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1.
Am J Clin Pathol ; 161(1): 49-59, 2024 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-37639681

RESUMO

OBJECTIVES: Penile squamous cell carcinomas (PCs) are rare malignancies with a dismal prognosis in a metastatic setting; therefore, novel immunotherapeutic modalities are an unmet need. One such modality is the immune checkpoint molecule programmed cell death ligand 1 (PD-L1). We sought to analyze PD-L1 expression and its correlation with various clinicopathologic parameters in a contemporary cohort of 134 patients with PC. METHODS: A cohort of 134 patients with PC was studied for PD-L1 immunohistochemistry. The PD-L1 expression was evaluated using a combined proportion score with a cutoff of 1 or higher to define positivity. The results were correlated with various clinicopathologic parameters. RESULTS: Overall, 77 (57%) patients had positive PD-L1 expression. Significantly high PD-L1 expression was observed in high-grade tumors (P = .006). We found that 37% of human papillomavirus (HPV)-associated subtypes and 73% of other histotype tumors expressed PD-L1, while 63% of HPV-associated tumors and 27% of other histotype tumors did not (odds ratio, 1.35; P = .002 when compared for HPV-associated groups vs all others). Similarly, PD-L1-positive tumors had a 3.61-times higher chance of being node positive than PD-L1-negative tumors (P = .0009). In addition, PD-L1 high-positive tumors had a 5-times higher chance of being p16ink4a negative than PD-L1 low-positive tumors (P = .004). The PD-L1-positive tumors had a lower overall survival and cancer-specific survival than PD-L1-negative tumors. CONCLUSIONS: Overall, PD-L1 expression is associated with high-grade and metastatic tumors. Lower PD-L1 expression is observed more frequently in HPV-associated (warty or basaloid) subtypes than in other, predominantly HPV-independent types. As a result, PD-L1 positivity, including higher expression, portends lower overall and cancer-specific survival. These data provide a rational for further investigating PD-L1-based immunotherapeutics in PC.


Assuntos
Carcinoma de Células Escamosas , Infecções por Papillomavirus , Neoplasias Penianas , Masculino , Humanos , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/metabolismo , Antígeno B7-H1/metabolismo , Ligantes , Prognóstico , Carcinoma de Células Escamosas/patologia , Neoplasias Penianas/patologia , Apoptose , Biomarcadores Tumorais/metabolismo
2.
Low Urin Tract Symptoms ; 6(1): 26-34, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26663497

RESUMO

OBJECTIVES: Functional and urodynamic (UDS) outcomes of W-configured ileal orthotopic neobladder (ONB) with extramural serosa-lined tunnel uretero-ileal anastomosis are presented METHODS: Consecutive 17 patients undergoing ONB during December 2009 to March 2011 were enrolled. Of these 15 men (bladder cancer 14, tuberculosis 1) with mean age 52.7 ± 11.3 years completed the follow-up. Pouch-related quality of life (PQOL) was assessed using a published questionnaire. Uroflowmetry, cystometry/cystography and urethral-pressure profilometry were done at two follow-up visits at least 3 months apart. Mean follow up 10 ± 5 months. Mean length of harvested ileum 48 ± 6 cm. RESULTS: Overall PQOL were similar at both evaluations (55 ± 11 and 54 ± 15, respectively). During first and second follow-up, maximum flow-rate, voided-volume and post-void residual urine were 11 ± 4 mL/sec, 246 ± 99 mL and 68 ± 74.9 mL and 10.4 ± 4.6 mL/sec, 234 ± 138 mL and 86 ± 146 mL, respectively. Mean neobladder capacity, compliance, maximum urethral closure-pressure (MUCP) and functional urethral length were 484 ± 244 mL, 50.5 ± 49.1 mL/cmH2 O, 42 ±20 cmH2 O and 22 ± 12 mm, and 468 ± 250 mL, 46.4 ± 47.5 mL/cmH2 O, 52 ± 27cmH2 O and 23 ± 12 mm, respectively. Patients with smaller pouch (r = 0.828; P = 0.0001), longer urethral length (r = -0.392; P = 0.023) and lesser incontinence (r = 0.429; P = 0.011) had significantly better PQOL. With continued supervised pelvic-floor rehabilitation, a trend in improvement in hesitancy (P = 0.058), MUCP (P = 0.05) and bothersome incontinence (P = NS) was observed. None of the patients had any obstruction or reflux of the upper tracts. CONCLUSION: The index ONB has reasonable storage and voiding characteristics but with a rider of nocturnal urinary incontinence.

3.
J Endourol ; 25(4): 603-6, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21473695

RESUMO

Ureteral injury is usually iatrogenic after gynecologic or obstetric surgeries. Ureterouterine fistula is a rare complication. It most commonly occurs after a caesarean section. A 24-year-old woman presented with paradoxic incontinence 1 week after caesarean section. Intravenous urography revealed a left ureterouterine fistula. She was treated successfully by laparoscopic ureteroneocystostomy.


Assuntos
Laparoscopia , Fístula Urinária/cirurgia , Anastomose Cirúrgica , Feminino , Humanos , Cuidados Intraoperatórios , Stents , Suturas , Tomografia Computadorizada por Raios X , Ureter/diagnóstico por imagem , Ureter/cirurgia , Fístula Urinária/diagnóstico por imagem , Urografia , Adulto Jovem
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