Histogenesis of human renal cell carcinoma using electron microscopy and immunohistochemical techniques

Determination of the tissue of origin of either normal or abnormal tissues in the body is usually reforred as histogenesis. Electron microscopy and immunohistochemical techniques have been used in the current experiment for histogenesis of one of the most agonizing kidney diseases, namely the renal cell carcinoma.40 kidneys were subjected after radical nephrectomy to immunohistochemical detection of the presence of intermediate filament cytokeratin, which is normally expressed in epithelial tissue and intermediate filament vimentin, which is normally expressed in mesenchymal non-myogenic cells. The kidneys were also examined by electron microscopy for detection of ultrastructure features that help determination the tissue of origin. From each kidney, two specimens were taken, one from the diseased area and another from far beyond the safety margin to serve as control. Additional control specimens were taken from nephrectomized kidneys for traumatic causes. Immunohistochemical study of the control specimens revealed expression of vimentin in the glomerular capillaries and expression of cytokeratin along the tubular epithelium. In cases of renal cell carcinoma, cytokeratin was expressed alone in 45% of cases, vimentin was expressed alone in 10% of cases and coexpression of both cytokeratin and vimentin was observed in 40% of cases while 5% of cases showed no expression. Electron microscopic study of the control specimens revealed the basic ultrastructure of the normal kidneys while the ultrastructure study of the diseased specimens revealed the basic features of the tumor. Expression of desmosomes was observed in almost all tumor specimens. The expression of the vimentin in some cases either alone or with cytokeratin was interpreted as a change in the characters of some tumor cells which indicates the need for additional techniques in such cases to get the proper interpretation. The prevalence of the expression of cytokeratin and the persistence existence of desmosomes indicate the epithelial origin of the tumor. The result of the current study is very beneficial for determining the line of therapy and follow up the patients. Moreover, it confirms the power of combined use of both immunohistochemistry and electron microscopy in histogenesis of any tissue with undetermined origin

Lower urinary tract sarcoma in adults and childern: are they two different diseases

In this study, two age groups were included, a pediatric group and an adult group. The primary tumor location was the bladder in 12 patients, prostate in nine and bladder/prostate in eight patients. The distribution of the clinical stage at diagnosis was stage II in six patients, stage III in 20 patients and stage IV in three patients. The response to chemotherapy was assessed and a subsequent treatment was determined according to the response. Eight patients had no evidence of the disease for 2-8 years following chemotherapy in all cases, radiotherapy in two and partial cystectomy in one case. Nine patients had no evidence of the disease for 1-9 years following radical cystectomy, chemotherapy and preoperative radiotherapy in two patients. Seven patients died and two patients did not followed up. In the adult group, there were seven patients with bladder tumors. Five patients had leiomyosarcoma and two had carcinosarcoma. All patients had organ confined disease except one. Radical cystectomy was performed in five patients, four of them were free of the disease for two, three, six and nine years after surgery. Subtotal cystectomy was carried out in one patient who died of a local recurrence of four years after surgery. The patient with metastatic disease was treated by palliative endoscopic resection and systemic doxorubicin and died of metastases one year after treatment

Prognostic factors in primary non-urachal adenocarcinoma of the urinary bladder: a clinical, histopathologic and flow cytometric study

Flow cytometric DNA analysis was carried out retrospectively on paraffin-embedded archival material of 93 primary pure non-urachal adenocarcinomas of the urinary bladder treated between 1981 and 1990. Tumors were classified according to histopathologic grade, stage, nodal pathology and flow cytometric DNA ploidy pattern and fraction of cells in the S-phase. The incidence of grossly aneuploid tumors was 88%. Mean follow up was 24.1 +/- 21.5 months. The crude overall survival was 62% and 50% at 2 and 5 years, respectively. Prognosis had significant correlation with tumor stage, grade and nodal pathology. The DNA ploidy pattern and fraction of cells in S-phase had no relation to stage, grade or prognosis. The results demonstrated that the DNA ploidy pattern and fraction of cells in S- phase are not prognostic parameters in non-urachal adenocarcinoma of the bladder due to the very high incidence of aneuploidy