p53 and Ki-67 expression in renal cell carcinomas of pregnant women and their correlation with prognosis: a pilot study.

In the present study, we reported two cases of renal cell carcinoma (RCC) diagnosed in pregnant women (Pt) that were submitted to radical nephrectomy, in both cases within the fourth month. The patients, after 13 and 3 years, respectively, did not show evidence of recurrent disease. We performed an immunohistochemical study on RCC specimens in comparison to seven age-matched controls (Cl). The panel of antibodies included Ki-67, p53, bcl-2, ER, PgR, PCNA, and IGF-1. We describe a difference in the expression of p53 and Ki-67. Specifically, p53 was highly expressed in RCC of both Pt but scarcely present or absent in Cl; by contrast, Ki-67 was hardly expressed or negative in RCC of both Pt, being commonly positive in Cl. These results may correlate with a good outcome of the disease in Pt. Although the limited number of cases did not permit any statistical evaluation, we postulate that these differences have not to be underestimated since they may disclose a correlation between pregnancy and biological behavior of tumoral disease. Further study may (dis)prove this hypothesis.

Testicular metastasis as isolated recurrence after radical prostatectomy. A first case.

Prostate cancer synchronously or metachronously metastasizing to the testis is a rare finding. We herein report on the first case of a solitary testicular metastasis from an organ-confined prostate cancer, diagnosed 6 months after a radical prostatectomy, without evidence of previous or concomitant biochemical and local recurrence.

Ninth commandment: 'Thou shalt not covet thy neighbor's wife!' Penetrating trauma to the corpora cavernosa caused by gunshot.

We describe a case of gunshot wound to the corpora cavernosa caused by a low-velocity bullet in a 43-year-old man. He volunteered that his lover's husband shot him with a handgun. The bullet had penetrated the right gluteal region with no exit wound causing a right corpus cavernosum lesion. A penile colour-duplex doppler ultrasonography did not reveal injuries of the cavernosal arteries or altered peak diastolic and systolic values. A three-dimensional computed tomography study corfirmed the presence of the bullet at the root of the right corpus cavernosum and allowed to identify the curvilinear ballistic trajectory, confirming a low-velocity penetrating bullet. The patient underwent exploratory surgery with removal of the bullet and primary repair of the identified unilateral albuginea rupture. The bullet, passing through clothing, probably slowed down causing less than expected harm. The follow-up visit after 2 months showed that the penile girth was not narrowed by such a repair. With a 2-year follow-up the patient has a normal penile ultrasound morphology and a normal sexual activity.

Epistaxis after PDE-5 inhibitors misuse.

A 32-year-old male presented to our department for recurrent epistaxis during sexual intercourses. The patient controlled the bleeding each time with sponge packs and gauzes. During the consultation, he volunteered that the trigger for the epistaxis appeared to have been misuse of phosphodiesterase (PDE)-5 inhibitors, Viagra and Cialis. This first report of epistaxis after PDE-5 inhibitors in a young patient underline the possibility that in the next years the number of similar cases might increase due to the diffusion of PDE-5 inhibitor misuse in recreational settings.

Cytomegalovirus and BK-Virus co-infection of a clinically non-functioning adrenal adenoma: innocent bystanders or new pathogenetic agents?

We report a case of a 64-year-old woman who underwent left adrenalectomy with removal of a 8,5 cm clinically non-functioning adrenocortical adenoma and a 4-cm myelolipoma. Molecular testing for viral infection demonstrated the presence of cytomegalovirus (CMV) DNA sequences in the adrenal adenoma, but not in the myelolipoma (confirmed by immunohistochemistry). Moreover, the adrenal adenoma was also positive for parvovirus B19, and both adrenal tumor samples were positive for polyomavirus BK (BKV) and adenovirus DNA sequences. This is the first report of co-infection of an adrenocortical adenoma by CMV and BKV. The role of these viruses in adrenal tumorigenesis was postulated.

Role of pharmacologic rehabilitation in the recovery of sexual function following radical prostatectomy.

