CA9 as a molecular marker for differential diagnosis of cystic renal tumors

ObjectiveCA9 is proven to be a powerful marker for clear cell renal cell carcinoma. The studies on CA9 have been limited to solid renal cell carcinomas (RCC). We have conducted a study of CA9 expression in renal cystic tumors. The purpose of the present study was to extend the utility of CA9 for cystic renal tumors.Materials and methodsImmunohistochemistry and enzyme-linked immunosorbent assay (ELISA) were used to detect CA9 expression in cystic renal tumors. Forty-three cystic renal tumors (22 benign and 21 malignant) were included for the immunohistochemical staining. Thirty-six patients with a cystic renal mass (20 malignant and 16 benign cystic tumors) were studied to measure CA9 level in the fluid by ELISA. Sixteen cysts (9 malignant and 7 benign cysts) were subjected both to immunohistochemistry and CA9 measurement in the fluid.ResultsUsing immunohistochemical staining, all the benign cystic renal tumors including the 18 simple cyst and 4 benign multilocular cystic nephromas did not express CA9. All 13 cystic clear cell RCC were scored as strong staining for CA9. For 8 multilocular clear cell RCC, 7 were scored as strong staining for CA9 and the other one was negative. There was a significant difference in positive percentage (P < 0.001) between the 2 groups of malignant and benign cysts. For the 16 benign cysts, the mean concentration of CA9 in the fluid of cyst was 162 ± 133 pg/ml (median: 0 pg/ml; range: 0–2140 pg/ml). For the 20 malignant renal cystic tumors, the mean concentration of CA9 in the fluid of cyst was 2043 ± 62 pg/ml (median: 2,140 pg/ml; range: 1,112–2,140 pg/ml). There was a significant difference in mean concentration of CA9 between the two groups of malignant and benign cysts (P < 0.001). The presence or absence of CA9 expression measured by immunohistochemistry and ELISA test was concordant in 14 out of 16 cases (88%).ConclusionsMalignant cystic renal tumors expressed strongly CA9 while the benign renal cysts did not express CA9. CA9 can be detected in the fluid of malignant cystic renal tumors. CA9 is a promising molecular marker to differentiate the malignant cystic renal tumors from the benign cysts.     

Matrix metalloproteinase-2 in a murine model of infantile-type polycystic kidney disease

It was previously found that elevated levels of matrix metalloproteinase (MMP)-2 (gelatinase A) and -9 (gelatinase B) were synthesized and secreted into the medium by cultured kidney tubules derived from cystic C57BL/6J-cpk mice. To determine whether increased synthesis and secretion occur in vivo in this mouse model of polycystic kidney disease, kidney protein extracts, mRNA, and tissue sections were compared for expression and activity of MMP-2 and -9. Although both MMP were detected in tissue extracts, the differences in expression levels and activity in normal and cystic kidneys were far greater for MMP-2. High levels of MMP-2 seemed to result from increased expression by the cystic kidneys predominantly in the second and third postnatal weeks (a time when the kidneys are undergoing rapid cystic enlargement). Much of the increased MMP was present in the inactive zymogen form, although active enzyme was readily detected by sodium dodecyl sulfate-polyacrylamide gel zymography and in situ zymography. MMP-2 was abnormally localized to the interstitium and to foci between cysts, suggesting that MMP-2 may regulate collagen accumulation at those sites, thus allowing cyst enlargement and limiting the severity of interstitial fibrosis.     

Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts,serous cystadenomas,mucinous cystic neoplasms,and mucinous cystadenocarcinoma.

