[Reproducibility of Gleason scores in prostate cancer].

OBJECTIVE: To investigate the reproducibility of Gleason scores for prostate cancer. METHODS: Based on the revised Gleason Scoring System of the International Society of Urological Pathology ( ISUP) , we analyzed the reproducibility and difference of Gleason scores in 49 cases of prostate cancer using the methods of combination and grouping. RESULTS: The total reproducibility of Gleason scores among 15 pathologists was good (κ = 0.642), 62.2% by the combination method, the highest in Gleason 5 + 5 (81.2%) and 5 +4 (73.3%), then in Gleason 4 + 4 (67.5%), 3 + 3 (64.0%), 4 +3 (61.3%), and 3 + 4 (44.0%), and the lowest in Gleason 4 + 5 (38.9%) and 3 + 5 (33.3%). The total reproducibility of Gleason scores by the grouping method was 71.4%, the highest in Gleason 9-10 (84.9%) , then in Gleason 7 (76.7%) and 6 (64.0%), and the lowest in Gleason 8 (60.7%). CONCLUSION: The reproducibility of Gleason scores remains to be further improved in prostate cancer, mainly concerning the understanding of Gleason 3 and 4 carcinoma.

[Clinical characteristics of IgG4 related retroperitoneal fibrosis: a report of 5 cases and literature review].

OBJECTIVE: To explore the clinical characteristics, treatment and prognosis of IgG4-related retroperitoneal fibrosis (RPF). METHODS: All the patients diagnosed as RPF in Peking University People's Hospital between February 2008 and October 2014 were included. Among them, 5 patients were identified as IgG4 related RPF. We analyzed their medical records and summarized the clinical, laboratory, and imaging features of IgG4 related RPF, which had taken the recent literature into account. RESULTS: All the 5 patients were male, with the average age 62.2 years (55-67 years). They mainly complained of abdominal pain, flank pain and weight loss, two of whom had concurrent antoimmune pancreatitis. Renal insufficiency was present in 3 patients (3/5). Four patients (4/4) showed increased erythrocyte sedimentation rate (ESR), while 3 patients (3/4) had higher serum C-reactive protein (CRP) and IgG. In addition, 4 patients (4/4) had significantly elevated serum IgG4 level. On computed tomography (CT) imaging, 5 patients showed retroperitoneal mass which surrounded the abdominal aorta and the iliac arteries, and even enveloped the ureters and the inferior vena cava. Only one patient received tissue pathological examination, which indicated the numbers of IgG4-positive plasma cells per high power field>10 and a ratio of IgG4-positive cells to all IgG-bearing cells>40%. One patient received simple surgical intervention, and 1 patient received medical treatment alone, while the remaining 3 patients received combined treatment of surgery and medications. follow-up was available for the 4 patients, all of whom had good prognosis. CONCLUSION: Part of RPF was actually IgG4-related, which was also nominated as IgG4 related RPF. It was a rare disease with unknown etiology, characterized by the elevated serum IgG4 concentration (≥1.35 g/L), with marked tissue infiltration by lymphocytes and IgG4-positive plasma cells with fibrosis, in addition to the presence of retroperitoneal mass. Glucocorticoids were the first-line therapy and IgG4 related RPF had a favourable prognosis.

[Age correlates with Gleason score in patients with prostate adenocarcinoma].

