Renal adenocarcinoma presenting as a spontaneous perirenal hematoma in a patient on warfarin therapy--case report and literature review.

We are presenting a rare case of a spontaneous extensive perirenal hematoma caused by ruptured renal adenocarcinoma in a patient who was on warfarin therapy because she had atrial fibrillation and three myocardial infarctions. A 77-year-old woman was admitted to our department with acute right flank pain and hemorrhagic shock. The anamnestic data revealed no trauma and hematuria. Abdominal ultrasonography and computed tomography scan showed large retroperitoneal hematoma. The patient underwent urgent surgery and radical nephrectomy was performed. A large retroperitoneal hematoma was found originating from a ruptured renal neoplasm in the upper pole of the right kidney. The pathohistological diagnosis was chromophobe renal cell carcinoma. The clinical, diagnostic and therapeutic peculiarities of this rare condition are presented, along with the literature review on the topic.

Evolution of the clinical presentation and outcomes after radical prostatectomy for patients with clinically localized prostate cancer--changing trends over a ten year period.

We demonstrate the evolution of the clinical presentation and outcomes for patients with clinically localized prostate cancer (PC) treated with radical retropubic prostatectomy (RRP) at our department, emphasizing epidemiologic significance of changes during the 10-year period. We assessed the annual trends for changes in patients age, preoperative prostate specific antigen (PSA), preoperative versus postoperative stages and Gleason grades, organ confined status and surgical margin status. A total of 488 RRPs were performed from January 1996 to December 2005 with the annual frequency increased from 8 to 129 (1512.5%). Mean patient age increased from 61.5 to 66.12 years in 2005, with the percentage of men aged more than 70 years increased from 12.5 to 26.5%, respectively. The detection of PC based solely on pathological PSA levels (as indication for prostate biopsy) rose impressively from 25.5 to 70% and the rates of postoperative organ-confined disease also increased significantly from 25 to 74.7%. Mean preoperative PSA decreased from 16.7 to 9.89 ng/mL. On the contrary, there was an increase in percentage of patients with preoperative PSA values ranging from 4 to 10 ng/mL (from 20 to 65.4%). Positive surgical margin rate decreased from 49.4 to 25% and percent of patients receiving neoadjuvant therapy decreased from 78.5 to 5.4%. Proportion of patients who were undergraded decreased from 75.1 to 31.7%. The rates of understaging have remained relatively stable over the years. During the study period, PC was increasingly detected by prostate biopsy on the basis of a pathological PSA level only and shifted significantly to more organ-confined stages with more favourable outcomes for pathological variables due to a more accurate assessment of clinical stage prior to surgery, reduced use of neoadjuvant therapy and improved surgical technique. Our data also argue strongly that routine PSA testing should be expanded and not restricted.

Management of fournier's gangrene: case report and literature review.

A 65-year-old man was referred to our department with clinical signs of septic shock and necrotizing soft tissue infection of the scrotal, perianal and right inguinal region. Initial presentation was a typical Fournier's gangrene. Because of the life-threatening condition, the initial treatment was extensive removal of necrotic tissue. Antibiotic therapy was administered and several debridements of the wound were done afterwards. Three weeks after the initial treatment, wide wound defects of the perianal, scrotal and inguinal regions were closed secondarily and the patient was discharged from the hospital. Fournier's gangrene is a surgical emergency. Although rare, it remains a life-threatening disease. Rapid and accurate diagnosis remains the key component in achieving successful outcome. Early aggressive surgical intervention together with fluid, hemodynamic and nutritional support and broad-spectrum antibiotics is the essential management to reduce mortality.

Seminal vesicle cyst with ectopic ureteral insertion and ipsilateral renal dysplasia--an unexpected diagnosis.

An extremely rare case of seminal vesicle cyst associated with ipsilateral renal dysplasia and ectopic ureter is presented. A 36-year-old patient underwent nephroureterovesiculectomy. Considering the clinical and imaging profile of the patient, a diagnosis of ureterocele with megaureter was initially suspected, but intraoperative findings and definitive pathological analysis of the specimen revealed right renal dysplasia with ectopic ureter opening into seminal vesicle cyst. The clinical and therapeutic peculiarities of this rare condition are presented and the literature on this topic is reviewed.

Immunohistochemical expression of tumor antigens MAGE-A1, MAGE-A3/4, and NY-ESO-1 in squamous cell carcinoma of the penis.

OBJECTIVES: To investigate by immunohistochemistry the expression of MAGE-A and NY-ESO-1/LAGE-1, cancer testis antigens (CTAs), in squamous cell carcinoma of the penis. METHODS: A total of 30 penile carcinoma samples from patients undergoing penile amputation at the Urology Clinics at the Zagreb Clinical Hospital Center and University Hospital "Sestre milosrdnice" from 1997 to 2004 were investigated in this study. Three monoclonal antibodies were used for immunohistochemical staining: 77B specific for MAGE-A1, 57B recognizing multiple MAGE-A CTAs, and D8.38, specific for NY-ESO-1 antigen. RESULTS: The expression of MAGE-A1 was not observed in the carcinoma samples, but both multi-MAGE-A and NY-ESO-1-specific reagents stained 29 (97%) of 30 samples. Immunohistochemical staining was prevailingly detected in the cytoplasm. A significant heterogeneity was observed within the same specimen, in which areas with strong positivity coexisted with CTA-negative areas. The extent of CTA expression did not correlate significantly with tumor grade. CONCLUSIONS: The results of this study have documented for the first time the expression of CTAs in squamous cell carcinoma of the penis. Additional research is warranted to explore the potential implications regarding both diagnosis and therapy.

Radical prostatectomy in a patient with osteogenesis imperfecta: a possible surgical trap.

An exceedingly rare case of a patient with osteogenesis imperfecta and prostate cancer is reported. The patient underwent radical prostatectomy, which had to be stopped due to the extremely narrow space for surgical manipulation. The clinical, diagnostic and operative peculiarities of the case are presented and the relevant literature reviewed.

Tumors in kidney fusion anomalies--report of five cases and review of the literature.

OBJECTIVE: Fusion anomalies of the kidney are rarely encountered and the association of malignant tumors with such conditions is exceedingly rare. Association of tumors with horseshoe kidney is also uncommon, with fewer than 200 cases having been reported in the literature, and the association of tumors with crossed-fused ectopia is even rarer, with only four cases having been reported so far. MATERIAL AND METHODS: During the past decade five patients with fusion anomalies have been treated for tumors in our clinic, four of whom had horseshoe kidney and one of whom had crossed-fused left-to-right ectopia. The clinical, diagnostic and operative peculiarities of each case are presented and the recent literature on this topic is reviewed. RESULTS: Two patients were diagnosed with renal cell carcinoma, two had transitional cell carcinoma and one had oncocytoma. CONCLUSIONS: The commonest tumor reported in kidney fusion anomalies is renal cell carcinoma, although its reported incidence is no higher than that in the normal population. In the case of transitional cell carcinomas, diagnosis is usually made at an advanced stage. The value of thorough urologic and radiological investigations is stressed. Angiography, whether classical or in combination with multi-slice CT, is considered essential in order to confirm renal anomalies and the tumor situation and to plan the surgical approach. In our experience, radical nephrectomy with isthmus division via a transperitoneal approach is the treatment of choice.