No AccessJournal of UrologyGuest Editorial1 Nov 1982Renal Cell Carcinoma Fray F. Marshall Fray F. MarshallFray F. Marshall More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)53278-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Renal Cell Carcinoma." The Journal of Urology, 128(5), p. 923 © 1982 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByPritchett T, Lieskovsky G and Skinner D (2018) Extension of Renal Cell Carcinoma into the Vena Cava: Clinical Review and Surgical ApproachJournal of Urology, VOL. 135, NO. 3, (460-464), Online publication date: 1-Mar-1986.Marshall F (2018) Editorial CommentJournal of Urology, VOL. 135, NO. 3, (464-464), Online publication date: 1-Mar-1986. Volume 128Issue 5November 1982Page: 923 Advertisement Copyright & Permissions© 1982 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Fray F. Marshall More articles by this author Expand All Advertisement PDF DownloadLoading ...

You have accessJournal of UrologyDiscussed Poster, Sunday, May 9, 2004, 1:00 - 5:00 pm1 Apr 2004615: Primary Prostate Stromal Cell Stimulate Phosphorylation of Androgen Receptor through RAS/Mitogen Activated Protein Kinase Pathway in LNCaP Cells Shuji Isotani, Horoyuki Konaka, Horoyuki Kubo, Zhi Hui Xie, WenChin Huang, Sharon Lim, Fray F. Marshall, Haiyen E. Zhau, and Leland W.K. Chung Shuji IsotaniShuji Isotani More articles by this author , Horoyuki KonakaHoroyuki Konaka More articles by this author , Horoyuki KuboHoroyuki Kubo More articles by this author , Zhi Hui XieZhi Hui Xie More articles by this author , WenChin HuangWenChin Huang More articles by this author , Sharon LimSharon Lim More articles by this author , Fray F. MarshallFray F. Marshall More articles by this author , Haiyen E. ZhauHaiyen E. Zhau More articles by this author , and Leland W.K. ChungLeland W.K. Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37877-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "615: Primary Prostate Stromal Cell Stimulate Phosphorylation of Androgen Receptor through RAS/Mitogen Activated Protein Kinase Pathway in LNCaP Cells." The Journal of Urology, 171(4S), p. 163 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 163 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Shuji Isotani More articles by this author Horoyuki Konaka More articles by this author Horoyuki Kubo More articles by this author Zhi Hui Xie More articles by this author WenChin Huang More articles by this author Sharon Lim More articles by this author Fray F. Marshall More articles by this author Haiyen E. Zhau More articles by this author Leland W.K. Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

No AccessJournal of UrologyAdult urology1 Sep 2007Urological Oncology: Renal, Ureteral and Retroperitoneal Tumors Fray F. MarshallM.D. Fray F. MarshallFray F. Marshall More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.05.083AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Thrombocytosis as a Prognostic Factor for Survival in Patients With Metastatic Renal Cell Carcinoma 1 : Poor prognosis associated with thrombocytosis in patients with renal cell carcinomac. BJU Int2000; 86: 203. Google Scholar 2 : Thrombocytosis is associated with a significant increase in the cancer specific death rate after radical nephrectomy. J Urol2002; 168: 1378. Link, Google Scholar © 2007 by American Urological AssociationFiguresReferencesRelatedDetails Volume 178Issue 3September 2007Page: 819-821 Advertisement Copyright & Permissions© 2007 by American Urological AssociationMetricsAuthor Information Fray F. Marshall More articles by this author Expand All Advertisement PDF DownloadLoading ...

No AccessJournal of UrologyUROLOGICAL SURVEY: ABSTRACTS1 Aug 2002Obesity and Renal Cell Cancer—a Quantitative Review Fray F. MarshallM.D. Fray F. MarshallFray F. Marshall More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64801-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Obesity and Renal Cell Cancer—a Quantitative Review." The Journal of Urology, 168(2), p. 877 © 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 168Issue 2August 2002Page: 877 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.MetricsAuthor Information Fray F. Marshall More articles by this author Expand All Advertisement Loading ...

Objectives. Determining the recurrence risk in patients treated for renal cell carcinoma (RCC) is important for providing prognostic information and planning potential surveillance strategies. The pathologic stage has been the most widely used single prognostic variable. However, with minimally invasive treatment modalities, the pathologic stage may not be readily available. We developed a biostatistical prognostic model for postoperative RCC that is independent of the pathologic stage.Methods. The records of 296 patients who underwent open nephrectomy for RCC at Johns Hopkins Hospital between 1990 and 1999 were reviewed. Cox proportional hazards regression analysis was used to generate a prognostic model.Results. The recurrence risk (R-rec) was determined from this model: R-rec = 1.55 x presentation (0-1) + 0.19 x clinical size (in centimeters). Using this equation, 79% of patients were identified as low risk compared with 45% of patients considered low risk by pathologic stage (pT1). Moreover, the separation between the high and low-risk survival curves increased.Conclusions. This model is the first to our knowledge that uses purely clinical variables to assess the postoperative prognosis in patients with RCC. These results, although not validated, provide substantial evidence that preoperative clinical variables may be used instead of the pathologic stage to determine the risk of recurrence. Uncoupling the reliance on pathologic stage for prognostic information removes a potential barrier to novel minimally invasive treatments for renal malignancy and provides a standard to which observation protocols can be compared. In the future, this model may facilitate selection of appropriate patients for less toxic adjuvant or neoadjuvant therapies. UROLOGY 58: 141-145, 2001. (C) 2001, Elsevier Science Inc.

