KEY OF DEFINITIONS FOR ABBREVIATIONS:Renal tumor enucleation allows for maximal parenchymal preservation. Identifying pseudocapsule integrity is critically important in nephron sparing surgery by enucleation. Tumor invasion into and through capsule may have clinical implications although it is not routinely commented on in standard pathologic reporting. We sought to describe a system to standardize the varying degrees of pseudocapsule invasion and to identify predictors of invasion. Materials and Methods:A multicenter retrospective review was carried out between

Background: Following to approval of Pembrolizumab for patients with advanced NSCLC, PD-L1 IHC 22C3 pharmDx (Dako) was adopted as a companion diagnostic test. While PD-L1 IHC 28-8 pharmDx (Dako) was established as a complementary diagnostic for Nivolumab. Recently many groups demonstrated the intra-tumor heterogeneity of these PD-L1 expressions, but there have been a few reports about the intra-patient or inter-tumor heterogeneity. We aimed to investigate the inter-tumor heterogeneity of PD-L1 IHC 22C3 and 28-8 pharmDx (Dako). Method: Between December 1, 2014 and May 7, 2018, total 517 patients with NSCLC underwent surgical resection at our hospital. We excluded all patients with no informed consent, with no lymph node metastasis, with chemotherapy/radiotherapy before surgery and with never enough volume of material for genetic testing. Finally, 35 formalin-fixed paraffin-embedded primary tumors with paired metastatic lymph nodes were available in this study. After staining by PD-L1 IHC 22C3 and 28-8 pharmDx (Dako) respectively, we counted tumor cells exhibiting membrane staining and calculated Tumor Proportion Score (TPS). Afterward, all cases were classified into three subgroups as follows; No Expression (TPS: <1%), Low Expression (TPS: 1-49%) and High Expression (TPS: 50%). Result: Average age of 35 patients was 66.8 years old and there were 10 females (28.6%), 10 never smokers (28.6%), 27 adenocarcinomas (77.1%) and 11 tumors with EGFR mutation. The number of cases in No Expression, Low Expression and High Expression in 22C3 were 7 (20.0%), 22 (62.8%) and 6 (17.1%) in primary tumor, meanwhile 18 (51.4%), 13 (37.1%) and 4 (11.4%) in metastatic lymph node, respectively. The concordant rate was 28.6% between TPS subgroups in primary tumor and that in metastatic lymph node. About 28-8 antibody, No Expression, Low Expression and High Expression were 8 (22.9%), 21 (60.0%) and 6 (17.1%) in primary tumor, meanwhile 18 (51.4%), 11 (31.4%) and 6 (17.1%) in metastatic lymph node, respectively. The concordant rate was 31.4% between TPS subgroups in primary tumor and that in metastatic lymph node. Conclusion: Our result demonstrated apparent discrepancy of TPS between primary tumor and metastatic lymph node in both PD-L1 IHC 22C3 and 28-8.

Introduction:To evaluate the clinical significance of discordant stone analyses in patients undergoing bilateral ureteroscopy.Methods: A retrospective chart review was performed for all patients undergoing stone extraction with bilateral ureteroscopy at our institution in an aim to identify patients who had bilateral stone analysis and 24-hour urine chemistry data available. Stones were then classified based upon the dominant present (>50%). Twenty-four hour urinalysis results were reviewed and statistical analysis performed comparing discordant and concordant patient populations, assessing significant differences that would potentially influence clinical management. Results:We identified 79 patients (158 renal units) who had bilateral stones removed at the time of ureteroscopy. The majority of stones were classified as calcium oxalate (CaOx) (60.1%) followed by calcium phosphate (CaP) (27.8%), brushite (5.1%), uric acid (UA) (4.4%

Introduction and Objective: The folate receptor (FR) protein is upregulated in numerous epithelial malignancies while having limited expression on normal tissues. This overexpression of FR in renal-cell carcinoma (RCC) can be exploited by attaching nearly any therapeutic or imaging agent for delivery to cancer cells. In one of its first applications, platinum-resistant ovarian cancer, folate was used to deliver pegylated liposomal doxorubicin (a folate-linked vinca alkaloid) and improved progression-free survival versus standard treatment. RCCs are thought to be the second highest FR-expressing cancer. OTL-38 is a folate analogue conjugated with a fluorescent dye that emits light in the near infrared spectrum. This longer wavelength allows for deeper penetration of the fluorescent light through tissues with the potential to better image tumors beneath adipose tissue or deeper into organ parenchyma. We are currently conducting a pilot, phase 2, nonrandomized study in patients with RCC, scheduled to undergo primary, partial, or radical nephrectomy. The aim is to explore the use of OTL-38 and fluorescence imaging to observe RCC at the margins of resection in partial nephrectomy and in lymph node(s) or other metastases for radical nephrectomy. Methods: Currently two patients have participated in the trial to date with an accrual target of 20 patients. The first was a 67-year-old male with an incidental 2.2 cm right-sided renal mass, and the second was a 70-year-old male with an enlarging 2 cm renal mass. Per protocol, both patients were administered OTL-38 in the preoperative area 1 hour before the procedure. Subsequently, both procedures were performed with robotic assistance as per normal routine with the use of Firefly fluorescence to aid in observation of OTL-38 uptake. Results: Intraoperative guidance through OTL-38 demonstrated minimal to no uptake of the OTL-38 as seen by Firefly fluorescence (green color). Surprisingly, the normal renal parenchyma showed strong uptake of OTL-38 as seen by Firefly fluorescence. Both pathology reports revealed conventional clear cell RCC. Immunohistochemistry slides of the tumor revealed only mild staining for folate. In contrast, immunohistochemistry slides of the normal renal parenchyma in the surgical margin revealed a strongly positive stain for folate. Conclusions: In conclusion, our first two patients' renal tumors did not stain strongly for folate; however, the normal renal parenchyma did, which served as an intraoperative guide to confirm a negative margin. Further study of patients will reveal whether folate receptors are, in fact, predominant or not in renal cell cancer.No competing financial interests exist.

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