First-line treatment with sunitinib for type 1 and type 2 locally advanced or metastatic papillary renal cell carcinoma: a phase II study (SUPAP) by the French Genitourinary Group (GETUG)†.

BACKGROUND: Papillary renal cell carcinoma (PRCC), type 1 and type 2, represents 10%-15% of renal cell carcinomas (RCC). There is no standard first-line treatment of metastatic PRCC (mPRCC). Anti-angiogenics have shown activity in retrospective studies but no prospective studies in pure papillary histology have been reported, but one with foretinib. PATIENTS AND METHODS: A prospective phase II study evaluated sunitinib in first-line treatment of mPRCC. The primary end point was overall response rate (ORR). Secondary end points were progression-free survival (PFS) and overall survival (OS). RESULTS: Fifteen and 46 patients, respectively, with type 1 and type 2 mPRCC were enrolled. Using the MSKCC scoring system: 12 (20%), 33 (55%) and 9 (15%) patients were, respectively, in the favourable, intermediate or poor risk group and 7 undetermined. Median follow-up is 51.4 months. In type 1, 2 patients 13% [95% confidence interval (CI) 0.1-30.5] had a partial response (PR), 10 had stable disease (SD) with 5 (33%) ≥12 weeks. In type 2, 5 patients 11% (95% CI 1.9-20.3) had a PR, 25 had SD with 10(22%) ≥12 weeks. Median PFS was 6.6 months (95% CI 2.8-14.8) in type 1 and 5.5 months (95% CI 3.8-7.1) in type 2. Median OS was 17.8 (95% CI 5.7-26.1) and 12.4 (95% CI 8.2-14.3) months, respectively, in type 1 and 2. Safety was as expected with sunitinib for metastatic RCC. CONCLUSION: Sunitinib showed activity in treatment of type 1 and 2 mPRCC but lower than in clear-cell mRCC. Both PFS and OS are longer in type I PRCC. Sunitinib represents an acceptable option in first-line treatment of mPRCC.

[Atypical cysts and cystic tumours of the kidney: histological, radiological and surgical considerations. Conclusions of the AFU 2007 forum]. / Kystes atypiques et tumeurs kystiques du rein : considérations anatomopathologiques, radiologiques et chirurgicales. Conclusions du forum AFU 2007.

Malignant tumours may have a cystic appearance. They are dominated by multilocular cystic renal cell carcinoma, usually low-grade, which rarely metastasize. The Bosniak classification distinguishes non suspicious lesions (type I and II) from suspicious lesions (type III and IV) requiring resection and lesions requiring follow-up (type IIF). The main feature suggestive of malignancy is the enhancement of the septa and the walls of the cyst. Renal cysts classified as IIF require surveillance by contrast-enhanced imaging (CT, MRI or ultrasound). The treatment of cystic tumours is based on surgery. Partial nephrectomy is recommended in this type of tumour regardless of the size. Laparoscopy is a validated technique in experienced hands. Aspiration is not very effective for the treatment of benign cysts, but may be useful for diagnosis. Surgical resection of the roof of the cyst is the most effective technique.

[Kidney cancer management in 2007: news and recommendations]. / Prise en charge du cancer du rein en 2007: actualités et recommandations.

In case of a single renal cell carcinoma strictly located in the kidney, the radical nephrectomy remains the treatment of choice. However, it has been estimated that nearly 30 to 40 % of renal cell carcinoma are about to recur after primitive surgery. In certain cases, conservative surgery can be discussed as an alternative to radical treatment, especially in case of exophytic renal tumour or less than 4 cm in diameter. New ablative techniques (radiofrequency and cryoablation) have shown promising results but the follow-up is still very limited. French national recommendation regarding kidney cancer have been updated in 2007 and following the development of clinical trials using antiangiogenic agents. Regarding the use of antiangiogenic agents, several points have to be taken into account: existence of renal cell carcinoma, presence of metastasis, number of metastasis, location and risk factor prognosis determination.

[What may be the waiting time between the diagnosis and surgical treatment of kidney cancer?]. / Quelle peut être la durée du délai entre le diagnostic et le traitement chirurgical du cancer du rein?

