A Study of Microsatellite Instability of Upper Urinary Tract Transitional Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: The objective of this study was to evaluate the role of microsatellite instability (MSI) in upper tract transitional cell carcinomas (TCC). MATERIALS AND METHODS: A total of 48 surgically treated renal pelvis and ureteral TCC patients were included in this study. MSI was determined by polymerase chain reaction (PCR) for amplification of the microsatellite sequences at mononucleotides BAT25 and BAT26, and dinucleotides D17S250, D2S123 and D5S346 in DNA and hMLH1 protein, p53 and Ki-67 expressions were determined by immunohistochemistry on retrieved tumor tissue. RESULTS: Twenty seven (56.2%) and 21 (43.8%) of the 48 patients had renal pelvis and ureteral TCC, respectively. Eighteen (37.5%) and 30 (62.5%) patients had superficial and invasive TCC, according to the pathological stage, while 24 each (50%) had low and high grade TCC, respectively. MSI was observed in 20.8% of tumors at mono-MSI and 22.9% at di-MSI. MSI-high and -low (instability >2 and <2 loci, respectively) were observed in 12.5 and 22.9%, respectively. From a univariate analysis, age, stage, tumor grade, tumor recurrence and the expressions of hMLH1 and Ki-67 were not related to MSI. However, in recurred cases, infiltrative tumors had 100% MSI compared to superficial tumors, and the expressions of p53 and Ki-67 were related to the stage and tumor grade, respectively (p<0.05). CONCLUSIONS: These results suggest that MSI may occur in upper tract TCC, as observed in other tumors. MSI was more frequently expressed in ureteral than renal pelvis tumors. However, MSI was not correlated with stage or grade, but was significantly correlated with the stage in recurred cases; and the expressions of p53 and Ki-67 were related to the stage and tumor grade.

Kissing Contusion Between the Posterolateral Tibial Plateau and Lateral Femoral Condyle: Associated Ligament and Meniscal Tears

PURPOSE: Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. MATERIALS AND METHODS: We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. RESULTS: ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%). In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p0.05). CONCLUSION: Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no signifficant difference in meniscal tears with or without kissing contusion.

Differentiation of Infiltrating Urothelial Tumor of Renal Pelvis from Renal Cell Carcinoma Invading into Renal Pelvis or Calyx / 대한비뇨기과학회지

PURPOSE: It is difficult to differentiate urothelial tumours of the renal pelvis, invading the renal parenchyma, from renal cell carcinomas, invading the renal pelvis or calyx. The purpose of this study was to assess the differences between the two conditions. MATERIALS AND METHODS: We retrospectively reviewed the medical records, and imaging studies, of 17 patients who underwent nephroureterectomy with bladder cuff excision for urothelial tumours of the renal pelvis, with parenchymal invasion, and of 30 patients who underwent radical nephrectomy for renal cell carcinomas, invading into the renal pelvis or calyx. We assessed the differences in clinical symptoms, urine cytology, intravenous urography, and CT findings between the two conditions. Pearson chi-square tests, with continuity corrections, were performed for statistical analyses. RESULTS: Renal cell carcinomas showed gross hematuria in only 10 cases (33%), positive findings of urine cytology in 1 case of 9 cases (11%). CT scans demonstrated contour bulging in 25 cases (83%), preservation of reniform shape in 5 cases (17%), peripheral location of tumour in 25 cases (83%), and abnormal CT nephogram in 1 cases (3%). In contrast, urothelial tumour of the renal pelvis showed gross hematuria in 13 cases (76%), positive findings of urine cytology in 9 cases of 15 cases (60%). CT scans demonstrated contour bulging in 1 cases (6%), preservation of reniform shape in 16 cases (94%), central location of tumour in all cases (100%), and abnormal CT nephogram in 10 cases (59%). There was no significant difference between renal cell carcinomas and urothelial tumours of the renal pelvis in blood chemistry or IVP. There were no cases of renal cell carcinoma concurrently with bladder tumour, while 2 cases (12%) of urothelial tumour of the renal pelvis had bladder tumours at the same time. CONCLUSIONS: The presence of gross hematuria, positive findings in urine cytology, the presence of bladder tumours, and tumour location, renal contour changes and CT nephogram in CT scans may be helpful in distinguishing both disease entities.

