The management of nevoid basal-cell carcinomas in this syndrome is sometimes very difficult, because of the high number of tumors and of their particular localizations. The authors reviewed the literature and here report their experience in the treatment of nevoid basal-cell carcinoma syndrome with aromatic retinoid etretinate (RO 10-9359; Tigason).

Appropriate management and prognosis of patients with penile carcinoma depends on an accurate knowledge of the regional node status. The usefulness of clinical and radiologic examinations in detecting the nodal spread of the disease is limited by the high rates of false-positive and false-negative results. On the other hand, routine or prophylactic lymphadenectomy is associated with 30% to 50% of the major morbidity and 3% of the mortality rate, so that caution is advisable for its use in patients with disease-free nodes. Even bilateral sentinel lymph node biopsy, as proposed by Cabanas, does not warrant an adequate selection of patients candidates to surgical treatment. The role of aspiration biopsy cytology in the management of penile carcinoma was evaluated in a study of 29 cases from the authors' institutions. Aspiration under fluoroscopic or computed tomographic guidance was performed using a 22-23-gauge Chiba needle. The accuracy of aspiration biopsy cytology in identifying the true stage of the disease was 100%. On histologic control, only one node contained malignant cells that were not detected by aspiration biopsy cytology, but this finding did not alter the stage of the patient. Positive cytology is conclusive of Stage III disease and, in this case, a curative lymphadenectomy may be attempted. Negative aspirations do not warrant the absence of metastatic nodal involvement as can be seen in two patients in this series. In such cases, however, a policy of "wait and watch" may be adopted, with repeated aspiration biopsies or surgical biopsy of the sentinel node area.

We report the computerized tomography and ultrasound-guided aspiration cytology results in the first case of renal cell carcinoma with bilateral adrenal involvement. The adrenal metastases were evident clinically 6 years after radical nephrectomy and were treated successfully by an operation. Aspiration cytology under computerized tomographic and sonographic guidance is an excellent procedure to evaluate enlarged adrenal glands in patients with renal cell carcinoma or other malignant neoplasms.

Whereas urine cytology has proved to be of considerable diagnostic value for nonpapillary urothelial carcinoma, carcinoma in situ, and high-grade urothelial tumors, controversy has arisen over the accuracy of cytology in the diagnosis of renal neoplasms. To establish the reliability of urine cytology as a detection technique, 436 urine specimens from 59 patients with histologically proven renal adenocarcinoma were examined. Malignant cells in urinary sediment were found in 121 (27.75%) specimens from 31 (52.54%) patients. Seven of 20 (35%) patients with Stage I tumor showed neoplastic cells in 16 (16.5%) of 97 urinary samples. Positive cytologic features were found in 36.9% of 84 urinary specimens from 7 (50%) of 14 patients with tumors smaller than 5 cm. Using only imaging methods, the renal neoplasm was diagnosed in 58 (98.3%) cases. Urine cytology is, therefore, of little value in the diagnostic evaluation of known renal masses and in the detection of early-stage disease. In the current series there was not a single case with positive cytologic findings in which radiology did not reveal the tumor. The cytologic examination of the urinary sediment is unreliable in the diagnosis of radiologically unresolved cases of renal neoplasms. In 15 patients (44%) who had cancer cells in the urine the neoplasm had not invaded the renal pelvis. In 36% of patients with negative urine cytologic findings the renal pelvis was involved by renal adenocarcinoma. In the current study the desquamation of neoplastic cells in the urinary stream did not depend on tumor invasion of the renal pelvis. Based on the assumption that the primary objective of a screening procedure is to achieve an adequate sensitivity for early detection of disease, the results led the authors to conclude that the use of urine cytology as a possible screening test of renal adenocarcinoma is futile. Factors in the current study that diminished the practical value of cytologic examination of urinary sediment included the large number of specimens without malignant cells and the insensitivity of the procedure in diagnosing early renal adenocarcinoma of limited extent. Although this is the largest series reported, the number of cases considered was limited and further detailed studies are mandatory to definitively clarify the value of urine cytology in detecting renal adenocarcinoma.

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