Ureteral carcinoma metastasizing to the testicle: Can misdiagnosis of orchiepididymitis be avoided?

Testicular metastases from ureteral carcinoma are rare and they are generally mimic orchiepididymitis. For this reason, these are associated to misleading diagnoses and cancer treatment delay. We believe that both timing and knowledge of genital blood and lymph reverse flow routes may represent two important parameters for avoiding misleading diagnoses and speed proper anticancer treatment. We describe a case and discuss pathophysiological data and relevant literature.

Prognostic significance of p53, bcl-2 and Ki-67 in high risk superficial bladder cancer.

BACKGROUND: Although tumor grade and stage are the most accurate prognostic factors in the evaluation of transitional cell bladder cancer, they cannot always predict the true tumor biological potential since superficial tumors of the same stage and grade may have completely different clinical courses. This study was performed in order to examine whether p53, bcl-2 and Ki-67 have any validity in predicting the course of superficial bladder tumors, with high risk for recurrence or progression, over the traditional prognostic factors that are currently used. Furthermore, we investigated whether any one of these markers maintains its prognostic capability after one course of intravesical instillations of IFN gamma. MATERIALS AND METHODS: The immunohistochemical evaluation of bladder tumor specimens, that were obtained transurethrally for the expression of p53, bcl-2 and Ki-67, was performed in 58 patients. After meticulous selection of cut-off values for the expression of the aforementioned markers, twenty-eight patients were treated only with transurethral resection (TURBT only group) while 30 patients received adjuvantly intravesical instillations of interferon gamma. The times to first recurrence and progression were recorded during the follow-up period which ranged from 3 to 36 months (mean 11.7 months). The prognostic significance of tumor stage, grade, presence of CIS, p53, bcl-2 and Ki-67 in determining the risk for recurrence, was studied with both univariate (log-rank test) and multivariate (Cox regression) methods of analysis, separately for the TURBT only group of patients and for those who received instillations. The same analysis was employed for the risk of progression in the overall number of progressed patients. RESULTS: According to both uni- and multivariate analysis of the prognostic significance for tumor stage (T), grade (G), presence of CIS, p53, Ki-67 and bcl-2 in each group of patients, the Ki-67 index was the only independent prognostic factor for recurrence in patients treated with TURBT only (p = 0.0044 univariate, p = 0.031 multivariate). None of the factors which were studied proved to have prognostic significance for recurrence in the group of patients who received adjuvant intravesical instillation with the immunomodulating agent. Although in the univariate analysis all the studied parameters except tumor stage seem to be associated in a statistically significant manner with higher risk for progression, the multivariate analysis did not yield any independent significant prognosticator. The same evaluation was performed only for the patients with grade 2 disease (28) and yielded statistically significantly higher risk for recurrence, both in uni- (p = 0.0081) and in multivariate analysis (p = 0.044) only in the patients with overexpression of Ki-67 who were treated with TURBT alone. CONCLUSION: The Ki-67 proliferative index has an independent validity in predicting those patients with high risk superficial bladder tumors who may recur in a short follow-up period. A similar relationship of Ki-67 overexpression to progression was not detected. The expression of p53 and bcl-2 does not seem to offer any prognostic information in predicting either recurrence or progression over the prognostic factors that are currently used in clinical practice.

Efficacy of postoperative bladder irrigation with water for injection in reducing recurrence rates of non muscle invasive bladder cancer.

The aim of the study was to investigate the results of bladder irrigation with Water for Injection (WFI) after transurethral resection of bladder tumours for comparison with those for adjuvant use of BCG. A total of 239 patients (158 with single tumours, group A, and 81 with multiple tumours, group B) received continuous intravesical postoperative irrigation with WFI. Some 128 patients received intravesical irrigation with WFI, followed by weekly instillations of BCG (group C). Recurrence-free rate (RFR) and recurrence-free intervals (RFI) were recorded. RFR for those patients who received only intravesical irrigation with WFI (groups A and B) was 75.8%, 66.2% and 63.2% at the 1st, 2nd and 3rd year of follow up, respectively. Corresponding rates for group C were 61.7%, 55.4% and 49%. Median RFI in group B were 18, 11, 15, 15 and 12 months for Ta, T1, grade 1, grade 2 and grade 3 tumours, respectively. In group C corresponding intervals were 20, 33, 8, 20 and 42 months. BCG improved RFR only in T1 (p=0.014) and grade 3 tumours (p=0.007). In conclusion, postoperative bladder irrigation with WFI could increase RFR during the first and second year of follow up.

Clinico-pathological prognostic factors of renal cell carcinoma: A 15-year review from a single center in Greece.

