Giant adrenal myelolipoma: report of a case and review of the literature.

Myelolipoma of the adrenal gland is a benign, endocrinologically inactive neoplasm composed of mature adipose tissue and a variable amount of hematopoietic elements. Rarely giant adrenal myelolipomas have been reported in literature and they are very unusual clinical entities. We describe a case in a 72 year-old woman observed at our Department of Urology for nausea, flank and abdominal pain. The surgical resected mass measured 16.5x11.5x10 cm and weighted 1 250 g. A survey of the literature on this topic is made.

A phase II study of tamoxifen in hormone-resistant metastatic prostate cancer: possible relation with prolactin secretion.

Recent experimental observations, showing the potential role of prolactin (PRL) as a tumor growth factor for prostate cancer and the unfavourable prognostic significance of enhanced chromogranin-A-secreting neuroendocrine cell proliferation, could contribute to a better understanding of the mechanisms responsible for the occurrence of hormone-resistance in the prostate cancer. Moreover, it has been shown that tamoxifen, which consistently exerts estrogenic activity in males, may inhibit prostate cancer cell proliferation in experimental studies. At present, there are no clinical data in humans. This preliminary phase II study was planned in an attempt to evaluate the therapeutic efficacy of tamoxifen in hormone-refractory metastatic prostate cancer. The study included 14 consecutive metastatic prostate cancer patients, who had progressed under the classical endocrine therapy with LHRH-analogs and/or anti-androgens. Patients received the same treatment plus tamoxifen at 20 mg/day orally. A decline greater than 50% in prostate-specific antigen (PSA) levels occurred in 4/14 (29%) patients within the first 2 months of therapy, with a median duration of 5 months. Mean pre-treatment levels of PRL were significantly higher in responder patients than in those who progressed. Moreover, abnormally high pre-treatment levels of PRL were found in 5/14 (36%) patients. The percent of clinical responses observed in patients with pre-treatment hyperprolactinemia was significantly higher than that found in patients with normal pre-treatment PRL concentrations. Finally, a significant decline in mean PRL levels upon tamoxifen therapy occurred only in the responder patients. This preliminary study seems to justify further clinical research to confirm the potential efficacy of tamoxifen in the treatment of hormone-refractory prostate cancer and to identify possible parameters, which may predict the response to treatment.

Possible involvement of prolactin in endocrine-resistant metastatic prostate cancer.

The hormone resistance of prostate cancer has been proved to depend at least in part on enhanced neuroendocrine activity and the resultant increase in blood concentrations of chromogranin A. Other experimental observations have suggested the involvement of prolactin (PRL), which appears to be a potential growth factor for prostate cancer. Abnormally high levels of PRL have been detected in metastatic prostate cancer, but the clinical significance of this finding has still to be clarified. In an attempt to explain the prognostic significance of serum PRL levels in prostate cancer, in this preliminary study we have analyzed the PRL levels in a group of metastatic prostate cancer patients with hormone-dependent or hormone-resistant cancer. The study included 50 patients with metastatic prostate cancer, 15 of whom had hormone-resistant tumors. The serum levels of PRL were measured by the RIA method. Abnormally high concentrations of PRL were found in 11/50 (22%) patients. Moreover, the percent of patients with cancer-related hyperprolactinemia was significantly higher in the hormone-resistant group than in the hormone-dependent group (8/15 vs 3/35, p < 0.01). This study confirms the possible existence of a hyperprolactinemic state in metastatic prostate cancer, as previously reported by other authors. Moreover, it appears to demonstrate that the occurrence of hyperprolactinemia is more frequent in hormone-resistant neoplasms, suggesting the possible involvement of PRL in hormone independence. Further studies concomitantly evaluating PRL and chromogranin A blood concentrations will be necessary to establish whether the hyperprolactinemia precedes and promotes the onset of hormone resistance in prostate cancer, or whether it is simply a consequence of the hormone independence.

