Renal and Adrenal Tumors Biology and Management

by Belldegrun, Arie; Ritchie, Alastair W. S.; Figlin, Robert A.; Oliver, R. T. D.; Vaughan, Edwin Darracott

• ISBN13: 9780198508229
• ISBN10: 0198508220
• Format: Hardcover
• Copyright: 2003-04-24
• Publisher: Oxford University Press

Summary

In the past decade there has been an explosion of far-reaching developments in the biological and physical sciences relevant to cancer. The incidence and mortality from renal cell carcinoma has continuously risen over the past 50 years. Despite this survival for patients has notably improved and great strides have been made in the management of patients with renal cell carcinoma. Our understanding of the natural history of renal cell carcinoma, the role of nephrectomy, the benefits of immunotherapy and the possibilities of new technologies are evolving and are being integrated with advances in classification and staging. This book provides a comprehensive source of information on renal and adrenal tumors that will be of practical interest for students, residents, physicians, and researchers alike. It reviews comprehensively the current understanding of the biology, pathophysiology and urological oncology of the disease, looking at the clinical problems and potential solutions including chapters on both the scientific and clinical principles. Fully illustrated, the book emphasizes new advances in molecular biology, pathogenesis, detection and experimental therapeutics and focuses on new developments in clinical research. An international team of recognized experts have been brought together to provide historical perspectives, an overview of basic facts, and an assessment and exploration of the newer developments in our understanding of the clinical, genetic, and molecular aspects of these diseases. The book clearly distinguishes what is generally agreed upon from what is still contoversial, giving both sides equal treatment.

Table of Contents

List of contributors	xvii
Part I, Section 1 Anatomy, epidemiology, and pathology
Historical perspective: past, present, and future	3	(14)
Amnon Zisman
Jean B. deKernion
Beginnings	3	(1)
Early innovations	4	(1)
Macro, micro, nano, and pico: the story of the classification of renal tumors	5	(1)
Staging and grading: from clinical gut feeling to accurate prediction of outcome	6	(1)
From physical examination as a staging procedure to incidental tumor detection	7	(1)
Nephron-sparing surgery, the golden decade of endourology and minimally invasive medicine	8	(1)
Nephrectomy, the urological cholecystectomy?	9	(1)
From the legend of Saint Peregrine to combating metastasis with designer cells and molecules	10	(1)
Adrenal tumors	11	(2)
References	13	(4)
Renal and adrenal anatomy	17	(14)
John F. Redman
Graham F. Greene
Kidney	17	(5)
Renal collecting structures	22	(3)
Adrenal	25	(1)
Renal and adrenal relationships	26	(4)
References	30	(1)
Diagnosis and management of the incidental renal mass	31	(9)
Allan J. Pantuck
Mitchell K. Rauch
Amnon Zisman
Arie Belldegrun
Introduction and epidemiology	31	(1)
Differential diagnosis	32	(1)
Management	33	(3)
Minimally invasive surgery for the incidental renal mass---the future is now	36	(2)
Conclusion	38	(1)
References	38	(2)
Epithelial tumors of the kidney	40	(15)
Stephen Stoerkel
Andreas Hinkel
Introduction	40	(1)
Epidemiology	40	(1)
Etiology	41	(1)
Histological classification	41	(1)
Pathologic staging	42	(1)
Morphology of epithelial renal tumors	43	(3)
Immunohistochemistry of kidney tumors	46	(1)
Pathomorphologic classification and cytogenetic correlation	46	(2)
Other prognostic indicators	48	(1)
Clinical aspects	49	(1)
Essentials of routine treatment	50	(1)
References	51	(4)
