Objective: To study the clinical characteristics, image findings, therapeutic method and prognosis of metanephric adenoma. Method: The clinical characteristic, image findings, operation methods and prognosis of 16 metanephric adenoma patients treated at Department of Urology, Peking University First Hospital from January 2004 to March 2016 were analyzed retrospectively. Results: There were 6 male and 10 female patients in the study. The mean age of patients was 33.7 years (ranging from 14 to 83 years). Two patients came to the hospital because of fever, while other 14 patients had no symptoms and found renal tumor by medical examination. One case was found polythemia vera and another 1 case showed mild anemia. Serum creatine of all the cases were in normal range. The tumor of 11 cases were at left side and 5 cases were at right. All patients took urinary tract ultrasound. Fifteen patients took CT examination. Among them, 14 cases were solid mass and 1 case was cystosolid.CT value was (41±4) HU. CT scan showed that the tumor was slight enhanced and CT value increased to (77±9) HU. Six patients took MRI examination. The MRI showed high or low signal of T1WI or T2WI scans.Tumor size was (4.7±3.9)cm (ranging from 1.7 to 17.5 cm). All 16 patients took operation and 11 of them took laparoscopic surgery while the other 5 cases took open surgery. Eleven cases took partial nephrectomy, 4 cases took nephrectomy and 1 case took nephroureterectomy. The surgical procedures were all successful and no complications occured during perioperative period. All cases were all confirmed metanephric adenoma by postoperative pathology and surgery cut edge were all negative. Immunohistochemical study showed that the positive rate of Vimentin, CD57, AE1/AE3, WT1, CK7 and AMACR respectively were 16/16, 15/16, 12/16, 10/16, 3/16 and 2/16. The median follow-up time of 16 cases was 44 months (ranging from 8 to 125 months) and none had recurrence or metastasis.One case died 125 months after surgery because of advanced age(83 years old). Conclusions: Metanephric adenoma is difficult to be diagnosed relying on clinical characteristics and image features. Pathology can help confirm the diagnosis. Partial nephrectomy is the first choice for operation and can achieve good prognosis. But it still needs a regular follow-up.

Objective: To study the impact to operation safety of preoperative renal artery embolization for management of ≥10 cm renal cell carcinoma. Methods: The clinical data of 239 cases with ≥10 cm renal cell carcinoma which all had underwent operation in Department of Urology, Peking University First Hospital from January 2002 to December 2014 were retrospectively analyzed. Fifty-three patients underwent preoperative renal artery embolization (therapeutic group) and 186 patients did not (control group). The effect of embolization on operative time, transfusion requirements, hospitalization, ICU stay and perioperative complications were analyzed by comparing the two groups using rank sum test and χ(2) test or Fisher exact test. Results: Comparing the therapeutic group and control group, there was significant difference in tumor location (on the left or right). The mean age, sex, mean primary tumor size, and TNM stage were similar in both groups. Comparing the therapeutic group and control group, there were more open surgeries in therapeutic group (96.2% vs. 82.3%, χ(2)=6.438, P=0.013). There were no significant differences in mean operative time (238 (525) minutes vs. 208 (583) minutes, Z=-2.182, P=0.062). The mean blood transfusion (700 (1 900) ml vs. 925 (8 800) ml, Z=-1.064, P=0.006) had significant difference. The therapeutic group had a longer mean hospitalization (21 (50) days vs. 15 (79) days, Z=-4.322, P=0.000) and higher rate of intensive care unit stay (54.7% vs. 34.4%, χ(2)=6.103, P=0.027). There was no significant difference in perioperative complications between two groups (0 vs.3.2%, P=0.408). Conclusion: Preoperative renal artery embolization in ≥10 cm renal cell carcinoma patients undergoing operation provides benefit in increasing operation safety and reducing perioperative death.