Pancreatic cystic lesions include inflammatory pseudocysts, benign serous tumors, and mucinous neoplasms, some of which are malignant. Clinical and radiologic indices are often inadequate to discriminate reliably among these possibilities. In an attempt to develop new preoperative diagnostic criteria to assist in decisions regarding therapy, the authors have performed cyst fluid analysis for tumor markers (carcinoembryonic antigen: CEA, CA 125, and CA 19.9), amylase content, amylase isoenzymes, relative viscosity, and cytology on 26 pancreatic cysts. The cases included nine pseudocysts, five serous cystadenomas, 4 mucinous cystic neoplasms, 7 mucinous cystadenocarcinomas, and one mucinous ductal adenocarcinoma with cystic degeneration. Carcinoembryonic antigen levels were high (> 367) in all benign and malignant mucinous cysts, but were low (< 23) in the pseudocysts and benign serous cystadenomas, an indication that CEA discriminates between mucinous and nonmucinous cysts (p < 0.0001). Values for CA 125 were high in all malignant cysts, low in pseudocysts, and variable in mucinous cystic neoplasms and serous cystadenomas. Levels of Ca 19.9 were nondiscriminatory. Cyst fluid amylase and lipase content were variable but were generally high in pseudocysts and low in cystic tumors. Amylase isoenzyme analysis was useful to differentiate pseudocysts from cystic tumors. Measurement of the relative viscosity in cyst fluid showed high (> serum viscosity) values in 89% of mucinous tumors and low values (< serum) in all pseudocysts and serous cystadenomas (p < 0.01). Cytologic analysis of cyst fluids was of limited value in differentiating pseudocysts from serous cystadenoma, but in seven of eight mucinous tumors provided useful diagnostic information and correctly classified three of five malignant tumors. The authors conclude that cyst fluid analysis can provide a preoperative classification of these diagnostically difficult lesions. The combination of viscosity, CEA, CA 125, and cytology can reliably distinguish malignant cystic tumors and potentially premalignant mucinous cystic neoplasms from pseudocysts and serous cystadenomas. Amylase content with isoenzyme analysis is useful to identify pseudocysts.     

Lectin peroxidase conjugate reactivity in acquired cystic disease of the kidney

The origins of acquired cysts, hyperplastic epithelia of cyst walls, and renal cell carcinomas were investigated by evaluating their lectin conjugate reactivity. Paraffin-embedded blocks from 9 patients with acquired cystic disease were examined by the high-sensitivity lectin-antilectin immune peroxidase method. 11-176 lesions in each patient, 690 lesions in total, were stained both with Tetragonolobus lotus lectin (T) and peanut lectin (P); the former is specific for proximal tubules and the latter for distal tubules and collecting ducts. Out of 606 acquired cysts with single-layered epithelia, 559 (92.2%) were positive for T and negative for P, and 66 out of 75 (88.0%) cysts with hyperplastic multilayered epithelia were positive for T and negative for P. Three out of 4 solid adenomas and, to varying degrees, 5 renal carcinomas revealed the same reaction. These results suggest that almost all cysts accompanying acquired cystic disease of the kidney, including those with single-layered and multilayered epithelia, as well as solid adenomas and renal cell carcinomas, are derived from proximal tubules.     

Expression of CA 72-4 (TAG-72) in the fluid contents of pancreatic cysts. A new marker to distinguish malignant pancreatic cystic tumors from benign neoplasms and pseudocysts.

OBJECTIVE: The authors evaluated cyst fluid CA 72-4 as a tumor marker in the differential diagnosis of pancreatic cystic lesions. SUMMARY BACKGROUND DATA: Pancreatic cystic lesions include inflammatory pseudocysts, serious cystadenomas, and mucinous tumors. Mucinous tumors can be further subdivided into mucinous cystadenocarcinomas and premalignant mucinous cystic neoplasms. The clinical and radiologic features of these lesions are unreliable to make a preoperative diagnosis of these diagnostically difficult lesions. Analysis of aspirated cyst fluid was proposed as an aid to making the preoperative differential diagnosis. Currently, a number of parameters have been reported as useful markers in cyst fluid aspirates, including the tumor markers carcinoembryonic antigen and CA 15.3, enzymes (amylase, lipase, and amylase isoenzymes), relative viscosity, and cytologic analysis. However, owing to the rarity of pancreatic cystic tumors, experience with cyst fluid analysis is limited. To define additional markers that might be useful in the differential diagnosis of pancreatic cysts, the authors measured the tumor-associated glycoprotein 72 (TAG-72) in aspirates from 19 pancreatic cystic lesions. METHODS: Cyst fluid from 19 pancreatic cysts was obtained by needle aspiration. The tumor marker TAG-72 was measured by a commercial (CA 72-4) immunoassay. RESULTS: Cyst fluid CA 72-4 levels in mucinous cystadenocarcinomas were markedly elevated (mean, 10,027 U/mL; range, 780 to 34,853 U/mL) compared with that in pseudocysts (mean, 3.8 U/mL; range, < 3 to 5.7 U/mL) and serous cystadenomas (mean and range, < 3 U/mL; p < 0.001). The level of CA 72-4 in benign mucinous cystic neoplasms was intermediate (mean, 44.2 U/mL; range, < 3 to 137 U/mL), but it was statistically different from either carcinomas (p = 0.009) or benign cysts (p < 0.001).     

