Giant renal cyst complicated with acquired crossed renal ectopia, hypertension and renal cell carcinoma: case report and review of the literature.

Simple renal cysts are acquired kidney lesion that are described as spherical, smoothed surfaced, with a serous, sub-yellow content. They are generally considered as a harmless anomaly, however cases of complicated renal cysts have been reported. We present a case of an enormous renal cyst (the biggest ever described) containing more than 25 L of fluid mimicking ascites, complicated with controlateral displacement of ipsilateral functional kidney and intra-abdominal organs, renal cell carcinoma and hypertension. Particular attention is carried in the analysis of the literature about different aspects of giant renal cysts like the ability to grow to a very giant size, the association with hypertension and renal cell carcinoma, the sensibility of the most important examinations to reveals malignancy and management.

Numb chin syndrome: the presenting symptom of a metastatic prostate carcinoma.

Numb chin syndrome is a sensory neuropathy characterized by numbness involving the distribution of the mental nerve that could be an uncommon manifestation of metastatic malignancy. Bony metastases are common in patients with advanced prostate carcinoma and involving preferentially vertebrae, sternum, pelvic bones, ribs and femurs. We report a case in an 82-year-old man presenting a history of mental neuropathy as the isolated presenting symptom of a widespread metastatic prostate cancer Numb chin syndrome was describe in some reviews as a late component of a previously diagnosed disease but this report underline the importance of this neuropathy as the isolated presenting symptom of a widespread metastatic prostate cancer. This event is very rare and enumerates four cases in the world literature.

Multicenter study on the use of gemcitabine to prevent recurrence of multiple-recurring superficial bladder tumors following intravesical antiblastic agents and/or BCG: evaluation of tolerance.

OBJECTIVES: The treatment of choice for superficial bladder TCC is endoscopic resection, followed or not by intravesical immuno/chemotherapy. Some patients are not responders to common intravesical therapy and are more exposed to disease progression. In this case the suitable treatment is radical cystectomy. Because gemcitabine is effective against advanced bladder cancer, we have initiated a study to evaluate the efficacy of its intravesical use to prevent relapse and disease progression, and tolerance and safety of this drug in patients with multi-treated bladders. In this preliminary study, we cite only data on tolerance. MATERIALS AND METHODS: 64 patients were selected, and 61 were evaluable (age range 39-84 years), with multiple-recurrent bladder TCC. All patients were previously treated with intravesical chemotherapy and/or immunotherapy. The protocol provided for intravesical instillation of gemcitabine (2000 mg) once per week for 8 weeks. We collected data regarding problems noted by the patients (both local and systemic). RESULTS: 53 patients out of 61 (86.9%) completed the cycle. Side effects appeared in 14 patients, 8 of these had to suspend the treatment. Severe side effects were systemic in 4 patients (1 systemic edema, 1 malaise and dysgeusia, 1 hyperthermia and severe strangury, 1 elevated transaminases and asthenia), and local in 4 patients (1 severe urinary urgency, 1 hematuria, 1 urinary incontinence, and 1 case of pelvic pain). In 6 patients we observed pelvic pain, hematuria, strangury and UTI of medium magnitude that did not require treatment interruption. CONCLUSIONS: We believe that the severe side effects requiring treatment interruption are attributable primarily to increased sensitivity in patients with multi-treated bladders. In our experience, the side effects responsible for suspension occurred at the start of treatment in 7 cases out of 8. Our study demonstrates the safety of intravesical gemcitabine in patients with recurrent and multi-treated superficial TCC of the bladder.

Testosterone supplementation in hypogonadal men: our personal experience.

