Penile schwannoma mistaken for hemangioma: a rare case report and literature review.

Penile neoplasm is uncommon. Schwannomas of the penis are especially rare. For this reason, it is difficult to get an accurate impression to enable decision making. This report primarily deals with the mistaken diagnosis of hemangioma, to the surgery, and the follow-up in real-world. A 38-year-old male patient presented with a palpable mass in the penile root that increased in size with erection. One year after the mass had been found, the patient visited the hospital and complained that the mass was growing. Moreover, the patient explained that the mass seemed to increase during penile erection. On physical examinations, a 2 cm mass without tenderness was palpated in the left penoscrotal junction. About 2.1 cm in size, an isoechoic mass was observed next to the corpus cavernosum on ultrasonography. There was high vascularity inside of the mass. Excision and biopsy were decided upon. Following surgery, a schwannoma was confirmed by pathology. After three months, the patient did not complain of any symptoms and had normal erectile function. Most of these tumors are benign. By December 2020, 40 cases were reported, of which 6 were diagnosed as malignant. The most frequent occurrence site is the penile shaft. In all cases, surgical resection was performed and no recurrence was found. The aim of this case report is to assist clinicians in choosing the best treatment option when faced with this rare condition by discussing the radiological, pathological, and clinical course.

Comparison Study of Learning Curve Using Cumulative Sum Analysis Between Holmium Laser Enucleation of the Prostate and Transurethral Resection of the Prostate: Is Holmium Laser Enucleation of the Prostate a Difficult Procedure for Beginner Urologists?

Objectives: Although there is no comparison study about the learning curves for holmium laser enucleation and other surgical modalities to treat benign prostatic hyperplasia (BPH), beginner urologists are hesitant to perform holmium laser enucleation because of its steep learning curve. Therefore, we investigated the degree of surgical difficulty of holmium laser enucleation by comparing its learning curve with that of transurethral resection. Patients and Methods: Two beginner urologists performed surgery for BPH: H.J.Y. performed holmium laser enucleation and K.H.K. performed transurethral resection. Of 141 patients, 72 were enrolled in the holmium laser enucleation group and 69 in the transurethral prostate resection group. After retrospectively reviewing medical records, we performed a cumulative sum analysis of resection speed (RS) and resected ratio (RR) to compare the learning curves of holmium laser enucleation and transurethral resection. Results: Both surgeons achieved RS competency with a speed <0.13 g/min. The surgeon who performed holmium laser enucleation achieved RR competency with a ratio <0.40, whereas the surgeon who performed transurethral resection achieved competency with a ratio <0.35. To achieve RS competency of 0.13 g/mL, the holmium laser enucleation and transurethral resection groups required 12 and 23 cases, respectively. To achieve RR competency of 0.35, the holmium laser enucleation and transurethral resection groups required 12 and 5 cases, respectively. Conclusions: Holmium laser enucleation is not a difficult procedure compared with transurethral resection in beginner urologists. Therefore, it is unnecessary to avoid holmium laser enucleation because the concerns that it may be difficult are unfounded.

Controlled Delivery of Stem Cell-Derived Trophic Factors Accelerates Kidney Repair After Renal Ischemia-Reperfusion Injury in Rats.

Renal disease is a worldwide health issue. Besides transplantation, current therapies revolve around dialysis, which only delays disease progression but cannot replace other renal functions, such as synthesizing erythropoietin. To address these limitations, cell-based approaches have been proposed to restore damaged kidneys as an alternative to current therapies. Recent studies have shown that stem cell-derived secretomes can enhance tissue regeneration. However, many growth factors undergo rapid degradation when they are injected into the body in a soluble form. Efficient delivery and controlled release of secreting factors at the sites of injury would improve the efficacy in tissue regeneration. Herein, we developed a gel-based delivery system for controlled delivery of trophic factors in the conditioned medium (CM) secreted from human placental stem cells (HPSCs) and evaluated the effect of trophic factors on renal regeneration. CM treatment significantly enhanced cell proliferation and survival in vitro. Platelet-rich plasma (PRP) was used as a delivery vehicle for CM. Analysis of the release kinetics demonstrated that CM delivery through the PRP gel resulted in a controlled release of the factors both in vitro and in vivo. In an acute kidney injury model in rats, functional and structural analysis showed that CM delivery using the PRP gel system into the injured kidney minimized renal tissue damage, leading to a more rapid functional recovery when compared with saline, CM, or vehicle only injection groups. These results suggest that controlled delivery of HPSC-derived trophic factors may provide efficient repair of renal tissue injury. Stem Cells Translational Medicine 2019;8:959&970.