Quantitative Analysis of Transforming Growth Factor-beta1 in Renal Cell Carcinoma / 대한비뇨기과학회지

Purpose: The transforming growth factor-beta (TGF-beta) is a peptide that has diverse biologic actions in human tissue and is thought to contribute to tumor development and progression. Increased TGF-beta1 levels were found in several types of malignant tumors. TGF-beta1 expression in RCC and adjacent normal kidney tissues was examined to determine the TGF-beta1 in renal cell carcinoma (RCC). MATERIALS AND METHODS: The TGF-beta1 protein levels in cancer and a normal portion of a specimen were analyzed in 61 radical nephrectomized clear cell type RCC by an enzyme-linked immunosorbent assay (ELISA), with the results compared with the clinicopathological characteristics. Immunohistochemical staining was performed to localize their expression. RESULTS: Compared with non-tumor kidney specimens, primary renal cell carcinoma demonstrated a significantly higher TGF-beta1 protein level (p<0.001). There were significant differences in the TGF-beta1 level among the histological grade (p<0.01). The tissue TGF-beta1 level was the highest in T4 stage, but there was no statistical significance between the T stages. Immunohistochemical analysis demonstrated that TGF-beta1 was localized to the tumor cytoplasm and their intensity reflected the protein expression level in these tissues. CONCLUSIONS: These results suggest that enhanced TGF-beta1 expression contributes to carcinogenesis and tumor progression in the later stages of renal cell carcinoma.

The Effect of Cold Baths after Hot Baths on Spermatogenesis in Rat Testicles / 대한비뇨기과학회지

PURPOSE: It has been reported that exposure of the testicles to high temperature through frequent saunas or hot baths causes impairment of spermatogenesis, however, there are few studies which offer ways to prevent it. The aim of this study is to evaluate the effect of a cold bath in preventing impaired spermatogenesis caused by exposure to a hot bath in the rat model. MATERIALS AND METHODS: Forty-five white male Sprague-Dawley rats (200-230gm) were divided into 3 groups; control, hot bath, hot followed by cold bath groups. The hot bath group was assigned to the hot bath (41-43oC) for 10 minutes and then exposed to the room temperature (23-24oC) for 3 minutes, whereas the hot followed by cold bath group was assigned to the cold bath (18-20oC) after the hot bath. Each procedure was repeated twice daily and 3 days a week for 4 weeks. Five randomly selected rats from each group were sacrified just after baths, and 4 and 8 weeks later. The testicular weight, the mean numbers of mature spermatids, Sertoli cells, spermatid to Sertoli cell ratio and tubular diameter were measured in each group. Two way analyses of variance (ANOVA) were performed for a statistical analysis. RESULTS: Just after completion of baths, the weight of testicle, the number of mature spermatid cells, the spermatid to Sertoli cell ratio and the tubular diameter significantly decreased in the hot bath group (0.71 +/- 0.08g, 0 +/- 0, 0 +/- 0, 0.20 +/- 0.01mm) compared to the control group (1.57 +/- 0.67g, 139.85 +/- 29.70, 7.24 +/- 1.36, 0.32 +/- 0.02mm), re spectively (p<0.05). However, there was no significant difference between the hot followed by cold bath group (1.36 +/- 0.20g, 127.00 +/- 26.14, 6.30 +/- 1.14, 0.31 +/- 0.01mm) and the control group, respectively. On the other hand, there was no significant dif ference between the hot bath group and the control group in the number of Sertoli cells per seminiferous tubules (p=0.110). After 4 and 8 weeks, the number of mature spermatids improved in the hot bath group despite showing significantly decreased findings compared with the control and hot followed by cold bath groups. CONCLUSIONS: The hot bath treatment significantly decreased spermatogenesis in the testicles of the male rat, whereas it was preserved in the cold bath after the hot bath. This result suggests that a cold bath is recommanded immediately after a hot bath to help impaired spermatogenesis caused by frequent hot baths.

