Expression of p53 Protein and its Clinical Significance in Transitional Cell Carcinoma of the Urinary Bladder / 대한비뇨기과학회지

To evaluate the prevalence and the role of mutation of p53 gene in the transitional ceI1 carcinoma of the urinary bladder with special attention to the clinicopathologic features, we examined p53 expression in paraffin-embedded tissues from 95 transitional cell carcinomas with various stages and grades and 5 specimens of morphologically normal bladder. Nuclear expression of p53 protein was detected by immunohistochemical analysis with avidin -alkaline phosphatase method, using the monoclonal antibody DO-7. And to evaluate the correlation of p53 expression with cell proliferation, expression of proliferating cell nuclear antigen(PCNA) was also assessed immunohistochemically in 43 specimens, using the monoclonal antibody PC1O. Median follow-up duration was 36 months(12-117 months). Immunohistochemical staining with p53 in 5 normal bladder specimens showed that 4 specimens exhibited absence of nuclear staining in urothelial and stromal cells and 1 specimen exhibited nuclear staining less than 5% of urothelial cells in the basal layer. Forty six(48%) of 95 specimens with transitional cell carcinoma of the bladder showed positive nuclear staining. Nuclear expression of p53 was observed with significantly higher frequency and stronger intensity(p20%). Recurrence rates of patients with superficial tumors were 2.2% per month for group A and 4.2% for group B, and patients in group B had a significantly 1ower disease-free interval(PO.1). Mean value of PCNA expression rates of 43 transitional cell carcinomas of the bladder was 12.1+8.34%(mean + SD). Mean value of PCNA expression rates was slightly higher in p53 positive-stained group(13.2+/-7.81%) than negative stained group(10.8+/-8.89%), but difference was not statistically significant(p>0.1). These results suggest that p53 mutations play an important role in the acquisition of aggressive biological natures in invasive bladder transitional cell carcinomas rather than in the genesis of tumors of low malignant potentials. This study also suggests that immunohistochemical examination of p53 in superficial bladder transitional cell carcinomas (especially, T1 tumors) offers significant information, and the degree of p53 expression might be a useful prognostic indicator which can be considered in treatment planning.

Large nonfunctioning adrenocortical carcinoma: a case report / 대한비뇨기과학회지

Nonfunctioning carcinoma of the adrenal cortex is an extremely rare disease. We have presented a case of nonfunctioning adrenocortical carcinoma. The patient was a 35 year-old female who had complained of discomfort and gradually growing mass in the left upper quadran1. No significant laboratory findings or evidence of hormonal disturbance wee clinically noted. Ultrasonography and abdominal CT revealed about 15 x 13cm sized mass in the left suprarenal area. Left adrenal gland. kidney and spleen were removed. The tumor was multilobulated but well encapsulated. measuring 16 x 15 x 13cm in size and weighing 420 grams. Cut surface of the tumor showed massive hemorrhage and necrosis, Microscopically, the tumor showed marked cellular pleomorphism, nuclear hyperchromatism and increased mitoses with some atypical mitoses. Capsular and vascular invasion of tumor cells was observed.

DNA flow cytometry in superficial bladder cancer / 대한비뇨기과학회지

A total or 44 patients with superficial bladder cancer underwent flow cytometric analysis of nuclei obtained from paraffin embedded specimens(44 first and 8 recurrent). Tumors could be classified according to their DNA content as diploid or aneuploid and to the proportion of proliferating cells (S-phase fraction). The degrees of cellular differentiation were related to the DNA patterns and to S-phase fractions. And reccurence-free rates were compared according to the DNA patterns. Of the total 52 specimens, 22 (42% ) showed aneuploid DNA patterns. The majority (83.9%) of low grade tumors had diploid pattern and the majority (81%) of high grade tumors had aneuploid pattern (p<0.005). Mean S-phase fraction of tota1 52 paraffin blocks was estimated as 11.17% (S.D.: 5.75). Mean S-phase fraction by grade was estimated as 9.95% (S.D. : 5.l4) in low grade tumors and 13.89%(S.D. : 6.10) in high grade tumors (p<0.05). Five-year recurrence-free rate was 77.8% in diploid group and 29.4% in aneuploid group (p<0.005). Mean S-phase fraction of the non-recurrent tumors was 8.91% (S.D. : 3.49). and that of the recurrent tumors 14.32% (S.D. : 7.76). The above results suggest that DNA ploidy and S-phase fraction as measured flow cytometry appear to be an important prognostic factors for superficial bladder cancer. And this information may be used to plan patient treatment according to the predicted risks.

Risk factors for lower urinary tract injuries in patients with traumatic pelvic fractures / 대한비뇨기과학회지

For identification of the risk factors for lower urinary tract injuries in patients with pelvic fractures, we reviewed the records of 332 patients with pelvic fractures and 60 patients with urethral or bladder ruptures not associated with pelvic fractures seen at our hospital during recent 5 years. The incidence of lower urinary tract injuries in patients with pelvic fractures was 9.9 per cent (urethra 57.6 per cent, bladder 36.4 per cent. and both 6.0 per cent).Of the 181 simple rami fractures 21 (11.6 percent) had lower urinary tract injuries. Of the 90 rami fractures combining other fractures 11 (12.2 per cent} had lower urinary tract injuries, especially 5 (50.0 per cent) of the 10 combining symphysis pubis diastasis. Of the 14 bladder ruptures 13 had gross hematuria, and of the 21 urethral ruptures all had blood at urethral meatus. For evaluation of significance of hematuria as a indicator for bladder ruptures, we reviewed 257 pelvic fractures without urethral ruptures and upper tract injuries. While of the 25 cases with gross hematuria 13 (52.0 percent) had bladder ruptures, of the 76 cases with only microscopic hematuria 1 case had bladder rupture. We conclude that the high risk factors for lower urinary tract injuries in patients with pelvic fractures are both rami fracture, dispacement of hemipelvis, and symphysis pubis diastasis. Therefore prompt diagnostic procedures for urethral and bladder ruptures must be performed in those cases, especially when combined with gross hematuria or blood at urethral meatus.

Capillary Hemangioma of Testis / 대한비뇨기과학회지

Hemangioma of the testis is an extremely rare lesion, more or less than 10 cases having been reported in infancy or early childhood in the world. We have experienced one case of capillary hemangioma of the left testis in 6 year old Korean male, which was suspicious to be a malignant tumor.