Kidney regeneration with biomimetic vascular scaffolds based on vascular corrosion casts.

We have developed a biomimetic renal vascular scaffold based on a vascular corrosion casting technique. This study evaluated the feasibility of using this novel biomimetic scaffold for kidney regeneration in a rat kidney cortical defect model. Vascular corrosion casts were prepared from normal rat kidneys by perfusion with 10% polycaprolactone (PCL) solution, followed by tissue digestion. The corrosion PCL cast was coated with collagen, and PCL was removed from within the collagen coating, leaving only a hollow collagen-based biomimetic vascular scaffold. The fabricated scaffolds were pre-vascularized with MS1 endothelial cell coating, incorporated into 3D renal constructs, and subsequently implanted either with or without human renal cells in the renal cortex of nude rats. The implanted collagen-based vascular scaffold was easily identified and integrated into native kidney tissue. The biomimetic vascular scaffold coated with endothelial cells (MS1) showed significantly enhanced vascularization, as compared to the uncoated scaffold and hydrogel only groups (P < 0.001). Along with the improved vascularization effects, the MS1-coated scaffolds showed a significant renal cell infiltration from the neighboring host tissue, as compared to the other groups (P < 0.05). Moreover, addition of human renal cells to the MS1-coated scaffold resulted in further enhancement of vascularization and tubular structure regeneration within the implanted constructs. The biomimetic collagen vascular scaffolds coated with endothelial cells are able to enhance vascularization and facilitate the formation of renal tubules after 14 days when combined with human renal cells. This study shows the feasibility of bioengineering vascularized functional renal tissues for kidney regeneration. STATEMENT OF SIGNIFICANCE: Vascularization is one of the major hurdles affecting the survival and integration of implanted three-dimensional tissue constructs in vivo. A novel, biomimetic, collagen-based vascular scaffold that is structurally identical to native kidney tissue was developed and tested. This biomimetic vascularized scaffold system facilitates the development of new vessels and renal cell viability in vivo when implanted in a partial renal defect. The use of this scaffold system could address the challenges associated with vascularization, and may be an ideal treatment strategy for partial augmentation of renal function in patients with chronic kidney disease.

Holmium laser enucleation of the prostate is effective in the treatment of symptomatic benign prostatic hyperplasia of any size including a small prostate.

PURPOSE: Although transurethral resection of the prostate (TURP) is considered the standard surgical treatment for benign prostatic hyperplasia (BPH), Holmium laser enucleation of the prostate (HoLEP) is replacing TURP. We compared TURP with HoLEP with matching for prostate size. MATERIALS AND METHODS: We retrospectively reviewed the medical charts of patients who underwent TURP and HoLEP performed by one surgeon at our institute. All patients were categorized into 3 groups on the basis of prostate size (group 1, <40 g; group 2, 40-79 g; and group 3, >80 g), and 45 patients were selected for each method. RESULTS: No major intraoperative complications were encountered. The mean resected tissue weight was 6.3, 18.3, and 28.0 g for groups 1, 2, and 3, respectively, for TURP and 8.7, 25.0, and 39.8 g, respectively, for HoLEP. The mean operation time was 51.8, 89.3, and 101.9 minutes for TURP and 83.6, 122.8, and 131.2 minutes for HoLEP in groups 1, 2, and 3, respectively. HoLEP had better resection efficacy than TURP for any size prostate, but there was no statistical difference between the methods. Both methods resulted in an immediate and significant improvement of International Prostate Symptom Score, peak urinary flow rates, and postvoid residual urine volume. CONCLUSIONS: HoLEP is effective for BPH treatment, regardless of prostate size, even in a small prostate. The perioperative morbidity of HoLEP is also comparable to that of TURP.