Paraneoplastic manifestations of renal cell carcinoma	55	(6)
Nehal Masood
Philip J. Gold
John A. Thompson
Endocrine paraneoplastic syndromes	55	(3)
Non-endocrine paraneoplastic syndromes	58	(1)
Summary	59	(1)
References	59	(2)
Staging of renal cell carcinoma	61	(5)
J. Stuart Wolf, Jr
Diagnosis	61	(1)
Clinical staging	62	(2)
Pathologic staging	64	(1)
Summary	65	(1)
References	65	(1)
Tumor markers	66	(8)
Peter Mulders
Introduction	66	(1)
Tumor-specific proteins as markers in RCC	67	(1)
Nonspecific proteins or markers related to malignant cells in RCC	68	(2)
Cell-specific proteins overexpressed in malignant cells in RCC	70	(1)
Conclusion	71	(1)
References	72	(2)
Renal cell carcinoma in dialysis and transplantation	74	(7)
Neyssan Tebyani
H. Albin Gritsch
Incidence and epidemiology	74	(1)
Tumor characteristics	75	(1)
Renal cell carcinoma in transplantation	75	(1)
Detection and treatment of renal carcinoma in patients with end-stage renal disease	76	(1)
Summary	77	(1)
References	77	(4)
Part I, Section 2 Renal cell carcinoma: molecular genetics and immunobiology
Basic biology and clinical behavior of renal cell carcinoma	81	(9)
Allan J. Pantuck
Amnon Zisman
Arie Belldegrun
Introduction	81	(1)
Presentation: incidental versus symptomatic	81	(1)
Other patient-related factors	82	(1)
Tumor-related determinants of clinical behavior	82	(5)
The UCLA integrated staging system (UISS)	87	(1)
On the horizon	87	(1)
References	88	(2)
Molecular cytogenetics of renal cell tumors	90	(8)
Gyula Kovacs
Type of tumor	90	(4)
Model of development of renal cell tumors	94	(1)
Clinical application	94	(1)
Summary	95	(1)
References	96	(2)
Hereditary renal cell carcinoma and the von Hippel--Lindau gene	98	(13)
Jodie K. Maranchie
W. Marston Linehan
Introduction	98	(1)
Hereditary papillary renal cell carcinoma (HPRCC)	98	(1)
Hereditary oncocytoma	99	(1)
Hereditary clear cell renal cell carcinoma	100	(2)
The normal von Hippel--Lindau gene	102	(1)
Germline vhl mutations	103	(1)
Correlation with sporadic tumors	104	(1)
Biochemistry of vhl	104	(1)
The vhl cellular phenotype	105	(1)
VHL-associated proteins	105	(3)
Summary	108	(1)
Conclusion	108	(1)
References	108	(3)
Antigens recognized by T lymphocytes on renal cell carcinoma	111	(7)
Benoit J. Van den Eynde
Michael Probst-Kepper
Introduction: the melanoma paradigm	111	(1)
Isolation of CTL against renal cell carcinoma	112	(1)
Antigens recognized by CTL on renal cell carcinoma	113	(3)
Conclusion and perspectives	116	(1)
References	116	(2)
Monoclonal antibodies to renal cancer antigens	118	(8)
C. Divgi
E. Oosterwijk
M. Steffens
N. Bander
Role of the immune system in renal cancer	118	(1)
Normal and neoplastic kidney antigens defined by monoclonal antibodies	118	(3)
Phase I/II radioimmunotherapy	121	(1)
Clinical trials with chimeric (human/mouse) G250	122	(1)
Phase I protein dose escalation study	122	(1)
Phase I 131I-labeled cG250 radioimmunotherapy	122	(1)
Fractionated cG250 therapy	123	(1)
Fractionated radioimmunotherapy with 131I-labeled cG250	123	(1)
Summary	124	(1)
References	124	(2)
Tumor vaccines	126	(9)
Stephen J. Freedland
Amnon Zisman
Arie S. Belldegrun
Introduction and background	126	(1)
Unmodified tumor cells as vaccines	127	(1)
Cytokine-based tumor cell vaccines	128	(1)
Dendritic-cell-based tumor vaccines	129	(1)
Antibody-based tumor vaccines	130	(1)
References	130	(5)
New approaches for biological therapy of kidney tumors: preclinical models and perspectives	135	(9)
Robert H. Wiltrout
Jon M. Wigginton
Summary	135	(1)
Background	135	(1)
Transplantable rodent models for RCC	136	(2)
Carcinogen-induced models of rodent renal carcinoma	138	(2)
Preclinical models where the development of RCC is associated with defined genetic mutations	140	(1)
