Primary retroperitoneal mucinous cystadenocarcinomas (PRMCs) are rare. This is the first reported case in the literature in English of PRMC in a man. The 64-year-old man presented with a large retroperitoneal cystic tumour measuring 24620616 cm 3 , which was removed intact. Areas ranging from a benign mucinous cyst to borderline mucinous tumour to mucinous cystadenocarcinoma were observed on microscopy. Strong patchy staining for cytokeratins 7 and 20 and strong diffuse staining for MUC2 and MUC5AC core peptides, similar to staining patterns in ovarian mucinous tumours, were shown in the benign and atypical epithelium. Staining for CA19.9 and carcinoembryonic antigen was also shown by both components. The theory of its origin from the mucinous metaplasia of peritoneal (mesothelial) inclusion cysts, rather than from ectopic ovarian tissue or ovarian teratomas, is supported by the occurrence of such a tumour in a male patient. P rimary retroperitoneal mucinous cystadenocarcinomas (PRMC) are rare, with less than 20 reported cases in the literature in English, and all occurring in the female sex. We report the case of a PRMC in a male patient, the first such case to our knowledge. We describe the expression of cytokeratins and mucin core peptides, with a review of the literature. CASE REPORTA 64-year-old man presented with acute abdominal discomfort. Physical examination showed a palpable non-tender left flank mass. Both testes were descended and were clinically normal. A computed tomography scan showed a 19615 cm 2 retroperitoneal cystic mass occupying the left side of the abdominal cavity ( fig 1A). It was separate from the pancreas and left kidney, which were normal. Laparotomy showed a large cystic tumour attached to the left psoas muscle; it was excised intact. The patient recovered and had no evidence of recurrent disease 18 months after the operation. PathologyThe specimen received was an intact cyst measuring 24620616 cm 3 , with a smooth external surface and containing yellow-brown gelatinous material. The cyst wall was thin, with several small firm projections on the inner surface measuring 0.1-0.5 cm in diameter.When viewed microscopically, the cyst wall was mostly lined by cuboidal to columnar mucinous cells of the intestinal type. In most areas, the cells were single-layered, with no evidence of atypia. Occasional broad projections with fibrous cores covered by similar mucinous epithelium were seen. In foci, the cells were stratified (3-4 cells high), with mild to moderate atypia and mitotic activity. Stroma-free papillae ( fig 1B) and foci with signet-ring-type cells were also observed ( fig 1C). The fibrous cyst wall showed the presence of spaces containing mucin and lined by atypical cells.

Introduction: The R.E.N.A.L Nephrometry Score (RNS) was developed to standardise the reporting of anatomical information of a renal mass. This study aimed to identify the association of preoperative clinical and tumor features assessed by the RNS with pathological upstaging of clinical T1 renal cell carcinomas (RCCs) in complete en bloc radical nephrectomy (RN) specimens. Materials and Methods: A review was performed for 65 consecutive RN patients (2005RN patients ( -2013, performed for a unilateral clinical T1N0M0 RCC. The RNS was measured in all patients based on preoperative computer-tomographic scans. Pathological review was performed to identify patients with final pathological upstaging. Associations were assessed with Fisher's exact test, student t test and Wilcoxon rank-sum test. Results: Of the 65 patients (41 male, mean age 59 years), 4 (6%) patients were upstaged to pT2 and 16 (25%) were upstaged to pT3a and above in the final histology. Upstaged patients were not significantly different from those without in terms of age, gender, race, surgical approach, side, grade and cell type. Independent tumor features associated with pathological upstaging were (R) tumor diameter (p = 0.021), and (L) central location within polar lines (p = 0.010). Tumors which were upstaged had a higher median total RNS than those without (9 vs. 10, p = 0.010). Complex tumors, with RNS ≥10, were associated with significantly increased risk of upstaging compared with low and intermediate complexity categories (RNS < 10) (RR = 2.56, 95% CI 1.22-5.37, p = 0.014). Conclusions: A higher RNS was associated with an increased risk of upstaging in clinical T1 cancers, predominantly from perinephric or sinus fat invasion in RN pathological specimens. This may have implications on the selection of surgical option for the clinical T1 renal mass. COP-02Long term results of a double-blind randomised controlled trial of interferon alpha-2b and low dose BCG in patients with high risk nonmuscle-invasive bladder cancer Introduction: Bacillus Calmette-Gu erin (BCG) immunotherapy, at full-dose in a maintenance schedule of 36 months, reduces recurrence and progression of high risk non-muscle-invasive bladder cancer (NMIBC). However, many patients do not complete the full course due to its toxicity or non-compliance. We report long-term results of a trial to evaluate the efficacy and toxicity of reduced dose Connaught-strain BCG with interferon alpha-2b (IFNa-2b). Material and Methods: This was a prospective, randomised, double-blinded, controlled, multi-institution clinical trial in which 140 patients with Stage Ta or T1 bladder cancer and/or CIS were assigned to one of three therapies following transurethral resection. Patients received 6weekly intravesical instillations of full-dose BCG (81 mg) or low-dose BCG (27 mg) or low-dose BCG plus IFNa-2b (10 MU) followed by 3 weekly booster instillations 6 weeks after the 6th instillation. They underwent close surveillance with regular cystoscopy and urine cytology. End points were time to local rec...