OBJECTIVE: To investigate the correlation between age and Gleason score (GS) in patients with prostate adenocarcinoma. METHODS: This study included 674 patients with pathologically confirmed prostate adenocarcinoma. We determined the GS, primary grade, and secondary grade of the cases, and compared them among different age groups. RESULTS: The mean age of the patients was (70.22 ± 8.26) yr, ranging from 25 to 96 years, (69.06 ± 8.35) yr in those with GS 6, (70.55 ± 8.16) yr in GS 7, (70.99 ± 6.54) yr in GS 8, (71.56 ± 9.18) yr in GS 9, and (72.79 ± 11.36) in GS 10. The mean GS, primary grade, and secondary grade were 7.08 ± 1.09, 3.54 ± 0.72, and 3.53 ± 0.66, respectively, and the mean GSs in the < 60 yr, 60-69 yr, 70-79 yr, and ≥ 80 yr groups were 6.86 ± 1.10, 6.99 ± 1.10, 7.08 ± 1.04, and 7.38 ± 1.23, respectively. Those with GS 6, 7, and ≥ 8 accounted for 37.7%, 34.3%, and 28.0%, respectively. The patients aged < 60, 60-69, 70-79, and ≥ 80 years constituted 10.5% (71/674), 30.6% (206/674), 47.6% (321/674), and 11.3% (76/674), respectively. The age of the patients was significantly correlated with GS (r2 = 0.013, P = 0.003) and the primary grade (r2 = 0.014, P = 0.002), but not the secondary grade (r2 = 0.005, P = 0.055). CONCLUSION: Of the prostate adenocarcinoma patients, those aged ≥ 70 years form a larger proportion, and those with GS ≥ 7 comprise a higher percentage. The age of the patient is correlated with Gleason score but has a limited value in its prediction.

[Basic features of the ISUP prostate carcinoma Gleason grading system: a preliminary analysis].

OBJECTIVE: To explore the basic features of the prostate carcinoma Gleason grading system of the International Society of Urological Pathology (ISUP). METHODS: We analyzed the means and proportions of the Gleason score (GS), primary grade (PG), secondary grade (SG) and third grade (TG) of 667 cases of prostate carcinoma. RESULTS: The means of GS, PG, SG and TG were 7.06 +/- 1.10, 3.53 +/- 0.66, 3.53 +/- 0.72 and 4.30 +/- 0.96, respectively. The cases with GS 5, 6, 7, 8, 9 and 10 accounted for 0.4% (3/677), 37.2% (252/677), 34.4% (233/677), 13.7% (93/677), 12.0% (81/677) and 2.2% (15/677), respectively; those with GS < or = 6 and > or = 7 constituted 37.7% (255/677) and 62.3% (422/677); those with GS3 + 3, 4 + 3 and 3 + 4 made up 37.2% (252/677), 19.2% (130/677) and 15.2% (103/677); and the TG cases held 10.3% (70/677), including 30.0% (21/70) of grade 3, 10% (7/70) of grade 4 and 60.0% (42/70) of grade 5. CONCLUSION: Our study showed a high proportion of GS, a low proportion of GS < or = 6, and a high proportion of GS > or = 7 in the ISUP prostate carcinoma Gleason grading system. TG of GS needs to be further understood.

[Expressions of CMTM8 and E-cadherin in primary and metastatic clear cell renal cell carcinoma].

OBJECTIVE: To investigate the expression and clinical pathological significance of CMTM8 and E-cadherin in primary and metastatic clear-cell renal cell carcinoma. METHODS: The immunohistochemistry was used to detect the expressions of CMTM8 and E-cadherin in 17 cases of primary clear-cell renal cell carcinoma, 8 cases of normal renal tissue, 9 cases of metastatic renal cell carcinoma in lungs and 10 cases of metastatic renal cell carcinoma in bones. RESULTS: The membranous staining intensities of CMTM8 and E-cadherin in normal renal tissue were strong, but reduced in low-grade clear-cell renal cell carcinoma. There were positive cytoplasmic stainings of CMTM8 and E-cadherin in high-grade clear-cell renal cell carcinoma. Increased cytoplasmic expression of CMTM8 was frequent in metastatic renal cell carcinoma, accompanied with reduced cell surface staining. The expression of E-cadherin could be negative or weakly positive at membrane and cytoplasma. CMTM8 and E-cadherin expressions were negatively correlated with development and metastasis in clear-cell renal cell carcinoma (r=-0.841 and r=-0.732, P<0.001). Moreover, CMTM8 was also correlated with the expression of E-cadherin (r=0.694, P<0.001). CONCLUSION: CMTM8 and E-cadherin are negatively correlated with tumorgenesis and development in clear-cell renal cell carcinoma. The location and intensity of their expressions have significant association with the prognosis.

A novel role of Id-1 in regulation of epithelial-to-mesenchymal transition in bladder cancer.

