Primary small cell neuroendocrine carcinoma of the urinary bladder: a clinicopathologic, immunohistochemical, and ultrastructural evaluation.

Small cell neuroendocrine carcinoma (SCNEC) of the urinary bladder is a rare but aggressive neoplasm that usually exhibits neuroendocrine differentiation. Here, the authors report a case of SCNEC in an 80-year-old man. The patient had gross hematuria and nodular mass involving the wall of the urinary bladder. Total cystectomy was done. The tumor consisted of small, uniform, round, and spindled-shaped cells with chromatin dark nuclei and numerous mitotic figures. The cells were reactive for chromogranin, neuron-specific enolase (diffuse), and keratin (focal). Ultrastructural studies revealed neurosecretory granules and intermediate filaments. The diagnosis of SCNEC with focal high-grade urothelial component was established. No metastasis was found at the time of diagnosis and the patient refused further chemotherapy or radiotherapy. The histogenesis, differential diagnosis, and prognosis of SCNEC of the urinary bladder were discussed.

Phenotypic characterization of the infiltrating immune cells in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma.

BACKGROUND: Immune cell infiltrate is a constant feature in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma. This study elaborates on the cells of the immune system present in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma. HYPOTHESIS: Here, we hypothesized that "the development of benign nodular prostatic hyperplasia and prostatic adenocarcinoma is associated with numeric alterations of the immune cell infiltrate". MATERIALS AND METHODS: A total of 50 transurethral prostatic resection specimens, each entailing normal prostate, benign nodular prostatic hyperplasia and high grade prostatic adenocarcinoma were evaluated for the density and phenotype of the immune cells using immunohistological methods and mouse monoclonal antibodies decorating T cells (CD3), histiocytes (CD68) and B lymphocytes (CD20). RESULTS: Immune cell infiltrate was composed of T cells, histiocytes and B-lymphocytes. CD(+)3 T lymphocytes and CD68(+) cells were the predominant cell populations. We observed variations in the density of the immune cells among the normal prostate, benign nodular prostatic hyperplasia and high grade prostatic adenocarcinoma. Compared with normal prostate, benign nodular prostatic hyperplasia had a statistically significant high density of immune cells (3.4+/-0.4versus 13.5+/-1.0, P<0.00). In contrast, a significant decrease in the counts of these cells was observed in high-grade prostatic adenocarcinoma compared to benign nodular prostatic hyperplasia (13.5+/-1.0 versus 5.2+/-0.3, P<0.01). CONCLUSIONS: The increased density of immune cells (predominantly CD(+)3 T cells) in benign nodular prostatic hyperplasia suggests that the initial response to cellular damage is mediated by cell-mediated immunity. The decreased density of immune cells in high-grade prostatic adenocarcinoma may reflect immunosuppression. The underlying mechanisms of these numeric variations are open for further investigations.

Iatrogenic bladder injuries during obstetric and gynecological procedures.

OBJECTIVE: To review the frequency of iatrogenic bladder injuries (IBI) occurring during obstetric and gynecological (OBG) procedures and we report a single center experience with these emergency urological consultations and interventions and analyze their outcomes and correlate them with the present day trends. METHODS: We reviewed retrospectively the relevant data of all IBI during various OBG procedures from the Medical Records of Abha Maternity Hospital, the OBG wing of Assir Central Hospital, Abha, Saudi Arabia over a period of 4.5 years (September 2000 to February 2005). Various relevant factors of the injuries were studied with their final outcome. RESULTS: Out of the 8,684 OBG procedures carried out during this period there were 20 occasions of IBI directly related, with an overall incidence of 0.23%. The majority of injuries were seen during obstetric procedures (85%) and 15% during gynecological procedures. Notably 90% of them were recognized intraoperatively and managed. Concomitant ureteric injury was noticed in 20% of the cases. Endourological and surgical options were both used in the management. Overall outcomes were very satisfactory, unrelated to the site, type or other associated injuries. CONCLUSION: The bladder is the most commonly injured organ during OBG interventions. Prompt recognition and repair of injuries should be the main goal. Gynecologists should be able to do at least a minimum diagnostic cystoscopy in emergency situations. It is well established that this can lessen, missing iatrogenic urinary tract injuries in this era of increasing gamut of gynecologic surgical and laparoscopic procedures.

Gartner duct cyst simplified treatment approach.

We present two patients with Gartner's duct cyst managed with simple marsupialization and successful long-term follow up.

Surgical approach of giant testicular cancer. Case report and literature review.

Testicular cancer, which generally presents as a scrotal mass of variable sizes, is amongst the most common malignancies in men in the 15- to 35- year age group. A high inguinal orchiectomy is the standard approach for removal of a scrotal mass suspicious of being malignant. A recent report described a combined use of an inguinal incision, for early clamping of the spermatic cord, and a scrotal incision for orchiectomy of a large size testicular seminoma. We hereby report a case of a large size testis cancer removed using a single oblique inguinoscrotal incision. This approach allows inguinal delivery of a large size of scrotal mass without additional concerns of scrotal tumor spillage and violation of tunica vaginalis.

Septic shock after transrectal ultrasound guided prostate biopsy. Is ciprofloxacin prophylaxis always protecting?

We report a case of septic shock complicating transrectal ultrasound guided prostate biopsy despite antibiotic prophylaxis with ciprofloxacin. Patient was recently treated with the same agent for other infectious illnesses.