Evaluation of Meniscal Tears of the Knee: The Usefulness of Fat-Suppressed Conventional Spin-Echo T1-Weighted MR Imaging

PURPOSE: To determine the usefulness of the fat-suppressed (FS) conventional spin-echo (CSE) sequence for the diagnosis of meniscal tears. MATERIALS AND METHODS: We retrospectively reviewed 323 MR images of the knee, the standard of reference being the findings of arthroscopy. In all knees, fast SE proton density-weighted and T2-weighted sagittal and coronal images and double-echo in steady state (DESS) sagittal images were obtained, and during 202 MR Procedures, FS-CSE T1-weighted sagittal images were also obtained. The results of MR imaging were then correlated with those of arthroscopy, the accuracy with which meniscal tears were diagnosed being compared between two groups: group I (202 knees for which FS-CSE T1-weighted sagittal images were obtained), and group II (121 knees for which these images were not obtained). For statistical analysis the chi-square test was used. RESULTS: In group 1, sensitivity, specificity and accuracy were 94.7%, 92.4% and 93.5%, respectively, for the medial meniscus, and 83.3%, 95.7% and 90.5% for the lateral meniscus. In group II, the corresponding findings were 92.5%, 94% and 93.3%; and 87.3%, 98.2% and 92.5%. The differences between the groups were not statistically significant (p>0.05) CONCLUSION: For meniscal tears of the knee, the addition of FS-CSE T1-weighted MR imaging to the fast SE proton density-weighted, T2-weighted and DESS sequences does not enhance diagnostic accuracy.

A Case of Fibrosarcoma of Kidney / 대한비뇨기과학회지

Fibrosarcoma of the kidney is rare and usually developed from renal capsule. In the past, this diagnosis was made more frequently and was easily mistaken for leiomyosarcoma. With improved histochemical techniques and a better understanding of mesenchymal derived tumors, the diagnosis of fibrosarcoma of the kidney is made rarely. Microscopically, this tumor discloses fascicular arrangement and herringbone appearance of spindle cells. Positive immunohistochemistry for vimentin along with nonreactivity of tumor cells for cytokeratin, S-100 protein, actin, and CD34 supported the diagnosis of fibrosarcoma. Herein, we report a case of fibrosarcoma of kidney with a brief review of the literatures.

Analysis of MR Imaging with FSE and DESS for the Diagnosis of Meniscal Tears in 316 Patients

PURPOSE: To evaluate the accuracy of a magnetic resonance(MR) imaging strategy that primarily uses fast spinecho(SE) sequences for the diagnosis of meniscal tears. MATERIALS AND METHODS: The original clinical interpretations of MR images in 316 patients who underwent imaging for suspected internal derangement of a knee joint were correlated with results from subsequent arthroscopy (mean interval : 48.9 days). In all patients, MR examinations included double-echo fast SE T2- weighted sagittal and coronal imaging and double-echo steady state (DESS) sequence sagittal imaging. In 199 patients fat-suppressed conventional SE T1-weighted sagittal imaging was used. In cases in which interpretation was erroneous, imaging findings and arthroscopy reports were reviewed. RESULTS: For ISO confirmed tears of the medial meniscus, sensitivity, specificity, and accuracy were 94 %, 93 %, and 94 %, respectively, while respective values for 147 confirmed tears of the lateral meniscus were 85%, 97 %, and 91%. These values are within the ranges recently reported for imaging strategies relying predominantly on conventional SE sequences. Of the 12 false-positive tears of the medial meniscus, five menisci showed a high signal contacting the surface on only one image and seven, that in all cases were located in the periphery of the posterior horn, showed such signal on more than one image. Of the six false-positive tears of the lateral meniscus, three menisci showed a high signal contacting the surface on only one image. Of the nine false-negative tears of the medial meniscus, eight menisci showed an abnormal signal that did not demonstrate definitive contact with the surface. Of the 22 false-negative tears of the lateral meniscus, 18 menisci showed this same type of signal. CONCLUSION: Fast SE imaging of the knee can be an alternative to conventional SE imaging for the detection of meniscal tears. Most errors in our series were due to either an abnormal signal that failed to show definitive contact with the surface, a high signal which contacted the surface on only one image, or a signal of this type that was located in peripheral posterior horn of the medial meniscus, on more than one image.

Spiral CT for the Measurement of Hepatic Metastatic Mass from Gastrointestinal Malignant Tumor: Relative Value of Arterial, Portal and Delayed Phase Scanning

