الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
RCC is the most common malignancy in the adult kidney. It is a highly aggressive neoplasm and represents the most lethal of urologic malignancies.Predicting the prognosis of RCC patients becomes essential for planning and optimizing treatment strategies .The prognosis of RCC is usually affected by such factors as performance status, pathological stage, nuclear grading, tumor size, and microscopic tumor necrosis. Yet, the accuracy of the traditional clinical and histologic markers is still unsatisfactory in certain clinical settings.FoxM1 is expressed only in proliferating cells while its expression is extinguished in differentiated or resting cells .It has been proposed that FoxM1 plays a major role in tumor proliferation, progression, angiogensis, migration and resistance to chemotherapy.Ki67, a marker of tumor proliferation has been shown to be a prognostic marker in several neoplasms. In trial to elucidate new prognostic factors for clear cell renal cell cacinoma, and to predict the patients’ outcome, the present study was carried out to evaluate the immunohistochemical expression of FoxM1 and Ki67 in relation to each other and to other clinicopathological variables which include patient -related factors such as age and sex of the patient, and tumor-related variables including tumor size, nuclear grade, tumor stage, metastatic status, renal vein invasion and patients’ outcome. A group of non clear cell renal cell carcinoma was studied for comparison. To achieve these aims, 30 cases of CCRCC and 10 cases of non CCRCC that underwent surgical resection at Alexanderia University Hospital were studied .The clinical, radiological and pathological data of all cases were collected from Pathology and Urosurgery departments, Faculty of Medicine, University of Alexandria. The age of the patients ranged from 30 to73 with a mean age of 53.73±10.58 years and male to female ratio 2.08:1.The tumor size was ≥ 7cm in 21 cases (52.5%) and >7cm in 19 cases (47.5%).The histological subtypes were stratified using AJCC/UICC classification. The most commonly encountered type was CCRCC: 30 cases (75%).The Fuhrman nuclear grade of CCRCC cases was as follows: 3 cases (10%) were nuclear grade I, 14 cases (46.7%) were nuclear grade II, 8 cases (26.7 %) were nuclear grade III and 5 cases (16.7%) were nuclear grade IV.Fuhrman nuclear grade of non CCRCC cases was as follows: one case (10%) was nuclear grade I, 3 cases (30%) were nuclear grade II and 6 cases (60%) were nuclear grade III. Patients were staged according to 2009 TNM classification system and TNM supplement 2012 in CCRCC, 8 cases (26.7%) were stage I, 5 cases (16.7%) were stage II, 6 cases (20%) were stage III and 11 cases (36.7%) were stage IV. Regarding non CCRCC, 3 cases (30%) were stage I, 6 cases (60%) were stage III and one case (10%) was stage IV.The patients’ outcome for the 30 cases of CCRCC included in the present study was as follows; 18 cases (60%) showed no evidence of disease, 5 cases (16.7%) were alive with disease and 7 cases (23.3%) died of their disease. Concerning non CCRCC, 9 cases (90%) showed no evidence of disease and one case (10%) was died of disease