In order to explore whether NF-κB activation correlates to the prognosis, chemoresistance, and sex hormone receptors status in ovarian serous carcinoma, we analyzed the expression of NF-κB, ER, and PR by immunohistochemistry in 72 cases of ovarian serous carcinoma, investigated the association among these markers, and evaluated their relations to clinicopathologic factors and prognosis. The positive rates were 88.9% for NF-κB cytoplasmic expression, 45.8% for NF-κB nuclear expression, 41.7% for ER, and 29.2% for PR. NF-κB nuclear expression was positively correlated with the 4th edition WHO grade (P=0.045) and tumor stage (P=0.001). NF-κB cytoplasmic expression was associated with preoperative serum CA125 level (P=0.015) and ascites (P=0.042). Neither cytoplasmic nor nuclear staining of NF-κB showed any association with survival. PR expression was correlated with tumor stage (P=0.023) and omental metastasis (P=0.022). Omental metastasis occurred more frequently in ER−/PR− tumors (P=0.009). No correlation between NF-κB expression and ER, PR expression was observed. In conclusion, in ovarian serous carcinoma, NF-κB nuclear expression correlated with the 4th edition WHO grade and PR was a favorable prognostic factor for ovarian serous carcinoma.

Objective: To investigate the clinical features and prognosis of rare subtypes of renal cell carcinoma. Methods: This retrospective study collected the data of 52 rare subtypes of renal cell carcinoma of patients who underwent surgery from January 2002 to December 2014 at Department of Urology, Peking University First Hospital. There were 12 patients with collecting duct carcinoma, 5 patients with Xp11.2 translocation renal cell carcinoma, 5 patients with mucinous tubular and spindle cell carcinoma, 30 patients with unclassified renal cell carcinoma. The study group included 25 male and 27 female patients, with mean age of 52 years. The mean tumour size was (6.5±3.9) cm (range: 1.5 to 21.0 cm). The basic clinical features, gross appearance, Fuhrman nuclear grade, TNM staging and prognosis of rare subtypes of RCC were studied. The OS curves were obtained for rare subtypes of renal cell carcinoma using the Kaplan-Meier method and compared using a Log-rank test. Results: The rate of lymph node and distant metastasis were 34.6% (18/52) and 17.3% (9/52). Malignancies were screened and detected by color Doppler ultrasonography or CT scan, however, no case was diagnosed before operation or aspiration, all cases were confirmed by the pathological examination. The average period of postoperative follow-up process was 65 months, and the mean survival time was (34±23) months. Conclusion: The clinical features of rare subtypes of renal cell carcinoma are similar to those of clear cell renal cell carcinoma, while the imaging changes will be helpful for diagnosis before operation.

OBJECTIVE To study the clinicopathological features and differential diagnosis of metanephric adenoma (MA). METHODS The clinicopathological data of 16 cases with MA diagnosed and treated in Peking University First Hospital from 2004 to 2016 were retrospectively analyzed, and the clinical characteristics, pathologic parameters, differential diagnosis, treatment options and prognosis of MA were analyzed with literature review. RESULTS The patients included 10 females and 6 males. The age of patients ranged from 14 to 83 years (mean=33.7 years). The partial nephrectomy was carried out for most patients. All cases were located in renal codex with 3 growing into the renal sinus. Histologically, the tumor was composed of tubules, papillary or glomeruloid structures and psammoma bodies were focally seen. Immunohistochemical study showed that all the cases expressed vimentin, and 94% cases expressed CD57, 63% WT1, 75% AE1/AE3, 19% cytokeratin 7 (CK7) and 13%α-methylacyl-CoA racemase (AMACR), and negative expressions for MA included CD10, neuron-specific enolase (NSE) and CD56. Follow-up information from 1 to 125 months was available in all the patients; and none of the patients showed any evidence of recurrence and metastasis. CONCLUSION The benign tumor characteristics of MA are not obvious for preoperative imaging diagnosis, and the diagnosis of MA should be based on the unique pathological features. Positive immunostain of CD57 is a useful indicator for MA diagnosis and differential diagnosis. The partial nephrectomy surgical treatment can achieve good clinical cure with good prognosis.

