Colon perforation during percutaneous renal surgery: a 10-year experience in a single endourology centre.

The use of percutaneous renal surgery has been recently revolutionised with novel endourological instruments and techniques. However, the incidence, prevention and management of severe complications such as colon perforation still lack consensus. By presenting our 10-year experience, we would like to highlight the diagnosis and management of the rare complication of colon perforation.

Expression of ERß and its co-regulators p300 and NCoR in human transitional cell bladder cancer.

OBJECTIVE: Several data support a possible role of estrogens in bladder carcinogenesis, mediated mainly through estrogen receptor-ß (ERß). We study the expression of ERß and its co-regulators p300 and nuclear co-repressor (NCoR) in patients with bladder cancer. PATIENTS AND METHODS: One hundred and eleven consecutive patients (74 males and 37 females), aged 23-90 years (mean 70 ± 10) diagnosed with transitional cell bladder cancer were included in this study. The control group consisted of 29 patients that underwent transurethral prostatectomy and consented to simultaneous bladder biopsies. Immunohistochemical studies took place on formalin-fixed, paraffin-embedded sections from the TUR (transurethral resection) specimens. We studied the expression of ERß, p300 and NCoR.χ(2) test was used to evaluate the relationship between the histological grade and ERß expression, grade and co-regulators expression and grade and gender. Spearman rank correlation coefficient (r) was used in order to estimate the direction and strength of correlations between histological grade and ERß-p300-NCoR expressions. The Cochran-Armitage test for trend was applied in order to examine possible trends across the ordered levels of histological grade. RESULTS: ERß was more frequently expressed in the nucleus of normal bladder epithelium compared to malignant bladder epithelium with statistical significant association (r = -0.25, p = 0.003). The p300 was expressed only in the nucleus of bladder cancer cells and a positive correlation between molecular expression and cancer progression was demonstrated (r = 0.55, p < 0.001). NCoR immunostaining was demonstrated in the nuclei of bladder cells. Nuclear staining was significantly higher in normal tissue than in cancer cells (r = -0.33, p < 0.001), with negative correlation. Furthermore, its expression in grade I tumors was significantly higher than in grade II (r = -0.46, p < 0.001) and grade III tumors (r = -0.51, p < 0.001). Thus, like ERß, NCoR expression in bladder epithelium decreased during cancer progression and loss of cell differentiation. There was no correlation between the levels of expression of the three proteins in normal bladder epithelium, but there was an inverse correlation between the nuclear expression of ERß and p300 in carcinomas (r = -3.88, p = 0.042). Statistical significant association was established when correlating ERß expression with NCoR expression (r = 0.273, p = 0.005), while co-regulators' nuclear expression did not correlate with each other (p > 0.05). CONCLUSIONS: In bladder carcinogenesis, we demonstrated inhibition in the expression of ERß and its co-repressor NCoR as well as increased expression of the co-activator p300.

Coordinated increased expression of Cyclooxygenase2 and nuclear factor κB is a steady feature of urinary bladder carcinogenesis.

OBJECTIVES: The inescapable relationship between chronic inflammation and carcinogenesis has long been established. Our objective was to investigate COX-2 and NF-κB immunohistochemical expression in a large series of normal epithelium and bladder carcinomas. METHODS: Immunohistochemical methodology was performed on formalin-fixed, paraffin-embedded sections from urinary bladder carcinomas of 140 patients (94 males and 46 females with bladder carcinomas). RESULTS: COX-2 expression is increased in the cytoplasm of bladder cells, during loss of cell differentiation (r(s) = 0.61, P-value < .001) and in muscle invasive carcinomas (P-value < .001). A strong positive association between tumor grade and nuclear expression of NFκB has been established. A positive correlation between COX-2 and nuclear NFκB immunoreactivity was observed. CONCLUSIONS: The possible coordinated upregulation of NFκB and COX-2, during bladder carcinogenesis, indicates that agents inhibitors of these two molecules may represent a possible new treatment strategy, by virtue of their role in bladder carcinogenesis.