Altered gene expression profile after exposure to transforming growth factor ß1 in the 253J human bladder cancer cell line.

PURPOSE: Transforming growth factor ß1 (TGF-ß1) inhibits the growth of bladder cancer cells and this effect is prominent and constant in 253J bladder cancer cells. We performed a microarray analysis to search for genes that were altered after TGF-ß1 treatment to understand the growth inhibitory action of TGF-ß1. MATERIALS AND METHODS: 253J bladder cancer cells were exposed to TGF-ß1 and total RNA was extracted at 6, 24, and 48 hours after exposure. The RNA was hybridized onto a human 22K oligonucleotide microarray and the data were analyzed by using GeneSpring 7.1. RESULTS: In the microarray analysis, a total of 1,974 genes showing changes of more than 2.0 fold were selected. The selected genes were further subdivided into five highly cohesive clusters with high probability according to the time-dependent expression pattern. A total of 310 genes showing changes of more than 2.0 fold in repeated arrays were identified by use of simple t-tests. Of these genes, those having a known function were listed according to clusters. Microarray analysis showed increased expression of molecules known to be related to Smad-dependent signal transduction, such as SARA and Smad4, and also those known to be related to the mitogen-activated protein kinase (MAPK) pathway, such as MAPKK1 and MAPKK4. CONCLUSIONS: A list of genes showing significantly altered expression profiles after TGF-ß1 treatment was made according to five highly cohesive clusters. The data suggest that the growth inhibitory effect of TGF-ß1 in bladder cancer may occur through the Smad-dependent pathway, possibly via activation of the extracellular signal-related kinase 1 and Jun amino-terminal kinases Mitogen-activated protein kinase pathway.

Growth inhibition after exposure to transforming growth factor-ß1 in human bladder cancer cell lines.

PURPOSE: Transforming growth factor-ß1 (TGF-ß1) plays a dual role in apoptosis and in proapoptotic responses in the support of survival in a variety of cells. The aim of this study was to determine the function of TGF-ß1 in bladder cancer cells. MATERIALS AND METHODS: The role of TGF-ß1 in bladder cancer cells was examined by observing cell viability by using the tetrazolium dye (MTT) assay after treating the bladder cancer cell lines 253J, 5637, T24, J82, HT1197, and HT1376 with TGF-ß1. Among these cell lines, the 253J and T24 cell lines were coincubated with TGF-ß1 and the pan anti-TGF-ß antibody. Fluorescence-activated cell sorter (FACS) analysis was performed to determine the mechanism involved after TGF-ß1 treatment in 253J cells. RESULTS: All six cell lines showed inhibited cellular growth after TGF-ß1 treatment. Although the T24 and J82 cell lines also showed inhibited cellular growth, the growth inhibition was less than that observed in the other 4 cell lines. The addition of pan anti-TGF-ß antibodies to the culture media restored the growth properties that had been inhibited by TGF-ß1. FACS analysis was performed in the 253J cells and the 253J cells with TGF-ß1. There were no significant differences in the cell cycle between the two treatments. However, there were more apoptotic cells in the TGF-ß1-treated 253J cells. CONCLUSIONS: TGF-ß1 did not stimulate cellular proliferation but was a growth inhibitory factor in bladder cancer cells. However, the pattern of its effects depended on the cell line. TGF-ß1 achieved growth inhibition by enhancing the level of apoptosis.

Association between obesity, prostate-specific antigen level and prostate-specific antigen density in men with a negative prostate biopsy.

