ABSTRACT
Adenomatoid tumor is a rare tumor of mesothelial origin, usually arising in the epididymis. It is the most common paratesticular tumor of middle-aged men. A rare variant of adenomatoid tumor is leiomyoadenomatoid tumor which is characterized by prominent spindle cell myoblastic and myofibroblastic proliferation in the background of an adenomatoid tumor with tubular spaces lined by mesothelial cells. In some cases, the spindle cell component obscures the adenomatoid tumor component, complicating accurate diagnosis. Here, we report two cases of paratesticular leiomyoadenomatoid tumor in 28-year-old and 50-year-old patients. The tumors from both cases were centered in the epididymis and measured 1.0 cm and 3.0 cm, respectively. Both had similar morphology with myofibroblastic proliferation in one case and myoblastic (smooth muscle) proliferation in the other. Both cases followed a benign course without local recurrence or distant metastasis for 14 and 22 months postoperatively, respectively. We propose the use of the term "adenomyomatoid tumor" to describe a neoplasm exhibiting adenomatoid tumor admixed with either leiomyomatous or myofibroblastic proliferation.
Subject(s)
Adenomatoid Tumor/pathology , Adenomatoid Tumor/surgery , Leiomyoma/pathology , Adenomatoid Tumor/diagnosis , Adult , Epididymis/pathology , Epididymis/surgery , Genital Neoplasms, Male/diagnosis , Genital Neoplasms, Male/pathology , Genital Neoplasms, Male/surgery , Humans , Leiomyoma/diagnosis , Leiomyoma/surgery , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Testicular Neoplasms/diagnosis , Testicular Neoplasms/surgeryABSTRACT
OBJECTIVE: We determined the prognostic significance of preoperative hydronephrosis in patients with transitional cell carcinoma (TCC) of the bladder undergoing radical cystectomy. MATERIALS AND METHODS: We performed a retrospective review of all patients undergoing radical cystectomy at a single institution from 1996 to 2006. Exclusion criteria included diagnosis other than TCC, upper tract TCC, incomplete medical records, or obstructing stones. Hydronephrosis was confirmed by radiographic imaging. Survival was determined by date of death or last clinic visit. RESULTS: Three hundred eight patients fulfilled the inclusion criteria; 203 (66%) had normal upper tracts, 82 (27%) had unilateral hydronephrosis, and 23 (7%) had bilateral hydronephrosis. Median overall survival of the study population was 34.3 months. There was a statistically significant difference in median survival between those without hydronephrosis (46.3 months), and those with unilateral (18.6 months, P = 0.004) or bilateral (13.4 months, P < 0.001) hydronephrosis. Preoperative hydronephrosis was significantly associated with higher pT stage (P < 0.001) as well postoperative positive margins (P = 0.039), but not with positive lymph nodes (P = 0.086). Preoperative hydronephrosis had no significant effect on survival in patients with pT0-3a, N0, surgical margin negative tumors, but was significantly correlated with decreased survival in patients with pT3b or greater, or N+, or surgical margin positive tumors (median survival 12.8 months vs. 23.4 months, P = 0.011). On multivariate analysis, preoperative hydronephrosis was a significant predictor of decreased survival. CONCLUSIONS: Preoperative hydronephrosis is an important and independent prognostic variable in patients with TCC of the bladder treated with radical cystectomy.
Subject(s)
Carcinoma, Transitional Cell/complications , Carcinoma, Transitional Cell/mortality , Hydronephrosis/complications , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/mortality , Adult , Aged , Aged, 80 and over , Carcinoma, Transitional Cell/surgery , Cystectomy , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Factors , Urinary Bladder Neoplasms/surgeryABSTRACT
BACKGROUND: Panniculectomy concurrent with gynecologic cancer surgery is safe and facilitates pelvic exposure in the morbidly obese patient. CASE: A 41-year-old morbidly obese female is diagnosed with recurrent adenocarcinoma of the cervix and has previously been treated with teletherapy and brachytherapy. She undergoes an anterior pelvic exenteration for curative intent. CONCLUSION: Panniculectomy at the time of pelvic exenteration is feasible. Morbidly obese patients with recurrent cervical cancer after treatment with pelvic radiation should be considered candidates for curative surgery.
