We strongly recommend extended radical lymphadenectomy to all patients undergoing radical cystectomy for bladder cancer to remove all metastatic tumor deposits completely. The operation can be conducted in routine clinical practice and our data may serve as a guideline for future standardization and quality control of the procedure.

Forceps, brushes or needles are currently the standard tools used during flexible bronchoscopy when diagnosing endobronchial malignancies. The new biopsy technique of cryobiopsy appears to provide better diagnostic samples. The aim of this study was to evaluate cryobiopsy over conventional endobronchial sampling.A total of 600 patients in eight centres with suspected endobronchial tumours were included in a prospective, randomised, single-blinded multicentre study. Patients were randomised to either sampling using forceps or the cryoprobe. After obtaining biopsy samples, a blinded histological evaluation was performed. According to the definitive clinical diagnosis, the diagnostic yield for malignancy was evaluated by a Chi-squared test.A total of 593 patients were randomised, of whom 563 had a final diagnosis of cancer. 281 patients were randomised to receive endobronchial biopsies using forceps and 282 had biopsies performed using a flexible cryoprobe. A definitive diagnosis was achieved in 85.1% of patients randomised to conventional forceps biopsy and 95.0% of patients who underwent cryobiopsy (p,0.001). Importantly, there was no difference in the incidence of significant bleeding.Endobronchial cryobiopsy is a safe technique with superior diagnostic yield in comparison with conventional forceps biopsy.

Patients with medullary thyroid carcinomas (MTC) were analyzed according to age, sex, and tumor stage. In addition, the MTC were screened for the predominant histologic pattern, immunocytochemical spectrum (60 tumors), and DNA content (DNA cytophotometry and DNA flow cytometry, 25 tumors). These findings were correlated with follow-up data available for 45 of these patients. Fortyeight percent of the tumors revealed a polygonal cell pattern, whereas 22% showed spindle-cell predominance. All tumors contained cytokeratin, chromogranin A, and calcitonin (CT). Calcitonin gene-related peptide (CGRP) was present in 92%, carcinoembryonic antigen (CEA) in 77%, neuron-specific enolase (NSE) in 75%, and vimentin in 53% of cases. Positivity for neurotensin, somatostatin, neurofilaments, bombesin, and alpha human chorionic gonadotropin (a-hCG) and serotonin ranged between 3% and 27%. All MTC were negative for substance P, adrenocorticotropic hormone (ACTH), thyroglobulin (TG), or S-100 protein. h l recurrences and regional lymph node metastases revealed identical staining patterns as the primaries. Prognosis of MTC was found not to be related to histologic features (dominant architectural pattern, cellular shape, presence of amyloid deposits) or immunocytochemical pattern. Instead, survival was significantly correlated to age, sex, and stage of disease. The best prognosis was seen in women younger than 40 years and revealing an early stage of disease. DNA measurements added valuable information in assessing the prognosis of MTC. Cancer 61:806-816, 1988. EDULLARY THYROID carcinoma (MTC) com-M prises only 3% to 12%' of all thyroid carcinomas. Despite its rarity it has attracted great attention because of its distinctive biological, morphologic, and functional features. Medullary thyroid carcinoma occurs both in a sporadic and inherited form and has an almost equal sex ratio.'-3 Its biological behavior is generally regarded to be intermediate between the anaplastic and the differentiated thyroid carcinomas. However, patients with MTC show great variability in survival, which can vary from months to 30 years after diagnosis.' Due to the From the *Institutes of Pathology, University of Hamburg, General Hospitals ?Hamburg-Altona and §Hamburg-Harburg. West Germany. the IlUniversity of Basel, Switzerland. and the $ tumor's rarity, investigations of a correlation between clinicopathologic criteria and prognosis in a large series of MTC patients are sparse. The current study therefore relates detailed morphologic features, immunocyto-chemical data, DNA content, tumor stage, age, and sex to the survival of 45 patients with MTC. Materials and Methods Formalin-fixed, paraffin-embedded material obtained from surgical specimens of 60 primary MTC was analyzed , In 13 of these cases, material of local recurrences (n = 6) and/or regional lymph node metastases (n = 9) also was available. Five lymph node metastases had been removed together with the primary, whereas the remaining four metastases and the local recurrences had been resected betw...