OBJECTIVE: To determine the association between body mass index (BMI), serum prostate-specific antigen (PSA) level and PSA density (PSAD) in patients with an elevated serum PSA level but a negative prostate biopsy. METHODS: This retrospective study enrolled men with a negative prostate biopsy but a serum PSA level of 3.0-10 ng/ml. All men underwent anthropometric measurements, serum PSA determination and transrectal ultrasound examination. BMI was grouped according to the Asia-Pacific obesity criteria: nonobese (<25 kg/m(2)) versus obese (≥ 25 kg/m(2)). Partial correlation and linear regression models between PSA, PSAD and BMI were conducted after adjusting for age. RESULTS: A total of 907 men were enrolled in this study. On multivariate analyses, PSA showed no significant correlation with age or BMI, whereas PSAD had a negative correlation with age and BMI. Similar results were obtained when patients were categorized as having low (3.0 < PSA ≤ 6.5 ng/ml) or high PSA (6.5 < PSA ≤ 10.0 ng/ml) levels. CONCLUSION: PSAD, but not PSA, demonstrated a significant negative correlation with BMI. This indicates that a new strategy including PSAD rather than simple PSA levels should be adopted in the study of obesity-adjusted PSA cut-offs.

Late-onset metastatic adenocarcinoma of the spermatic cord from primary gastric cancer.

BACKGROUND: Metastatic cancers of the paratesticular tissue are very rare; however, the most frequent primary site of spermatic cord metastasis is the gastrointestinal tract. CASE PRESENTATION: We recently observed two cases of late-onset metastatic adenocarcinoma of the spermatic cord. Both patients complained of groin discomfort with a palpable mass in the scrotum and inguinal area. Radical orchiectomy and adjuvant chemotherapy were performed in both patients. Although the prognosis of patients with metastatic adenocarcinoma of the spermatic cord is typically poor, the prognosis of our patients was favorable after follow-up for 14 to 18 months. CONCLUSIONS: In patients with groin discomfort or swelling and a history of gastric cancer, metastatic adenocarcinoma should be included in the differential diagnosis for early detection of tumors.

Experience of ultrasonography-guided percutaneous core biopsy for renal masses.

PURPOSE: We evaluated the safety and accuracy of ultrasonography-guided percutaneous core biopsy collection in patients with renal masses. MATERIALS AND METHODS: From June 2008 to August 2012, 30 percutaneous core biopsies of renal masses were performed. The biopsies obtained were small tumors (<4 cm) with ambiguous radiologic findings or that met classic renal biopsy indications. The biopsy results were compared with the final pathological results after definitive surgical treatment. Ultrasonography was performed on the day after biopsy collection to rule out any complications. RESULTS: The mean age of the patients was 57.7 years, and the mean tumor size was 3.39 cm. Twelve of the lesions were in the left kidney, and 18 were in the right kidney. All but one core biopsy contained sufficient material for histopathological analysis. The biopsy results showed 17 renal cell carcinomas (56.7%), 3 angiomyolipomas (10.0%), 2 oncocytomas (6.7%), 1 adenocarcinoma (3.3%), and 7 benign lesions (23.3%). A total of 18 cases underwent surgery, and the pathological results confirmed the initial biopsy diagnosis for 17 of 18 cases (94.4%). The one (5.9%) inaccurate biopsy result was found to be a urothelial carcinoma of the kidney. No needle tract seeding was found in the pathological specimens or on follow-up imaging. A small perinephric hematoma (1-2 cm) was seen in 5 cases (16.7%), but all patients remained hemodynamically stable. CONCLUSIONS: Ultrasonography-guided renal biopsy is a safe, effective, and accurate method for evaluating small renal masses. This procedure may help in selecting treatment modalities for small renal masses.

Anterior urethral valve and diverticulum in a neonate with febrile urinary tract infection.

Anterior urethral valve is a rare congenital anomaly that can cause obstructive uropathy. Herein, we report a case of an anterior urethral valve that led to the development of febrile urinary tract infection in a neonate.

Use of cystoscopic tattooing in laparoscopic partial cystectomy.

PURPOSE: During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. MATERIALS AND METHODS: LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. RESULTS: All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. CONCLUSIONS: Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.

A case of renal schwannoma.

Schwannomas are benign tumors that arise from the neural sheath of Schwann cells. Renal schwannomas are extremely rare and are commonly misdiagnosed as renal cell carcinoma, which typically results in a radical nephrectomy. We present a case of a renal schwannoma that mimics a renal pelvis tumor.