When announcing the diagnosis of renal cell carcinoma, the urologist and the patient can wonder about the waiting time for surgically treating the cancer. This review aimed to investigate the scientific facts to determine the time between the diagnosis of kidney cancer and the achievement of surgically. The natural history of kidney cancer has been the fundamental of the therapeutic management. The time between diagnosis and surgical treatment depends on the conditions under which the diagnosis was established. Patients with symptomatic cancer or discovered at metastatic stage had to be treated quickly. In case of incidental diagnosis, evaluation of tumors has resulted in the selection of patients who can wait several months between diagnosis and surgical treatment of kidney cancer on the condition watchful waiting. The modalities of this assessment, radiological and anatomopathological, must be validated by further studies.

[Rare kidney tumors in an adult]. / Tumeurs rares du rein de l'adulte.

Rare kidney tumors can either be benign or malignant. Benign tumors include epithelial tumors and mesenchymatous ones developed from kidney cells. Malignant tumors are represented by the carcinoma of the collecting tubes as well by the sarcoma. Other malignant tumors of the extra-renal origin are also observed as lymphomas and neuro-endocrine tumors.

[Kidney tumors: clinical and pathological findings and detection]. / Tumeur du rein: données anatomo-cliniques et détection.

The detection and the clinical and pathological findings of kidney tumors have much progressed over the last 15 years. The incidence of asymptomatic renal masses has increased up to 30% during this time. This is mostly due to advances in ultrasound and computed tomography imaging. So, the therapeutic management of these masses has also been significantly changed. A better knowledge of their clinical and anatomical features allowed a more efficient mutlidisplinary approach and a better assessment of their prognosis.

[Renal onococytic adenoma]. / L'adénome oncocytaire du rein.

Renal oncocytic adenoma. Renal oncocytic adenoma is a rare neoplasm now considered as a benign tumour. The purpose of this paper is to describe the radiological features of this tumour and to assess the value of imaging work-up in the diagnosis and management of patients with renal oncocytic adenomas.

CD44s and CD44v6 expression in localized T1-T2 conventional renal cell carcinomas.

To assess the prognostic value of CD44s and CD44v6 tumour expression for patients with T1-T2 conventional renal cell carcinomas, a retrospective immunohistochemical analysis of 95 patients was undertaken. These patients had undergone a radical nephrectomy, performed in three institutions in France between 1987 and 1993. The mean age of the patients was 62.9+/-10.2 years (range from 37 to 85 years) with 66.3% males. At the time of surgery, 84 patients had a T1 and 11 a T2 renal tumour. Fuhrman nuclear grading showed 44 (46.3%) tumours of grade 1, 39 (41.1%) of grade 2, and 12 (12.6%) of grade 3. The mean follow-up period was 58.1+/-36.1 months. At the end of follow-up, eight patients (8.4%) had metastatic disease and no local recurrence was seen. Immunohistochemistry showed that 26 tumours (27.4%) expressed CD44s, but none expressed CD44v6. Statistical analysis showed that CD44s expression was correlated with tumour size (p=0.006) and Fuhrman grading (p<10(-4)). Among the various parameters tested for the multivariate analysis, CD44s expression correlated only with disease-free survival (p=0.04). It is concluded that CD44s expression, but not CD44v6, is of potential prognostic interest in patients with localized T1-T2 conventional renal cell carcinomas.

Fine-needle percutaneous biopsy of renal masses with helical CT guidance.

PURPOSE: To evaluate the feasibility, accuracy, and clinical role of fine-needle percutaneous biopsy of renal masses, with helical computed tomographic (CT) guidance. MATERIALS AND METHODS: In 63 patients (mean age, 62 years), 73 biopsies were performed. The median tumor size was 4.0 cm. Tumor biopsy was performed with an 18-gauge needle by using helical CT guidance in an outpatient setting. Two to four cores per tumor were obtained. RESULTS: Biopsy material was insufficient for analysis in 15 (21%) procedures. The median tumor size of failed or successful biopsies was 3.0 or 4.8 cm, respectively (P =.03). A benign lesion was found at eight biopsies. Two samples were suspicious for renal cell carcinoma (RCC). RCC was found in 38 biopsy samples. The remainder were transitional cell carcinoma, metastasis, lymphoma, or sarcoma. Twenty-six patients underwent nephrectomy. The accuracies of biopsy for histopathologic and Fuhrman nuclear grade evaluation were 89% and 78%, respectively. For tumors of 3.0 cm or smaller or larger than 3.0 cm, 37% (11 of 30) or 9% (four of 43) had failure of biopsy, respectively (P =.006). No substantial morbidity occurred. CONCLUSION: Fine-needle biopsy with helical CT guidance is accurate for the histopathologic evaluation of renal masses without morbidity. Indications are renal lesions that do not have the typical radiologic features of RCC, Bosniak category III or IV cystic lesions, and locally advanced or metastatic RCC.

