The authors present the case of a 71-year-old female patient who was operated on for 16 days of abdominal pain. The work points to malignant melanoma as a rare cause of abdominal pain and then shows the inscrutability of malignant melanoma and the importance of a multidisciplinary approach to this type of disease including subsequent dispensary by an oncologist. The emphasis on the prevention of this disease is an integral part of this approach.

Le cancer du rein représente actuellement 3 % de l’ensemble des cancers. L’utilisation de cytokines dans le stade métastatique de la maladie a été le standard jusqu’à ces dernières années, produisant des réponses partielles et de courtes durées. La recherche sur l’angiogenèse dans le cancer du rein a entraîné des avancées considérables pour le développement de nouvelles thérapies antiangiogéniques. Le sunitinib (SUTENT®), le sorafenib (NEXAVAR®), et le bevacizumab (AVASTIN®) sont trois des quatre molécules acceptées à ce jour pour leurs utilisations dans le cancer du rein métastatique qui présentent une bonne tolérance démontrée au cours des différentes études. L’évidence clinique a fait du sunitinib le standard de référence en première ligne de traitement du cancer du rein métastatique, l’association bevacizumab + interféron alpha (IFN alpha) peut-être considérée comme une option. Le sorafenib est quant à lui recommandé en seconde ligne de traitement chez les patients réfractaires aux cytokines, le sunitinib étant aussi accepté dans cette indication. Des schémas d’associations de ces molécules sont en phase d’évaluation, leurs utilisations en phase néoadjuvante et adjuvante sont également étudiées et devraient changer, à moyen terme, la prise en charge de cette maladie.Renal cell carcinoma accounts for approximately 3% of all human malignancies. The use of cytokines in metastatic stage of disease has been the standard until last decades, presenting partial and short duration responses. Research on angiogenesis in renal carcinoma has brought important advances to understand tumor biology and to allow us development of new antiangiogenic drugs. Sunitinib (SUTENT®), sorafenib (NEXAVAR®) and bevacizumab (AVASTIN®) are actually three molecules accepted to use in metastatic renal cell carcinoma (mRCC), with a good tolerability demonstrated in different studies. Clinical evidence shows sunitinib to be reference standard of care for the first-line treatment of mRCC. The use of bevacizumab in combination with interferon alfa (IFN alfa) can also be considered in this setting. Sorafenib is recommended for second-line treatment in cytokine-refractory patients, sunitinib being also accepted in this situation. Other combination of these molecules and their use as neo-adjuvant and adjuvant therapy is being evaluated and should change in the short term the management of the disease.

Localization of hemangioma in retroperineum causes late diagnosis of the disease. The tumour is usually detected only when the clinical symptoms caused by the pressure of the surrounding tissues occur. This article presents the case of retroperitoneal hemangioma preoperatively diagnosed as suspect feochromocytoma.

Objectives: Genetic causes of sporadic and familial renal oncocytomas are not known. We analyzed these tumors genetically in order to detect tumor–specific chromosome alterations. Methods: DNA from 26 sporadic and 31 familial renal oncocytomas were screened by comparative genomic hybridization according to standard protocols including degenerate oligonucleotide–primed PCR. Results: Chromosome alterations were detected in 19/26 sporadic (73%) and in 4/31 familial renal oncocytomas (13%). Partial or complete losses of chromosome 1 were most frequently found in both sporadic (15/26) and familial tumors (2/4). Less frequently, loss of chromosome 14 (3/26) was detected in sporadic renal oncocytomas as well as losses of 2p, 2q, 4q, 10 and 18 and gains of 1q and 17q in individual sporadic tumors. Inter–tumor variation of chromosome aberrations was prominent in 1 patient, where 1 tumor showed gains of chromosomes 5, 6q, 7, 10p, 12 and 13q, whereas the second tumor exhibited gains of chromosomes 5 and 7 and loss of 10q. In contrast to sporadic renal oncocytomas, most familial tumors (87%) were devoid of chromosome instabilities. Conclusion: Our results demonstrate that partial or complete loss of chromosome 1 is the most common alteration in renal oncocytomas, sporadic and familial. However, chromosome changes are much rarer in familial than in sporadic renal oncocytomas.

The authors submit a detailed analysis of the death of a 42-year-old man after a second renal transplantation. The patient died with symptoms of cardiac failure in a septic condition of obscure etiology where even detailed examination did not provide a timely answer as regards the lethal pathogen. Aspergillus fumigatus is a rare lethal pathogen. Despite this it is, as all opportune infections, for patients with immunosuppressive therapy a serious life threatening infection [1, 2]. In a group of 650 transplantations performed since 1961 in Hradec Králové it is the first death caused by generalized Aspergillus infection.

The authors draw attention to an uncommon cause of obstructive ileus in children, i.e. malignant lymphoma of the small intestine in a 10-year-old boy.

