Parameters predictive of multicentricity in renal cell carcinoma.

Over a 3-year period, 83 radical nephrectomies were performed for renal cell carcinoma. The preoperative radiologic investigations and pathology were reviewed. The incidence of multicentricity of the tumors was correlated with various clinical and pathologic parameters. These included polar location, histologic type, histologic grade (divided into low: Fuhrman grade 1 to 2; and high: Fuhrman grade 3 to 4), size on pathology, pathologic stage, capsular invasion, microscopic vascular invasion, renal vein or inferior vena cava (IVC) involvement, collecting system involvement, lymph node metastases and adrenal gland metastases. The incidence of multicentricity was 9/83 (11%). On univariate analysis, no factors were predictive of multicentricity. On logistic regression analysis, microscopic vascular invasion (p=0.021) and tubulo-papillary histology (p=0.049) were the only significant independent predictors of multicentricity. A model incorporating these parameters missed all multicentric tumors.

Sarcomas of the spermatic cord: significance of wide local excision.

A respective review was performed of 18 patients presenting with spermatic cord sarcomas over a 28 year period to determine factors predictive of local recurrence and disease-specific survival. Factors assessed at predictors of local recurrence included tumor grade, histology, positive surgical margins, and inadequate excision, defined as scrotal violation or excisional biopsy. In addition to these factors, local recurrence and the presence of hematogenous metastasis were evaluated as predictors of disease-specific survival. Nine patients were originally treated with radical orchiectomy; 2 underwent trans-scrotal orchiectomy; 6 had an excisional biopsy; and 1 had scrotal exploration followed by radical orchiectomy. The presence of positive surgical margins was a significant predictor of early local recurrence on univariate analysis. Local recurrence and the presence of hematogenous metastasis were significant predictors of disease-specific survival on univariate analysis. This emphasizes the importance of radical orchiectomy with local excision in the management of spermatic cord sarcomas.

Genitourinary tuberculosis masquerading as a ureteral calculus.

The genitourinary tract is a common extrapulmonary site of tuberculosis infection, yet remains a rare clinical entity in North America. We report the case of a 37-year-old man who presented for extracorporeal shock wave lithotripsy for a suspected ureteral stone on imaging. Further workup confirmed a diagnosis of genitourinary tuberculosis. Medical management was undertaken and, ultimately, nephrectomy performed. This case highlights the importance of maintaining a high index of clinical suspicion for genitourinary tuberculosis.