Objective To investigate the clinical features of genitourinary invasion by malignant lymphoma.Methods Three cases of genitourinary invasion by malignant lymphoma were reported.Case 1,a 68-year-old man,complained of right flank malaise for 1 month.CT showed a soft tissue shadow of 4.0 cm?5.5 cm with homogeneous density at right renal hilus,and diffusely thickened right greater psoas muscle at the level from lower pole of the kidney to internal iliac muscle with low-density soft tissue shadow inside.Case 2,a 72-year-old man,presented with distended left leg for 2 weeks.CT indicated left seminal vesicle mass with soft tissue density of 2.5 cm in diameter,and a soft tissue mass of 6.5 cm?4.5 cm at the left iliac artery furcation.Case 3,a 48-year-old woman,complained of fever for 1 month.CT showed well-defined,solid masses of 8.0 cm?6.0 cm and 7.0 cm?6.5 cm,respectively,in diameter with inhomogeneous density at bilateral adrenal gland areas.The incidence,clinical features,prognosis and surgical treatment of this disease were summarized in combination with review of the literature.Results All 3 cases underwent operations.The primary foci originated from pelvic or retroperitoneal lymph nodes.The kidney,seminal vesicle and adrenal gland were involved in each of the 3 cases.The pathological types were all non-Hodgkin diffusive big B cell lymphoma.One case died 2 months after operation.The other 2 received CHOP chemotherapy after operation,and were followed for 4 months and 2 years,respectively.They were both alive with no recurrence at last time of the follow-up.Conclusions Genitourinary invasion by malignant lymphoma is an uncommon disease with atypical clinical presentations and poor prognosis.Surgical treatment has little effect,while radiotherapy and chemotherapy should be the first choice.Explorative surgery has positive significance for definite diagnosis.

iple occurrence of the tumor, which can decline its recurrence and postpone its progression.

Objective To explore the safety and efficacy of small margin in nephron sparing surgery for early localized renal cell carcinoma (RCC). Methods A total of 325 cases of RCC with normal contralateral kidney and staged as Tla were retrospectivly studied.According to the margin size,125 cases were with surgical margin ≤ 5 mm (group ≤ 5 mm),102 cases with margin 6-9 mm (group 6-9 mm) and 98 cases with margin ＞ 10 mm (group ＞ 10 mm).The margin size and status was pathologically evaluated and clinical results including local recurrence,distant metastasis and overall survival rate were followed up and comparatively analyzed. Results None of the patients had positive surgical margins.The mean and median margin sizes were 2.2 and 2.0 mm for group ≤ 5 mm,6.7 and 6.0 mm for group 6-9 mm and 11.8 and 12.0 mm for group ＞ 10 mm.The difference was statistically significant (P=0.025).The mean and median follow-up time for all the patients were 79 and 83 months (range 15-132 months),with 69 and 73 months (range,15-130 months) for group ≤ 5 mm,83 and 86 (range,17-132 months) for group 6-9mm and 82 and 82 (range 60-103 months) for group ＞ 10 mm.Three patients in group ≤ 5 mm,5 in group 6-9 mm and 2 in group ＞ 10 mm died of no-cancer related disease during follow-up.One patient in group ≤ 5 mm (0.74％) experienced ectopic recurrence in the same kidney and one in group 6-9 mm was detected local recurrence in situ (0.98％).No distant metastasis was detected in all the patients.The overall 5-year survival rate for patients in groups ≤ 5mm,6-9 mm and ＞ 10 mm were 99.2％,99.0％ and 98.0％,respectively.(Kaplan-Meier survival analysis,Log Rank,x2 =1.511,P=0.470). Conclusions Small margin in nephron sparing surgery is safe and effective in treating RCC with stage T1a,which provides excellent renal function preservation,favorable long-term progression-free survival rate,and is not associated with an increased risk of local recurrence.

