Primer malignant giant cell tumour of kidney: a case report.

Osteoclast-like giant cell tumours of the kidney are extremely rare and usually accompanied by a conventional urothelial neoplasm such as papillary, transitional renal cell, or sarcomatoid carcinoma. Although they have morphological features similar to those of the giant cell tumours in the skeletal system, their counterparts in the urinary system show highly malignant features. Our case is the third primer malignant giant cell tumour of the kidney in the literature. The patient was a 50-year-old male and underwent nephroureterectomy for a mass of 18×14×13cm in his left kidney. However, the patient died in the second month postoperatively as a result of local recurrences and multiple distant metastases. The general condition of the patient deteriorated progressively; hence, he could not have any adjuvant therapy. Having more information about the pathological and clinical findings of these exceedingly rare tumours can help inform treatment steps.

Crossed fused renal ectopia in children: a review of clinical profile, surgical challenges, and outcome.

INTRODUCTION: Crossed fused renal ectopia is a rare congenital malformation, wherein both kidneys are present unilaterally, with the ureter of the crossed kidney opening into the bladder on the contralateral side. It has varied presentation from incidental detection to renal impairment. In this largest series of crossed fused renal ectopia, the authors assessed the clinical profile of these children and also attempted to shed light on the challenges in the surgical management. METHODS: It is a retrospective study conducted from January 2009 to July 2018, among patients evaluated for crossed fused ectopia, in the Department of Pediatric Surgery, Christian Medical College, Vellore. Electronic medical records of 36 children were reviewed. Imaging modalities and operative interventions were recorded. Results were analyzed. RESULTS: A total of 36 children were found to have crossed fused ectopia, with male preponderance. Most children presented within one year of age with urinary tract infection being the commonest cause. The most common associated anomaly was anorectal malformation. Ultrasound abdomen and pelvis, micturating cystourethrogram, and radionucleotide scans were the imaging modalities preferred for diagnosis and follow-up. Left-to-right ectopia was more common with inferior ectopic variant being the most common. The predominant urological problems include pelviureteric junction obstruction, vesicoureteric junction obstruction, and vescioureteric reflux. Ureteric re-implant was the most common surgery performed followed by pyeloplasty. Pelvi-pelvostomy, uretero-ureterostomy, bladder augment with Mitrofanoff, and other procedures were performed for select cases. CONCLUSION: Crossed fused renal ectopia is a challenging entity which requires individualized management plans based on the predominant urological anomaly and the functional status. Surgical options are diverse and are guided toward the symptomatic urological problem with focus on preserving the renal function. The long-term prognosis is good in these children.

Improving PET spatial resolution and detectability for prostate cancer imaging.

Prostate cancer, one of the most common forms of cancer among men, can benefit from recent improvements in positron emission tomography (PET) technology. In particular, better spatial resolution, lower noise and higher detectability of small lesions could be greatly beneficial for early diagnosis and could provide a strong support for guiding biopsy and surgery. In this article, the impact of improved PET instrumentation with superior spatial resolution and high sensitivity are discussed, together with the latest development in PET technology: resolution recovery and time-of-flight reconstruction. Using simulated cancer lesions, inserted in clinical PET images obtained with conventional protocols, we show that visual identification of the lesions and detectability via numerical observers can already be improved using state of the art PET reconstruction methods. This was achieved using both resolution recovery and time-of-flight reconstruction, and a high resolution image with 2 mm pixel size. Channelized Hotelling numerical observers showed an increase in the area under the LROC curve from 0.52 to 0.58. In addition, a relationship between the simulated input activity and the area under the LROC curve showed that the minimum detectable activity was reduced by more than 23%.

Auricular episthesis retained by an attachment system (2 case reports).

The use of osseointegration for bone anchorage in the prosthetic management of craniofacial defects has been successfully applied for many years. Different methods can be used for reconstruction of the aural atresia. Nowadays plastic surgery for auricular reconstruction and the bone-anchored episthesis are used for correction of aural atresia. There have been several studies in the literature comparng these techniques. According to those studies, bone-anchored episthesis is an excellent alternative to plastic reconstructive surgery of the auricle. In the present study we present 2 cases with different etiologic factors. The patients' right external ears were absent. There was loss in hearing function in one of the patients. We applied external ear episthesis with a bone-anchored system.

