Clear-cell renal cell carcinoma single thyroid metastasis: A single-center retrospective analysis and review of the literature.

Renal cell carcinoma (RCC) is known to cause metastasis to unusual sites, which can be both synchronous or metachronous. Thyroid gland is a rare site for metastasis. However, RCC is the most common primary neoplasm to metastasize to the Thyroid gland. Report of three cases and review of the literature.

Primary melanoma of the bladder: Case report and review of the literature.

Skin melanoma represents one of the most common and lethal solid tumor. It usually develops on the skin but it can occur in any tissues with melanine- containing-cells (extracutaneous malignant melanoma). Only 4-5% of malignant melanomas originate in extracutaneous tissues, and they have an extremely lethal behavior (1). These non-skin malignant melanomas are rare but extremely aggressive. Primary melanoma of the genitourinary tract accounts for less than 0.2% of all melanomas. To date only 28 cases of primary bladder melanoma (PMM) are described. We report a rare case of PMM of the bladder in a 72 years old man treated with radical cystectomy and immunotherapy with Nivolumab.

Full Neurovascular Sparing Extraperitoneal Robotic Radical Prostatectomy: Our Experience with PERUSIA Technique.

INTRODUCTION: Primary aim of this study was to investigate the feasibility and the safety of PERUSIA (posterior, extraperitoneal, robotic, under santorini, intrafascial, anterograde) radical prostatectomy (RP). Secondary aim was to evaluate oncologic and functional results. The main intent of PERUSIA is to reduce injury of the Neuro-Vascular Bundles (NVB) and to preserve periurethral anterior structures. This is the first reported prospective cohort study about our technique. MATERIALS AND METHODS: We collected prospective data of a cohort of 210 patients who had undergone PERUSIA RP between January 2013 and May 2015. Key points of this technique included the following: posterior approach to intrafascial plane, which was developed from the median to lateral side, anterograde preservation of the Veil of Aphrodite, and development of an anterior avascular plane to preserve the santorini plexus. We included only sexually potent patients with low-risk disease. Perioperative, oncologic, and functional outcomes were collected. Postoperative full continence was defined as no pad use. Patients were defined potent when International Index of Erectile Function (IIEF-5) score was >17. Median follow-up was 22 months. RESULTS: Median operative time and median estimated blood loss were 120 minutes and 150 mL, respectively. 25 patients (11.9%) experienced a total of 36 complications overall with an overall complication rate of 17.1%. We reported 3 (8.3%) grade IIIb complications and no major ones. Overall positive surgical margin rate was 20% with biochemical recurrence occurring in 3.8% of patients at a median follow-up of 22 months. Immediate urinary continence rate (1 day after catheter removal) was 66.6%. At 3 and 12 months, the continence rate was 90.4% and 96.1%, respectively, while sexual potency rate was 70.4% and 80.9%. CONCLUSION: PERUSIA RP has proved to be safe and effective for low-risk prostate cancer with exciting functional outcomes in terms of early recovery of urinary continence and sexual potency.

Expression of inflammasome-related genes in bladder cancer and their association with cytokeratin 20 messenger RNA.

BACKGROUND: Inflammation plays a crucial role in different stages of cancer development and has long been associated with various types of cancer. Strong associations between dysregulated inflammasome activity and human heritable and acquired inflammatory diseases highlight the importance of this pathway in the immune response. The inflammasome is a large complex of NOD-like receptors called NLRs and drives growth and progression of different tumors. The aim of the present study was the characterization of some NLR genes, NLRP3, NLRP4, NLRP9, and NAIP, in urine sediment of patients with bladder cancer. Cytokeratin 20 and survivin were used as confirmed markers of bladder cancer. BASIC PROCEDURES: For this study, 3 groups of subjects were considered: patients harboring bladder cancer, subjects affected by bladder inflammation (CTR1), and healthy subjects (CTR0). Total RNA was extracted from urine sediments and resulting complementary DNA was used for amplification by real-time polymerase chain reaction. Results were stratified according to tumor stage, grade, and risk of progression and recurrence. MAIN FINDINGS: The expression of cytokeratin 20 was always significantly higher in patients with bladder cancer when compared with that in both the tumor-free groups. NLRP3, NLRP4, NLRP9, and NAIP were overexpressed in patients with BCa when compared with that in CTR0. Stratification according to tumor stage, grade, and risk of recurrence and progression showed NLRP up-regulations in patients with early-stage cancer. NAIP was overexpressed in high-risk patients in comparison to CTR0 and in high-grade patients compared with CTR0 and CTR1. PRINCIPAL CONCLUSIONS: These data are relevant to demonstrate the role of inflammasome in urothelial carcinoma, making NLR genes in urine sediment potential candidates for bladder cancer diagnosis.