[Diagnostic value of percutaneous biopsy of the renal masses. 73 cases]. / Valeur diagnostique des biopsies percutanées des masses rénales. A propos de 73 cas.

The aim of this study is to evaluate the diagnostic value of percutaneous biopsies of renal masses with comparison of pathological data between the biopsies and the surgical specimens. Thus, we retrospectively studied 73 biopsies of patients, who were referred to our institution between 1995 and 1997. The mean age of the patients was 60 +/- 14 years with a male predominance (67%). Twenty per cent of the biopsies were negative. Eleven per cent of the biopsies were benign lesions (oncocytoma, angiomyolipoma, infectious lesions). For renal cell carcinomas, the correlation coefficient between biopsy histology and final pathology was 0.87. Conversely, it was only 0.36 for the Führman grading. Nevertheless, low (1-2) and high (3-4) grades were accurately separated (0.92). We conclude that the percutaneous biopsy is a useful tool for diagnosis of renal masses.

[Recommendations for reforming prostatic specimens. Les Membres du Sous-Comité Prostate du Comité de Cancerologie de l'Association Française d'Urologie]. / Recommandations pratiques pour les prélèvements prostatiques. Les Membres du Sous-Comité Prostate du Comité de Cancerologie de l'Association Française d'Urologie.

The purpose of these recommendations proposed by the members of the <>, is to provide an informative report for the clinician and the pathologist, in the management of patients with prostate cancer. These recommendations are common to the ADSAP and UICC recommendations on prostate cancer. Standardized forms are recommended to be included in every report.

[General principles of macroscopic examination of kidney tumors]. / Principes généraux de l'examen macroscopique des tumeurs du rein.

We describe the main methods of gross examination of renal tumours. The pathologic result should refer to the TNM staging, which was achieved by UICC and AJCC in March, '97.

Functional conservation of the transportin nuclear import pathway in divergent organisms.

Human transportin1 (hTRN1) is the nuclear import receptor for a group of pre-mRNA/mRNA-binding proteins (heterogeneous nuclear ribonucleoproteins [hnRNP]) represented by hnRNP A1, which shuttle continuously between the nucleus and the cytoplasm. hTRN1 interacts with the M9 region of hnRNP A1, a 38-amino-acid domain rich in Gly, Ser, and Asn, and mediates the nuclear import of M9-bearing proteins in vitro. Saccharomyces cerevisiae transportin (yTRN; also known as YBR017c or Kap104p) has been identified and cloned. To understanding the nuclear import mediated by yTRN, we searched with a yeast two-hybrid system for proteins that interact with it. In an exhaustive screen of the S. cerevisiae genome, the most frequently selected open reading frame was the nuclear mRNA-binding protein, Nab2p. We delineated a ca.-50-amino-acid region in Nab2p, termed NAB35, which specifically binds yTRN and is similar to the M9 motif. NAB35 also interacts with hTRN1 and functions as a nuclear localization signal in mammalian cells. Interestingly, yTRN can also mediate the import of NAB35-bearing proteins into mammalian nuclei in vitro. We also report on additional substrates for TRN as well as sequences of Drosophila melanogaster, Xenopus laevis, and Schizosaccharomyces pombe TRNs. Together, these findings demonstrate that both the M9 signal and the nuclear import machinery utilized by the transportin pathway are conserved in evolution.

[Malignant Leydig cell tumor of the testis secreting progesterone]. / Tumeur maligne à cellules de Leydig du testicule sécrétant de la progestérone.

Malignant Leydig cell tumours of the testis occur in only 0.1-0.3% of patients with testicular tumours. Less than 50 cases of malignant Leydig cells tumours have been previously reported. A report of a new case is presented. This tumour was unusual because of high progesterone level. We analyzed malignant pathologic signs of Leydig cell tumours as immunohistochemical proliferation index. Management of this tumour, for which chemotherapy is not yet available, is discussed.

Namibia's exceptional admission to the ILO.