Distinguishing the benign and malignant adnexal mass: an external validation of prognostic models.

OBJECTIVE: Because external validation of the present models has not been reported, the purpose of the present study was to assess existing diagnostic models that are used to distinguish malignant from benign masses. METHODS: We tested the performance of existing models in a prospectively assembled data set of 170 patients with an adnexal mass. Twenty-one models that have been reported previously were assessed. The models were based on combinations of ultrasound findings, color Doppler tests, CA-125 measurement, age, and/or menopausal status. For each model, we constructed ROC curves and calculated an area under the ROC curve. RESULTS: Of the 170 adnexal masses that were operated on, 30 (18%) were malignant. The area under the ROC curve of 21 models that were externally validated varied between 0.69 and 0.90. We found the performance of the existing models to be inferior to the performance reported in the initial studies. Even models that incorporated multiple diagnostic tools and that were developed using logistic regression models or neural networks had an area under the ROC curve of 0.86 at maximum. In the case where we focused on almost perfect sensitivity, the highest specificities varied between 0.45 and 0.60. CONCLUSION: Although diagnostic models might be of value in the preoperative assessment of the adnexal mass, their diagnostic performance is not as good as that reported in the original publications.

Adenovirus type 7 penton purification of soluble pentamers from Escherichia coli and development of an integrin-dependent gene delivery system.

Adenoviral gene therapy vectors suffer from the disadvantages of toxicity and immunogenicity associated with the expression of adenoviral genes from the vector backbone. We report here an alternative strategy for gene delivery that utilizes a single component of the adenoviral type 7 capsid, the penton base (Ad7PB). The Ad7PB gene was sequenced and its amino-acid composition was deduced from its nucleotide sequence. The penton was expressed in Escherichia coli as a soluble C-terminal fusion with glutathione S-transferase (GST-Ad7PB) and was purified by single-step affinity chromatography. Both GST-Ad7PB and cleaved (GST-free) Ad7PB retained the ability to fold into pentamers as observed by electron microscopy. GST-Ad7PB was able to bind a synthetic peptide (FK20) derived from the Ad type 7 fiber and retard DNA through a polylysine chain present at the C-terminus of this linker peptide. GST-Ad7PB was an effective cell transfecting agent when assayed on 293 cells. Transfection was not dependent upon the presence of lysosomotropic agents indicating efficient endosome escape capability. Excess of an RGD-containing peptide derived from Ad7PB was able to inhibit transfection indicating specific integrin-mediated uptake of the GST-Ad7PB-FK20-DNA complexes. We propose that Ad7 pentons can be developed into integrin-specific gene delivery agents.

Primary malignant lymphoma of the uterine cervix associated with cold-reacting autoantibody-mediated hemolytic anemia.

A 66-year-old woman presented with autoimmune hemolytic anemia of the cold antibody type as one of the first symptoms of a non-Hodgkin lymphoma (NHL) localized primarily in the uterine cervix. Cold-reacting autoantibody-mediated hemolytic anemia is a rare complication of NHL. Its occurrence as one of the presenting symptoms of NHL is even more unusual. The incidence of a primary malignant lymphoma in the genital tract is low. The combination of these phenomena in one patient make this case unique in the English literature.

Histomorphology of the urethral process of the goat (Capra hircus).

The urethral process of the goat was an extension of the pars spongiosa of the male urethra. The erectile (cavernous) tissue of the urethral process was a continuation of the corpus spongiosum penis. The epithelium lining the urethra was stratified transitional. Two compact fibrocartilaginous strands were embedded in the erectile tissue, which were absent towards the tip of the urethral process. Smooth muscle was absent in the tunica mucosa-submucosa of the urethral process. The tunica mucosa-submucosa was richly supplied with blood vessels and nerves and it may be assumed that the urethral process is a sensory structure. Large cavernous sinuses, within the erectile tissue, were lined by endothelial cells. There was a circular fibroelastic layer enclosing the entire corpus spongiosum penis to withstand expansion of the erectile tissue during erection and copulation. The surface epithelium lining the urethral process was stratified squamous. A few connective tissue papillae were observed evaginating into the surface epithelium.