Analysis of pathological character of 4 200 bladder tumor cases / 中华泌尿外科杂志

Objective To investigate the histopathologic characteristics of bladder tumor and provide theoretical basis for the reasonable selection of treatment modality.Methods This retrospective study collected the pathological data of 4 200 bladder tumor from May 2001 to October 2014.There were 3 443 male and 757 female, and the average diameter of these tumors was (1.8 ± 0.6) cm (ranged 0.2 to 6.5 cm).Among all cases, 3 214 (76.5％) cases were solitary tumor while 986 (23.5％) were multiple tumors.The histologic subtype, pathological grade and stage, the existence of vascular and lymphovascular invasion, tumor in situ, abnormal variants and rare subtypes were recorded and analyzed.Results 162 cases (3.9％)were benign tumors and 4 038 cases (96.1％)were malignant tumors including 4 008 cases of urothelial cancer (UC), 18 cases of primary adenocarcinoma and 12 cases of primary bladder squamous carcinoma.Furthermore, 2 460 (61.4％)cases were high grade UC while 1 548(38.6％)cases were low grade.320 cases were found intravascular tumor embolus or lymphovascular tumor thrombus and 391 (9.3％)cases were found metaplasia of squamous epithelium.Moreover, there were 230 cases of squamous differentiation, 120 cases of glandular differentiation, 110 cases of both squamous and glandular differentiation, and 39 cases (0.9％)of other rare subtypes or variations.On pathological stage, 112 (2.8 ％) cases were carcinoma in situ, 548 (13.7％)cases were Ta, 2 599(65.1％)cases were T1, 480(12％)cases were T2, 92 cases(2.3％)were T3 and 23 cases(0.6％)were T4 stage, with the rest cases being unable to be accurate staging.Multiple Logistic regression analysis revealed that lymphovascular invasion was related to tumor grade , pathological stage and abnormal differentiation (P ＜ 0.02).Moreover, UC with squamous and glandular differentiation were related with tumor recurrence and progression (P =0.02).Conclusions Most bladder tumors were high grade and low stage urothelial cancer with various forms of differentiation.Squamous and glandular differentiation were most common variation which should be avoided to diagnosed as hybrid carcinoma.Lymphovascular tumor thrombus and abnormal differentiation were correlated with tumor stage and grade.

Pathological characteristics of small renal carcinoma and its clinical value / 中华泌尿外科杂志

Objective To study the clinical and histopathologic features of small renal carcinoma (diameter≤4 cm)and provide theoretical basis for evaluating the safety,efficacy and prognosis of nephron sparing surgery.Methods This retrospective study collected the pathological data of 490 patients with small renal cell carcinoma,who were treated in our hospital,from May 2000 to October 2014.We recorded and analyzed the tumor size,histological subtype,Fuhrman grading,pathological stage,the existence of mulifocality,vascular invasion,tumor psuedocapsule,hemorrhage or necrosis and distant metastasis.Results The median diameter of tumor was (3.2 ± 0.6) cm,ranged 0.6 to 4.0 cm.Of all the subjects,422 (86.1％) were clear cell carcinoma,32 (6.5％) were chromophobe cell carcinoma,23 (4.7％) were papillary carcinoma and 13 (2.7％) were other rare types.Among the 422 clear cell carcinoma cases,27 were Fuhrman grade Ⅰ,157 were Ⅰ-Ⅱ grade,210 were grade Ⅱ,21 were Ⅱ-Ⅲ grade,7 were grade Ⅲ and no one was grade Ⅳ.Multifocal tumors were found in 18 cases (3.7％) and tumor embolus of renal vein was found in 6 cases (1.2％).Intact psuedocapsule were found in 326 (66.5％) tumors with the thickness ranged from 0.2 to 1.0 mm.Tumor infiltration without the psuedocapsule penetration were found in 82 cases (16.7％),penetrated into the psuedocapsule were found in 11 cases (2.2％),infringement of perirenal fat were found in 9 cases (1.8％).Hemorrhage and necrosis were found in 240 cases (48.9％),synchronous lung metastases occurred in 3 patients (0.6％).Logistic regression analysis revealed that tumor invasion and pseudocapsule penetration were related to Fuhrman Ⅱ-Ⅲ,Ⅲ and tumor diameter (P =0.04).Moreover,tumor size was related with histological grade and renal capsule invasion (P =0.02).Nevertheless,there was no relationship among tumor size,renal vein embolus or mulifocality (P =0.35).Conclusions Although most small renal tumors are high differentiation and low grade,but rare cases are aggressive with infringement of perirenal fat or early distant metastasis,suggesting heterogeneity in its biological behavior.Most small renal tumors have obvious psuedocapsule.When the tumor size is greater than 3.0 cm and its Fuhrman classification was high,the psuedocapsule and perirenal fat are more likely to be infiltrated.Nephron sparing surgery should remove the tumor and its surface adipose tissue entirely.