Vaccination with irradiated granulocyte-macrophage colony-stimulating factor (GM-CSF)-secreting gene-transduced cancer vaccines induces tumoricidal immune responses. In a Phase I human gene therapy trial, eight immunocompetent prostate cancer (PCA) patients were treated with autologous, GM-CSF-secreting, irradiated tumor vaccines prepared from ex vivo retroviral transduction of surgically harvested cells. Expansion of primary cultures of autologous vaccine cells was successful to meet trial specifications in 8 of 11 cases (73%); the yields of the primary culture cell limited the number of courses of vaccination. Side effects were pruritus, erythema, and swelling at vaccination sites. Vaccine site biopsies manifested infiltrates of dendritic cells and macrophages among prostate tumor vaccine cells. Vaccination activated new T-cell and B-cell immune responses against PCA antigens. T-cell responses, evaluated by assessing delayed-type hypersensitivity (DTH) reactions against untransduced autologous tumor cells, were evident in two of eight patients before vaccination and in seven of eight patients after treatment. Reactive DTH site biopsies manifested infiltrates of effector cells consisting of CD45RO+ T-cells, and degranulating eosinophils consistent with activation of both Th1 and Th2 T-cell responses. A distinctive eosinophilic vasculitis was evident near autologous tumor cells at vaccine sites, and at DTH sites. B-cell responses were also induced. Sera from three of eight vaccinated men contained new antibodies recognizing polypeptides of 26, 31, and 150 kDa in protein extracts from prostate cells. The 150-kDa polypeptide was expressed by LNCaP and PC-3 PCA cells, as well as by normal prostate epithelial cells, but not by prostate stromal cells. No antibodies against prostate-specific antigen were detected. These data suggest that both T-cell and B-cell immune responses to human PCA can be generated by treatment with irradiated, GM-CSF gene-transduced PCA vaccines.

Cadherins are a family of calcium-dependent, cell-cell adhesion molecules that play an important morphoregulatory role in a wide variety of tissues. Alterations in cadherin function have been implicated in tumor progression in a number of adenocarcinomas. Despite the increasing number of new cadherins identified, little is known about cadherins in normal renal tissue and renal carcinomas. A novel cadherin transcript, cadherin-6, was recently described to be present in renal cancer cell lines and fetal kidney, but no data on protein expression nor tissue localization has been reported. In this study, we demonstrate that the expression of cadherin-6 is restricted to the proximal tubule epithelium. This finding is critical because these cells give rise to the majority of neoplasms of this organ. Furthermore we demonstrate typical cadherin features of cadherin-6, including cytoplasmic binding to alpha- and beta-catenin. We present data of cadherin-6 expression in a series of 32 primary renal cell cancers. Cadherin-6 expression tended to vary with histology in these samples. Whereas the majority of renal cell cancers with histology-associated poor prognosis (i.e., high grade clear cell carcinomas and sarcomatoid renal tumors) show aberrant expression of cadherin-6, in tumors with a favorable prognosis (i.e., low grade clear cell carcinomas and papillary cancers), normal cadherin-6 expression was predominant. Overall, these findings demonstrate specific expression of cadherin-6 in the proximal renal tubules in normal human kidney and suggest that alterations of cadherin-6 expression are associated with progression of renal cell carcinoma.

PURPOSE:We determined the natural history and clarified the treatment of adrenal myelolipoma.MATERIALS AND METHODS:A retrospective review of medical records and radiographic imaging studies of 20 patients diagnosed with adrenal myelolipoma was performed.RESULTS:Of 20 patients 4 presented with abdominal pain and 1 had Cushing's syndrome. The remaining tumors were discovered incidentally. Four patients underwent surgery because of abdominal pain in 2, adrenal hyperfunction (Cushing's syndrome) in 1 and a tumor 10.5 cm. in largest dimension in 1. Of 15 patients (16 adrenal myelolipomas) followed without surgical intervention for an average of 3.2 years (range 0.3 to 10.8) 13 remained asymptomatic and 2 experienced persistent, vague abdominal discomfort. One patient was lost to followup. A total of 13 tumors from 12 patients was serially imaged, with tumor size increasing in 6, decreasing in 2 and remaining unchanged in 5.CONCLUSIONS:These data suggest that the majority of adrenal myelolipomas can be treated conservatively. While tumors can become enlarged, they also exhibit variable growth, and size and growth rate do not necessarily correlate with symptoms. Computerized tomography can be used for diagnosis.