Computed tomography for the diagnosis of a renal mass

The accuracy of differential diagnosis of renal mass lesions by computed tomography (CT) was evaluated. A retrospective study was done on 23 patients with renal mass lesion suspected by conventional IVP. Cases studied included 6 renal cell carcinomas, 1 nephroblastoma, 2 transitional cell carcinomas of renal pelvis, 3 parapelvic cysts, 2 polycystic kidneys and 9 other benign renal lesions. CT, especially with enhancement, is advantageous for evaluation of the extent of the tumor and also for the differentiation between cystic and solid masses by their attenuation. However, angiography and venography could provide valuable information for surgery of malignancy; and, retrograde pyelography also would help in assessing the extent of tumor spread in the renal pelvis. Two of our cases of parapelvic cyst and a case of renal bleeding could not be distinguished accurately by CT. Sonography or other diagnostic procedures might be helpful in such cases.     

Cystic vestibular schwannomas: a possible role of matrix metalloproteinase-2 in cyst development and unfavorable surgical outcome

OBJECT: The authors evaluated the clinical manifestations and surgical results in patients with cystic vestibular schwannoma (VS), and investigated the matrix metalloproteinase (MMP) expression of the cyst fluid and wall in an attempt to elucidate the pathogenesis and characteristics of this disease. METHODS: The clinical and neuroimaging features, perioperative findings, and surgical outcomes in 24 cases of cystic VS and 82 cases of solid VS, all of which were treated using the suboccipital approach, were retrospectively compared. To evaluate the role of MMP in cystic VS, gelatin zymography and immunohistochemical studies of the cyst fluid, wall, and solid portion were performed in nine cases of this disease. The mean duration of symptoms was shorter (14.0 months compared with 26.1 months; p = 0.04) and the mean size of the tumor was larger (43.8 mm compared with 34.2 mm; p = 0.048) in the cystic than the solid VS group. Although gross-total resection was easier to accomplish in this group (100% compared with 84.1%), adhesion to the facial nerve was more frequent (62.5% compared with 48.8%; p = 0.042). On gelatin zymography studies, MMP-2 expression was ubiquitously observed in all cyst fluids. Immunohistochemical analysis of the cyst wall showed that MMP-2 was apparently localized to the tumor cells on the luminal inner surface, adjacent to the cyst cavity. CONCLUSIONS: Resection of cystic VS is complicated by severe adhesion of the tumor capsule to the facial nerve and the large size of the lesion. The authors believe that MMP-2 may be involved in the pathogenesis of cyst formation or in its enlargement and may aggravate adhesion to the facial nerve, either by promoting the enlargement of the tumor or engendering the degradation of the tumor-nerve barrier proteolytically.     

