Genital premalignant and malignant diseases: a retrospective study of male genital skin biopsies.

BACKGROUND: Genital skin malignancies are a rare entity encountered by clinicians that may result in significant morbidity and mortality. Lack of familiarity or expertise in this area among clinicians can delay appropriate management of these conditions and may result in disease progression. METHODS: We performed a retrospective descriptive cohort study of male patients who received a genital skin biopsy reported by one major dermatopathology laboratory between January 2017 and December 2018 with a histological diagnosis of a premalignant or malignant condition. Patient age, type of clinician, clinical notes, genital site, type of biopsy performed, and histopathological diagnosis were evaluated. RESULTS: Of the 1525 male genital skin biopsies available for analysis, 5% (74/1525) were premalignant or malignant diseases. These included penile intraepithelial neoplasia (PeIN) (42/74, 57%), followed by invasive squamous cell carcinoma (SCC) (11/74, 15%), Bowenoid papulosis (BP) (9/74, 12%), basal cell carcinoma (8/74, 11%), malignant melanoma (2/74, 2.7%), extramammary Paget's (1/74, 1.4%), and metastatic cutaneous deposits (1/74, 1.4%). PeIN and BP most commonly affected the penile shaft ([18/42] 43% and [4/9] 44%, respectively), invasive SCCs most commonly affected the glans penis (4/11, 36%), and all BCCs (8/8, 100%) were located on the scrotum. Invasive SCCs were most biopsied by urologists, BP was most biopsied by dermatologists, and PeINs and BCCs were most biopsied by general practitioners. CONCLUSIONS: A variety of genital malignancy types were found in males. A greater understanding of male genital premalignant and malignant conditions may help guide education and further research in this area.

Penile squamous cell carcinoma following childhood hypospadias repair.

We report a case of a 46-year-old man who presented with recurrent lower urinary tract infections and obstructive voiding symptoms on the background of a proximal hypospadias repair at 4 years of age. A mass was later identified at his distal urethra, which on biopsy was found to be a penile squamous cell carcinoma. The lesion was excised en bloc, and at 10 months post-excision, the patient has no evidence of local or regional recurrence.

Ureaplasma urealyticum infection presenting as pyelonephritis and perinephric abscess in an immunocompromised patient.

We report a case of an immunosuppressed 67-year-old woman who presented with fever of unknown origin. Further investigation revealed multiple left renal and perinephric abscesses. These were managed with percutaneous drainage and broad-spectrum antibiotics; however, no clinical improvement resulted. No organism was identifiable on standard microscopy and culture of all drain, blood and urine samples taken. Left nephrectomy with right urinary diversion was performed for sepsis management and to protect the patient's right kidney. Eventually, Ureaplasma species' RNA was detected in the patient's drain fluid using PCR and 16S ribosomal RNA gene sequencing. The patient was treated successfully with targeted antibiotic therapy and underwent extensive rehabilitation following this. Histopathology of the nephrectomy specimen suggested xanthogranulomatous pyelonephritis.

Urethral syringocele: unseen but existing.

BACKGROUND: Bulbourethral syringocele is an uncommon and under-diagnosed condition most commonly seen in the paediatric population, although there is increasing recognition in adults. Due to the difficulty in diagnosis, we report our experience of urethral syringocele in a quaternary paediatric hospital, with differing presentations, diagnosis and treatment. METHODS: This is a retrospective review of seven cases of children over a period of 14 years, including their presentations, diagnosis, treatment and follow-up. A review of the current literature is presented. RESULTS: The median age of these seven cases at presentation was 11 years (6 days to 16 years). Clinical features varied with age, with obstructive uropathy in a neonate, urinary tract infection in an infant, scrotal abscess in two children and lower urinary tract obstructive symptoms in three teenagers. Diagnostic voiding cystogram diagnosed the majority of syringoceles and two were seen on magnetic resonance imaging. Five boys underwent endoscopic transurethral deroofing and two children required transperineal marsupialization. Long-term follow-up showed all had complete resolution of symptoms. CONCLUSION: Urethral syringocele presents from the neonatal period to late adolescence, with the presenting features reflective of age. Surgical management can be performed endoscopically or by open approach. Awareness of this condition and inclusion in the differential diagnosis, particularly in the setting of an atypical or recurrent scrotal abscess, could avoid a prolonged therapeutic course.

Natural history and quality of life in patients with cystine urolithiasis: a single centre study.

