Renal fibrohistiocytic sarcoma. Three cases and a review of the literature.

The purpose of this paper is to report three unpublished cases of so-called "renal malignant fibrous histiocytoma" which should be more appropriately called "renal fibrohistiocytic sarcoma", and to review and analyze the data concerning 41 cases collected from the literature and our three new cases, making a total of 44 cases. Our third case is very interesting; in addition to the fact that this condition is rare, this particular patient also had concomitant nonmalignant ascites and compression of the descending colon, both conditions being rarely associated with renal cancer. The average age of the patients was 58 years; in 66% of the cases the tumor involved the left kidney; 57% of the patients were males; the average tumor size was 12 cm; nephrectomy was performed in 93% of the cases; the average survival was 16 months. In none of the cases was a preoperative diagnosis correctly made. It is concluded that a triad of symptoms and signs (renal pain, weight loss, and large tumor size) as well as a triad of imaging characteristics (areas of low density on the CT scan, hypoechoic areas on ultrasound, and hypovascularity on angiography) may hold the promise of a preoperative diagnosis. It is suggested that the tumor arises from the system of Gerota's fascia-renal capsule.

Leiomyosarcoma of the bladder and subsequent urethral recurrence.

A case of leiomyosarcoma of the bladder with subsequent urethral recurrence is presented. Although it is well documented that urethral recurrence, or more likely new occurrence, is not uncommon following transitional cell carcinoma of the bladder, we believe that this is the first reported instance of a sarcoma of the bladder and urethral recurrence. Therefore, management of sarcoma of the bladder might include distal urethrectomy at the time of cystoprostatectomy.

Cyclophosphamide, doxorubicin hydrochloride and 5-fluorouracil in advanced carcinoma of the prostate.

Combination chemotherapy consisting of cyclophosphamide, doxorubicin hydrochloride and 5-fluorouracil was evaluated in 21 patients with metastatic adenocarcinoma of the prostate who were unresponsive to conventional therapy. All patients had extensive bone metastases. Of the 21 patients 5 (29 per cent) had a subjective response and an additional 12 (57 per cent) remained stable for 2 to 13 months after initiation of therapy. The median survival of patients with a subjective response was 60 weeks compared to 40 weeks for the stable patients. Patients who progressed on therapy had a median survival of 22 weeks. The significant response rate with a corresponding improvement in survival for patients on this 3-drug regimen suggests a need for additional trials to determine the response rate and survival compared to single agents.

Management of urethral valve obstruction in male neonates.

Over the past 6 years, 18 neonates with a posterior urethral valve obstruction have been treated. The mortality has been markedly reduced by meticulous investigation, better medical management of renal failure, greater use of catheter drainage and simpler methods of valve ablation and reduction in the use of nephrostomy and ureterostomy. Mortality was 33%, but ther has been no mortality in the last 7 patients.