Gigantic spermatocytic seminoma: A rare tumor of germ cell origin.

Introduction: Spermatocytic seminoma represents a rare hystologic type of malignant testicular germ cell tumor with slow course and low malignant potential. Case report: We presented a 69-year-old patient with atypical clinical presentation of spermatocytic seminoma initially diagnosed as gigantic hydrocoellae which compromised walking. After long term evolution clincal picture presented with signs and symptoms of acute scrotum. Preoperative echosonography was performed and the diagnosis of testicular infiltrative tumor was established. After that left scrotal orchiectomy was performed. Patohistological examination revealed spermatocytic seminoma Conclusion: Inspite good prognosis there is a low probability of development of high grade malignancy sinchronous sarcoma within the testis with a high potential for lymphogenic and hematogenic dissemination. Individual approach is necessary in accordance with the pathohistological diagnosis.

Unrecognised adrenergic symptoms and the delayed diagnosis of urinary bladder paraganglioma.

INTRODUCTION: Paraganglioma is a rare neuroendocrine neoplasm that may arise from the extra-adrenal autonomic paraganglia. Urinary bladder paraganglioma is typically presented as repeated episodes of palpitations, headache or blood pressure rise immediately after micturition. Management of these tumors includes radical surgical treatment with preoperative antihypertensive preparation, and a life-long follow-up. CASE REPORT: We presented a middle-age female patient with functional urinary bladder paraganglioma, with a 3-year history of repeated episodes of abdominal pain, dysuria and hematuria. After obtaining more precise anamnestic data, the patient reported occasional simultaneous presence of mild adrenergic symptoms, that did not cause any particular attention at first. Morphological and biohumoral examinations suggested paraganglioma of the urinary bladder. Open partial cystectomy was performed, detecting a submucosal mass, while immunohistochemical analysis confirmed the presence of chromaffin tissue. Clinical manifestations, diagnostic approach, management and histopathological findings of urinary bladder paraganglioma are discussed. CONCLUSION: Since the prognosis with localized paraganglioma is good, we underlined the importance of a well-timed, accurate and detailed medical history in all the patients with even mild, inexplicable micturition-provoked adrenergic symptomatology.

Relationship between of short-course preoperative radiotherapy and serum albumin level and postoperative complications in rectal cancer surgery.

BACKGROUND/AIM: The identification of risk factors could play a role in improving early postoperative outcome for rectal cancer surgery patients. The air of this s5udy was to determine the relationship between short-course preoperative radiotherapy (RT), serum albumin level and the development of postoperative complications in patients after anterior rectal resection due to rectal cancer without creation of diverting stoma. METHODS: This retrospective study included patients with histopathologically confirmed adenocarcinoma of the rectum with the clinical stage of T2-T4 operated on between 2007 and 2012. All the patients underwent open anterior rectal resection without diverting stoma creation. Preoperative serum albumin was measured in each patient. Tumor location was noted intraoperatively as the distance between the inferior tumor margin and anal verge. Tumor size was measured and noted by the pathologist who assessed specimens. Some of the patients received short-course preoperative RT, and some did not. The patients were divided into two groups (group 1 with short-course preoperative RT, group 2 without short-course preoperative RT). Postoperative complications included clinically apparent anastomotic leakage, wound infection, diffuse peritonitis and pneumonia. They were compared between the groups, in relation to preoperative serum albumin level, patient age, tumor size and location. RESULTS: The study included 107 patients (51 in the group 1 and 56 in the group 2). There were no significant difference in age (p = 0.95), gender (p = 0.12) and tumor distance from anal verge (p = 0.53). The size of rectal carcinoma was significantly higher in the group 1 than in the group 2 (51.37 +/- 12.04 mm vs. 45.57 +/- 9.81 mm, respectively; p = 0.007). The preoperative serum albumin level was significantly lower in the group 1 than in the group 2 (34.80 +/- 2.85 g/L vs. 37.55 +/- 2.74 g/L, respectively; p < 0.001). A significant correlation between the tumor size and the serum albumin level was found (p = 0.042). Overall, postoperative complications were observed in 13 (25.5%) patients in the group 1 and in 10 (17.8%) patients in the group 2 without significant difference between the groups (p = 0.18). A significantly lower level of serum albumin was found in patients with postoperative complications and in those who died. A significant difference in anastomotic leakage occurrence between groups was found (p = 0.039). Male gender and the lower level of serum albumin were significant predictors for anastomotic leakage occurrence (p = 0.05 and p = 0.002, respectively), but preoperative RT had no significant impact on it. CONCLUSIONS: A lower serum albumin level, but not short-course of preoperative RT, was significantly associated with postoperative complications development after rectal resection with' out diverting stoma.

The clinical course of non-muscle invasive bladder cancer after transurethral resection of the tumor with or without subsequent intravesical application of bacillus Calmette-Guérin: The influence of patients gender and age.

