Faculty Bibliography

Inflammatory myofibroblastic tumor (IMT), previously referred to as 'inflammatory pseudotumor', is a rare spindle cell neoplasm which typically affects young patients. The lesion has a tendency to recur following resection and has a low metastatic potential1 . Initially described in the lung, IMT have since been recognized in a wide variety of anatomic sites

Angiomyolipoma (AML) is a benign tumor that typically consists of 3 tissue elements: thick-walled blood vessels, smooth muscle cells, and adipocytes. The most common location for AML is renal; however, extrarenal AML has been described. Reports of extrarenal AML within the genitourinary tract are rare. We report a case of AML at the left ureterovesical junction and the evaluation and management decisions regarding this lesion

Mammalian urothelium undergoes unique membrane specialization during terminal differentiation making numerous rigid-looking membrane plaques (0.3-0.5 micron diameter) that cover the apical cell surface. The outer leaflet of these membrane plaques is almost twice as thick as the inner leaflet hence the name asymmetric unit membrane (AUM). Ultrastructural studies established that the outer leaflet of AUM is composed of 16 nm particles forming two dimensional crystals, and that each particle forms a 'twisted ribbon' structure. We showed recently that highly purified bovine AUMs contain four major integral membrane proteins: uroplakins Ia (27 kD), Ib (28 kD), II (15 kD) and III (47 kD). Studies of the protease sensitivity of the different subdomains of uroplakins and other considerations suggest that UPIa and UPIb have 4 transmembrane domains, while UPII and UPIII have only one transmembrane domain. Chemical crosslinking studies showed that UPIa and UPIb, which share 39% amino acid sequence, are topologically adjacent to UPII and UPIII, respectively, thus raising the possibility that there exist two biochemically distinct AUM particles, i.e., those containing UPIa/UPII vs. UPIb/UPIII. Bovine urothelial cells grown in the presence of 3T3 feeder cells undergo clonal growth forming stratified colonies capable of synthesizing and processing all known uroplakins. Transgenic mouse studies showed that a 3.6 kb 5'-flanking sequence of mouse uroplakin II gene can drive the expression of bacterial LacZ gene to express in the urothelium. Further studies on the biosynthesis, assembly and targeting of uroplakins will offer unique opportunities for better understanding the structure and function of AUM as well as the biology of mammalian urothelium

Alterations in the p53 gene have been described in a variety of human malignant neoplasms. We have examined 29 stage B prostate carcinomas for alterations in the p53 gene and for amplification of the MDM-2 gene. No evidence of mutations in the conserved exons 5 to 8 was found by polymerase chain reaction single-stranded conformation polymorphism analysis and no accumulation of p53 protein was found by immunohistochemistry. However, loss of heterozygosity at the p53 locus was observed in 11% of information cases. Amplification of the MDM-2 gene was not observed by Southern blot hybridization. In contrast, stage C and D prostate carcinomas showed accumulation of p53 protein in 33 to 66% of cases. We conclude that alterations in p53 function are infrequent in clinically localized prostate cancers but are more common in advanced cancers

Clinically significant ureteral obstruction caused by the inflammatory complications of severe pancreatitis is rare with only eight previously reported cases. We present two additional cases and review the world literature. Clinically significant ureteral obstruction can affect either or both ureters and present simultaneously with an episode of pancreatitis or months later. If symptomatic ureteral obstruction is present, prompt urologic drainage is recommended. Definitive correction of the obstruction is frequently required and depends on the obstructive mechanism

OBJECTIVE. This study investigates the relationship between clonal chromosomal abnormalities detected in nonfamilial renal cell carcinoma and the clinical outcome, specifically, whether or not patients whose tumors had karyotypic changes have a different prognosis than those whose tumors did not. METHOD. Fresh tumor tissue obtained from 32 cases was grown in tissue culture. Twenty four grew successfully and were harvested and multiple cells of each karyotyped. Clinical follow-up was obtained for at least five years or until the time of death. RESULTS. Fourteen of 24 cases demonstrated karyotypic abnormalities including loss of Y chromosome (64%), trisomy 7 (50%), trisomy 12 (14%), trisomy 9, 10, 14, 15, 16, and 17, monosomy 9 and 20, and long-arm deletion of chromosome 16 (1 case each). Tumors were well-differentiated in 16 cases, moderately differentiated in 5 cases, and poorly differentiated in 1 case; 13 cases were pathologic Stage I, 5 Stage II, and 6 Stage III. Thirty-three percent of the patients demonstrated clinical progression. CONCLUSIONS. No significant difference in prognosis could be found between patients with and without karyotypic abnormalities. The only clinical or pathologic difference which could be established was sex distribution. Significantly greater numbers of males had karyotypic abnormalities than females, but this could be explained by the high number of Y chromosome deletions that were detected. The lack of correlation between karyotypic abnormalities and clinical outcome may reflect a confounding factor in genetic evolution such that clinically determining chromosomal changes present early in a tumor's growth in vivo may no longer be present when the tumor is diagnosed, treated, or after it is grown in culture. This may make demonstration of such clinically significant chromosomal changes very difficult

The technique for the Bellevue Pouch, another continent intestinal reservoir, is described. A large-capacity low-pressure reservoir is created from detubularized ascending colon, cecum, and terminal ileum. Continence is achieved by means of an intussuscepted segment of ileum and a modulating colonic pressure cuff wrapped around it. The operation has been performed on 19 patients, all of whom achieved satisfactory continence. Two patients were converted to free drainage systems at a later date. Average follow-up was twenty-five months

We report a case of prostatic abscess due to Candida tropicalis in a nonacquired immunodeficiency syndrome patient with diabetes. The diagnosis and management are discussed, and the literature is reviewed

Of 52 patients who underwent partial nephrectomy for tumor 44 were found to have renal cell carcinoma. The indications for this parenchyma-sparing procedure were categorized according to the initial status of the contralateral kidney and included bilateral tumors or tumor in a solitary kidney in 16 patients (mandatory indications), unilateral carcinoma with compromise of the contralateral kidney by a benign disease process in 9 (relative indications) and small peripheral tumor with a normal contralateral kidney in 19 (elective indications). There were 4 recurrences that accounted for 3 deaths, all in patients with mandatory indications. All patients who underwent partial nephrectomy for relative or elective indications were without definite evidence of recurrent disease at last followup (over-all mean 36 months). Our results suggest that conservative surgery can often provide effective and advantageous therapy for renal cancer and we encourage further consideration of the role of partial nephrectomy as an alternative to radical nephrectomy in selected patients with small peripheral tumors and normal contralateral kidneys