Objective To summarize the treatment experience of the solitary kidney with renal artery aneurysm.Methods Clinical data of 1 solitary renal artery aneurysm patient treated in our hospital in May.2012 was retrospectively analyzed.The 48 yrs man with a history of hypertension for 10 years,but responded to medical treatment poorly.The highest blood pressure was up to 180/100 mmHg (1 mmHg =0.133 kPa).Preoperative check found that the serum creatinine was 64 μmol/L.Color Doppler ultrasound showed no detection of left kidney,the renal artery enlarged to the range of 21 mm× 14 mm.CT scan showed that the right renal artery locally enlarged,suggesting artery aneurysm.Renal computerized tomography angiography showed that left renal agenesis,right renal with artery aneurysm close to the renal hilum with size of 17.1 mm× 19.1 mm,was located on the distal renal artery bifurcation,involving 2 artery branches.The diagnosis was right solitary kidney with renal artery aneurysm.Renal aneurysm clip occlusion was performed under general anesthesia,blood pressure was controlled to 70/40 mmHg during the procedure.After exposing the renal artery,the renal artery was visible with a diameter of 25 mm and with a basement width about 19 mm,which located in the main renal artery and overrode the branches of the two renal arteries.After the clamp of the artery aneurysm from two sides to center and the middle part of it was overlapped,the artery aneurysm reduced obviously,and clipped the aneurysmal wall with noose suture.When loosen the clamp of main renal artery,the artery aneurysm was not enlarged,blood pressure up to 120/80 mmHg.Results The operation was successful,operation time was 75 min,intraoperative blocking time was 15 min,intraoperative blood loss was 50 ml,and there was no intraoperative and postoperative complication.Postoperatively immediate and the first postoperative day serum creatinine were 95 μmol/L and 150 μmol/L.2 week after surgery the index decreased to 74 μmol/L.After operation the blood pressure was control successful,and kept at 130/80 mmHg.Conclusions Solitary kidney with renal artery aneurysm is rare.Renal aneurysm clip occlusion is a safe,effective and feasible treatment option,especially for the patients with solitary kidney.

Eighty six patients with renal masses≤4.0 cm underwent ultrasound or CT-guided core needle biopsies.The clinical data including the initial biopsy technique,pathologic findings,and the clinical outcome were retrospectively reviewed. Biopsies were failed for diagnosis in 6 cases ( 7％ ) because of necrosis or hemorrhage of the tissue specimens.Of 80 successful biopsies,52 cases (65％) were diagnosed as malignant tumor and 28 cases (35％) as benign. Five patients had biopsy complications (6％),including postoperative hypotension,hemouria and perirenal hematoma. Forty-seven patients underwent surgical extirpation ; the consistency rate of histopathological diagnosis between biopsy and surgical specimens was 100％ in these patients.The results indicate that ultrasound or CT-guided core needle biopsy is an effective and safe procedure for diagnosis of renal small masses.

Objective To discuss the method and effect of large renal staghorn calculi by anatrophic nephrolithotomy (AN).Methods Fifty-two patients with large renal staghom calculi underwent AN.Bilateral renal calculi disease was present in 3 patients,so that a number of 55 procedures were operated.Preoperative evaluation included urinalysis,urine culture,renal function,and ultragound,CT,KUB and IVU.A flank incision was between the 11th and 12th ribs and the kidney was freed.After interrupted renal pedicle in situ hypothermia,the renal parenchyma incision was made along the avascular plane which is outside in the back of the kidney.The collecting system was opened.The calculi were removed.The collecting system was reconstructed.The renal parenchyma was closed and the renal circulation was reestablished.The protected management of renal function was made intraoperative.Postoperative follow-up consisted of urinalysis,renal function,ultrasound,KUB,IVU and ECT.Results The operative time was (117±45) minutes.The renal ischemia time WaS (29±15)minutes.Five cases underwent blood transfusion.Mean amount of blood transfusion was 230 ml.Four cases had remained calculi.The stone-free rate was 92.3%.No recent complication occurred after operation.Postoperative follow-up indicated that renal function was normal.Conclusions AN is the most appropriate method for patients with large renal staghorn calculi because of the highest stone-free rate,the lowest stone-recurred rate and a safe and effective operative procedure with less complication.Renal function damages just little through a series of protected management.Nephrectomy is avoided to part of patients.

Objective To study the relationship between X-linked inhibitor of apoptosis protein (XIAP) expression and transitional cell carcinoma(TCC) development. Methods Forty-three TCC tissues and 12 normal transitional epithelial tissues were applied to detect XIAP expression by semi-quantitative RT-PCR, immunohistochemistry and western blot. The data were statistically analyzed by using SPSS11.5 according to the 2 groups (TCC and normal transitional epithelial) as well as the dif-ferent subgroups (tumor stage, grade, single or multiple tumor, primary or recurrence tumor). Results XIAP expression in TCC tissues was higher than in normal transitional epithelial tissues(im-munohistochemistry: 22±5 and 16±2, Western blot:1.21±0. 15 and 0. 61±0.24, mRNA: 1.17± 0. 30 and 0. 75±0. 17, P<0. 05). In the bladder tumors group, XIAP expression in recurrence tumors was higher than in primary tumors(immunohistochemistry: 24±3 and 20±3, Western blot: 1.66±0.28 and 1.10±0. 23, mRNA: 1.44±0. 27 and 1.05±0. 23, P<0. 05). However, there were no significant differences according to the tumor stage and tumor grade as well as tumor multi-plicity or not. Conclusion XIAP expression might serve as a biomarker in TCC diagnosis and recur-rence prediction.

