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Sarcomas of the bladder occur rarely in adults. As a result, the natural history of these unusual tumors and the best methods of treatment are uncertain. We reviewed our experience with 13 patients presenting between 1970 and 1980 (5 had leiomyosarcoma, 5 had carcinosarcoma and 3 had rhabdomyosarcoma). Gross hematuria nearly always was the presenting symptom. Patients treated by partial cystectomy fared poorly, while 7 treated by radical cystectomy and supravesical urinary diversion had an excellent prognosis: 6 (86 per cent) have been free of disease for more than 1 year, including 4 who have survived more than 45 months without evidence of recurrence or metastasis.

Of 21 patients who underwent bench surgery for renal malignancies (renal cell carcinoma in 16 and transitional cell carcinoma in 5) 15 also had autotransplantation and 6 did not. In 5 patients the contralateral kidney was removed simultaneously for synchronous bilateral renal malignancy, and 16 had cancer in a solitary kidney. In the 3 patients who underwent nephrectomy for complications after autotransplantation no evidence of residual tumor was noted on histopathological examination. Of 9 patients 1 (11 per cent) had local recurrence after successful autotransplantation (renal cell carcinoma). Two patients with transitional cell carcinoma died of metastatic disease. Treatment failed in 31 per cent of the 16 patients with renal cell carcinoma (metastatic disease in 4 and metastatic disease with local recurrence in 1). Removal of solitary or synchronous bilateral renal cell cancer by bench surgery with subsequent autotransplantation is effective. For high grade transitional cell carcinoma of a solitary kidney its value is doubtful without adjuvant systemic treatment.

A prospective study was done to evaluate the roles of serum N-acetylneuraminic acid (NANA) and the lipid-bound subfraction of sialic acid (LSA) concentrations in the detection and staging of cancer, and the follow-up of treatment in patients with genitourinary malignancies. Multiple determinations were obtained in 177 subjects: 90 normal volunteers, 38 patients with prostate cancer, 20 patients with bladder cancer, 15 patients with renal cell cancer, and 14 patients with benign urologic diseases. The results showed a low incidence of elevated values in patients with early stages of cancer and a high incidence of false-positive values with serum NANA concentrations in patients with benign urologic diseases, especially prostatitis. Serum NANA and LSA concentrations were highly correlated with the stage and grade in patients with advanced urologic cancer, and may be used as markers of tumor activity during follow-up under treatment; currently, however, they are not useful in the screening of patients for urologic cancer. Their usefulness in prostatic cancer is at least comparable to that of acid phosphatase determinations by the enzymatic and radioimmunoassay methods, which were elevated in a smaller percentage of patients with prostate cancer than were the NANA or LSA concentrations.

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