Objective:To investigate the expression pattern and prognostic values of CD44 and CK18 in ovarian serous carcinoma. Methods:Immunohistochemical evaluation inclu-ding CD44 and CK18 was performed in paraffin wax-embedded tissues of 72 cases of ovarian se-rous carcinoma. The expression and the relationship with clinical parameters of these markers were analyzed. Results:The positive rates were 66. 7% for CD44 and 100% for CK18. Clusters of CD44+cells scattered in tumor tissue,and the expression pattern was more prominent in high-grade serous carcinoma. CK18 expression significantly correlated with age (P=0. 014) and lymph node metastasis ( P=0 . 015 ) . CD44 and CK18 expression levels neither were correlated with chemotherapeutic effects and overall disease free survival time,nor showed any mutual re-lationship between each other. Conclusion:The expressions of CD44 and CK18 are correlate with the prognosis of ovarian serous carcinoma,but they are not satisfactory indicators for che-motherapeutic effects and survival time.

To evaluate the association between tumor squamous and/or glandular differentiation and tumor biological characteristics and to validate the impact of these histologic variants on oncologic outcomes of UTUC patients.

Renal cell carcinoma (RCC) with rhabdoid differentiation is a recently described variant of RCC, which has seldom been reported in China. This form of differentiation has been generally associated with a poor prognosis and is often present in tumors with a poorly differentiated morphology. The development of a rhabdoid morphology appears to represent a common dedifferentiation pathway for renal parenchymal malignancies. The aim of this study is to evaluate the incidence and clinicopathologic features of RCC rhabdoid differentiation in Chinese adult patients and to further investigate its origin. We reviewed 723 cases of RCC obtained between January 2012 and March 2014 in Peking University First Hospital. From these cases, 10 (1.4%) were found to have areas of classic rhabdoid morphology. Immunohistochemistry for vimentin, cytokeratin (CK) (pan-cytokeratin (AE1/AE3), CK20, CK5/6, CK7, and CK8/18), RCC, CD10, Pax-2, Pax-8, CD117, desmin, muscle-specific actin, CD68, p53, and Ki-67 was performed in each case using the labeled streptavidin-biotin method. Rhabdoid differentiation was identified in association with clear cell RCC, papillary RCC (II type), and sarcomatoid RCC. We compared the morphologic and immunohistochemical features between rhabdoid and nonrhabdoid components. In our cases, rhabdoid differentiation was characterized by the presence of cohesive large epithelioid cells with abundant pink cytoplasm and central eosinophilic intracytoplasmic inclusions and 1 or more large, oval, eccentric, or irregular nuclei containing prominent nucleoli. Most of the rhabdoid areas showed a solid growth pattern. In our series, RCC with rhabdoid differentiation had an aggressive biological behavior, and rhabdoid components were most likely associated with high-grade tumors of advanced stage. In all cases, the rhabdoid and nonrhabdoid tumoral areas without sarcomatoid differentiation exhibited the very similar immunophenotype as follows: vimentin (+/−), AE1/AE3 (+), CK8/18(+), CK7(+/−), CK5/6 (−), CK20 (−), RCC (focal +), CD10 (focal +), Pax-2 (+), Pax-8 (+), CD117 (+/−), desmin (−), muscle-specific actin (−), and CD68 (−). On p53 and Ki-67 immunohistochemistry, the positive rate of rhabdoid cells for both p53 and Ki-67, similar to sarcomatoid cells, was higher than that of nonrhabdoid tumor cells without sarcomatoid differentiation. Our results indicate that the incidence rate of rhabdoid differentiation in Chinese adult RCC patients is lower than that of foreign reports. We support that the rhabdoid and nonrhabdoid tumor cells originate from the same clone, and the rhabdoid components present high proliferative activity and indicate a poor prognosis.

