KRAS Mutation in Serous Borderline Tumor of the Testis: Report of a Case and Review of the Literature.

Ovarian-like epithelial tumors of the testis, including serous borderline tumors, are rare entities. We report the case of a 60-year-old man with a left intratesticular mass who had a radical orchidectomy. Histologically, the tumor was identical to the ovarian counterpart showing a well-delineated cystic lesion characterized by intraluminal papillae. The papillae are lined by atypical cuboidal or ciliated cells and are associated with psammoma bodies. The tumor cells express cytokeratin 7 (CK7), cytokeratin 5-6 (CK5-6), cancer antigen 125 (CA125), estrogen (ER), progesterone (PR), Wilm's tumor gene (WT1), paired box gene 8 (PAX8), Ber-EP4, and epithelial membrane antigen (EMA). The diagnosis of a serous borderline tumor of the testis was proposed. Mutation testing using next-generation sequencing showed a Q61K KRAS gene mutation. To the best of our knowledge, this is the second case report of a serous borderline tumor of the testis with a Q61K KRAS gene mutation.

Epididymal polar dissociation: A rare entity.

Epididymal fusional anomalies have been found to be associated with conditions of testicular maldescent with the several studies investigating this association reporting several variations in epididymal anatomy and epididymal-testicular fusion. To our knowledge, a single case of an isolated lower epididymal pole with a normal vas deferens, dubbed "Epididymal Polar Dissociation", has been reported in the literature. In this report, we report the second case of epididymal polar dissociation discovered in a 17-year-old during surgical management of left testicular torsion.

Salvage high-intensity focused ultrasound versus salvage radical prostatectomy for radiation-recurrent prostate cancer: a comparative study of oncological, functional, and toxicity outcomes.

PURPOSE: To compare oncological, functional, and toxicity outcomes of patients with radiation-recurrent prostate cancer (PCa) after external beam radiation therapy (EBRT) or brachytherapy (BT) treated with salvage high-intensity focused ultrasound (S-HIFU) or salvage radical prostatectomy (S-RP). METHODS: This retrospective study compared 52 patients with radiation-recurrent PCa after EBRT or BT treated with S-HIFU (n = 27) or S-RP (n = 25) between 1998 and 2016. We estimated overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) at 5 years. Incontinence after local salvage therapy (LST) was scored according to the number of pads used per day. Complications were graded according to the Clavien-Dindo classification. RESULTS: Both groups were similar for pre-LST tumor features, however, no S-HIFU patients received BT and S-RP patients were younger and healthier. Median follow-up was 45 months for S-HIFU and 43 months for S-RP. No significant differences were found in estimated 5-year OS (80.9% vs. 61.9%, p = 0.24), 5-year CSS (84.0% vs. 74.0%, p = 0.36), and 5-year MFS (60.3% vs. 55.2%, p = 0.55) for S-HIFU vs. S-RP, respectively. We observed a significant difference in pad-dependent status at 12 months (22.2% vs. 56.0%, p = 0.01) and in the number of Clavien ≥ III complications [9 (7/27 patients) vs. 16 (12/25 patients), p = 0.027] in favor of S-HIFU vs. S-RP, respectively. CONCLUSION: S-HIFU and S-RP could both be considered valuable LST options for patients with radiation-recurrent nonmetastatic PCa with sufficient life expectancy. S-RP is associated with more pad-dependent patients at 12 months.

Cytoreductive prostatectomy: what is the evidence? A systematic review.

INTRODUCTION: Cytreductive prostatectomy is an experimental surgical approach to metastatic prostate cancer (mPCa), with the scope of improving local symptoms and potentially ameliorate oncologic outcomes. Aim of the current systematic review is to analyze available evidence to support this approach and explore published data a future trial on cytoreductive prostatectomy. EVIDENCE ACQUISITION: A systematic review was conducted searching all relevant studies published in PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar and Ovid database until August 1, 2018. A search was performed including the combination of following words: "cytoreductive" AND "prostatectomy" AND "prostate" AND "cancer"). Of the 49 initial papers identified, 28 were excluded after screening by the authors, leaving 21 articles eligible for the review. EVIDENCE SYNTHESIS: In vitro and in vivo models support the concept of removing the primary tumor, considered a "sanctuary site," in order to reduce the metastatic potential of prostate cancer. Large retrospective population studies have reported improved oncologic outcomes for men undergoing cytoreductive prostatectomy, though such results are limited by the retrospective design and major selection biases. Little evidence from well designed prospective trials is available, yet a net improvement of overall survival has not been reported. Nonetheless, most studies reported a reduction of local complications after cytoreductive prostatectomy (<10%) compared to best systemic therapy (25-30%). Prospective randomized trials are underway: their results will help elucidate the true impact of cytoreductive prostatectomy on oncologic outcomes of mPCa. CONCLUSIONS: Although supported from a biological point of view and albeit encouraging results of population-based studies, cytoreductive remains to date experimental. A true benefit on overall survival of mPCa is not supported by current evidence. The results of prospective trials are eagerly awaited.

Innovations in imaging modalities for recurrent and metastatic prostate cancer: a systematic review.

INTRODUCTION: The last decade has witnessed tremendous changes in the management of advanced and metastatic castration resistant prostate cancer. In the current systematic review, we analyze novel imaging techniques in the setting of recurrent and metastatic prostate cancer (PCa), exploring available data and highlighting future exams which could enter clinical practice in the upcoming years. EVIDENCE ACQUISITION: The National Library of Medicine Database was searched for relevant articles published between January 2012 and August 2017. A wide search was performed including the combination of following words: "Prostate" AND "Cancer" AND ("Metastatic" OR "Recurrent") AND "imaging" AND ("MRI" OR "PET"). The selection procedure followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles and is presented using a PRISMA flow chart. EVIDENCE SYNTHESIS: Novel imaging techniques, as multiparametric magnetic resonance imaging (MRI), whole-body MRI and Choline and prostate-specific membrane antigen (PSMA) PET imaging techniques are currently revolutioning the treatment planning in patients with advanced and metastatic PCa, allowing a better characterization of the disease. Multiparametric MRI performs well in the detection of local recurrences, with sensitivity rates of 67-98% and overall diagnostic accuracy of 83-93%, depending on the type of magnetic field strength (1.5 vs. 3T). Whole body MRI instead shows a high specificity (>95%) for bone metastases. PET imaging, and in particular PSMA PET/CT, showed promising results in the detection of both local and distant recurrences, even for low PSA values (<0.5 ng/mL). Sensitivity varies from 77-98% depending on PSA value and PSA velocity. CONCLUSIONS: Whole body-MRI, NaF PET, Choline-PET/CT and PSMA PET/CT are flourishing techniques which find great application in the field of recurrent and metastatic PCa, in the effort to reduce treatment of "PSA only" and rather focus our therapies on clinical tumor entities. Standardization is urgently needed to allow adequate comparison of results and diffusion on a large scale.

Management of Anastomosis Leakage Post-RALP: A Simple Trick for a Complex Situation.

A case of 74 years old male patient who underwent RALP with bladder neck reconstruction. Persistent vesicourethral anastomotic leak was seen at cystography. A self-made side fenestrated Foley catheter was used and on the day after, a complete reversal in fluid output between the Foley catheter and the drain was seen.