In order to optimize the management of patients with renal cell carcinoma (RCC) it is important to define the genetic risk for metastatic disease. In this study we performed comparative genomic hybridization (CGH) on metastatic tumors aiming at the identification of genetic alterations associated with metastatic disease. We analyzed 46 renal tumors along with their metastases, and 15 non-metastatic renal tumors. Tumors were classified pathologically according to the Heidelberg classification of RCC, and staged according to the TNM-system. Standard CGH was performed using microdissected archival tissues and DOP-PCR. The average numbers of chromosomal aberrations per tumor were 3.0, 2.1 and 3.9 in patients without metastasis, in patients who developed metastases after a two-year latency period (late onset of metastatic disease) and in patients who developed metastases within two years after therapy of the primary tumor (early onset of metastatic disease). CGH revealed chromosomal aberrations in 91% of primary metastatic tumors. Deletions or losses of chromosomes 9 (26% vs 6%), 10 (21% vs 6%) and 18 (23% vs 0) and 17 (28% vs 7%) occurred more often in metastatic tumors than in non-metastatic tumors. Furthermore, these aberrations were more common in patients with early metastases. CGH analysis of 40 pairs of primary RCCs and their corresponding metastasis revealed similar aberrations in 70% of cases. In 30%, however, metastases showed additional chromosomal aberrations not detected in the corresponding primary tumors. In conclusion, we identified genetic alterations associated with metastatic disease in RCC which could be useful for predicting prognosis. Genetic changes leading to metastases occurred early in tumorigenesis of metastatic tumors.

Chromofobni karcinom ma specificke nejen biologicke chovani, ale take histologickou stavbu, histochemicke, ultrastrukturalni a cytogeneticke vlastnosti (1).

In the last years the incidence of renal cell carcinoma diagnosis increased about 15-20%. The main aim of this study was to analyse the reason of the increase of incidence. In the present autopsy series comprising 23,801 autopsies the percentage of patients who died of renal cell carcinoma is 1.77% in Jena and 1.55% in Königgrätz (200,000 inhabitants each). Over this time the incidence of renal cell carcinoma in autopsies has increased. In spite of the increased amount of incidentally found renal cell carcinomas since beginning widespread use of ultrasonography the percentage of clinically recognized renal cell carcinomas on the total of all found renal cell carcinomas in autopsies is nearly constant about the 12-year period in Jena and 10-year period in Königgrätz. Thus, the increased number of radical nephrectomies is not only caused by widespread use of ultrasonography. The increasing trend of the incidence of renal cell carcinoma seems to be real.

Summary In the last years the incidence of renal cell carcinoma diagnosis increased about 15–20 %. The main aim of this study was to analyse the reason of the increase of incidence. In the present autopsy series comprising 23.801 autopsies the percentage of patients who died of renal cell carcinoma is 1,77 % in Jena and 1,55 % in Königgrätz (200.000 inhabitants each). Over this time the incidence of renal cell carcinoma in autopsies has increased. In spite of the increased amount of incidentally found renal cell carcinomas since beginning widespread use of ultrasonography the percentage of clinically recognized renal cell carcinomas on the total of all found renal cell carcinomas in autopsies is nearly constant about the 12-year period in Jena and 10-year period in Königgrätz. Thus, the increased number of radical nephrectomies is not only caused by widespread use of ultrasonography. The increasing trend of the incidence of renal cell carcinoma seems to be real.

Objective: In recent years the incidence of renal cell carcinoma (RCC) diagnosis has increased about 15-20%. It remains to be established whether this increase of incidence is reality or not. The main aim of this study was to analyze the reason for the increase of incidence. Methods: In the present study, 23, 247 autopsies performed in the years 1985-1995 in the area of Jena (Germany) (14,793 autopsies) and Hradec Kralove (Czech Republic) (8,454 autopsies) were analyzed. Results: In this autopsy series comprising 23,247 autopsies, the percentage of patients who died of RCC is 1.76% in Jena and 1.55% in Hradec Kralove (200,000 inhabitants each). Over this time the incidence of RCC in autopsies has increased. Conclusion: In spite of the increased amount of incidentally found RCCs since beginning widespread use of ultrasonography, the percentage of clinically recognized RCCs in the total of all found RCCs in autopsies is nearly constant over the I I-year period in Jena and 10-year period in Hradec Kralove. Thus, the increased number of radical nephrectomies is not only caused by widespread use of ultrasonography. The increasing trend of the incidence of RCC seems to be real.

The authors submit the case-history of an adverse rapidly progressing phlegmon and septicaemia in a patient after transplantation of a cadaverous kidney with a functional graft. The patient was admitted repeatedly to the Transplantation Centre of the Urological Clinic, Faculty Hospital Hradec Králové with acute cellular rejection for corticosteroid treatment.