Possible involvement of prolactin in endocrine-resistant metastatic prostate cancer.

The hormone resistance of prostate cancer has been proved to depend at least in part on enhanced neuroendocrine activity and the resultant increase in blood concentrations of chromogranin A. Other experimental observations have suggested the involvement of prolactin (PRL), which appears to be a potential growth factor for prostate cancer. Abnormally high levels of PRL have been detected in metastatic prostate cancer, but the clinical significance of this finding has still to be clarified. In an attempt to explain the prognostic significance of serum PRL levels in prostate cancer, in this preliminary study we have analyzed the PRL levels in a group of metastatic prostate cancer patients with hormone-dependent or hormone-resistant cancer. The study included 50 patients with metastatic prostate cancer, 15 of whom had hormone-resistant tumors. The serum levels of PRL were measured by the RIA method. Abnormally high concentrations of PRL were found in 11/50 (22%) patients. Moreover, the percent of patients with cancer-related hyperprolactinemia was significantly higher in the hormone-resistant group than in the hormone-dependent group (8/15 vs 3/35, p<0.01). This study confirms the possible existence of a hyperprolactinemic state in metastatic prostate cancer, as previously reported by other authors. Moreover, it appears to demonstrate that the occurrence of hyperprolactinemia is more frequent in hormone-resistant neoplasms, suggesting the possible involvement of PRL in hormone independence. Further studies concomitantly evaluating PRL and chromogranin A blood concentrations will be necessary to establish whether the hyperprolactinemia precedes and promotes the onset of hormone resistance in prostate cancer, or whether it is simply a consequence of the hormone independence. (Int J Biol Markers 2005; 20: 123-5).

[Technical problems in achieving continence after radical retropubic prostatectomy by the "digitoclasia" technique]. / Problemi di tecnica per la continenza dopo prostatectomia radicale retropubica con tecnica "digitoclasica".

Radical prostatectomy today has become a frequent operation in all urology wards. An increasing attention is nowadays paid to the question of post-operation continence, which is considered a fundamental aspect for a good quality of life. The Authors propose two variations to the Walsh's technique: conservation of the distal sphincter obtained by "digitoclasic" isolation of the same and conservation of the proximal sphincter obtained by means of a personal preparation technique of the vesical neck and anastomosis of the same to the urethral stump. The record of cases, not large enough, and in particular some initial failures occurred during the finalization phase of the technique, do not yet allow to draw final conclusions.

[Pure primary carcinoid of the testis. Description of a case]. / Carcinoide primitivo puro del testicolo. Descrizione di un caso.

A case of primary pure carcinoid tumor of the testis which occurred in a 37 year male is reported. Symptoms suggestive of a carcinoid syndrome were not noted. The patient was treated by radical orchiectomy. The pathological specimen showed the morphological characteristics of carcinoid and no teratomatous components. Histochemically, the argyrophil reaction was positive. The immunohistochemical studies revealed positivity for chromogranin, S-100 and NSE. The patient remains symptom free and in good health conditions after 2 years from surgery.

[Conservative endoscopic treatment of urothelial cystic dysplasia of the upper urinary tract]. / Tratamiento conservador endoscópico de la displasia quística urotelial de la vía excretora alta.

We highlight the importance of the new diagnostic possibilities afforded by ureterorenoscopy and nephroscopy in the differential diagnosis of single or multiple cystic dysplasia of the upper excretory tract. Moreover, endoscopic treatment was performed in the two cases reported herein. In the first case the biopsy procedure was also therapeutic and in the second case cyst removal resolved the ureteral obstruction. Because the disease is detected infrequently and because treatment may be required even less frequently, several technical solutions have been applied to assess efficacy and reliability. Diathermy coagulation has proved to be the safest, fastest and the most effective. Follow-up has documented the absence of recurrence and good reepithelialization of the ureteral wall without progression to stricture. In those cases with single cyst, one-stage diathermy loop resection permits obtaining biopsy material and radical removal of the neoformation.