Pneumoscrotum: report of two different cases and review of the literature.

Pneumoscrotum is the term used to describe the presence of air within the scrotum and includes scrotal emphysema as well as pneumatocele. The etiology varies; in some cases, pneumoscrotum may be due to life-threatening disease like pneumothorax or Fournier gangrene. Despite this, pneumoscrotum is a rarely debated issue. We present two different cases of pneumoscrotum and a review of the literature. The first case report is about a 29 year old male patient affected by Duchenne syndrome who showed pneumoscrotum after cardiopulmonary resuscitation that was performed for asphyxic crisis and cardiovascular arrest. We carried out local puncture with an 18-gauge needle, and the pneumoscrotum was successfully solved. The second case report is about a 56 year old male with pneumoscrotum due to Fournier gangrene who underwent radical exeresis of all necrotic tissues and drainage. This is why most of the scrotal skin and all of the penis skin were removed; as a result, the testicles, epididymis, and cavernosa corpora were externalized. On postoperative day one, the patient was feverless and underwent hyperbaric chamber therapy. No postoperative complications occurred. Accurate evaluation of the pneumoscrotum is always needed. Despite the benign course of most of the clinically evident pneumoscrotum cases, this condition should never be underestimated.

Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer.

OBJECTIVE: To investigate feasibility and safety of our surgical strategy and clinical and oncological efficacy. MATERIALS AND METHODS: In a high volume tertiary institution 225 radical cystectomies were performed from January 2012 to December 2014. We prospectively collected data of a cohort of 12 patients who underwent immediate open radical cystectomy for bladder cancer causing massive haematuria, acute anemia, and impossibility of postponing surgery. A retrospective study was carried out to evaluate operative data, intra- and postoperative complications, and oncologic outcomes. The Clavien-Dindo Classification was used to grade complications. The oncologic outcome was evaluated in terms of positive overall and soft tissue surgical margins and cancer specific survival at a median follow-up of 26 months. RESULTS: Mean preoperative haemoglobin was 6.8 mg/dL. Mean operative time was 278 minutes. Mean blood loss was 633 mL. The overall transfusion rate was 100% with a mean of 3.6 blood units per patient before surgery and 1.8 units postoperatively. No intraoperative complications occurred. Major complications (defined as grades III, IV, and V according to Clavien-Dindo Classification) were 18,5%. In fact grade III complications were 14.8% and grade IV complications were 3.7%. Grade V did not occur. The positive surgical margin rate was 33.3% and cancer specific survival was 58,3% at median follow-up of 26 months. CONCLUSIONS: Immediate surgical management seems feasible, safe, and efficacious.

Retroperitoneal laparoscopic renal tumour enucleation with local hypotension on demand.

PURPOSE: Laparoscopic partial nephrectomy is the standard treatment for peripheric cT1 renal tumours and is usually performed under warm ischaemia. However, it is important to reduce ischaemia time as much as possible to avoid renal damage. The aim of our study was to investigate the feasibility and safety of our technique and to evaluate short-term functional and oncological results. MATERIALS AND METHODS: From June 2010 to December 2012, 54 consecutive patients with T1a-T1b renal tumour were enrolled in a high-volume tertiary institution. All patients underwent laparoscopic enucleation with controlled selective hypotension on demand. Karnofsky performance status scale, R.E.N.A.L. Nephrometry Score and Clavien-Dindo Classification were used to assess patients' status, to stratify patients according to kidney disease and to evaluate complications, respectively. Renal function was evaluated with serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) preoperative and 3, 5, 7 and 90 days postoperatively. RESULTS: All the procedures were completed laparoscopically. Renal hypotension was necessary in 3/54 cases. Mean intraoperatively blood loss was 210 ± 98 ml. Renal carcinoma was found in 87 % patients. Margins revealed to be positive in 5.5 % cases. Mean hospital stay was 7.2 days. Grade IIIa and IIIb postoperative complications were 5.5 and 11 %, respectively. At 3 months, increase for sCr was 0.04 mg/dL; eGFR reduction was 1.2 ml/min. At a median follow-up of 20 months, there was one local recurrence that happened in a positive margin case. CONCLUSIONS: Our preliminary results proved laparoscopic enucleation with controlled selective local hypotension on demand to be a feasible, safe and effective technique for T1 renal tumours.

Robot assisted laparoscopic excision of a paraganglioma: new therapeutic approach.

The Paraganglioma is the most common extra-adrenal pheochromocytoma arising from neural crest (1) (It will better to write: The paraganglioma is an extra-adrenal pheocromocytoma arising from the neural crest. 10% of pheocromocytomas are extra-adrenal and can arise form chromaffin tissue derived from primitive neuroectoderm). Minimally invasive techniques allow surgeons to perform the procedure without wide exposure and mobilization of intra abdominal organs. To our knowledge we present the third case of robotic excision of a retroperitoneal paraganglioma.