Orthotopic xenografts of human RCC in athymic mice	140	(1)
Prospects	141	(1)
References	141	(3)
Preclinical animal models for the investigation of biological approaches to the therapy of neuroblastoma	144	(12)
Jon M. Wigginton
Introduction	144	(1)
Transplantable models of murine neuroblastoma	144	(1)
Transgenic models of murine neuroblastoma	145	(1)
Xenograft models of human neuroblastoma	146	(1)
Utilization of preclinical models for evaluation of the biological therapy of neuroblastoma	146	(5)
Future prospects for the biological therapy of neuroblastoma	151	(1)
References	152	(4)
Angiogenesis in renal cell carcinomas	156	(9)
Jeff A. Wieder
Arie Belldegrun
Overview of angiogenesis	156	(1)
The role of angiogenesis in metastases	157	(1)
Measuring angiogenesis and angiogenic potential	157	(1)
Evidence for angiogenesis in renal cell carcinoma	158	(1)
Angiogenesis and the von Hippel--Lindau gene	159	(1)
Prognostic significance of angiogenic potential	159	(1)
Anti-angiogenesis therapy for RCC	159	(2)
Summary	161	(1)
References	161	(4)
Spontaneous regression and the natural history of renal cell cancer	165	(13)
R.T.D. Oliver
Spontaneous tumor regression in renal cancer and possible mechanisms to explain it	165	(2)
Response to therapy after exclusion of spontaneous regression compared with literature reports	167	(2)
Survival and randomized cytokine trials	169	(1)
Influence of spontaneous regression and lead-time bias on prognostic factor analyses	169	(1)
New approaches to prognostic factor analysis using simple peripheral blood parameters	170	(1)
Prognostic factor analysis and the need for adjuvant and neoadjuvant trials	171	(2)
Mechanism of spontaneous regression and its relative response in cytokine trials	173	(1)
The significance of tumors arising in immunosuppressed individuals to the natural history of renal cell cancer	173	(1)
Conclusion	174	(1)
References	175	(3)
Prognostic indicators: localized disease	178	(8)
Dieter Bruno
David F. Paulson
Introduction	178	(1)
Tumor-specific factors	178	(5)
Patient-specific factors	183	(1)
References	183	(3)
Prognostic factors in advanced renal cell carcinoma	186	(11)
Paul J. Elson
Patient- and disease-related factors	186	(4)
Cytogenetics	190	(1)
Immunological factors	190	(1)
Markers of cell proliferation, apoptosis, and metastasis	191	(1)
Conclusions	192	(1)
References	192	(5)
Part I, Section 3 Renal cell carcinoma: imaging and management
Evaluation of the renal mass and the role of renal biopsy	197	(27)
Ojas Shah
Samir S. Taneja
Renal mass presentation/detection	197	(1)
Is the renal mass solid or cystic?	198	(3)
Is the renal mass benign or malignant?	201	(10)
The role of percutaneous biopsy	211	(3)
Staging of the renal mass	214	(4)
Preoperative planning	218	(1)
References	219	(5)
Role of the excretory urogram in contemporary uroradiologic practice	224	(22)
Steven S. Raman
Sherelle Laifer-Narin
Sachiko T. Cochran
Indications and contraindications for the excretory urogram	224	(1)
Technique	224	(1)
The normal excretory urogram	225	(1)
Tumors of parenchymal origin	226	(13)
Tumors of the urothelium	239	(1)
The adrenal gland	240	(5)
Summary	245	(1)
References	245	(1)
Radiologic imaging: computerized tomography and magnetic resonance imaging	246	(12)
Zoran L. Barbaric
Terminology	246	(1)
Renal carcinoma	246	(9)
Adrenal cortical carcinoma	255	(1)
References	256	(2)
Ultrasound imaging	258	(10)
Sherelle Laifer-Narin
Cystic renal masses	258	(3)
Solid renal masses	261	(4)
Recently developed ultrasound techniques	265	(1)
Conclusions	266	(1)
References	267	(1)
PET imaging in renal cancer	268	(5)
Marc Seltzer
Jean Emmanuel Filmont
Background	268	(1)
