Quadruple primary urogenital cancers - A case report.

INTRODUCTION: Urogenital cancers are not an uncommon occurrence in daily practice. Prostate cancer is the second most frequent cancer in men, kidney cancer accounts for 2.4% of all cancers and bladder cancers represent 3.1% of cancers in both men and women [1]. However, the cases of a simultaneous development of all three cancers, including one with a neuroendocrine component, are very few and far between. PRESENTATION OF CASE: Our case report involves a case of a patient with prostate adenocarcinoma, clear-cell renal carcinoma, papillary renal carcinoma and small-cell bladder cancer. The patient was treated as if he had separate pathologies by a multidisciplinary team: surgical and oncological, performing radical cystoprostatectomy with left perifascial nephroureterectomy, right ureterostomy and adjuvant chemotherapy, with excellent outcome even four years after the initial diagnosis. DISCUSSION: The distinct features of this case are the occurence of four different malignancies of the urogenital system, the family history of colon cancer, the development of small-cell carcinoma of the bladder, which is extremely rare and the good outcome, despite the quadruple malignancies and the aggresivity of the small-cell carcinoma. CONCLUSION: Mutiple primary malignancies are a relatively rare pathology, but should be considered as a possibility in patients who already had a second malignancy. Cases of patients with MPMs should be supervised by a multidisciplinary team and should be followed closely.

Small-cell carcinoma of the urinary bladder: where do we stand?

Small-cell carcinoma of the urinary bladder is a very rare pathology, but with a very aggressive behavior and disappointing prognosis. The literature concerning this type of cancer is scarce and physicians may encounter difficulty trying to manage it. Most articles involve the study of case series, without definite results due to the small number of patients. The present article aims at gathering the most significant articles and results in order to offer a broad perspective on the existing literature concerning this pathology.

Vascular anatomy in the lumbar spine investigated by three-dimensional computed tomography angiography: the concept of vascular window.

OBJECTIVE: To report an in vivo anatomic evaluation of prevertebral vessels in the lumbar spine using three-dimensional (3D) computed tomography (CT) angiography and to develop the concept of vascular window for surgical access to L4-5 and L5-S1 disks. METHODS: In 146 patients who were scheduled for anterior lumbar spine surgery, 3D CT angiography was performed preoperatively. Spinal disorders included degenerative disk disease (n = 120) and low-grade spondylolisthesis (n = 26). 3D reconstructions were obtained using the volume-rendering technique. Level of aortic bifurcation and iliocavum confluence, presence of the ascending iliolumbar vein, presence of the central sacral vessels, and anatomic variations were analyzed. A vascular window at L5-S1 was defined as the "free vascular" area for the anterior part of the L5-S1 disk. A vascular window at L4-L5 was defined as the "free vascular" area for the left anterolateral part of the L4-5 disk. RESULTS: The level of aortic bifurcation was most often observed at L4 (64%). The iliocavum confluence occurred most frequently at L5 (44%). The iliolumbar ascending vein and central sacral vessels were identified in 84% and 72% of cases. Five (3.5%) anatomic variations were noted: right internal iliac vein draining into the left common iliac vein in two cases and tortuous vessels in three cases. A vascular window was measured to 34.5 mm ± 12 at L5-S1 and to 23 mm ± 8 at L4-L5. The vascular window was <25 mm in approximately one in four patients at L5-S1 and in approximately two in three patients at L4-L5. CONCLUSIONS: This study confirms that vascular anatomy in the lumbar spine is characterized by a great variability that has significance for preoperative assessment. 3D CT angiography allowed for an effective evaluation of the relationships between the prevertebral vessels and the intervertebral disks at L4-L5 and L5-S1. Although adherence of vessels to the anterior ligament cannot be predicted by this technique, the concept of vascular windows investigated preoperatively by CT angiography could be helpful in predicting the need for vessel mobilization during anterior lumbar spine surgery.