AIM: To investigate the prognostic significance of certain clinical and pathological factors of renal cell cancer. MATERIALS AND METHODS: One hundred and fourteen patients who underwent radical nephrectomy between 1996 and 2011 in our hospital were examined. Parameters including age, gender, mode of presentation, hematological and pathological parameters were evaluated for their role as predictors of disease-free and overall survival. RESULTS: Median follow-up was 69 months. Predominant histological type, pathological stage, and nuclear grade were clear cell carcinoma, pT1, and Fuhrman II, respectively. Five-year overall and disease-free survival were 86% and 82%, respectively. Only nuclear grade (P = 0.02) and preoperative anemia (P < 0.01) were correlated with overall survival, while pathological stage, nuclear grade, anemia, and neutrophil-to-lymphocyte ratio of 2.7 or greater were associated with disease-free survival (P = 0.02, P = 0.038, P < 0.01, P = 0.049, respectively). In the multivariate setting, anemia (P = 0.04) and pathological stage (P = 0.026) were the only independent statistically significant predictors of disease-free survival, while anemia (P = 0.018) and neutrophil to lymphocyte ratio (P = 0.034) were the only factors correlated with overall survival. CONCLUSIONS: Due to the wide application of various imaging studies, patients with kidney cancer are diagnosed more often with localized disease and favorable pathological features. Fuhrman nuclear grade, pathological stage, preoperative anemia, and neutrophil to lymphocyte ratio are strongly associated with survival. In localized disease, such information could be used to guide the intensity of follow-up and identify high-risk patients who can be targeted for adjuvant therapy trials.

The effectiveness of otis urethrotomy combined with six weeks urethral dilations until 40 Fr in the treatment of bladder outlet obstruction in women: a prospective study.

PURPOSE: To evaluate the effectiveness of Otis urethrotomy combined with six weekly urethral dilations until 40 French (Fr) in the treatment of women with urodynamic diagnosis of bladder outlet obstruction (BOO). MATERIALS AND METHODS: Women diagnosed with lower urinary tract symptoms underwent urodynamic evaluation. Severity of symptoms and quality of life were assessed with international prostate symptom score (IPSS) and quality of life (QoL) questionnaires. Bladder outlet obstruction was defined as the presence of two or more of the following: maximum flow rate (Qmax) < 12 mL/s, detrusor pressure at maximum flow (PdetQmax) > 50 cmH2O and urethral resistance factor (URF) greater than 0.2. Ten out of 25 women diagnosed with BOO met the criteria. All women underwent Otis urethrotomy to 40 F and six-week urethral dilations until 40 F. After six months all patients underwent free uroflowmetry. Moreover post voiding residual (PVR), IPSS-QoL were recorded. RESULTS: Six months post-operatively there was a significant improvement in all parameters: IPSS = 13.5 vs. 22.5 (P = .001), QoL = 3 vs. 5 (P = .001), voided volume = 312 mL vs. 216 mL (P = .055), Qmax = 27.5 mL/s vs. 12 mL/s (P = .001), and PVR = 27.5 mL vs. 170 mL (P = .005). Five women had close follow up during an average of 82 months. They maintained improved QoL (P < .005) and low PVR (P < .002). All other parameters lost their statistical significance. CONCLUSION: The described therapeutical modality seems to improve all clinical and urodynamic parameters in women with evidence of BOO not related to detrusor sphincter dyssynergia or obvious functional and anatomical pathology.

The lipophilic extract of Hypericum perforatum exerts significant cytotoxic activity against T24 and NBT-II urinary bladder tumor cells.

Hypericum perforatum L. (St. John's wort) is a medicinal plant used for many pathologies, especially for the treatment of mild to moderate depression. In the present study we have investigated the cytotoxic activity of the locally collected (Epirus region) Hypericum perforatum L. against cultured T24 and NBT-II bladder cancer cell lines. The lipophilic extract of the herb, prepared using petroleum ether, induced apoptosis displaying LC(50) values at concentrations as low as 4 and 5 microg/mL. A fraction of this extract displayed 60 % cell growth inhibition at a concentration of 0.95 microg/mL. Evaluating the importance of various biologically active components of the extract, it was found that hypericins (hypericin, pseudohypericin, etc.) were identified only in the methanolic (lipophobic) extract of the herb, and not in the active lipophilic extract. In addition, hyperforin concentrations in the lipophilic extract and its most active fraction, were 0.94 microg/mL, and 0.17 microg/mL, respectively, while the active cytotoxic concentration of pure hyperforin appeared in the range of 1.8 microg/mL - 5.0 microg/mL. Therefore, pure hyperforin does not seem to contribute significantly to the cytotoxicity activity. Chlorophylls were identified in low, not significantly different, concentrations in all extracts and fractions and were not correlated to the biological activity. Owing to the combination of significant cytotoxic activity, natural abundance and low toxicity, the lipophilic extract of Hypericum perforatum holds the promise of being an interesting, new, antiproliferative agent against bladder cancer that deserves further investigation.