Characterization of solid renal masses	269	(1)
Primary staging	270	(1)
Re-staging	270	(1)
Monitoring therapy	270	(1)
Conclusion	271	(1)
References	271	(2)
Therapeutic options for localized disease	273	(7)
James E. Montie
Ricardo Beduschi
Rationale for treatment decisions	273	(1)
Conservative management	273	(1)
Surgical management	274	(3)
Conclusion	277	(1)
Summary	277	(1)
References	278	(2)
Radical nephrectomy	280	(5)
Mark P.J. Wright
Alastair W.S. Ritchie
History	280	(1)
Preoperative preparation	280	(1)
Radical nephrectomy	280	(2)
Postoperative management	282	(1)
Laparoscopic radical nephrectomy	283	(1)
References	283	(2)
Inferior vena caval tumors	285	(13)
Andrea Sorcini
John A. Libertino
Clinical presentation and diagnosis	285	(3)
Classification and surgical approach	288	(6)
Prognosis	294	(1)
Summary	295	(1)
References	295	(3)
Laparoscopic radical nephrectomy	298	(11)
David Y. Chan
Louis R. Kavoussi
Introduction	298	(1)
Basic surgical principles	298	(4)
Clinical results	302	(5)
Conclusions	307	(1)
References	307	(2)
Nephron-sparing surgery	309	(9)
Reza Ghavamian
Horst Zincke
Introduction	309	(1)
Indications	309	(1)
Diagnosis	309	(1)
Preoperative preparation	310	(1)
Surgical considerations	310	(1)
Operative technique	310	(5)
Complications	315	(1)
Results of nephron-sparing surgery	316	(1)
Follow-up	317	(1)
References	317	(1)
Lymph node dissection	318	(6)
Amnon Zisman
Allan J. Pantuck
Arie S. Belldegrun
Introduction	318	(1)
The incidence of positive retroperitoneal lymph node dissection	318	(1)
The distribution of positive nodes in RCC patients	318	(2)
What is the benefit from improved staging offered by lymphadenectomy?	320	(1)
The therapeutic role of RPLND in RCC patients	320	(2)
The procedure	322	(1)
References	323	(1)
Surveillance strategies following surgery for renal cell carcinoma	324	(7)
Robert G. Uzzo
Andrew C. Novick
Introduction	324	(1)
The natural history of renal cell carcinoma	324	(1)
Who, when, where, and what of recurrent renal cell carcinoma	325	(3)
Stage-specific guidelines for surveillance following radical nephrectomy or nephron-sparing surgery	328	(1)
References	329	(2)
Adjuvant therapy for renal cell carcinoma	331	(3)
Joseph Baar
Donald L. Trump
Introduction	331	(1)
Adjuvant radiation therapy	331	(1)
Adjuvant hormonal therapy	331	(1)
Adjuvant immunotherapy	331	(1)
Adjuvant IFNα	332	(1)
Interleukin-2	332	(1)
Conclusion	332	(1)
References	332	(2)
Complications of surgery for renal cell carcinoma	334	(9)
John M. Corman
Introduction	334	(1)
Radical nephrectomy	334	(1)
Partial nephrectomy	335	(1)
Direct comparisons	336	(3)
Conclusion	339	(1)
References	339	(4)
Part I, Section 4 Renal cell carcinoma: metastatic disease
Immunologic therapy for renal cell carcinoma	343	(8)
Allan J. Pantuck
Amnon Zisman
Arie Belldegrun
Introduction	343	(1)
Historical perspective	343	(1)
Components of the immune response	343	(3)
New approaches in immunotherapy for RCC	346	(2)
Conclusions	348	(1)
References	349	(2)
Natural history and prognostic factors associated with metastatic renal cell carcinoma	351	(8)
David M.J. Hoffman
Robert A. Figlin
General description	351	(1)
Symptoms	351	(1)
Histologic types	352	(1)
Prognostic factors	352	(1)
Immunotherapy	353	(1)
Patterns of spread	353	(1)
Site-specific disease therapy	354	(1)
Radiation therapy	355	(1)
Role of nephrectomy	355	(1)
Conclusion	356	(1)
References	356	(3)
Radiation therapy: basic sciences	359	(8)
Jesse Aronowitz
Peter Hahn
Gabriel Haas
Historical perspective	359	(1)
Radiation physics and treatment planning	359	(2)
Classical radiobiology	361	(2)
Increasing the efficacy of therapy	363	(1)
Radiation pathology and radiation carcinogenesis	363	(2)
Molecular radiation biology	365	(1)