Purpose. To elucidate the characteristics and risk factors for positive biopsy outcomes in Chinese patients with prostate specific antigen (PSA) 4–10 ng/mL and develop a risk-stratification score model. Methods. The data of 345 patients who underwent transrectal ultrasound-guided prostate biopsy between 2011 and 2013 was retrospectively analyzed. Digital rectal examination (DRE), prostate volume (PV), magnetic resonance imaging (MRI), and smoking status were also collected. Positive biopsy outcomes were defined as prostate cancer (PCa) and high grade PCa (HGPCa, Gleason Score≥7). Results. The median PSA was 7.15 (IQR 5.91–8.45) ng/mL. Overall 138 patients (40.0%) were shown to have PCa, including 100 patients (29.0%) with HGPCa. Smaller PV, elder age, MRI results, and positive DRE were proved to be predictive factors for positive biopsy outcomes in both univariate and multivariate analysis. We developed a “PAMD” score which combined the four factors to categorize patients into three risk groups, and the model performed good predictive sensitivity and specificity. Conclusion. The prevalence of prostate cancer in Chinese patients with PSA 4–10 ng/mL was 40%, including 29% patients with high grade disease. DRE, age, MRI, and PV were predictive factors for positive biopsy outcomes, and the PAMD score model could be utilized for risk-stratification and decision-making.

Kindlin-2 has been known to promote most cancer progression through regulation of multiple signaling pathways. However, a novel tumor suppressive role of Kindlin-2 was identified in serous epithelial ovarian cancer progression, which sharply contrasts to the tumor promoting roles for Kindlin-2 in most other cancers. While we demonstrated that Kindlin-2 was highly expressed in control tissues, a drastic low expression of Kindlin-2 was found in the tumor tissues of serous epithelial ovarian cancer, especially in the high-grade serous epithelial ovarian cancer. Importantly, Kindlin-2 inhibited serous epithelial ovarian cancer cell peritoneal dissemination in a mouse model. For clinical relevance, low Kindlin-2 expression correlated with higher tumor grade and older patients. Intriguingly, decreased Kindlin-2 expression predicts poor overall and progression-free survivals in serous epithelial ovarian cancer patients. Mechanistically, Kindlin-2 induced a mesenchymal to epithelial transition in serous epithelial ovarian cancer cells, at least in part, by up-regulation of estrogen receptor α which was recruited to the promoter of E-cadherin and thereby enhanced the transcription of E-cadherin. Collectively, we concluded that inadequate Kindlin-2 is an independent risk factor for serous epithelial ovarian cancer patients.

OBJECTIVE:To compare the efficiency of three different estrogen receptor (ER) immunostaining scoring systems by analyzing the correlation between ER status and clinicopathologic features for prediction of prognosis of patients with endometrial carcinoma (EC). METHODS:ER immunostaining (EnVision method) was performed in 160 type I EC and 39 type II EC paraffin samples and was scored by ASCO/CAP criterion, H-Score and Allred scoring system. Correlation between ER status and clinicopathologic features was statistically analyzed. RESULTS:ASCO/CAP criterion, H-Score and Allred (cutoff point: 4-8) scoring system showed high concordance in the following aspects. In EC patients, ER status was significantly associated with presurgical CA125 levels (P = 0.015, P = 0.007, P = 0.023), histologic grades (all P < 0.01) and PR status (all P < 0.01). In type I EC cohort, ER status was significantly correlated with PR status (P = 0.008, P < 0.01, P < 0.01) and p53 status (P = 0.042, P = 0.001, P < 0.01). As of the predictive value of ER status for type I EC patient age, ASCO/CAP (P = 0.027) and H-Score criteria (P = 0.035) were both superior to Allred score system (P = 0.064). Among well-known predictive clinicopathologic parameters, including FIGO stage, lympho-vascular involvement, lymph node metastasis, depth of myometrial invasion and omental involvement, ASCO/CAP scoring offered a better correlation (P = 0.005, P = 0.002, P = 0.021, P = 0.067, and P = 0.067, respectively) than H-Score (P > 0.05) and Allred scoring system (P > 0.05). CONCLUSIONS:Compared with H-Score and Allred scoring system, ASCO/CAP criterion is more closely correlated with predictive clinicopathologic parameters. Therefore it may be used as a simple, highly efficient prognostic indicator for EC patients in routine practice.