BACKGROUND AND OBJECTIVE: Inhibitor of differentiation or DNA binding -1 (Id-1) has been shown to be increased in several types of advanced cancer, and to be associated with aggressive and metastatic abilities of cancer cells. Recently, more and more evidence indicates that epithelial-to-mesenchymal transition (EMT) is an important mechanism taking place during tumor invasion and metastasis, but the molecular pathways underlying EMT have not been clearly established. This study was to investigate the expression of Id-1 in bladder cancer and its association with EMT. MATERIALS AND METHODS: A total of 169 tissues, consisting of 147 primary bladder cancers and 22 adjacent normal tissues were included in this study. Id-1, E-cadherin, and ß-catenin were examined immunohistochemically in paraffin sections. The pBabe-Id-1 expression retroviral vector and retroviral vectors containing an Id-1-specific small interfering RNA oligonucleotides (si-Id-1) were transfected into 2 bladder cancer cell lines respectively. Then, we used Western blotting and immunofluorescent staining to detect the cellular expression of epithelial markers and mesenchymal markers. The invasion and migration ability of bladder cancer cells were identified by type I collagen invasion assay and wound closure assay. RESULTS: We demonstrated that increased Id-1 expression was associated with advanced tumor stage and grade. In addition, the increased Id-1 expression in bladder tumors was also correlated with decreased membranous E-cadherin and ß-catenin expression. In vitro, studies showed that inactivation of the Id-1 gene conferred morphologic transition of bladder cancer cells from a fibroblastic to epithelial appearance, and overexpression of Id-1 could lead to acquisition of a fibroblastic spindle cell phenotype accompanied by loss of cell-to-cell contacts. By Western blotting and immunofluorescent staining, we showed that the expression level of Id-1 was correlated with the expression of mesenchymal markers but was inversely correlated with the expression of epithelial markers. Moreover, results of collagen invasion and wound closure assays showed ectopic Id-1 expression led to increased ability of invasion and migration. CONCLUSIONS: Our results suggest that Id-1 may play roles in tumor progression and EMT activation in bladder cancer.

[Perivascular epithelioid cell tumor of urinary system: a clinicopathologic analysis of 21 cases].

OBJECTIVE: To study the clinicopathologic features and differential diagnosis of perivascular epithelioid cell tumors (PEComas) occurring in the urinary system. METHODS: The clinicopathologic features of 21 cases of PEComa from September 2002 to September 2010 occurring in the urinary system were retrospectively reviewed. Immunohistochemical study for HMB 45, S-100 protein, smooth muscle actin, desmin, Melan A and Ki-67 was carried out. RESULTS: Amongst the 21 cases studied, there were 5 males and 16 females. The age of patients ranged from 16 to 76 years (median = 51.3 years). Twenty cases occurred in the kidney and 1 in the bladder. The predominant histopathologic subtype of renal PEComas was classic type (10/20), followed by epithelioid type (5/20), smooth muscle type (3/20), inflammatory type (1/20) and sclerosing type (1/20). Immunohistochemical study showed that HMB 45 and smooth muscle actin were positive in 95.2% (20/21) and 80.9% (17/21) cases, respectively. Melan A, desmin and S-100 protein were expressed in 71.4% (15/21), 61.9% (13/21) and 33.3% (7/21) cases, respectively. The mean proliferative index was 1.29% (range = 0 to 5%). HMB 45 and Melan A were expressed in all of the 5 cases of epithelioid PEComas, whereas smooth muscle actin and desmin were only expressed in one of them. There was no significant difference between epithelioid PEComas and non-epithelioid PEComas in the expression of HMB 45, Melan A, smooth muscle actin and desmin. Positive staining for HMB 45 and smooth muscle actin was demonstrated in the case of bladder PEComa. CONCLUSIONS: PEComas of the urinary system predominantly affect the kidney. Epithelioid renal PEComas and bladder PEComa are relatively rare and have unique pathologic features. It is necessary to distinguish PEComas from other malignant tumors. Immunohistochemical study for HMB 45, Melan A and smooth muscle actin is helpful for confirmation of diagnosis.