PURPOSE: To evaluate the relative value of arterial, portal and delayed phase images in the measurement of hepatic metastatic mass arising from gastrointestinal malignant tumor using spiral CT. MATERIALS AND METHODS: Thirty-three with 45 metastatic tumors of the liver underwent tri-phasic spiral CT. For this purpose one or two lesions were chosen in each patient whose primary tumor was shown to be stomach cancer(n=15), colon cancer(n=16), or ileal cancer(n=1). Tumor size ranged from 1 to 12.2 (mean, 4.3)cm. Arterial, portal and delayed phase images were obtained at 30 -35 seconds, 70 -75 seconds, and 3 minutes, respectively, after the injection of contrast materials. Using a work station, two radiologists independently measured the longest diameter of the selected lesions, and a second measurement was taken three days later. Contrast, as well as intra-and interbserver differences among the three phases, was statistically analysed. RESULTS: Intra- and interobserver difference were, espectively, 2.3 and 3.8 mm during the portal phase; 3.3 and 4.6 mm during the arterial phase; and 2.9 and 4.5 mm during the delayed phase. ANOVA with Tukey's multiple comparison showed that none of these differences were statistically significant. Contrast between mass and liver parenchyma was especially clear during the portal phase (p=0.0001, using the Kruskal-Wallis CONCLUSION: Intra- and interobserver differences in the measurement of hepatic metastatic tumors were statistically insignificant during all three phases. The least difference and best contrast were seen during the portal phase.

Comparison of CT & MRI Findings in the Staging of Rectosigmoid Carcinoma According to New AJCC Classification

PURPOSE: To evaluate the diagnostic accuracy of computed tomography(CT) and magnetic resonance imaging(MRI)in the staging of rectosigmoid carcinoma according to the new AJCC classification. MATERIALS AND METHODS: BetweenAugust 1997 and October 1998, 36 patients with pathologically proven rectosigmoid carcinoma who underwent preoperative CT and MRI were evaluated. CT scans were performed with spiral CT in 27 cases and with conventional CT in nine. In all cases, MR images were obtained using a 1.5T unit and a body arrayed coil. T1- and T2-weightedimages were obtained in axial, sagittal, and coronal planes. On the basis of the results of CT scanning and MRI,tumor stage was determined by two radiologists using the AJCC cancer staging manual(1997). They reached aconsensus and compared their results with the pathologic stage. The T-stage was T1 in three cases, T2 in two, T3in 26, and T4 in five. The N-stage was N0 in 16 cases, N1 in seven, and N2 in 13. RESULTS: In the case of CT, thediagnostic accuracy of T-staging was 67%, and that of N-staging, 44%. For MRI, the corresponding figures were 83%and 67%. For T-staging, MRI was more accurate than CT(P=0.006), but for N-staging, the diagnostic accuracy of CT and MRI was statistically equivalent (P>0.05). CONCLUSION: MRI using a body arrayed coil is a useful preoperative diagnostic tool for the local staging of rectosigmoid carcinoma.

Three-Dimensional Short-Range MR Angiography and Multiplanar Reconstruction Images in the Evaluation of Neurovascular Compression in Hemifacial Spasm

PURPOSE: To evaluate the diagnostic efficacy of three-dimensional(3D) short-range MR angiography(MRA) andmultiplanar reconstruction(MPR) imaging in hemifacial spasm(HS). MATERIALS AND METHODS: Two hundreds patientswith HS were studied using a 1.5T MRI system with a 3D time-of-flight(TOF) MRA sequence. To reconstructshort-range MRA, 6-10 source images near the 7-8th cranial nerve complex were processed using a maximum-intensityprojection technique. In addition, an MPR technique was used to investigate neurovascular compression. We observedthe relationship between the root-exit zone(REZ) of the 7th cranial nerve and compressive vessel, and identifiedthe compressive vessels on symptomatic sides. To investigate neurovascular contact, asymptomatic contralateralsides were also evaluated. RESULTS: MRI showed that in 197 of 200 patients there was vascular compression orcontact with the facial nerve REZ on symptomatic sides. One of the three remaining patients was suffering fromacoustic neurinoma on the symptomatic side, while in two patients there were no definite abnormal findings. Compressive vessels were demonstrated in all 197 patients; 80 cases involved the anterior inferior cerebellarartery(AICA), 74 the posterior cerebellar artery(PICA), 13 the vertebral artery(VA), 16 the VA and AICA, eight theVA and PICA, and six the AICA and PICA. In all 197 patients, compressive vessels were reconstructed on one 3Dshort-range MRA image without discontinuation from vertebral or basilar arteries. 3D MPR studies providedadditional information such as the direction of compression and course of the compressive vessel. In 31 patientsthere was neurovascular contact on the contralateral side at the 7-8th cranial nerve complex. CONCLUSION: Inpatients with HS, 3D short-range MRA and MPR images are excellent and very helpful for the investigation ofneurovascular compression and the identification of compressive vessels.