AIM: The aim of the present study is to evaluate the role of pharmacological postoperative sexual rehabilitation in the recovery of erectile function following radical retropubic prostatectomy. METHODS: Following radical retropubic prostatectomy 113 patients were divided into 2 groups: 77 (group 1) underwent pharmacologic rehabilitation with intracavernous PGE1 starting with 5 mg once or twice weekly beginning 1 month after surgery, followed by oral sildenafil 50-100 mg twice a week after recovery of spontaneous erections, while 36 (group 2) acted as controls. The 2 groups were homogeneous for age and preoperative IIEF5 score, while nerve-sparing techniques were used more frequently in group 1. RESULTS: With 1 year follow-up 42% of group 1 patients have recovered sexual function, versus 8% of group 2 (P < 0.001). The mean recovery time was 7 months, and 56% of rehabilitated patients with bilateral preservation of the neurovascular bundles recovered sexual function, compared to 37.5% of those with unilateral preservation and 28.5% of those operated with non nerve-sparing technique. Intracavernous PGE1 caused pain in 27% of cases. CONCLUSIONS: Pharmacologic rehabilitation significantly impacts on the recovery of sexual function following radical prostatectomy, and the optimal treatment schedule is still to be defined.

Bladder papilloma in a 9-year-old girl: a case report.

Transitional cell carcinoma of the bladder is a rare entity in childhood. We report on a 9-year-old girl with transitional cell carcinoma of the bladder who presented with gross hematuria. Ultrasonography revealed a papillary lesion in the bladder, and the diagnosis was confirmed by cistoscopy. Complete transurethral resection of the lesion was performed and follow-up with urine cytology, vesical ultrasound and transurethral cystoscopy at 4 years showed no evidence of recurrence.

Clinical characteristics and overall survival in genitourinary sarcomas treated with curative intent: a multicenter study.

OBJECTIVES: Adult soft tissue sarcomas in general, and those arising from the urological organs in particular, are a group of rare tumours with a generally poor prognosis, only a few studies are available. We report our experience with this type of tumours in a multicenter study carried out in a single region of Central Italy (Tuscany). METHODS: Pre-treatment and follow-up data were obtained from 22 adult patients, all residing in Tuscany, treated consecutively between 1984 and 2002 for primary or locally recurrent genito-urinary sarcomas in 8 urology departments in the area. All cases were classified according to the French Federation of Cancer Center System Grading Scheme for Adult Sarcomas (FFCC) and Broders System. The crude survival probability was estimated by using the Kaplan-Meier method and differences between patient sub-groups were assessed by the log rank test. RESULTS: The study series included 18 males and 4 females. The mean age at diagnosis was 61+/-21.5 years (range: 15.3-89.1). The most common site was paratesticular (n=9, 40.9%), followed by kidney (n=8, 36.4%), prostate (n=3, 13.6%) and penis and bladder (1 case each, 4.6%). 15 cases (68.2%) were classified as FFCC III, and 16 (72.7%) as Broders IV. The most common histological type was leiomyosarcoma (8 cases, 36.7%), followed by liposarcoma (6, 27.3%), rhabdomyosarcoma (3, 13.6%) and other histological types (5, 22.7%). At the last follow-up (mean: 3.66+/-3.25 years; range 0.15-10.0), 11 of the 22 patients (50%) were still alive. The overall survival rate at 1, 3 and 5 years was 85.9%, 62.0% and 48.8%, respectively. There were no significant differences in survival according to sex, age or histological type. When we compared paratesticular vs. kidney and prostate cancer cases, a significant difference in survival emerged (p=0.02). According to size and grade of the tumour we also found a significant difference in survival (p=0.0006 and p=0.01, respectively). CONCLUSIONS: In our representative series, 3 tumor parameters (site, size and grade) appeared to represent the most important prognostic factors in adult genitourinary sarcomas.

Urinary BTA-stat, BTA-trak and NMP22 in surveillance after TUR of recurrent superficial transitional cell carcinoma of the bladder.