Renal malignant solitary fibrous tumor with single lymph node involvement: report of unusual metastasis and review of the literature.

UNLABELLED: Solitary fibrous tumors are rare mesenchymal spindle cell neoplasms that are usually found in the pleura. The kidneys are an uncommon site and only few cases of renal solitary fibrous tumor exhibit malignant behavior metastasizing to the liver, lung, and bone through the hematogenous pathway. PURPOSE: To describe the first case of lymph node metastasis from renal solitary fibrous tumor in order to increase the knowledge about the malignant behavior of these tumors. PATIENTS AND METHODS: A 19-year-old female patient had intermittent hematuria for several months without flank pain or other symptoms. A chest and abdomen CT scan was performed and showed a multi-lobed bulky solid mass of 170 × 98 × 120 mm in the left kidney. One day before the surgery, the left renal artery was catheterized and the kidney embolization was performed using a Haemostatic Absorbable Gelatin Sponge and polyvinyl alcohol. We then performed a radical nephrectomy with hilar, para-aortic, and inter-aortocaval lymphadenectomy. RESULTS: Estimated intraoperative blood loss was 200 mL and the operative time was 100 minutes. No postoperative complications occurred. The hospital stay was 7 days long. The histological examination was malignant solitary fibrous tumor of the kidney. Cancerous tissue showed cellular atypia, with an increased mitotic index (up to 7 × 10 hpf). Immunohistochemical analysis showed positive results for CD34, BCL2, partial expression of HBME1, and occasionally of synaptophysin. Histological evaluation confirmed the presence of metastasis in one hilar node. The patient did not receive any other therapy. At 30-month follow-up, the patient was in good health and no local recurrence or metastases had occurred. CONCLUSION: This is the first case of lymph node metastasis from a renal solitary fibrous tumor showing unusual malignant behavior; this finding adds new information about the biology and progression of these tumors, which remain unclear.

Endoscopic rendez-vous after damage control surgery in treatment of retroperitoneal abscess from perforated duodenal diverticulum: a techinal note and literature review.

INTRODUCTION: The duodenum is the second seat of onset of diverticula after the colon. Duodenal diverticulosis is usually asymptomatic, but duodenal perforation with abscess may occur. CASE PRESENTATION: Woman, 83 years old, emergency hospitalised for generalized abdominal pain. On the abdominal tomography in the third portion of the duodenum a herniation and a concomitant full-thickness breach of the visceral wall was detected. The patient underwent emergency surgery. A surgical toilette of abscess was performed passing through the perforated diverticula and the Petzer's tube drainage was placed in the duodenal lumen; the duodenostomic Petzer was endoscopically removed 4 months after the surgery. DISCUSSION: A review of medical literature was performed and our treatment has never been described. CONCLUSION: For the treatment of perforated duodenal diverticula a sequential two-stage non resective approach is safe and feasible in selected cases.

Laparoscopic partial nephrectomy of thyroid cancer metastasis: case report and review of the literature.

BACKGROUND: Follicular cell thyroid carcinoma is a quite aggressive form of thyroid cancer. About 10% of follicular thyroid carcinoma shows multiple metastases: lung and bone are the most common sites of metastasis. Renal involvement from thyroid primary cancer is very rare with incidence of 4.5%-5.9%. PURPOSE: We report the first laparoscopic conservative treatment of renal metastasis from thyroid cancer. This is a new and useful approach in order to delay malignant disease progression and to reduce the surgical discomfort of the patient. PATIENTS AND METHODS: We present the case of a 67-year-old woman, undergoing total thyroidectomy for follicular thyroid cancer with bone and lung metastasis. During adjuvant radiometabolic treatment, renal metastasis was diagnosed. Renal metastasis showed high metabolic activity, reducing the effectiveness of radioiodine therapy for secondary lesions. For this reason, we performed a laparoscopic simple enucleation of the single renal metastasis using extraperitoneal access and a clampless procedure. RESULTS: THE EXCISION OF THE RENAL LESION IMPROVED THE EFFECTIVENESS OF ADJUVANT RADIOIODINE THERAPY: two months after surgery, the patient underwent adjuvant radiometabolic treatment with iodine-131 (150 mCi) and the following whole body scan showed only a small uptaking area at the level of the vertebral metastasis. The lung micrometastases were not detectable. At 36 months follow-up, malignant disease was clinically stable and well controlled. CONCLUSION: Minimally invasive renal surgery with preservation of renal function and rapid recovery contributed to the success of radioiodine therapy and delayed the progression of the disease.