UNLABELLED: BACGROUND/AIM: The therapy with intravesical instillation of bacillus Calmette-Guérin (BCG) after transurethral resection (TUR) of tumor is the gold standard of treatment of non-muscle invasive bladder cancer (NMIBC). The role and importance of BCG intravesical therapy in various shape of tumors, were confirmed by our previous investigation. The aim of this study was to examine whether incidence of recurrence and tumor regression differs depending on sex and age of patients. METHODS: This study included a total of 899 patients suffering from NIMBC, treated at our institution from January 1, 2007 to March 1, 2013. Two groups of patients were formed: patients underwent TUR + BCG therapy (the group I) and the group II with patients in whom TUR was performed as only therapy. These two groups of patients were divided into subgroups of respondents male and female, age 60 years or younger and older than 60 years. Statistical analysis was performed using χ2 test and the Kolmogorov-Smirnov test. RESULTS: This research suggests that if the frequency of recurrence is seen as the only parameter, considering all the subjects, the lowest recurrence rate was determined in the male subjects, aged 60 years and younger who had received BCG after TUR. A high statistical significance was found in the incidence of recurrence in patients younger than 60 years, depending on the response to the therapy, while in those older than 60 years, the difference was at the level of statistical significance. This can be attributed to a certain degree of infravesical obstruction in older men. CONCLUSIONS: Sex and age of patients may have a significant influence on the course and outcome of NMIBC. The disease has the most malignant and most aggressive behavior when present in males older than 60 years.

External validation of existing nomograms predicting lymph node metastases in cystectomized patients.

OBJECTIVES: Karakiewicz et al. and Green et al. created pre-cystectomy nomograms to predict lymph node involvement. The aim of the study was to externally validate these two nomograms in intermediate-volume institutions in Europe. PATIENTS AND METHODS: Data from a Serbian single-centre cystectomy series comprising 183 patients with bladder cancer were used for the validation of two US nomograms, which were originally based on data from 726 and 201 patients, respectively. A multivariate regression model assessed the value of the clinical parameters integrated in the two nomograms. The expected predictive accuracy, calibration and clinical utility according to the nomograms were calculated. RESULTS: Comparison of our dataset with the previously published data shows differences in nearly all underlying risk variables. Overall, 109 (59.6 %) patients had lymph node metastases. The analysis demonstrated that hydronephrosis and status of lymph nodes on computed tomography have independent prognostic value. The performance of the nomograms deteriorated from the development set, and the predictive accuracies for the two models showed moderate discriminatory ability (61.2-69.1 %). In the decision curve analysis, only the Green et al. model predicting lymph node positivity provided net benefit. CONCLUSIONS: The Green et al. nomogram seems applicable to patients from Europe, despite varying risk factors in the validation dataset. Acceptance of such a tool into daily clinical management may lead to more appropriate decision-making. Nevertheless, further improvement and implementation of novel statistical models with enhanced predictive accuracy is needed.

Scoring system development for prediction of extravesical bladder cancer.

BACKGROUND/AIM: Staging of bladder cancer is crucial for optimal management of the disease. However, clinical staging is not perfectly accurate. The aim of this study was to derive a simple scoring system in prediction of pathological advanced muscle-invasive bladder cancer (MIBC). METHODS: Logistic regression and bootstrap methods were used to create an integer score for estimating the risk in prediction of pathological advanced MIBC using precystectomy clinicopathological data: demographic, initial transurethral resection (TUR) [grade, stage, multiplicity of tumors, lymphovascular invasion (LVI)], hydronephrosis, abdominal and pelvic CT radiography (size of the tumor, tumor base width), and pathological stage after radical cystectomy (RC). Advanced MIBC in surgical specimen was defined as pT3-4 tumor. Receiving operating characteristic (ROC) curve quantified the area under curve (AUC) as predictive accuracy. Clinical usefulness was assessed by using decision curve analysis. RESULTS: This single-center retrospective study included 233 adult patients with BC undergoing RC at the Military Medical Academy, Belgrade. Organ confined disease was observed in 101 (43.3%) patients, and 132 (56.7%) had advanced MIBC. In multivariable analysis, 3 risk factors most strongly associated with advanced MIBC: grade of initial TUR [odds ratio (OR) = 4.7], LVI (OR = 2), and hydronephrosis (OR = 3.9). The resultant total possible score ranged from 0 to 15, with the cut-off value of > 8 points, the AUC was 0.795, showing good discriminatory ability. The model showed excellent calibration. Decision curve analysis showed a net benefit across all threshold probabilities and clinical usefulness of the model. CONCLUSION: We developed a unique scoring system which could assist in predicting advanced MIBC in patients before RC. The scoring system showed good performance characteristics and introducing of such a tool into daily clinical decision-making may lead to more appropriate integration of perioperative chemotherapy. Clinical value of this model needs to be further assessed in external validation cohorts.

Scoring system for prediction of lymph node metastasis in radical cystectomy cohort.