The productive use of radiotherapy in renal cancer	366	(1)
References	366	(1)
The use of systemic chemotherapy in the treatment of metastatic renal cell carcinoma	367	(14)
Lucy A. Godley
Nicholas J. Vogelzang
Introduction	367	(1)
Chemotherapy	367	(4)
Hormonal therapy	371	(1)
Immunotherapy	371	(1)
Combination chemo/hormonal/immunotherapy	372	(1)
Conclusions	372	(2)
References	374	(7)
Interferon for renal cell carcinoma	381	(7)
Eric J. Small
Robert J. Motzer
Introduction	381	(1)
Response assessment in renal cell carcinoma	381	(1)
Monotherapy with interferon	382	(2)
Interferon as part of combination therapy programs	384	(1)
Second-line therapy	385	(1)
Adjuvant therapy	385	(1)
Future directions	385	(1)
References	386	(2)
The role of interleukin in metastatic renal cell carcinoma	388	(12)
Ronald M. Bukowski
Introduction	388	(1)
Interleukin-2	388	(5)
Interleukin-4	393	(1)
Interleukin-12	394	(1)
References	395	(5)
Adoptive immunotherapy of renal cell cancer	400	(7)
Alfred E. Chang
Qiao Li
Guihua Jiang
Donna M. Sayre
Bruce G. Redman
Introduction	400	(1)
Lymphokine-activated killer (LAK) cells	400	(1)
Tumor-infiltrating lymphocytes (TIL)	401	(1)
Vaccine-primed lymph node (VPLN) cells	402	(2)
Discussion	404	(1)
References	405	(2)
Immunotherapy for metastatic disease---the French experience	407	(4)
Sylvie Negrier
Francais d'Immunotherapie
The CRECY trial	407	(2)
Studies of subcutaneous cytokine regimens	409	(1)
Discussion and perspectives	409	(1)
Conclusions	410	(1)
References	410	(1)
Cell-based therapy in the treatment of renal cell carcinoma	411	(13)
Barbara J. Gitlitz
Arie S. Belldegrun
Robert A. Figlin
Introduction	411	(1)
Adoptive immunotherapy	411	(5)
Other therapeutic cell populations	416	(1)
Dendritic cells (DC)	417	(2)
Conclusions	419	(1)
References	419	(5)
Role of nephrectomy in metastatic disease	424	(12)
Robert C. Flanigan
Paul Matthew Yonover
Introduction	424	(1)
Epidemiology	424	(1)
Prognostic factors	424	(1)
Role of palliative nephrectomy	425	(1)
Spontaneous regression	426	(1)
Angioinfarction plus nephrectomy	426	(1)
Nephrectomy with resection of metastases	427	(1)
Adjuvant therapies	427	(2)
Cytoreductive nephrectomy	429	(4)
Conclusion	433	(1)
References	433	(3)
Surgical resection of metastases	436	(11)
Joel W. Slaton
David A. Swanson
Introduction	436	(1)
Selection of patients for metastasectomy: general considerations	436	(1)
Results after solitary metastasectomy	437	(1)
Site-specific results of metastasectomy	438	(4)
Resection of metastatic disease after cytokine therapy	442	(2)
Summary	444	(1)
References	444	(3)
Gene therapy for metastatic kidney cancer	447	(9)
Nejd F. Alsikafi
Mitchell H. Sokoloff
Introduction	447	(1)
Principles and practice of gene therapy	447	(2)
Gene therapy for renal cell carcinoma	449	(4)
Conclusions	453	(1)
References	453	(3)
Brain metastases	456	(15)
Gregory J. Rubino
Incidence	456	(1)
Symptoms	456	(1)
Factors contributing to prognosis	456	(1)
Diagnosis	457	(1)
Treatment options	457	(8)
Treatment indications	465	(1)
Factors influencing treatment decision	466	(1)
References	467	(4)
Palliative therapy of advanced renal cell carcinoma	471	(8)
Sophie D. Fossa
Introduction	471	(1)
Specific anticancer treatment	472	(1)
Palliative surgery	472	(1)
Palliative radiotherapy	473	(1)
Treatment of symptoms	473	(2)
Quality of life and psychological distress	475	(1)
References	475	(4)
Part 2, Adrenal tumors
Imaging of adrenal masses	479	(7)
Susan Teeger
Nicholas Papanicolaou
E. Darracott Vaughan, Jr
Introduction	479	(1)
Adrenal adenomas	479	(1)
Adrenal carcinoma	479	(1)
Differentiating adrenal adenoma from metastasis	480	(2)
Other adrenal pathologies	482	(2)
Conclusion	484	(1)
References	484	(2)