Inverse expression of estrogen receptor-beta and nuclear factor-kappaB in urinary bladder carcinogenesis.

OBJECTIVES: To investigate the expression of nuclear factor-kappaB (NF-kappaB) and estrogen receptor-beta (ER-beta) signalling pathways in bladder urothelial carcinoma according to clinicopathological features, in order to elucidate their role during carcinogenesis. METHODS: Immunohistochemical methodology was carried out on formalin-fixed, paraffin-embedded sections from urinary bladder carcinomas of 140 patients (94 males and 46 females) who underwent transurethral resection of bladder neoplasms. Correlations between ER-beta and NF-kappaB, and tumor grade and T-stage were evaluated, along with demographic data, sex and age. RESULTS: A significant decrease in ER-beta expression in the nucleus of bladder cells during loss of cell differentiation (r(s) = -0.61, P-value < 0.001, test of trend P-value = 0.003) and in muscle invasive carcinomas (T2-T4; test of trend P-value < 0.001) was found. p65 Subunit of NF-kappaB was expressed in the nucleus and in the cytoplasm of bladder epithelial cells. A strong positive association between tumor grade and nuclear expression of NF-kappaB was shown. No correlation between NF-kappaB, nuclear or cytoplasmic staining, with T-stage was observed. An inverse correlation between ER-beta and nuclear p65 immunoreactivity was observed (r(s) = -0.45, P-value < 0.001). There was no correlation with demographic data. CONCLUSIONS: Our immunohistochemical study suggests the possible inverse regulation of NF-kappaB and ER-beta transcription factor during bladder carcinogenesis. Selective ER-beta agonists and agents, inhibitors of NF-kappaB, might represent a possible new treatment strategy for bladder urothelial tumors.

The relationship between androgens, regulators of collagen metabolism, and Peyronie's disease: a case control study.

INTRODUCTION: Changes in collagen metabolism have been postulated to play a pivotal role in the pathogenesis of Peyronie's Disease (PD). Androgens such as dehydroepiandrosterone sulfate (DHEA-S) and testosterone influence collagen metabolism by modulating the activity of matrix metalloproteases (MMP) and tissue inhibitors of metalloproteases (TIMP). AIM: The aim of this study was to evaluate the interrelationship between androgens (DHEA-S and testosterone), key regulators of collagen metabolism such as insulin-like growth factor (IGF) 1 and IGF Binding Protein 3 (IGF-BP3), the MMP/TIMP system, and PD. METHODS: Age matched PD patients (14) and healthy men (10) who acted as controls were recruited. Blood samples were collected from all subjects in the early morning hours after an overnight fast. MAIN OUTCOME MEASURES: Serum levels of testosterone, sex hormone binding globulin, DHEA-S, 3-α-androstanediol glucuronide, pro-MMP-1, MMP-1, MMP-2, TIMP-1, TIMP-2, IGF-1 and IGF-BP3 were measured in both groups. Statistical methods included univariate, bivariate, and multivariate regression models. RESULTS: Levels of DHEA-S (114.5 vs. 169.5 µg/dL; p = 0.03), IGF-BP3 (2.96 vs. 3.79 µg/mL; p = 0.01), and TIMP-1 (173.1 vs. 195 ng/mL; p = 0.01) were significantly lower in PD patients. In contrast, the level of TIMP-2 (102 vs. 85 ng/mL; p = 0.001) was significantly lower in the control group. Using stepwise regression analysis, only TIMP-2 (p < 0.001) and DHEA-S (p = 0.04) were significantly related to PD in the final model (R(2) = 0.63). TIMP-1 and DHEA-S (r = 0.55, p < 0.05) were positively correlated in the PD group, whereas IGF-1 and testosterone (r = -0.54, p < 0.05), and IGF-BP3 and testosterone (r = -0.68, p < 0.05) were negatively correlated in PD patients. CONCLUSIONS: Our findings suggest that decreased levels of adrenal androgens may be implicated in the pathogenesis of PD. The mechanism and clinical relevance of this observation remain to be established.