Purpose: Resection of a posterior symphyseal osteophyte during radical retropubic prostatectomy was evaluated.Materials and Methods: The surgical technique is described. Results: A favorable experience was noted in 10 patients with partial symphyseal resection.Conclusions: Partial symphyseal resection of an osteophyte protruding from the posterior symphysis can facilitate radical retropubic prostatectomy by improving visualization of the apex of the prostate.

PURPOSE:We describe the presenting features, treatment approach and prognosis of adrenocortical carcinoma with intracaval extension of tumor thrombus.MATERIALS AND METHODS:In addition to 3 patients with adrenocortical carcinoma associated tumor thrombus treated at our institution, we reviewed an additional 26 patients described in the literature from 1972 to 1997 with regard to presentation, management and outcome.RESULTS:We identified 23 female and 6 male patients 6 to 77 years old (mean age 41.3). Of the lesions 24 originated in the right adrenal gland. Mean tumor size was 10.1 cm. and 89% of lesions were at least 9 cm. in greatest dimension. Tumor thrombus extended to the atrium in 15 patients, retrohepatic cava in 7 and subhepatic cava in 7. Flank or abdominal discomfort was the most common presenting complaint and abnormal steroid metabolism was documented in 76% of patients. Cardiac bypass techniques were used in 14 patients and none of the 3 intraoperative mortalities, 2 thromboemboli and 1 exsanguination, occurred using this approach. Eight patients received postoperative mitotane, 6 of whom had no evidence of residual disease at the time of case description.CONCLUSIONS:All patients with large adrenal tumors, especially those arising from the right gland, should undergo careful evaluation of the vena cava for thrombus. The best chance for survival is via complete surgical extirpation which is facilitated by the use of cardiac bypass techniques. There is evidence to support the early use of postoperative mitotane if there is a suspicion of residual or recurrent disease.

Purpose: Sodium and chloride transport was measured by using the Ussing chamber-voltage clamp technique to evaluate alterations occurring in ileal segments interposed in the urinary tract in a fat enterocystoplasty model.Materials and Methods: In adult male Sprague-Dawley rats which had undergone augmentation ileocystoplasties 3 months earlier, intestinal segments were explanted from the neobladders and native ileal segments were removed separately for electrolyte transport and morphometric analysis.Results: Basal ileal active sodium and chloride absorption and cyclic nucleotide-induced chloride secretion were attenuated in transplanted ileum in contrast to central tissue, Morphologically, there was villus epithelial hyperplasia, crypt hyperplasia and chronic inflammation in transplanted segments, but villus height:crypt length ratios were unchanged.Conclusions: Pathophysiologic derangements in intestinal segments interposed in the urinary tract include inhibition of sodium and chloride transport processes and mucosal hyperplasia. The use of the Ussing chamber/voltage clamp technique described herein offers a new approach for additional studies of the metabolic consequences following urinary diversion.

Purpose: We evaluate whether partial nephrectomy can be performed safely and efficaciously for renal tumors.Materials and Methods: The results of 67 partial nephrectomies performed between 1977 and 1994 for renal cell carcinoma (51), oncocytoma (9), angiomyolipoma (3), transitional cell carcinoma (3) and other nonneoplastic lesions (2) were analyzed retrospectively in detail.Results: Diminished complication rates were noted after 1988, and were attributed to improvements in surgical technique and an increased incidence of smaller, serendipitously discovered turners. Although 35.5% of the patients had preoperative renal impairment (mean serum creatinine 2.1 mg./dl.), there were minimal changes in renal function and no patient required acute hemodialysis following partial nephrectomy. Among 42 patients with clinical stage T1 to T2 renal cell carcinoma undergoing partial nephrectomy local recurrence was identified in 8.3% of those with primary neoplasms. All 6 patients with local recurrence had negative surgical margins, recurrence often distant from the operative site and multifocal disease, implicating multicentricity as the etiology of local recurrence. Five patients (83.3%) with local recurrence were alive and asymptomatic at a mean of 138 months after partial nephrectomy. Since capsular penetration was identified in 5 of 27 renal cell carcinomas (18.5%) with a diameter of 3.5 cm. or less, aggressive surgical resection with adequate tumor-free parenchymal and perinephric margins is necessary even for small lesions.Conclusions: With improved surgical techniques, including regional hypothermia, intraoperative sonography, meticulous dissection and injection of the collecting system with methylene blue, partial nephrectomy is safe and effective in properly selected patients.