Diagnostic tests of adrenal cortical and medullary function	486	(44)
Zhenqi Liu
Helmy M. Siragy
Robert M. Carey
Introduction	486	(1)
Steroid synthesis	486	(1)
Glucocorticoids	487	(14)
Mineralocorticoids	501	(9)
Androgens	510	(3)
Adrenal medulla	513	(9)
References	522	(8)
Selection of patients with incidentally discovered adrenal masses for operation	530	(6)
Masaru Murai
Ken Marumo
Introduction	530	(1)
Incidence	530	(1)
Pathology	530	(1)
Differential diagnosis of adrenal incidentaloma	531	(3)
Management of incidentally discovered adrenal masses	534	(1)
References	534	(2)
Diagnosis and treatment of primary aldosteronism	536	(7)
Jon D. Blumenfeld
E. Darracott Vaughan, Jr
Introduction	536	(1)
Diagnostic subsets	536	(1)
Diagnostic strategies	537	(3)
Medical treatment	540	(1)
Surgical outcomes	541	(1)
Summary	541	(1)
References	541	(2)
Adrenocortical carcinoma	543	(7)
Richard D. Schulick
Murray F. Brennan
Introduction	543	(1)
Incidence and demographics	543	(1)
Etiology	543	(1)
Classification and staging	544	(1)
Presentation	544	(1)
Diagnosis	545	(1)
Extent of disease	545	(1)
Treatment	546	(1)
Survival	547	(1)
Re-operative treatment	548	(1)
Follow-up	548	(1)
References	548	(2)
Pheochromocytoma	550	(8)
McClellan M. Walther
Graeme Eisenhofer
Karel Pacak
W. Marston Linehan
Introduction	550	(1)
Pathology	550	(1)
Clinical features	550	(1)
Differential diagnosis	551	(1)
Special clinical situations	551	(1)
Associated diseases	552	(1)
Hereditary forms of pheochromocytoma	552	(1)
Diagnostic evaluation	553	(1)
Current management	554	(1)
References	555	(3)
Congenital adrenal hyperplasia: 21-hydroxylase deficiency and 11β-hydroxylase deficiency	558	(8)
Maria I. New
Introduction	558	(1)
Steroidogenesis	558	(1)
Fetal development	559	(1)
21-Hydroxylase deficiency	559	(1)
11β-Hydroxylase deficiency	560	(2)
Treatment	562	(1)
Prenatal diagnosis and treatment	562	(1)
References	563	(3)
The surgical management of congenital adrenal hyperplasia	566	(8)
G. Bino Rucker
Dix P. Poppas
Introduction	566	(1)
Pathophysiology	566	(1)
Embryology	567	(1)
Treatment	567	(5)
Null allele subset of congenital adrenal hyperplasia	572	(1)
Conclusion	572	(1)
References	573	(1)
Open adrenalectomy: indications and surgical options	574	(7)
E. Darracott Vaughan Jr
Introduction	574	(1)
Adrenal surgery	574	(6)
Summary	580	(1)
References	580	(1)
Partial adrenalectomy: indications and technique	581	(4)
Christian P. Pavlovich
McClellan M. Walther
Indications	581	(1)
Technical considerations	582	(1)
Summary	583	(1)
References	583	(2)
Lateral transperitoneal laparoscopic adrenalectomy	585	(6)
Steven Shichman
R. Ernest Sosa
E. Darracott Vaughan, Jr
Introduction	585	(1)
Lateral transperitoneal operative technique	585	(2)
Discussion	587	(2)
Conclusion	589	(1)
References	589	(2)
Laparoscopic versus open adrenalectomy	591	(7)
Anoop M. Meraney
Inderbir S. Gill
Introduction	591	(1)
A comparison of laparascopic and open adrenalectomy	591	(2)
Laparoscopic adrenalectomy: transperitoneal versus retroperitoneal	593	(2)
Needlescopic adrenalectomy	595	(1)
Financial analysis: laparoscopic versus open adrenalectomy	595	(1)
Outpatient laparoscopic adrenalectomy	595	(1)
References	596	(2)
Laparoscopic adrenalectomy by the posterior lumbar approach	598	(5)
Shiro Baba
Masatsugu Iwamura
Introduction	598	(1)
Materials and methods	598	(1)
Surgical technique	598	(2)
Postoperative care	600	(1)
Results	600	(1)
Discussion	601	(1)
Conclusion	601	(1)
References	601	(2)
Acute and chronic interstitial cryotherapy of the adrenal	603	(6)
David A. Schulsinger
R. Ernest Sosa
Aaron P. Perlmutter
E. Darracott Vaughan, Jr
Introduction	603	(1)
Materials and methods	603	(1)
Results	604	(1)
Discussion	604	(3)
Conclusion	607	(1)
References	607	(2)
Index	609