Burned-out testicular tumor with retroperitoneal lymph node metastasis: a case report.

INTRODUCTION: A burned-out seminoma of the testis is an exceptionally rare clinical entity, with few reports found in the literature. CASE PRESENTATION: A case of burned-out tumor of the testis in a 31-year-old man is reported. The tumor presented as a retroperitoneal mass with histological characteristic of a seminoma. The testes on clinical examination were normal, and a suspicious lesion in the scrotum was only identified after ultrasound. Incision of the abdominal mass was decided, followed by orchectomy. Histological examination of the testis revealed a suspicious lesion with characteristics of spontaneous regression of germ cell tumors. CONCLUSION: We describe one of very few cases worldwide, where spontaneous regression of a primary testicular tumor occurred after demonstration of retroperitoneal lymph node metastasis, a phenomenon known as burned-out seminoma, which is hard to recognize and incompletely characterized by physicians.

Subcutaneous emphysema of the scrotum (pneumoscrotum) due to traumatic pneumothorax: a case report.

INTRODUCTION: Subcutaneous emphysema of the scrotum due to traumatic pneumothorax is a rare medical situation and only a few cases are reported in the literature. CASE REPORT: We present the case of a 22 year old man who was admitted to the emergency department after a motorcycle accident having a painless crepitant scrotum and chest excoriations. Further evaluation revealed subcutaneous emphysema of the scrotum caused by left pneumothorax. CONCLUSION: In conclusion, subcutaneous emphysema of the scrotum (or pneumoscrotum) due to traumatic pneumothorax is not an urgent condition and assessment should be supportive with intervention directed at the etiology, e.g. the pneumothorax.

Adenomatoid tumor of epididymidis: A case report.

BACKGROUND: Adenomatoid tumors are regarded as distinctive benign mesothelial neoplasms of the paratesticular region, most commonly occuring at the tail of the epididymidis.Because of its rarity, the clinical and histopathological aspects are discussed. CASE PRESENTATION: We present the case of a 41-year-old patient with an adenomatoid tumour located in the tail of the left epididymis that referred to our department with gradual enlarged intrascrotal mass. The diagnosis was achieved by echography, and was confirmed by surgical excision and histological analysis. CONCLUSION: Due to its low incidence in intrascrotal pathology, we believe it is important for the physician to be aware of this interesting entity in order to make a differential diagnosis from other inflammatory processes and to adopt the proper surgical approach.

Rapture of renal angiomyolipoma during pregnancy: a case report.

INTRODUCTION: Rapture of a renal angiomyolipoma and massive retroperitoneal hemorrhage, during pregnancy is rare and occasionally fatal. The association of this complication with pregnancy has been reported sporadically in the literature. CASE PRESENTATION: We report a case of a 28 years old woman, in 33 week of her first pregnancy who came to our hospital complaining of abdominal pain in the right hemiabdomen, associated with nausea and vomiting. The ultrasound and MRI (Magnetic resonance imaging) scan showed a 7 x 7 x 5 cm mass suggestive of angiomyolipoma in the right kidney, with evidence of retroperitoneal bleeding right perirenal and intrarenal haematoma. Given the size of the tumor, presence of symptoms and hemodynamic instability of the patient right nephrectomy was performed, following emergency caesarean delivery. The histological study of the resected mass revealed the presence of angiomyolipoma. CONCLUSION: In conclusion, it seems that these tumours show a greater growth index in pregnant women. Angiomyolipoma with spontaneous bleeding during pregnancy is a dangerous condition that may cause mortality in the mother and fetus, but elective, simultaneous cesarean section and radical nephrectomy can be performed. We have also done a review of the literature focusing on its management and its relationship with pregnancy.