (CT). On the other hand, it can be used for the diagnosis of atypical forms of cancers (small, hypovascular, cystic or hemorrhagic cancers) which raise problems of differential diagnosis with some pseudotumoral lesions, complex cysts and benign tumors. Its complementarity to CT for the characterization of an atypical mass results from the signal information it provides, from a better contrast resolution, and from the possibility to make sections in all planes of space. Except for angiomyolipoma, which has a fatty content, there is no really specific MR criterion as present to evidence benign renal tumors. Concerning regional extension, CT remains the primary technique of choice, as it allows studying the limits of the tumor, the renal compartment ans its walls, the renal vein and the inferior vena cava, the neighboring organs and the contralateral kidney all together. Its findings allow defining the indications of MRI, which, as a complementary exploration, is often decisive to assess venous invasion.
Primary human kidney and bladder tumours were implanted into both nude rats (rnu/rnu) and nude mice (nu/nu). 40% of bladder tumours and 27% of kidney tumours were established as xenografts. Histological sections of primary tumour and xenografts confirmed their similarities. Two patients with renal tissues were hypercalcaemic prior to nephrectomy, and animals in which these tumours grew as xenografts also became hypercalcaemic. Cell lines were established in tissue culture from two of the kidney tumour xenografts, and chromosome studies have confirmed their human karyotype.
Late results of conservative management were investigated in 102 patients with renal carcinoma. Their ages were 60 to 90. A symptomatologic therapy alone was used in the management of 60 patients, 38 were treated with hydroxyprogesterone capronate and 4 with nolvadex. All the patients suffered from concomitant diseases. The refusals of operative treatment were because of such causes as: 1) extension of the tumor process in 29; 2) severe intercurrent diseases in 41; 3) cancer of a single, single-functioning kidney or the both kidneys in 7; 4) the patients' refusals in 25 patients. After the described treatment 71.6% of them lived 1 year, 36.8%-3, and 26.2%-5 years, that was quite comparable with the postoperative results. Prognostically beneficial treatment criteria were: a patient's age of 70 or more years, the stage T1-2N0M0V0, asymptomatic course of the disease, absence of anemia, accelerated erythrocyte sedimentation rate (ESR) more than 40 mm/h; the tumor size less than 10 cm. The most unfavourable prognostic criteria were: T4 stage of the disease, decrease of a hemoglobin level lees than 80 g/l, tumor size more than 10 cm. No one of the 41 patients who had had at least of these signs survived over 3 years. The use of hydroxyprogesterone capronate had no advantages over the symptomatic therapy and did not prolong a patient's life. A 5-year survival of patients managed on hormonal therapy was 22%, on the symptomatic one, 27.1%.(ABSTRACT TRUNCATED AT 250 WORDS)
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The rarely appearing gigantocystic form of the carcinoma of the kidney diagnosed in a 57-year-old male is described. In connection with the case the possibilities of the development of the cysts which were observed in cystic carcinoma of the kidney as well as the clinical, diagnostic, therapeutic and prognostic problems of this form of tumour are discussed.
A case of a surgically treated primary quartet cancer is reported, along with a review of the Japanese literature. A 68-year-old woman, curatively operated for a right breast cancer 6 years previously, was then diagnosed as having a left renal cell carcinoma, a thyroid cancer, and a sigmoid colon cancer as a result of a subsequent screening examination within one year. These synchronous, triple cancers were resected in a curative operation for each. Histopathologically, each neoplasm was proven to be a primary cancer lesion, and two different types (papillary and trabecular) were found in the thyroid gland.
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