From pure testicular Teratoma to primitive neuroectodermal tumor: Successful management of Teratoma malignant transformation with widespread metastases in a young adult.

Midline retroperitoneal masses in young males often present a diagnostic challenge, with metastases from testicular origins being a primary consideration. Beyond the initial pathology of testicular cancer, these masses can undergo transformation, including the development of teratomas. This report describes an unusual case of a calcified retroperitoneal mass originating from a testicular pure teratoma that underwent a rare transformation into a Primitive Neuroectodermal Tumor (PNET), comprising approximately 85 % of the tumor volume. The patient's successful treatment involved a comprehensive approach combining surgical resection and chemotherapy.

Unusual Location of Residual Mass in an Uncorrected Undescended Testis with Germ Cell Tumor.

Intra-abdominal cancer in an adult with undescended testis (UDT) is rare owing to widespread screening and management during childhood. Here, we present a 33-year-old gentleman with a complaint of abdominal pain and pelvic mass which appeared to be an uncorrected UDT with cancerous degeneration. Additional evaluation revealed a suspicious mass in the retrovesical space which remained after chemotherapy. Histologic evaluation after resection of this mass indicated cancer spread of testicular origin behind the bladder.

Comparison of the Charlson comorbidity index, the modified Charlson comorbidity index, and the recipient risk score in prediction of the graft and patient survival among renal graft recipients: historical cohort in a single center.

OBJECTIVE: To compare the predictive values of Charlson comorbidity index (CCI), modified Charlson comorbidity index kidney transplant (mCCI-KT) and recipient risk score (RRS) indices in prediction of patient and graft survival in kidney transplant patients. METHODS: In this retrospective study, all patients who underwent a live-donor KT from 2006 to 2010, were included. Demographic data, comorbidities and survival time after KT were extracted and the association between above indices with patient and graft survival were compared. RESULTS: In ROC curve analysis of 715 included patients, all three indicators were weak in predicting graft rejection with the area under curve (AUC) less than 0.6. The best models for predicting the overall survival were mCCI-KT and CCI with AUC of 0.827 and 0.780, respectively. Sensitivity and specificity of mCCI-KT at cut point of 1 were 87.2 and 75.6. Sensitivity and specificity of CCI at cut point of 3 were 84.6 and 68.3 and for RRS at cut point of 3 were 51.3 and 81.2, respectively. CONCLUSION: The mCCI-KT index followed by the CCI index provided the best model in predicting the 10-year patient survival; however, they were poor in predicting graft survival and this model can be used for better stratifying transplant candidates prior to surgery.

Studying the effect of donor kidney volume ratios to recipients' body surface area, body mass index, and total body weight on post-transplant graft function.

OBJECTIVES: The goal of this study was to retrospectively investigate the relationship between renal transplanted volume indexes (Total kidney volume (TKV)/Body surface area (BSA), Renal parenchymal volume (RPV)/BSA, Renal cortical volume (RCV)/BSA, RPV/Body mass index (BMI), RCV/BMI, RPV/Weight, RCV/Weight), and short- and long-term function of the graft. METHODS: One-hundred and twelve live donor-recipient pairs from 2017 to 2018, whose donors underwent preoperative renal computed tomography angiography and recipients survived during 12 months of follow-up, were included in this study. RESULTS: The crude and adjusted linear regressions for the effect of volume measurements by voxel and ellipsoid methods on the estimated glomerular filtration rate (eGFR) at different post-transplantation times demonstrated that the RPV/weight ratio had the most substantial crude effect on the eGFR 12 months and 4 years after renal transplant. Receiver operating characteristic (ROC) curves for six different renal volume ratios demonstrated no significant difference between these ratios in terms of discriminative ability (p value < 0.05). A strong direct correlation between TKV calculated by the ellipsoid formula with RPV and RCV measured using OsiriX software was noted. Analysis of ROC curves for renal volume indices has demonstrated fair to good discriminative ability of our cut-off points to estimate 4-year post-transplantation eGFR > 60 mL/min. CONCLUSION: Renal transplant recipients' volume indices, such as RPV/weight, had strong correlations with eGFR at different points in time, and renal transplant recipients with the volume ratios higher than our cut-off points had a good chance of having a 4-year post-transplantation eGFR higher than 60 mL/min.

Medium-Term Outcomes of COVID-19 Infection After Kidney Transplantation for Ongoing Living and Deceased Kidney Transplantations within the COVID-19 Pandemic.

OBJECTIVES: To present the early to midterm experience of two referral kidney transplantation centers with living and deceased kidney transplantations that were performed within the COVID-19 pandemic. MATERIALS AND METHODS: All cases performed in two referral centers in Iran within the COVID-19 pandemic were investigated. Transplantations were performed from May 2020 to February 2021. The protocol for screening included nasopharyngeal RT-PCR with chest CT scan for living and deceased transplantations in center A and RTPCR for living transplantations and chest CT scan for deceased transplantations in center B. Patients were followed for 14-26 months after transplantation regarding COVID-19 infection and its outcomes in case of infection. RESULTS: 103 kidney transplantations were performed during the study period including 54 (52.4%) living and 49 (47.6%) deceased kidney transplantations. Twenty-four recipients (23.3%) and a living donor (1%) were infected with COVID-19. The severity of COVID-19 infection was mild, moderate, severe, and critical in 16 (66.6%), 4 (16.6%), 2 (8.4%), and 2 patients (8.4%), respectively. Two mortalities were observed within transplantation recipients with COVID-19 infection (1.9%). 87.5% (7/8) COVID-19 infections in center B were observed in recipients of deceased transplantations who were screened only by chest CT scan. CONCLUSION: The results of this study indicate a low frequency of COVID-19 mortality (1.9% for the whole cohort and 8.3% within COVID-19 infected patients) for recipients of living and deceased kidney transplantation that were performed within the COVID-19 pandemic. The above findings highlight for the first time in a large study the probability of living kidney transplantation during the COVID-19 pandemic in case strict screening of donors and recipients and close supervision of operating rooms and wards are implemented. We further hypothesize the inadequacy of chest CT scan for screening of COVID-19 in kidney transplantation surgery candidates.

Comparison of Single Monthly Instillations of Intra-Vesical Bacillus Calmette-Guerin Maintenance Therapy with Southwest Oncology Group Regimen in Non-Muscle Invasive Bladder Cancer Patients-A Retrospective Analysis In a Single Institute.

PURPOSE: To compare the efficacy and complication rate of monthly instillations of Bacillus Calmette-Guerin (BCG) as maintenance therapy in intermediate and high risk Non-Muscle Invasive Bladder Cancer (NMIBC) patients with the current standard Southwest Oncology Group (SWOG) protocol. MATERIALS AND METHODS: In this observational retrospective study, 40 intermediate and high risk NMIBC patients, receiving standard BCG maintenance regimen, were compared with another 40 NMIBC patients, undergoing monthly intra-vesical instillations of BCG with regard to recurrence, progression and major and minor adverse effects. RESULTS: The two groups were similar in their basic characteristics except for the older age in the monthly instillation group ( 70.95 ± 9.66 years vs. 64 ± 8.8, p = 0.001). Study objectives between the monthly instillation group and the standard group, including recurrence ( 17.5 % vs. 25%, p = 0.34) and progression rate ( 7.5% vs. 10%, p = 0.54) did not show statistically significant difference. Major and minor complication rate also did not show any difference between the two groups. CONCLUSION: In addition to the currently recommended standard protocol of BCG maintenance therapy, our study shows that the monthly regimen can be recommended in intermediate and high risk NMIBC patients without compromising the efficacy of the treatment.

Extra-Peritoneal versus Trans-Peritoneal Open Radical Cystectomy - Comparison of Two Techniques in Early Post-Operative Complications.

PURPOSE: The conventional Trans-Peritoneal Radical Cystectomy (TPRC) harbors numerous postoperative complications, the most prevalent of which are Gastrointestinal (GI) problems. To reduce these morbidities we introduced our own version of extra-peritoneal approach and compared it with the conventional method.  Materials and Methods: In a cross-sectional observational retrospective design, eligible bladder cancer patients whom underwent Extra-Peritoneal Radical Cystectomy (EPRC) or TPRC in our center, were considered for this study and were compared for early post-operative complications . RESULTS: Ninety nine patients in TPRC and 81 in EPRC were compared. The two techniques differed in their mean operation time (298.2±37.8 min TPRC vs. 262.8±37.2 min EPRC , P: 0.001). Early GI complications were lower in EPRC groups, including oral intake intolerance ( 21 vs. 8, P: 0.04), ileus (19 vs. 8, P: 0.04),  intestinal obstruction (3 vs. 0, P: 0.04) and anastomosis leak (8 vs. 1, P: 0.01). Urine leak (14 vs.7 , P: 0.02) and wound related complications (19 vs. 6 , P: 0.02) also favored EPRC group. CONCLUSION: The extra-peritoneal technique is beneficial in reducing the post operative morbidity, especially the more prevalent GI complications. This approach is functionally safe and allows preservation of the peritoneal integrity.

Prognostic value of dynamic renal scan with 99mTc-EC in patients with kidney transplantation: a prospective descriptive study.

INTRODUCTION: Renal transplantation is the gold standard treatment for chronic kidney disease. Renal scintigraphy has been performed widely to evaluate postsurgical complications of transplantation, but there are little data regarding 99mTc-EC scintigraphy in kidney transplantation. METHODS AND MATERIALS: This was a prospective descriptive study. All patients who underwent kidney transplantation and passed an uneventful postoperative period entered the study. Demographic characteristics, including age, gender, biochemical parameters before and after the transplantation and 99mTc-EC parameters including time to max, time to ½ max, slope from max to ½ max, upslope time interval and time to 2/3 max as well as episodes of rejection, were recorded. Patients were then followed up for 1 year at 3-, 6-, 9- and 12-month intervals. RESULTS: Forty-one patients who underwent renal transplantation entered the study. Mean ± SD age of patients was 40.65 ± 12.84 years (min 17 and max 74 years). In total, 25% (10) of patients experienced one or two episodes of rejection and were hospitalized. Time of max, time of 1/2 max, time from max to 1/2 max, time of 2/3 max, time from max to 2/3 max and upslope time interval had a significant association with transplant rejection using a Cox regression model. With 1-min increase in time of max, the risk of rejection increased by 27% (hazard ratio = 1.27; CI, 1.03--1.56) and with 1-min increase in time of 1/2 max, the risk of rejection increased by 28% (hazard ratio = 1.28; CI, 1.14-1.45). DISCUSSION: 99mTc-EC renal scintigrahpy was able to predict kidney transplantation rejection in our patients. 99mTc-EC renal scintigrahpy is beneficial to evaluate transplant kidney function to prevent complications and helps close follow-up.

Supradiaphragmatic Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: A Case Series at a Single Center.

INTRODUCTION: Inferior vena cava tumor thrombectomy in renal cell carcinoma patients is a challenging procedure, frequently requiring the vascular bypass technique for high-level thrombi with additional complications. Adopting a technique such as intrapericardial control in selected cases will circumvent these problems. Here, we present the results of our intrapericardial control technique during supradiaphragmatic inferior vena caval tumor thrombectomy. CASE PRESENTATION: The records of six patients with supradiaphragmatic tumor thrombi, who underwent radical nephrectomy and thrombectomy at our center with intrapericardial control between the years 2008 and 2015, were retrospectively reviewed. The patients' characteristics, intra- and postoperative data, histology, and follow-up records were gathered and compared. There were no immediate or 30-day postoperative deaths. The mean age of the patients was 61.3 years (range 46 - 75). The total mean duration of surgery was 315 minutes and the mean amount of transfused red blood cells was 4.33 units during surgery and 0.8 units in the postoperative period. The average hospitalization duration was 8 days (range 5 - 17). Tumor stage was T3 in four patients and T4 in two, due to ipsilateral adrenal involvement. The mean duration of follow-up was 33.5 months. Only one of the patients developed recurrences, first in the tumor bed and then at the site of the skin incision; these were excised with no apparent complications. CONCLUSIONS: Radical nephrectomy and tumor thrombectomy by intrapericardial control without cardiopulmonary bypass and hypothermic circulatory arrest is a safe and effective procedure that can avoid serious intra- and postoperative complications while providing acceptable cancer-control and mortality results.