H. J. Rumpelt

This paper reports on 32 chromophobe cell renal carcinomas observed in 697 renal cell cancers (RCC) of adults (peak in the sixth decade of life). The chromophobe cell-type differs from other types of RCC macroscopically, the cut-surface being predominantly of grey-beige colour. Histologically, there are two variants: one is the typical (light) variant (n = 22) and the other is eosinophilic (n = 10). Both variants have in common (a) reaction of the cytoplasm with Hale's acid iron colloid; (b) electron microscopic detection of cytoplasmic microvesicles (150-300 nm), frequently with 'inner vesicles', and (c) low glycogen content in comparison with the clear cell carcinoma. Immunocytochemical investigations on the intermediate filaments show a positive reaction for cytokeratins No. 18 (uniformly) and Nos. 7 and 19 (to varying extents) for both variants, whereas vimentin was not found in any of these carcinomas, in contrast to the clear-cell type. The cytomorphological grading revealed predominantly G II tumours. A lymph node metastasis was found in one patient. On the basis of the mortality curves determined, the prognosis for patients with chromophobe cell carcinomas is more favourable than that of the clear-cell type. In terms of differential diagnosis, on the one hand, the typical (light) variant of the chromophobe cell RCC must be delimited from the clear-cell RCC, and on the other hand, the eosinophilic variant must be distinguished from the chromophilic or 'granular' RCC. Microscopic, histological, histochemical, electron microscopic, and intermediate filament analysis results document that the chromophobe cell type of RCC is a distinct entity. The implications for the nomenclature of RCC, especially with regard to the 'granular' type, are discussed.

Summary. 1. The effect of parenteral administration of fructose and sorbitol on hepatic adenosine phosphates (AP) and intermediates of carbohydrate metabolism was examined in man and rat.—2. Intravenous injection of fructose rapidly decreases ATP, total adenosine phosphates (AP), and inorganic phosphate in the liver of fed male and female rats. The depletion in hepatic ATP and total AP is also observed in the regenerating rat liver following partial hepatectomy. Equimolar administration of sorbitol has the same effect on liver AP has that observed following fructose, while glucose administration produces no significant changes.—3. In man i.v. infusion of 0.6–0.8 g/kg body weight of fructose or sorbitol reduces hepatic ATP to about 50 %, and total AP to about 65 % of initial values. Glucose has no effect. Blood AP content is not affected by intravenous infusion of 500 ml of 10 % fructose in man.—‐4. Fructose distinctly increases the content of various hexose phosphates and triose phosphates in the liver of man. Fructose‐1‐phosphate accumulates 4‐to 5‐fold and α‐glycerophosphate 3‐fold during infusion of 0.6–0.8 g/kg body weight of fructose within 30 minutes.—5. RNA‐synthesis in the regenerating rat liver following partial hepatectomy as neasured by incorporation of 6‐ 14 C‐orotic acid is distinctly inhibited by i. v. injection of 1.6 g of fructose kg. The incorporation rate of 1‐ 14 C‐D, L‐leucine into rat liver protein drops to 35 % of initial levels within 10 minutes after the same amount of fructose, whereas glucose has no inhibitory effect.—6. Both ATP and Pi are important inhibitors of AMP degradation. Thus the drop in total AP content can be explained by the increased breakdown of the latter. This assumption is supported by the observation that injection of fructose plus equimolar amounts of Pi reduces the decrease in total AP, but not in ATP content. The concentration of the final product of AMP degradation, uric acid, increases distinctly following i. v. fructose administration in man.—7. These results indicate that in clinical medicine infusion of large doses of fructose or sorbitol have more disadvantages than advantages compared to glucose.

Bellini duct carcinomas have recently been identified as a new entity in the spectrum of renal cell carcinomas and 10 cases have now been reported. The present paper adds detailed clinical and morphological data on six new cases. In addition, immunohistological and electronmicroscopical results support the origin of these tumours from the renal collecting ducts, especially the papillary ducts (Bellini ducts). A set of immunohistological reactions, including reactions to cytokeratins 13 and 19, vimentin and UEA-1 was found to facilitate the differential diagnosis of Bellini duct carcinomas from other renal cell carcinomas and infiltrating urothelial carcinomas of renal pelvis.