Objective Protein 4.1N (4.1N) is a member of the Protein 4.1 family that is involved in cellular processes such as cell adhesion, migration and signaling. In this study, we evaluated the expression of 4.1N protein and its potential roles in epithelial ovarian cancer (EOC) tumorigenesis and progression. Methods 4.1N protein expression was investigated in a total of 280 samples including 74 normal tissues, 35 benign, 30 borderline and 141 malignant epithelial ovarian tumors by immunohistochemistry. Correlation between 4.1N expression levels and clinicopathologic features was statistically analyzed. The expression of 4.1N in EOC cell lines was examined by western blotting. Results Immunohistochemistry analysis revealed that, although there was no loss of 4.1N expression in normal tissues and benign tumors, absence of Protein 4.1N was significantly more common in EOCs (44.0%) than in borderline tumors (3.3%) (p < 0.001). Furthermore, loss or decreased expression of 4.1N protein expression was correlated with malignant potential of the tumors (14.3% in benign tumors, 56.7% in borderline tumors and 92.9% in malignancy) (p < 0.001). In EOC samples, loss of 4.1N protein was significantly associated with advanced-stage (p = 0.004), ascites (p = 0.009), omental metastasis (p = 0.018), suboptimal debulking (p = 0.024), poorly histological differentiation (p = 0.009), high-grade serous carcinoma (p = 0.001), short progression-free-survival (p = 0.018) and poor chemosensitivity to first-line chemotherapy (p = 0.029). Moreover, western blotting analysis revealed that expression of 4.1N protein was lost in 4/8 (50%) EOC cell lines. Conclusions 4.1N protein expression level was significantly decreased during malignant transformation of epithelial ovarian tumors and that loss of 4.1N expression was closely correlated to poorly differentiated and biologically aggressive EOCs.

Objective:To investigate the expressions and its significances of E-cadherin and p120 catenin(p120) in serous ovarian carcinoma.Methods:Using immunohistochemical technique,the expressions of E-cadherin and p120 in 31 cases of low-grade ovarian serous carcinoma and 70 cases of high-grade ovarian serous carcinoma were examined.Their relationship with clinicopathological data was analyzed.Results:The positive expression rates of E-cadherin in low-grade and high-grade serous carcinoma were 71.0% and 61.4% respectively(P=0.356).The positive expression rates of p120 in low-grade and high-grade serous carcinoma were 83.9% and 60.0% respectively(P=0.018).In the group of high-grade serous carcinoma,the expressions of E-cadherin and p120 were significantly correlated with FIGO staging(P=0.015,P=0.011),lymph node metastasis(P=0.001,P=0.001) and invaded omentum(P=0.028,P=0.018).E-cadherin expression was correlated with age(P=0.011) while p120 was not(P=0.226).In the group of low-grade serous carcinoma,only the expression level of p120 showed significant association with lymph node metastasis(P=0.042),invaded omentum(P=0.048) and preoperative CA125 level(P=0.042).Conclusion:Expression of p120 protein in high-grade serous ovarian carcinoma is significantly reduced.And only in high-grade serous ovarian carcinoma,loss of E-cadherin and p120 expression are correlated with FIGO staging,invasion and tumor metastasis,suggesting that E-cadherin and p120 may have different functions in the development of different types of ovarian serous carcinoma.