超声造影检查在肾脏非典型占位性病变诊断中的价值

目的:探讨超声造影检查对肾脏非典型占位性病变的诊断价值。方法:回顾性分析2015年5月至2019年6月北京大学第一医院收治的44例肾脏非典型占位性病变患者的常规超声和超声造影检查资料。男26例,女18例。年龄(55.9±13.7)岁。44例共47个占位,均行常规超声检查观察肿物的位置、大小、回声、边界、彩色血流情况,做出常规超声诊断。行超声造影检查观察肿物增强时相、增强水平、增强模式、是否有环状增强,做出超声造影诊断。将超声检查诊断与最终病理或临床诊断进行比较。绘制受试者工作特征(ROC)曲线,比较常规超声和超声造影检查对肾脏非典型占位性病变的诊断效能。结果:本研究47个病灶中,诊断为恶性15个,良性32个。19个病灶经手术病理诊断,分别为肾细胞癌13个、肾淋巴瘤2个、肾囊肿3个、炎性肉芽肿1个;28个经增强CT或MRI检查诊断为良性肿瘤或假性肿瘤,且定期随访≥1年无变化,分别为血管平滑肌脂肪瘤5个、囊肿15个、肾连接部皮质缺损3个、肾柱肥大2个、未萎缩肾实质1个、驼峰肾1个、瘢痕1个。常规超声检查病灶最大径(2.5±1.3)cm。肾细胞癌常规超声检查以低回声多见(8/13);超声造影检查以快进快出为主(9/13),多为不均匀低增强(6/13),9个发现假包膜,6个发现坏死。2个肾淋巴瘤常规超声检查均为低回声;超声造影检查均为快进快出,等增强1个,低增强1个。5个肾血管平滑肌脂肪瘤常规超声检查为高回声;超声造影检查以慢进慢出为主(4/5),低增强2个,高增强2个,等增强1个。肾囊肿常规超声检查以无回声多见(16/18);超声造影检查,单纯性肾囊肿无增强,复杂性肾囊肿囊壁或分隔薄且均匀强化,呈慢进慢出、等增强或低增强。炎性肉芽肿常规超声检查呈囊实性;超声造影检查实性部分与肾实质同步强化,呈低增强。肾柱肥大、驼峰肾和局限性未萎缩肾实质常规超声检查为低回声;超声造影检查为与肾实质同进同出的均匀等增强,无明显包块轮廓出现。肾连接部皮质缺损和瘢痕常规超声检查为高回声,超声造影检查自始至终无增强。常规超声检查将1个炎性肉芽肿、1个未萎缩肾实质、2个复杂肾囊肿误诊为恶性,2个高回声肾细胞癌误诊为良性;超声造影检查仅将1个炎性肉芽肿误诊为恶性。常规超声检查对良恶性病变诊断的敏感性为86.7%,特异性为87.5%,准确性为87.2%,ROC曲线下面积0.871。超声造影检查对良恶性病变诊断的敏感性为100.0%,特异性为96.9%,准确性97.9%,ROC曲线下面积为0.984。常规超声与超声造影检查的ROC曲线下面积比较差异有统计学意义(P=0.03)。结论:超声造影检查对肾脏非典型占位性病变的诊断效能优于常规超声检查,对于常规超声检查诊断困难的肾肿瘤,以及酷似肾占位病变的良性病变和解剖异常的诊断和鉴别诊断具有优势。     

Acquired renal cystic disease after liver transplantation in children

To our knowledge, the development of renal cystic disease that may contribute to kidney dysfunction has never been reported after liver transplantation. Herein we have reported on the fortuitous finding of renal cystic lesions upon computed tomographic scans (CT) in 33 (30%) of 108 pediatric liver transplant recipients who were the subjects of a prospective study evaluating long-term kidney dysfunction at 10 years after liver transplantation. The renal lesions had 2 different appearances: that of simple renal cysts and that of round lesions that were spontaneously hyperdense before contrast injection. These high-density lesions had a low signal on T2 weighted sequences, but 70% of them had been missed at ultrasonography. Their aspect upon CT and magnetic resonance favored cystic lesions filled with hemorrhagic or milk calcium content. Both types of cystic lesions were associated in 14 children. The renal lesions were significantly associated with moderate renal dysfunction, biopsy-proven chronic liver graft rejection, and thrombosis of the retrohepatic vena cava. The physiopathology of these lesions is undetermined. Two important questions need to be clarified with respect to the risk of progression of renal dysfunction associated with individual volume changes and/or increased number of renal cysts, as well as the risk of renal cancer as has been reported in dialyzed patients with acquired cystic kidney disease.     

Sirolimus ameliorates the enhanced expression of metalloproteinases in a rat model of autosomal dominant polycystic kidney disease.

BACKGROUND: Remodelling of matrix and tubular basement membranes (TBM) is a characteristic of polycystic kidney disease. We hypothesized that matrix and TBM degradation by metalloproteinases (MMPs) could promote cyst formation. We therefore investigated the renal expression of MMPs in the Han:SPRD rat model of autosomal dominant polycystic kidney disease (ADPKD) and examined the effect of sirolimus treatment on MMPs. METHODS: 5-week-old male heterozygous (Cy/+) and wild-type normal (+/+) rats were treated with sirolimus (2 mg/kg/day) through drinking water for 3 months. RESULTS: The mRNA and protein levels of MMP-2 and MMP-14 were markedly increased in the kidneys of heterozygous Cy/+ animals compared to wild-type +/+ as shown by RT-PCR and Western blot analyses for MMP-2 and MMP-14, and by zymography for MMP-2. Strong MMP-2 expression was detected by immunoperoxidase staining in cystic epithelial cells that also displayed an altered, thickened TBM. Tissue inhibitor of metalloproteinases-2 (TIMP-2) expression was not changed in Cy/+ kidneys. Sirolimus treatment leads to decreased protein expression of MMP-2 and MMP-14 in Cy/+, whereas MMP-2 and MMP-14 mRNA levels and TIMP-2 protein levels were not affected by sirolimus. CONCLUSION: In summary, in kidneys of the Han:SPRD rat model of ADPKD, there is a marked upregulation of MMP-2 and MMP-14. Sirolimus treatment was associated with a marked improvement of MMP-2 and MMP-14 overexpression, and this correlated also with less matrix and TBM alterations and milder cystic disease.     

Elevation of serum levels of metalloproteinase-1, tissue inhibitor of metalloproteinase-1 and type IV collagen, and plasma levels of metalloproteinase-9 in polycystic kidney disease

Several studies on polycystic kidney disease (PKD) have revealed a number of extracellular matrix (ECM) abnormalities, suggesting that an abnormal ECM plays a role in the development of tubular cysts. Cystic kidney tubules synthesize and secrete high levels of metalloproteinases (MMP), which may participate in the restructuring of the tubular basement membrane. The aim of the present study was to determine whether serum MMP-1, tissue inhibitor of metalloproteinase (TIMP)-1, and type IV collagen levels, and plasma MMP-9 levels were altered in patients with PKD. Sixteen patients with autosomal dominant polycystic kidney disease, and 20 healthy controls were included in this study. Specific enzyme immunoassays were used to measure MMP-1, MMP-9, TIMP-1, and type IV collagen levels. Serum MMP-1 (14.8 +/- 3.6 ng/ml), TIMP-1 (288.6 +/- 48.6 ng/ml), and type IV collagen (192.6 +/- 38.8 ng/ml) concentrations, and plasma MMP-9 (90.2 +/- 26.8 ng/ml) concentrations in patients with PKD were significantly higher than those in healthy controls (MMP-1; 6.6 +/- 0.9 ng/ml, p < 0.01, MMP-9; 36.4 +/- 12.2 ng/ml, p < 0.01, TIMP-1; 164.6 +/- 22.8 ng/ml, p < 0.01, and type IV collagen; 86.6 +/- 14.2 ng/ml, p < 0.001). The present results suggest that ECM abnormalities associated with cystic kidney may result from aberrant degradation as well as from abnormal synthesis of ECM components.     

