Penile Paget's Disease: A Case Report and Review of the Literature.

Extramammary Paget's Disease (EMPD) is a rare cutaneous, slow growing, intraepithelial adenocarcinoma that can be either primary (intraepithelial arising within the epidermis) or secondary (intraepithelial spread of a visceral carcinoma). Here we present the case of a 63-year-old male with EMPD of the glans penis stemming from underlying urothelial carcinoma. Our treatment decision elected for management with chemotherapy and local treatment with radiation therapy. Subsequent, review of the literature demonstrated a rare disease with a variety of underlying malignancies causing this secondary pathology. Caregivers should be aware of the association of Paget's disease and urothelial cancer and should have a high index of suspicion that erythematous penile lesions may represent Paget's disease and that penile biopsies should be performed early in this setting.

Molecular prognostication in bladder cancer--a current perspective.

The optimal management of bladder cancer depends on the accurate assessment of the tumour's biological potential. Advances in molecular biology and cytogenetics have spurred intense research in identifying and characterising prognostic markers for patients with transitional cell carcinoma (TCC) of the bladder. The molecular changes that occur can be categorised into (1) chromosomal alterations leading to carcinogenesis, (2) cellular proliferation as a result of dysregulation of cell cycle control, and (3) growth control processes such as angiogenesis leading to metastasis. The accumulation of these changes ultimately determines a tumour's clinical behaviour and response to therapy. As the understanding of bladder cancer evolves, novel molecular markers for prognostication will make their way from the research laboratory to the clinical setting with the promise to improve patient care and outcomes.

Surgical approaches to venous tumor thrombus.

The extension of tumor thrombus into the vena cava by renal cell carcinoma remains a technically challenging surgical condition. Attention to surgical detail and perioperative care can provide long-term survival in the appropriately selected patient. In reviewing our experience of 99 patients with venous tumor extension: renal vein only (n = 31), infrahepatic vena cava (n = 22), intrahepatic vena cava (n = 34), and intra-atrial extension (n = 12), we have demonstrated overall 2- and 5-year survival rates of 54% and 33%, respectively. Level of tumor thrombus appears to be correlated with overall survival. We continue to advocate an aggressive, optimistic approach for those patients with clinically confined tumors with isolated venous tumor thrombus extension.