OBJECTIVES: To evaluate NMP22, BTA-Stat and BTA-Trak tests in monitoring recurrent transitional cell carcinoma of the bladder. METHODS: The tests were performed in 179 selected patients being followed up for recurrent superficial bladder tumors: 55 patients had bladder recurrence and 124 patients were recurrence free. The NMP22 test was obtained in all patients; BTA-Stat and BTA-Trak in the last 96 and 74 patients, respectively. Sixty-four patients (51.6%) were undergoing adjuvant intravesical chemotherapy. RESULTS: Sensitivity was 74, 57 and 62% and specificity was 55, 62 and 79% for NMP22, BTA-Stat and BTA-Trak, respectively. A high percentage of patients submitted to intravesical chemotherapy had false-positive tests. Positive predictive values of the NMP22, BTA-Stat and BTA-Trak tests were 42.2, 40 and 45.4%, and negative predictive values were 82.9, 76.9 and 88.4%, respectively. CONCLUSIONS: NMP22, BTA-Stat and BTA-Trak tests cannot replace cystoscopy and cannot be adopted as routine tools in surveillance after TUR in patients with superficial bladder cancer.

Pure squamous cell carcinoma of the bladder in western countries. Report on 19 consecutive cases.

INTRODUCTION: Pure squamous carcinoma (SCC) is a rare entity in western regions. The management of SCC still remains similar to that of transitional carcinoma, although it is a different entity. A retrospective review can be helpful in understanding the biological behavior of this uncommon vesical tumour. MATERIAL AND METHODS: Nineteen consecutive cases of pure SCC of the bladder, not related to bilharziasis or spinal cord injury, are herein reported. Fifteen patients were submitted to radical cystectomy, combined with emasculation in 1 case and unilateral nephroureterectomy in another. Partial cystectomy was performed in 1 patient and transurethral resection followed by radiotherapy in 3 more cases. Involvement of prostatic urethra and upper urinary tract was evident in 9 (47.3%) and 5 patients (26.3%), respectively. Four patients were submitted to neoadjuvant chemotherapy and 1 to presurgical radiotherapy without any objective response. Adjuvant chemotherapy was performed in 3 patients. At a mean follow-up of 52 months, 6 patients (31.5%) are alive without any evidence of disease. SCC antigen was monitored in 5 patients. The possible role of this marker in bladder SCC is discussed. CONCLUSIONS: Invasion of the upper urinary tract and prostatic urethra seems more common in SCC than in transitional cell carcinoma. Distant metastases are rare. Most patients die after attempts of locoregional control of the tumor have failed. Extensive surgery is recommended. Preoperative radiotherapy should be considered since pelvic recurrences are the leading cause of progression in squamous cell carcinoma.

Verrucous scrotal carcinoma in a patient with hypospadias: is there a possible association?

We report a case of a locally advanced verrucous scrotal cancer in a patient with hypospadias. Surgical excision was performed and no recurrence was noted with 14 months of follow-up. To our knowledge, this association has not been reported. Historically, scrotal carcinoma is occupation related, but none of the occupational predisposing factors was identified in this patient. This observation suggests that hypospadias and secondary chronic inflammation of the scrotal skin, caused by prolonged contact with urine, may contribute to an increased risk of verrucous carcinoma.

PSA and second-line therapy of hormone refractory prostate carcinoma.

The aim of the present study was to correlate PSA response with subjective response (bone pain and performance status), in patients treated for hormone refractory carcinoma of the prostate. Twenty-four patients were introduced into the study. Median PSA was 198 ng/ml. Symptom score, performance status and PSA were monitored monthly for 3 months and then 3-monthly. Sixteen patients (66%) showed a PSA response (median value 10 ng/ml). In 8 patients (33%) PSA was <4 ng/ml. Eight patients (33%) only had a subjective response. However, 75% of the patients with a PSA value <4 ng/ml had a subjective improvement. On the other hand, subjective response was 25% only in patients in whom PSA value decreased to <50% of the initial value but >4 ng/ml. In conclusion, PSA response is not always related to subjective improvement and does not always implicate a beneficial effect of the therapy for the patient.