A Rare Case of Right Ventricular Myxoma with Tricuspid Valve Endocarditis.

BACKGROUND: Although myxoma is the most common form of benign cardiac tumor, which is a rare condition itself, less than 3-4% of cases are detected in the right ventricle (RV). The clinical presentations vary widely and are nonspecific, causing challenging diagnosis. Although rare, myxoma can coexist with infective endocarditis (IE). CASE REPORT: We report a rare case of right ventricular myxoma presenting with dyspnea and fever, which was later found to be complicated with concomitant tricuspid valve endocarditis during surgery as well as the performed surgical approach. CONCLUSION: RV myxoma is a rare entity requiring a high index of suspicion due to varying nonspecific presentations. Concomitant IE should be suspected in patients with persistent fever. Antibiotics and careful surgical approach are needed to prevent complications, including embolization.

Early upregulation of AR and steroidogenesis enzyme expression after 3 months of androgen-deprivation therapy.

BACKGROUND: Androgen deprivation therapy (ADT) is a standard treatment for advanced prostate cancer (PCa). However, PCa recurrence and progression rates during ADT are high. Until now, there has been no evidence regarding when progression begins. This study evaluated the gene expression of intraprostatic androgen receptor (AR) and steroidogenic enzymes in the early stages of ADT. METHODS: Prostate tissue samples were taken from PCa patients with urinary retention who received ADT (ADT-PCa; n = 10) and were further subgrouped into ADT ≤12 months (n = 4) and ADT > 12 months (n = 6). The ADT-PCa tissues were then compared with BPH (n = 12) and primary (no treatment) PCa tissues (n = 16). mRNA for gene expression analysis of AR and steroidogenic enzymes was extracted from formalin-fixed paraffin embedded (FFPE) tissues and analyzed by real-time PCR. Protein expression was evaluated by immunohistochemistry with specific antibodies. RESULTS: AR gene expression was higher in the ADT-PCa group than in the BPH or primary PCa group. Both the ADT ≤12 and > 12 months subgroups had significantly higher relative gene expression levels of AR (p < 0.01 and 0.03, respectively) than the primary PCa group. In the ADT-PCa group, AR protein expression showed an increasing trend in the ADT ≤12 months subgroup and was significantly elevated in the ADT > 12 months subgroup compared with the PCa group (100%; p < 0.01). Half (50%) of the patients in the ADT ≤12 months subgroup were found to have upregulation of AR, and one showed upregulation beginning at 3 months of ADT. A trend toward elevated relative gene expression of SRD5A3 was also apparent in the ADT groups. CONCLUSION: AR and steroidogenic enzymes are upregulated in ADT-PCa patients as early as 3 months, without PSA elevation. Steroidogenic enzymes, particularly SRD5A3, were also upregulated before PSA rose.

Abnormal dartos fascia in buried penis and hypospadias: Evidence from histopathology.

INTRODUCTION: The importance of the pathology of the dartos fascia in hypospadias and buried penis is still debatable. Understanding the properties of connective tissue of dartos fascia in hypospadias and buried penis may give a clue to the underlying mechanism. OBJECTIVE: This study aimed to compare connective tissue and vascularization of dartos fascia between normal penis, buried penis, and hypospadias. STUDY DESIGN: We conducted this prospective study from May 2013 to November 2016. We collected dartos fascia specimens from three groups: buried penis, hypospadias, and normal penis as control. All of the patients underwent primary surgery in all groups. Patients with penile abnormalities, such as phimosis or Balanitis Xerotica Obliterans (BXO) were excluded from the normal penis group. We compared the fibers between these groups using Masson trichrome histochemical staining, Gomori's silver impregnation staining, Weigert resorcin-fuchsin staining, and CD31 immunohistochemistry staining for evaluation of collagen fibers, reticulin fibers, elastin fibers, and endothelial cells of blood vessels, respectively. The collagen fibers, reticular fibers, elastic fibers, and vascular vessels were counted with ImageJ and manually calibrated and counted and were analyzed using the one-way ANOVA test. The assessment conducted by two pathologists was blinded, without knowing the clinical diagnosis of patients. RESULTS: There was a total of 60 patients with 20 patients in each group. Collagen fibers for most cases of buried penis and hypospadias showed thicker but fewer collagen fibers than the normal penis. There was a reduction of total collagen and elastin of dartos fascia in hypospadias and buried penis cases. On the other hand, the ratio of reticulin fibers, which represents collagen type III to total collagen, was increased compared to normal penis. DISCUSSION: Although the dartos fascia in buried penis and hypospadias is thick and inelastic when palpated or during traction/counter traction, it is well-vascularized tissue. This inelastic dartos fascia tissue is an abnormal tissue, but its characteristics are not similar to fibrotic tissue. However, further study with a larger sample is warranted and should differentiate the degree of chordee in patients with hypospadias and buried penis. CONCLUSIONS: There was a difference between connective the tissue of dartos fascia in buried penis and patients with hypospadias compared with normal penis. Inelastic dartos fascia tissue in patients diagnosed with buried penis and hypospadias is an abnormal tissue. Therefore, it is suggested that this tissue is excised during reconstructive surgery. Further research is needed to unveil the pathophysiology of the condition.

Thrombus-like Tumor of Renal Cell Carcinoma Mimicking Transitional Cell Carcinoma of Kidney: A Case Report.

Renal cell carcinoma (RCC) is the most common malignancy of the kidney. It is not commonly form tumor thrombus in the ureter or renal pelvis. A 29-year-old woman presented with asymptomatic gross hematuria. Contrast CT study revealed a tumor suspected to be a Transitional Cell Carcinoma (TCC). However, tumor thrombus was found in the renal pelvis and ureter. We performed Nephroureterectomy, bladder cuff excision, and lymph node dissection, and the tumor was diagnosed histopathologically as RCC. We report a very rare case of thrombus-like tumor of renal cell carcinoma mimicking transitional cell carcinoma of kidney.