Objective To evaluate the long-term therapeutic results and the safety of nephronsparing surgery(NSS) for the treatment of renal cell carcinoma. Methods Clinical data of 243 NSSfor renal cell carcinoma were retrospectively analysed. Of them, 159 were males and 84 were femaleswith average age of 58 years (range from 24 ?77 years). The average tumor size was 3. 4 cm (rangefrom 1.1 to 6. 7 cm). Three cases were solitary renal cell carcinoma, 11 were bilateral renal cell carcinoma; 237 cases were in stage T_(1a). and 6 cases were in stage T_(1b). No lymph node and distant metastasis, no renal vein cancer tumor embolus and inferior vena cava tumor embolus was found. Postoperative follow-up was carried out by ultrasound, CT and renal function. Cancer specific survival was estimated using Kaplan-Meier method and log-rank test. Results After a mean 31 months (1-147months) follow-up, long-term follow-up data were obtained in 232 cases because the other 11 did notlive in Dalian, 52 were treated with interferon. Four of the 232 patients treated with NSS had died:1died from lung cancer 16 months after lung cancer treatment, the other 3 died from cardiovascular diseases. The total survival rate and cancer specific survival rate were 98. 3% and 100. 0%, respectively.Local tumor recurrences were detected in 5 patients and tumor metastasis was detected in 1 patient.The recurrence rate was 2. 2%, and the metastasis rate was 0. 4%. The complications included temporary renal failure and urine leakage. The complication rate was 5. 6%. Conclusions NSS for renalcell carcinoma is a safe and feasible treatment option. It has the advantages of low local recurrence,good long-term survival rate and low complication rate. NSS can maximally reserve functional nephron, reduce the risk of chronic renal failure, preserve patient's quality of life and increase patient'ssatisfaction.

OBJECTIVETo improve the diagnosis and treatment of testicular torsion.

METHODSThe clinical data of 9 cases of suspected testicular torsion were restrospectively analyzed to summarize the diagnostic experiences.

RESULTSThe 9 patients were 12-27 (mean 15) years old, 8 treated by surgery and 1 by spontaneous detorsion under anesthesia. Among them, 7 cases were proved to be testicular torsion and 1 case was acute epididymitis. Of the 7 cases of testicular torsion, 6 were found to have 180-720-degree torsion around the spermatic cord and 1 case 180-degree around the verticality of the spermatic cord. The accuracy rate of color ultrasonic examination was 87.5%.

CONCLUSIONPatients with acute scrotum pain should have color ultrasonic examination. Not all cases of the disease had testicular torsion around the spermatic cord. Emergency operation should be performed on any suspected case of testicular torsion.

Adolescent ; Adult ; Child ; Humans ; Male ; Spermatic Cord Torsion ; etiology ; therapy

OBJECTIVETo investigate the incidence and associated factors of multicentricity in renal cell carcinoma (RCC) in Chinese patients.

METHODSOne hundred and two kidney samples from radical nephrectomy due to RCC were step sectioned at 3 mm intervals and examined. All tissue abnormalities were removed, stained and examined for multicentricity. Then, on each slice of the sample, both the parenchymal margin of 15 mm beyond the pseudocapsule and tissue around the renal sinus were continuously sectioned and examined for completeness of the pseudocapsule and vascular and lymph node invasion. The relationship between muliticentricity and other pathological parameters was evaluated.

RESULTSThe incidence of multicentricity was 15.7% (16/102); it was significantly lower in primary tumors < or = 4.0 cm than in tumors > 4.0 cm (4.9%, 2/41 vs 23.0%, 14/61; chi(2) = 6.055, P = 0.014). The incidence was 9.8% (8/82) in tumors without vascular invasion and 40.0% (8/20) in those with it (P = 0.003, Fisher's exact test). The incidence of multicentricity was 1.9% (1/53) in tumors with a complete pseudocapsule and 30.6% (15/49) in those without it (chi(2) = 15.885, P = 0.000). The grade, stage, subtypes and lymph node invasion of the primary tumor were not significantly associated with multicentricity. Multiple logistic regression analysis showed that pseudocapsular incompleteness and vascular invasion were two significant predictors of RCC multicentricity (P = 0.005 and 0.023).

CONCLUSIONSThe incidence of multicentricity of RCC in this group of patients was in accordance with published studies. Multifocality was significantly associated with tumor size, pseudocapsule completeness and vascular invasion. NSS should be limited to tumors less than 4.0 cm when the contralateral kidney is normal and careful long-term follow-up is necessary in tumors with positive vascular invasion and incomplete pseudocapsule.

Aged ; Carcinoma, Renal Cell ; epidemiology ; pathology ; surgery ; China ; epidemiology ; Female ; Humans ; Incidence ; Kidney Neoplasms ; epidemiology ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness