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Abbreviations: BPH = benign prostatic hyperplasia, FLASH = fast low-angle shot, SE « spin echo.

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Purpose: Ever since the recognition of the inverted papilloma as a distinct lesion of the urinary tract, there has been discussion about the possible (pre)malignant potential of this rare tumor, with subsequent uncertainty about followup. Hampering the discussion are the low frequency, the unknown etiology, the difficult histopathological diagnosis and the reported association with transitional cell carcinoma. We reviewed the literature and studied our patients, resulting in the largest series reported in the literature to date. Materials and Methods: We selected 51 patients with an inverted papilloma without a history of or a concordant transitional cell carcinoma of the urinary tract. Histology of all patients was reviewed.Results: After review, as many as 14 patients appeared to be misdiagnosed (transitional cell carcinoma in 11)* In 37 patients, we could confirm the diagnosis of inverted papilloma, with characteristics that were highly comparable to those described in the literature. Only 1 patient had a superficial bladder tumor after 49 months.Conclusions: Reviewing these data and our own results, we conclude that an inverted papil loma does not seem to be a risk factor for transitional cell carcinoma, although inverted papillomas and transitional cell carcinoma appear to be related to some extent. Therefore, frequent and long-term followup does not seem to be necessary provided that there is no doubt about the difficult histological diagnosis.

Aims-Investigation of the histopathological changes in prostatectomy specimens of patients with prostate cancer after high intensity focused ultrasound (HIFU) and identification of immunohistochemical markers for tissue damage after HIFU treatment. Methods-Nine patients diagnosed with adenocarcinoma of the prostate underwent unilateral HIFU treatment seven to 12 days before radical prostatectomy. The prostatectomy specimens were analysed histologically.Immunohistochemical staining and electron microscopy were performed to characterise more subtle phenotypic changes. Results-All prostatectomy specimens revealed well circumscribed HIFU lesions at the dorsal side of the prostate lobe treated. Most epithelial glands in the centre of the HIFU lesions revealed signs of necrosis. Glands without apparently necrotic features were also situated in the HIFU lesions, raising the question of whether lethal destruction had occurred. This epithelium reacted with antibodies to pancytokeratin, prostate specific antigen (PSA), and Ki67, but did not express cytokeratin 8, which is indicative of severe cellular damage. Ultrastructural examination revealed disintegration of cellular membranes and cytoplasmic organelles consistent with cell necrosis. HIFU treatment was incomplete at the ventral, lateral, and dorsal sides of the prostate lobe treated. Conclusions-HIFU treatment induces a spectrum of morphological changes ranging from apparent light microscopic necrosis to more subtle ultrastructural cell damage. All HIFU lesions are marked by loss of cytokeratin 8. HIFU does not aVect the whole area treated, leaving vital tissue at the ventral, lateral, and dorsal sides of the prostate.