Clinical and pathological analysis of urothelial carcinoma with clear cell variant / 中华泌尿外科杂志

Objective To investigate the clinical and pathological features of urothelial carcinoma with clear cell variant.Methods The pathological and clinical data of 7 cases pathological diagnosed urothelial carcinoma with clear cell variant between March 2005 and May 2014 were retrospectively reviewed.There were 6 males and 1 female,aged 46-75 years (mean,61 years).Clinical manifestations included gross hematuria in 5 cases,hematuria and backache in another 2 cases.The mean tumor size was 3.5 cm (ranged 2.0-6.0 cm).One case was multiple tumor and 6 cases were single tumor.Five cases were positive in urine cytology.All the 7 cases accepted surgical treatment,including radical nephroureterectomy in 2 cases,transurethral resection of bladder tumor plus pharmorubicin regular intravesicalinstillationin 1 case,and radical cystectomy in 4 patients.Results Pathological findings revealed that all the tumors were high-grade urothelial carcinoma with clear cell variant in different proportion.Among them,clear cell tumor was predominant in 1 case and focal in other 6 cases.Meanwhile,tumorsaccompanied by glandular differentiation were found in 2 cases,squamous differentiation was found in 1 case,and micropapillary variant was found in 1 case.Vascular tumor embolus was found in 4 cases.Pathological stage was pT2a (n =1),pT2b (n =3),and pT3a (n =3).Immunohistochemicalstaining revealed cytokeratin 7 (+),cytokeratin 20 (+),epithelial membrane antigen (+)and prostate specific antigen (-).Six cases were followed up.The bladder preservation case was followed up for 8 months without recurrence.In 3 radical cystectomy cases,1 died of cancer 25 months after surgery and another 2 case were followed up for 10 and 12 months after surgery without recurrence and metastasis.In 2 nephroureterectomy cases,1 died of tumor metastasis 18 months after surgery and the other case was followed up for 6 months without recurrence or metastasis.Conclusions Urothelialcarcinoma with clear cell variant is a malignancy often with advanced stage and poor prognosis.Radical surgery is recommended for the treatment.

Overview of the British pharmaceutical standard-setting system / 中国卫生政策研究

The paper presents a detailed review of British pharmaceutical standards including British Pharma-copoeia, European Pharmacopoeia, British Approved Names, Reference Standards and Non-Statutory Pharmaceutical Standards. British pharmaceutical standards are established by the British Pharmacopoeia Commission, Expert Advi-sory Groups, Panels of Experts and Working Parties, British Pharmacopoeia Commission Secretariat, British Pharma-copoeia Laboratory, and standard-setting procedures are clear and definite. British Pharmacopoeia standards are le-gally binding, and pharmaceutical products sold in the United Kingdom must comply with pharmacopoeia require-ments. British pharmaceutical standards can serve as an important reference for reforms to China’s pharmaceutical standards, including the scientific management of pharmaceutical standards, the improvement of organizational frame-works in the establishment pharmaceutical standards, the promptness of amendments to pharmacopoeia, and the uni-versality of international exchanges.

On the Development and Edification of Canadian Guidelines for the Pharmacoeconomic Evaluation / 中国药房

AIM:To put forward the suggestions for standardizing the pharmacoeconomic research.METHODS:The background of formulation and main points of Canadian Guidelines for the Pharmacoeconomic Evaluation were introduced and its recent development was described.At the same time,we put forward our tentative plan about establishing Chinese guidelines for the pharmacoeconomic evaluation.RESULTS ＆ CONCLUSION:A series of guidelines for the pharmacoeconomic evaluation should be established,which is approved by departments of social safeguard,drug supervision and public health administration,to standardize the pharmacoeconomic research.The goverment should make corresponding policy publicized and make pharmacoeconomic evaluation connect with drug price,clinically rational drug use,catalog of classified management of drugs and catalog of drugs in medical insurance.A pharmacoeconomic framework,which conforms China's national conditions and is controlled by goverment,will established.