Microvascular invasion is an independent and relevant clinical prognostic parameter for low clinical stage renal cell carcinoma.

The higher frequency of bcl-2 immunostaining in tumor samples was observed in association with more advanced Gleason scores and suggests that an increase in the ratio of this anti-apoptotic protein often occurs during progression of prostate cancers.

An 81 y/o man presented with a transitional cell carcinoma and underwent a transurethral resection. Adjuvant onco-BCG was introduced. After 9 months of follow-up, a local tumoral recurrence occurred and a new transurethral resection revealed sarcomatoid carcinoma with osseous elements. A radical cystoprostatectomy was then carried out.

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CONTEXT: Renal cell carcinoma is the third most frequent genitourinary neoplasia, and there is currently an increase in the incidental diagnosis of tumors confined to the kidneys. OBJECTIVE: To study the survival of patients with incidental and symptomatic renal tumors who have undergone nephrectomy.DESIGN: Retrospective. SETTING: Hospital Sírio Libanês and Beneficência Portuguesa de São Paulo. PARTICIPANTS: 115 patients with diagnosis of renal cell carcinoma, operated on by the same group of surgeons and evaluated by a single pathologist. MAIN MEASUREMENTS: Sex, age and diagnosis method, analyzed in two groups, according to the tumor diagnosis: Group 1 with incidental diagnosis and Group 2 with symptomatic tumors. The anatomopathological characteristics and patient survival in both groups were evaluated. A statistical analysis was performed using the Student t, chi-squared, log rank and Kaplan-Meyer tests. RESULTS: Among the studied patients, 59(51%) had an incidental diagnosis, with 78% diagnosed by ultrasonography, 20% by computerized tomography scan and 2% during surgeries; 56 patients (49%) were symptomatic. Tumor locations were equally distributed between the two kidneys, and the surgery was conservative for 24% of the incidental and 9% of the symptomatic group. In the incidental group only one patient had tumor progression and there was no death, while in the symptomatic group there were 5 progressions and 10 deaths. The 5-year specific cancer-free survival was 100% in the incidental and 80% in the symptomatic group (p = 0.001) while the disease-free rate was 98% in the incidental and 62% in the symptomatic group (p < 0001). CONCLUSION: Incidental renal tumor diagnosis offers better prognosis, providing longer disease-free survival.

Incidentally discovered CCR have more favorable pathological characteristics, the patients have disease free survival when compared to symptomatic CCR.

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RESUMO -OBJETIVOS. O comportamento do carcinoma de células, porém já existem propostas para modificá-lo novamente 7,8,9 . Estudos atuais relatam excelentes resultados com cirurgia conservadora 10 , no entanto a maioria não compara a sobrevida entre os pacientes com tamanhos tumorais distintos.Nós, retrospectivamente, avaliamos o tamanho tumoral e a presença de fatores prognósticos na recorrência e sobrevida dos pacientes com CCR com objetivo de rediscutir o ponto de corte do atual T1(TNM-1997), julgando que existe uma diferença substancial no prognóstico dos tumores a partir de 4 cm de diâmetro. MÉTODOSNo período entre janeiro de 1988 e julho de 1999, 128 pacientes com CCR foram operados por um mesmo grupo de cirurgiões nos Hospitais Sírio Libanês e Beneficência Portuguesa de São Paulo sendo avaliados retrospectivamente. A avaliação pré-operatória compreendeu exames hematológicos e exames de imagem como a ultra-sonografia (US), tomografia computadorizada (TC) e/ou ressonância nuclear magnética, urografia excretora, cinti- lografia óssea e radiografia de tórax. O seguimento pós-operatório variou entre 2 e 138 meses (mediano: 33 meses). Os pacientes foram consultados sobre a participação no estudo através de carta informativa e termo de consentimento pós-informação e posteriormente foi feita análise retrospectiva através dos dados de prontuário. Destes, foram excluídos oito pacientes porque tinham material anatomopatológico insuficiente para revisão ou este era inconclusivo.As informações clínicas resgatadas destes prontuários incluíram idade, sexo, rim acometido, data do diagnóstico, apresentação clínica inicial, propedêutica, histórias pregressas, antecedentes pessoais e familiares, terapia cirúrgica realizada (radical ou conservadora), laudo anatomopatológico e seguimento pós-operatório.Todo material anatomopatológico (lâ-minas coradas com H.E e fragmentos blocados em parafina) foi revisado ao microscópio ótico por um único patologista. O acompanhamento pós-operatório foi realizado no consultório e quando a última consulta se deu há mais de três meses houve