OBJECTIVE: To describe the natural history and quality of life (QoL) in patients with cystine urolithiasis. PATIENTS AND METHODS: A cohort study was carried out involving participants recruited from a single surgeon's case mix. Patients with cystinuria and related urolithiasis were invited to complete a questionnaire involving demographic information, use of medical treatment, surgical interventions and the 36-item short-form 36-item short-form health survey (SF-36). RESULTS: In all, 14 patients completed the survey. The SF-36 survey showed lower QoL than the general public in seven of eight domains. The mean interventional rate in patients with cystinuria was 10.6 procedures per patient. Most patients reported previous use of d-penicillamine and urinary alkalinisation medications, with most ceasing due to side-effects or lack of perceived efficacy. CONCLUSION: Cystinuria is associated with a high rate of surgical intervention and lower QoL than the general public. Individuals with this condition report that medical management is either ineffective or poorly tolerated. There is a need for further improvements in medical management of cystinuria, to reduce the rate of operative intervention.

Lower urinary tract symptoms: thinking beyond the urinary tract.

We present a case of a 54-year-old man with progressive lower urinary tract symptoms over 12 months. Physical examination, urinalysis, serum biochemistry and ultrasound of the renal tract were all unremarkable. Flexible cystoscopy was normal. Urodynamic assessment revealed an overactive bladder of unknown aetiology. The patient went on to have an MRI of the lumbosacral spine which showed a spinal cord tumour of the conus medullaris. The patient underwent a laminectomy and resection of the tumour. Histology showed myxopapillary ependymoma of the spinal cord. This case highlights the need to consider the full spectrum of causes, urological and non-urological, in assessing a patient with voiding dysfunction.

The N-terminal region of wheat streak mosaic virus coat protein is a host- and strain-specific long-distance transport factor.

Understanding the genetics underlying host range differences among plant virus strains can provide valuable insights into viral gene functions and virus-host interactions. In this study, we examined viral determinants and mechanisms of differential infection of Zea mays inbred line SDp2 by Wheat streak mosaic virus (WSMV) isolates. WSMV isolates Sidney 81 (WSMV-S81) and Type (WSMV-T) share 98.7% polyprotein sequence identity but differentially infect SDp2: WSMV-S81 induces a systemic infection, but WSMV-T does not. Coinoculation and sequential inoculation of SDp2 with WSMV-T and/or WSMV-S81 did not affect systemic infection by WSMV-S81, suggesting that WSMV-T does not induce a restrictive defense response but that virus-encoded proteins may be involved in differential infection of SDp2. The viral determinant responsible for strain-specific host range was mapped to the N terminus of coat protein (CP) by systematic exchanges of WSMV-S81 sequences with those of WSMV-T and by reciprocal exchanges of CP or CP codons 1 to 74. Green fluorescent protein (GFP)-tagged WSMV-S81 with CP or CP residues 1 to 74 from WSMV-T produced similar numbers of infection foci and genomic RNAs and formed virions in inoculated leaves as those produced with WSMV-S81, indicating that failure to infect SDp2 systemically is not due to defects in replication, cell-to-cell movement, or virion assembly. However, these GFP-tagged hybrids showed profound defects in long-distance transport of virus through the phloem. Furthermore, we found that four of the five differing amino acids in the N terminus of CP between the WSMV-S81 and WSMV-T isolates were collectively involved in systemic infection of SDp2. Taken together, these results demonstrate that the N-terminal region of tritimoviral CP functions in host- and strain-specific long-distance movement.

Characterization of a U.S. Isolate of Beet black scorch virus.

ABSTRACT The first reported U.S. isolate of Beet black scorch necrovirus (BBSV) was obtained and characterized. Host range of the virus for localized and occasionally systemic infection included the Chenopodiaceae and Tetragonia expansa; Nicotiana benthamiana supported symptomless systemic infection by the virus. The complete nucleotide sequence of the genomic RNA of the virus, designated BBSV-Co, exhibits 93% similarity to the genome of the 'Ningxia' isolate of BBSV from China. Amino acid sequence similarity in predicted genes ranged from 95% in the p4 gene to 97% in the p82 and coat protein genes. A potential additional gene exists within the U.S. isolate of BBSV that is absent from Chinese isolates of BBSV due to nucleotide differences between these isolates within the coat protein gene. Coat protein analysis by isoelectric focusing and by mass spectroscopy indicated the presence of phosphorylated residues. Using primer extension analysis of the 5' end of the genome and site-directed mutants of genomic clones of BBSV-Co from which infectious RNA was produced, the native 5' end of the BBSV-Co genome was determined to be 5'-GAAACCTAACC...3', lacking the two terminal adenosine nucleotides in the published sequences of BBSV from China.