INTRODUCTION AND OBJECTIVES: Around thirty years of age, we assist to a physiological, progressive and slow involution of the testicular function accompanied by a fall of the plasmatic levels of testosterone. Rarely hypogonadism is manifest in so young age with signs and symptoms, unless it is subsequent to severe events. After 50 years of age, it can present with a series of aspects that negatively influence the physical and sexual efficiency. The aim of this study is to prove if the replacement therapy with testosterone is able to restore a physiological gonadal function, without incurring in unpleasant side effects to prostate, liver and cardiac muscle. MATERIAL AND METHODS: We report our experience on 123 patients over 60 years of age (mean age 71) and 12 patients over 30 (mean age 37). These last ones were submitted to andrologic assessment after genital trauma. Both groups of patients have reached our observation from December 2000 to June 2003 for important asthenia and decrease of libido associated with impairment of secondary sexual characters and erectile deficit of various degrees. Respectively 76 and 12 patients did not show contraindications for testosterone therapy and they began injections with testosterone for at least 6 months. RESULTS AND CONCLUSIONS: Although compliance to testosterone treatment has not been equal in the time in all the subjects, undesirable effects are not highlighted. All the patients have reported complete or partial recovery of physical efficiency and improvement of sexual life, evaluated by means of IIEF scale and ADAM-AMS questionnaires. The replacement pharmacological treatment with testosterone improves the physical and sexual performance of the adult patient affected by symptomatic hypogonadism.

Effect of bicalutamide therapy on prolactin response to L-dopa in metastatic prostate cancer patients.

OBJECTIVES: The secretion of prolactin (PRL), which is a growth factor for prostate cancer cell proliferation, has been proven to present profound alterations in advanced prostate cancer patients, consisting of abnormally elevated baseline levels and paradoxical response to L-dopa. Moreover, the efficacy of standard therapies for prostate cancer may be mediated at least in part by changes in PRL secretion. The present study was carried out to analyze the effects of the new antiandrogen agent bicalutamide on basal levels of PRL and on its response to L-dopa in metastatic prostate cancer patients. MATERIAL & METHODS: The study included 10 metastatic prostate cancer patients. They were treated with bicalutamide at a dose of 50 mg/day orally. They were investigated with L-dopa test before therapy and after one month of treatment. L-dopa was given orally at 500 mg, by collecting blood samples before and at 60, 120 and 180 minutes after L-dopa administration. Serum levels of PRL were measured by the RIA method. RESULTS: Abnormally basal levels of PRL were seen in 4/10 (40%) patients. Mean PRL basal levels decreased after bicalutamide therapy, without, however, significant differences. Before therapy, a paradoxical increase in PRL levels after L-dopa occurred in 4 patients, 3 of them showed basal concentrations of PRL within the normal range. Moreover, bicalutamide therapy significantly reduced PRL increase in response to L-dopa. CONCLUSIONS: This study would suggest that the measurement of the only basal levels is not sufficient to define as normal the secretion of PRL in advanced prostate cancer, because of the possible existence of altered response to the dynamic tests for PRL secretion. Moreover, the study shows that the antitumor therapy with the new anti-androgen bicalutamide may reduce PRL secretion and improve its paradoxical secretion in response to L.-Dopa. Further studies will be required to better define the possible prognostic impact of changes in PRL secretion on the efficacy of treatments for metastatic prostate cancer.

A 7-year history of an intratesticular mass: patient description and review of the literature about dermoid cysts of the testis.

A dermoid cyst is a particular form of a cystic teratoma. In the testis, it is very rare, with only a few cases reported in world literature. A 19-year-old patient come to our attention with a 7-year history of an intratesticular cystic mass. Sonography showed a large hypoechoic solid mass. The tumour markers alpha-fetoprotein, beta-human chorionic gondatotrophin, and lactate dehydrogenase were negative. Chest X-ray was negative. He underwent surgical exploration of the right testis and enucleation of the mass with testis preservation. At 14 month of follow-up, the patient had no complications and no recurrence of the lesion. Surgical enucleation is the treatment of choice in consideration of hormonal, psychological, and reproductive aspects. Orchiectomy should have been the treatment of choice, if the mass had substituted all testicular parenchyma and if there had been some malignant transformations.