PIP: Namibia officially became the 136th ¿member state¿ of the International Labour Office (ILO) on October 3, 1978. At that time Namibia was politically dependent on South Africa and lived under apartheid. This stood in contradiction to international law, given that since October 1966 the UN General Assembly had terminated the Republic of South Africa's mandate over the territory. In 1967 it had entrusted its official administration to the UN Council for Namibia, which requested Namibia's admission to the ILO as a full member. Namibia met all the criteria required of a state: an established population and territory, a stable and internationally recognized legal structure, together with the capacity to enter into relations with other states. Namibia was recognized by the Conference as the de-facto authentic government through an election in which 368 voted in favor of Namibia with no oppositions and 50 abstentions.^ieng

[Malignant histiocytofibroma of the bladder. A case report]. / Histiocytofibrome malin de la vessie. A propos d'un cas.

Malignant histiocytofibroma of the bladder is a rare (16 cases reported in the literature) and very aggressive sarcoma. It is sometimes associated with a haematological malignancy. The authors report a case of malignant histiocytofibroma of the bladder in a 72-year-old haemodialysed woman with a poor general status. She had a history of chemotherapy and radiotherapy for gastrointestinal lymphoma 6 years previously. Treatment consisted of palliative cystectomy for bladder pain and haematuria. A massive pelvic and abdominal wall recurrence occurred two months after cystectomy and the patient died. The authors review the 16 cases of malignant histiocytofibroma of the bladder reported in the literature. Histiocytofibroma is a tumour which requires aggressive treatment with a combination of radical surgery and systemic chemotherapy.

[Prostatic urothelial location of a tumor of the bladder]. / Localisation urothéliale prostatique d'une tumeur de vessie.

Prostatic urothelial carcinoma concomitant with a bladder tumour is rare, but its incidence is increasing due to the precision of histological examination and the prevalence of bladder carcinoma in situ. Its prognosis depends on the depth of the prostatic lesion: carcinoma in situ, involvement of the ducts or even the stroma. In the case of high grade bladder tumour, multifocal tumour or bladder carcinoma in situ, a transurethral resection of the prostate is the best way of detecting this lesion. The therapeutic options depend on the depth of the prostatic invasion.

[Contralateral perirenal metastasis of renal adenocarcinoma]. / Métastase périrénale controlatérale d'un adénocarcinome rénal.

The objective of this paper is to report an exceptional case of solitary contralateral perirenal metastasis from a renal cell carcinoma. Investigation of this 62-year old patient, presenting with isolated haematuria, revealed a tumour, 9 cm in diameter, in the upper pole of the right kidney, associated with contralateral metastasis in the left perirenal fat. A right radical nephrectomy and left lumpectomy including the fat around the tumour were performed via a bilateral subcostal incision. Pathological staging was pT3b N0 M1, Fuhrman grade III. With a follow-up of eight months, this patient was asymptomatic with a normal radiological assessment.

[Prognostic factors of renal adenocarcinoma: study of a series of 233 patients]. / Les facteurs pronostiques de l'adénocarcinome rénal: Etude d'une série de 233 patients.

OBJECTIVE: To identify certain prognostic factors of renal cell carcinoma in a retrospective series of 233 patients. PATIENTS AND METHODS: 233 patients (162 males and 71 females with a mean age of 60 years) were operated for renal cell carcinoma between January 1980 and December 1991. sith a mean follow-up of 41.7 months. Statistical analysis was performed according to the Kaplan-Meier method for survival curves, according to the Mantel-Cox model for univariate or multivariate analysis and according to Student's t test and Chi-square test for comparison of quantitative and qualitative variables. RESULTS: The operative and global mortality was 2.2% and 28%, respectively. The following prognostic factors were identified: visceral metastases (p = 0.0001), lymph node invasion (p = 0.001), symptomatic nature of the tumour (p = 0.0004), local pathological stage (p = 0.0001) and nuclear grade (p = 0.0001). Multivariate analysis showed that the first 3 factors were the most pejorative (relative risk (RR) = 6.7, 4.6, and 1.7, respectively). Venous invation, multifocal tumours, and cell type were not studied in our series. CONCLUSION: This study confirmed that metastases, lymph node invasion and symptomatic tumours were the most pejorative prognostic factors.

[Urachal adenocarcinoma associated with urothelial tumor of the bladder. Report of a case]. / Association d'un adénocarcinome de l'ouraque et d'une tumeur urothéliale de vessie. A propos d'un cas.

The authors report a rare association of adenocarcinoma of the urachus and urothelial bladder carcinoma. Treatment consisted of cystoprostatectomy with removal of the urachus and cutaneous ureterostomy. A review of the literature indicates that adjuvant treatment has yet to be defined. This is a chance association whose prognosis depends on the invasive nature of the urothelial tumour.