Objectives To evaluate the role of regional lymph node dissection (LND) in a series of patients with renal cell carcinoma (RCC) with no suspicion of nodal metastases before or during surgery. Patients and methods A series of 167 patients with RCC, free from distant metastases at diagnosis, and who underwent radical nephrectomy at our hospital between January 1990 and October 1997, was reviewed. The mean (median, range) follow-up was 51 (45, 19±112) months. Of the 167 patients, 108 underwent radical nephrectomy alone and 59 had radical nephrectomy with regional LND limited to the anterior, posterior and lateral sides of the ipsilateral great vessel, from the level of the renal pedicle to the inferior mesenteric artery. Of these 59 patients, 49 had no evidence of nodal metastases before or during surgery. The probability of survival was estimated by the Kaplan±Meier method, using the log-rank test to estimate differences among levels of the analysed variables. Results The overall 5-year survival was 79%; the 5-year survival rate for the 108 patients who underwent radical nephrectomy alone was 79% and for the 49 who underwent LND was 78%. Of the 49 patients with no suspicion of lymph node metastases, one (2%) was found to have histologically con®rmed positive nodes. Conclusion These results suggest that there is no clinical bene®t in terms of overall outcome in undertaking regional LND in the absence of enlarged nodes detected before or during surgery.
BACKGROUND The TNM classification system considers tumor size and, in particular tumor, greatest dimension as the only prognostic indicator for intracapsular renal cell carcinoma (RCC). The objective of the current study was to evaluate the role of nuclear grading and its importance as a prognostic indicator in patients with intracapsular (T1‐T2) RCC. METHODS A retrospective study was performed on 213 patients with RCC limited to the kidney who were free from distant metastases at the time of diagnosis and who underwent radical nephrectomy from January 1990 to November 1999. All patients were staged according to the 1997 TNM classification system. Nuclear grading was determined according to the criteria proposed by Fuhrman et al. The patients' status was evaluated last in November 2000. The mean follow‐up was 52 months (range, 12–130 months). The probability of survival was estimated by using the Kaplan‐Meier method, with the log‐rank test used to estimate differences among levels of the analyzed variables. A multivariate Cox proportional hazards model was performed to estimate the relative importance of the variables in predicting survival. RESULTS The 5‐year disease specific survival rates for patients with pT1 and pT2 tumors were 93.5% and 61.1%, respectively. The 5‐year disease specific survival rates for patients with Grade 1, Grade 2, and Grade 3–4 tumors were 95.9%, 86.8%, and 60.1%, respectively. A comparison of the survival curves both by stage and grade showed a statistically significant difference. For patients with pT1 lesions, the 5‐year disease specific survival rate was 94.2% for patients with Grade 1–2 disease and 89.8% for patients with Grade 3–4 disease. For patients with pT2 lesions, the 5‐year disease specific survival rate was 72.2% for patients with Grade 1–2 disease and 20% for patients with Grade 3–4 disease. CONCLUSIONS Within intracapsular tumors that measure > 7.0 cm in greatest dimension, nuclear grade is an important morphologic variable for predicting long‐term survival. Identification of patients with nuclear Grade 3–4 tumors is important prognostically to determine the metastatic potential of pT2 tumors, because this subgroup of patients may benefit from adjuvant immunotherapy. Cancer 2002;94:2590–5. © 2002 American Cancer Society. DOI 10.1002/cncr.10510
A 31-year-old man presented with a 2-week history of left groin pain associated with redness and discomfort at the base of the penis. He denied any history of dysuria, frequency or urethral discharge. He reported having at least five female sexual partners within the previous year. Physical examination included a normal retractile foreskin. There was a 1.5 cm erythematous, indurated cord-like lesion on the dorsal aspect of the base of penis. Blood and urinary tests were normal. A clinical diagnosis of Mondor's phlebitis of the penis was made. The patient was treated with diclofenac and a broad-spectrum antibiotic, and subsequently discharged. Four weeks later the patient returned complaining of a
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