Characterization of matrix metalloproteinases in human urine: alterations during adolescence

 Matrix metalloproteinases (MMPs) are a family of at least 14 zinc-dependent proteinases that have been implicated in matrix turnover under both normal and pathological conditions. Previous studies have shown that several MMPs are produced in various cell types in the kidney, suggesting that MMPs may be involved in renal morphogenesis and remodelling. Using a variety of techniques, including gelatin and casein zymography, gelatin affinity chromatography, immunoblotting, and immunoprecipitation, we have identified the major gelatinases in human urine as MMP-2 and MMP-9. Latent forms of both enzymes were detected in urine, as well as lower molecular mass species of each, consistent with activated forms of MMP-2 and MMP-9. MMP-2 and MMP-9 were also measured in individual human urine samples (n=40). No significant gender differences in MMP concentrations were detected. However, renal MMP expression appeared to be age dependent; the highest average amounts of urine MMP-2 were detected during adolescence, while the converse was true of urine MMP-9. Together, these findings indicate that under normal conditions, human urine contains MMP-2 and/or MMP-9, suggesting that these two MMPs are normally produced within the kidney, where they may regulate normal renal remodelling and matrix homeostasis in an age-specific manner. Received: 9 February 1998 / Revised: 27 July 1998 / Accepted: 28 July 1998     

彩色多普勒超声引导介入治疗肾囊性病变387例

目的：总结彩色多普勒超声引导下介入治疗肾囊性病变的远期疗效。探讨彩色多普勒超声引导下介入穿刺治疗肾囊性病变的穿刺要点。方法：对387例良性肾囊性病变（其中单纯性肾囊肿291例、多囊肾96例）,其中男229例,女158例,年龄11岁～91岁,平均48.6岁。囊肿直径最大143mm×129mm,最小32mm×30mm。对387例良性肾囊性病变采用实时彩色多普勒超声引导穿刺硬化治疗,对直径〉80mm及囊内感染者治疗后保留导管持续引流。结果：单纯性肾囊肿中77例治疗后随访2年,214例随访6个月,266例囊肿完全消失、无复发;25例治疗后囊肿直径小于30mm,随访期内囊肿无明显增大。96例接受穿刺抽液硬化治疗多囊肾患者,治疗后随访6～24个月,肾功能得到不同程度改善或未继续恶化者70例,26例患者肾功能进行性下降。结论：实时超声引导可提高穿刺治疗肾囊肿的准确性,该法简便易行、创伤小、疗效可靠、并发症少,有较高的应用价值。     

Matrix metalloproteases in BAL fluid of patients with cystic fibrosis and their modulation by treatment with dornase alpha

BACKGROUND: Matrix metalloproteinases (MMPs) are involved in the remodelling and degradation of extracellular matrix and may play a role in pulmonary tissue destruction in cystic fibrosis (CF). METHODS: Bronchoalveolar lavage (BAL) fluid levels of MMP-8, MMP-9, and their natural inhibitor TIMP-1 were measured on two occasions within 18 months in 23 children with mild CF, 13 of whom were treated with DNase. RESULTS: MMP-8 (39.3 (6.8) v 0.12 (0.01) ng/ml), MMP-9 (58.0 (11.4) v 0.5 (0.02) ng/ml), and the molar ratio of MMP-9/TIMP-1 (0.36 (0.05) v 0.048 (0.01)) were significantly higher in patients with CF than in control children without lung disease. Gelatine zymography showed the typical banding pattern of neutrophil derived MMP-9, including 130 kDa NGAL-MMP-9 complex and 92 kDa latent MMP-9 bands; 85 kDa bands (corresponding to active MMP-9) were seen in all patients. There was a close correlation between BAL fluid concentrations of MMPs and alpha(2)-macroglobulin, a marker of alveolocapillary leakage. After 18 months MMP levels were increased in untreated patients and decreased in patients treated with DNase. CONCLUSIONS: Uninhibited MMPs may contribute to pulmonary tissue destruction even in CF patients with mild lung disease that may be positively affected by treatment with DNase.     

C-erb B-2 amplification in cystic renal disease.

Gene amplification (overexpression) of c-erb B-2 was tested in a variety of cystic renal diseases, renal cell neoplasms (adenomas and carcinomas) and end stage kidneys without cysts. C-erb B-2 encodes a receptor-like protein that shares homology with, but is distinct from the epidermal growth factor (EGF) receptor. A monoclonal antibody that immunoprecipitates a protein of approximately 185 kD from a lysate of NIH/3T3 cells transfected with the c-erb B-2 gene was utilized for testing. Simple renal cysts, cystic renal dysplasia, autosomal recessive polycystic kidney disease (ARPKD), and non-cystic, essentially normal kidneys failed to show c-erb B-2 overexpression. In contrast, autosomal-dominant polycystic kidney disease (ADPKD), acquired (dialysis-associated) cystic disease (ACD), non-cystic end stage kidneys and renal cell neoplasms revealed overexpression of c-erb B-2 with some frequency (40% or more of cases tested). Three cystic disorders revealing c-erb B-2 overexpression also showed platelet-derived growth factors (PDGFs) expression in similar locations (cyst lining and adjacent tubules). Other growth factors [insulin-like growth factor (IGF-I), fibroblast growth factor (FGF) and beta transforming growth factor (TGF beta)] were not noted to be overexpressed in either c-erb B-2 positive or negative cystic diseases. C-erb B-2 may be a marker related to the proliferative/growth capabilities of selected cystic diseases, including potential for associated genesis of benign and malignant renal cell tumors.     

Human Kallikrein 8 Expression in Salivary Gland Tumors

The human kallikrein 8 protein (KLK8) is expressed in many normal tissues including esophagus, skin, testis, tonsil, kidney, breast, and salivary gland, and is found in biological fluids including breast milk, amniotic fluid, seminal fluid and serum. It has also been shown to be a biomarker and prognostic factor for breast cancer. The aim of this study was to determine whether KLK8 is expressed in salivary gland tissues and salivary gland tumors (both benign and malignant), in order to compare normal with tumor tissues. Pleomorphic adenomas, adenoid cystic carcinomas, polymorphous low grade adenocarcinomas, acinic cell carcinomas, mucoepidermoid carcinomas, and adenocarcinomas NOS of both minor and major salivary glands were examined. The results of this study indicate that most salivary gland tumors show high levels of expression of KLK8.     

Intraoperative ultrasound during renal parenchymal sparing surgery for hereditary renal cancers: a 10-year experience

PURPOSE: We review our 10-year experience with intraoperative ultrasound during renal parenchymal sparing surgery in patients with hereditary renal cancers. MATERIALS AND METHODS: Between 1991 and 2000, 68 nephron sparing procedures were performed on 26 women and 27 men, all but 1 of whom had a hereditary predisposition to renal cancer, for example von Hippel-Lindau, hereditary papillary renal cancer. Intraoperative ultrasound was performed after the surgeon removed all visible or palpable lesions. High frequency transducers (7 MHz.) and color Doppler were used in all cases. Lesions were characterized as simple cysts, complex cysts or solid masses, and were recorded on a map. RESULTS: A total of 935 lesions (mean 12.8 lesions per kidney) were removed in 68 nephron sparing operations performed on 53 patients. Of these lesions 870 were removed without while 65 required intraoperative ultrasound. In 17 of 68 (25%) procedures intraoperative ultrasound identified renal cancers that were not detectable by the surgeon. Mean tumor size of ultrasound detected lesions was 1.0 cm. (range 2 mm. to 4 cm.). Of the 32 cystic lesions identified by intraoperative ultrasound 5 contained renal carcinoma, and 29 of the 33 solid renal masses were renal cell carcinomas. During reoperations ultrasound enabled the surface of the kidney to be evaluated even when it was inaccessible due to scar tissue or adherent perinephric fat. CONCLUSIONS: Intraoperative ultrasound can be performed after all visible lesions have been removed and identifies additional tumors in 25% of patients with hereditary renal cancer, thus ensuring that as many tumors as possible have been removed during renal parenchymal sparing surgery.