OBJECTIVES: The objective of the study was to assess whether pretreatment clinical parameters combined with computed tomography can improve the prediction of lymph node metastasis in patients with bladder cancer treated with radical cystectomy. PATIENTS AND METHODS: In a single-center retrospective study, demographic and clinicopathological information (initial transurethral resection [grade, stage, multiplicity of tumors, lymphovascular invasion], hydronephrosis, abdominal and pelvic computed tomography) and the presence of lymph node disease on final pathology of 183 patients with bladder cancer undergoing radical cystectomy and pelvic lymph node dissection were reviewed. Logistic regression and bootstrap methods were used to create an integer score for estimating the risk of positive lymph nodes. Various measures for predictive ability and clinical utility were determined. RESULTS: On pathological examination, 59.6% of patients had positive lymph nodes. In a multivariable analysis, status lymph nodes on computed tomography and hydronephrosis were the most strongly associated predictors. The resultant total possible score ranged from 0 to 10, with a cut-off value of >4 points. The area under the receiver operating characteristic curve was 0.806. Relative integrated discrimination improvement was 14.3%. In the decision curve analysis, the model provided net benefit throughout the entire range of threshold probabilities. However, the final model was roughly equivalent to using the clinical exam. CONCLUSIONS: The pre-cystectomy scoring system improved the prediction of lymph node status in patients with bladder cancer. Our model represented a user-friendly staging aid, but a large multi-center study should be performed before widespread implementation.

[Influence of demographic and socioeconomic characteristics on the quality of life].

INTRODUCTION: The quality of life is a multidimensional concept, which is best expressed by the subjective well-being. Evaluation of the quality of life is the basis for measuring the well-being, and the determination of factors that determine the quality of life quality is the basis for its improvement. OBJECTIVE: To evaluate and assess the determinants of the perceived quality of life of group distinguishing features which characterize demographic and socioeconomic factors. METHODS: This was a cross-sectional study of a representative sample of the population in Serbia aged over 20 years (9479 examinees). The quality of life was expressed by the perception of well-being (pleasure of life). Data on the examinees (demographic and socioeconomic characteristics) were collected by using a questionnaire for adults of each household. To process, analyze and present the data, we used the methods of parametric descriptive statistics (mean value, standard deviation, coefficient of variation), variance analysis and factor analysis. RESULTS: Although men evaluated the quality of life with a slightly higher grading, there was no statistically significant difference in the evaluation of the quality of life in relation to the examinee's gender (p > 0.005). Among the examinees there was a high statistically significant difference in grading the quality of life depending on age, level of education, marital status and type of job (p < 0.001). In relation to the number of children, there was no statistically significant difference in he grading of the quality of life (p > 0.005). CONCLUSION: The quality of life is influenced by numerous factors that characterize each person (demographic and socioeconomic characteristics of individual). Determining factors of the quality of life are numerous and diverse, and the manner and the strength of their influence are variable.

[Characteristics of reproductive health of women in their generative age].

INTRODUCTION: Any research of reproductive health has to encompass the relevant connotations of this complex term. In order to establish relevant multidimensional characteristics, it is necessary to assess intercorrelations of the characteristics most commonly used to describe it. OBJECTIVE: Our aim was to describe the characteristics of reproductive health and to establish their significance in describing this term. METHODS: Within the study of health of adult inhabitants of Serbia, on the sample of 2,817 women aged 20-49 years, the data on different reproductive health characteristics were collected by way of a structured questionnaire. By way of factorial analysis (principal components method, Kaisser Varimax criterion), representative characteristics (factors) were selected out of a large number of characteristics, describing reproductive health of women in a multidimensional way, interrelationships of the factors were explained, and carriers--the most important individual characteristics--were selected for further analysis. RESULTS: The characteristics of female reproductive health in Serbia are poor, both from the health policy standpoint and in comparison with other countries. Reproductive health describes 7 relevant factors and their carriers (characteristics which best reflect the variability of characteristics involved in a factor). These involve sexual behaviour (self-assessed HIV infection risk), contraception (use of contraceptive devices on one's own initiative), adequate protection of reproductive health (usage of gynaecological services even when healthy), abortions (pregnancy outcome), HIV control (HIV testing usage), postpartal protection (visits of field nurses after being discharged from maternity ward) and reproductive period (doctor visits after being discharged from maternity ward). CONCLUSION: All the characteristics of reproductive health used in various studies are not equally important in the description of this complex phenomenon. Factorial analysis can explain intercorrelations of the studied characteristics and make possible the selection of those most representative.

[Determinants of the most significant characteristics of reproductive health].

INTRODUCTION: Reproductive health of women is determined by females' demographic and socio-economic characteristics, their behaviour, and the complex of environmental factors. OBJECTIVE: The paper examines the predictive impact of personal and environmental characteristics, health and healthcare characteristics regarding the most important aspects of reproductive health. METHODS: From a sample of 2,718 women, aged 20-49 years, we collected information on various characteristics using a structured questionnaire. Based on factorial analysis (principal components method, Kaisser Varimax criterion) we selected representative variables (factors), describing personal (demographic and socio-economic) characteristics of women, their environment (family, household, community), health (attitudes towards health, life-style, health status), healthcare (independent) and the characteristics of reproductive health (dependent variables). The predictors were analyzed by multiple regression and correlation. RESULTS: Sexual behaviour was determined by socio-economic status, personal tidiness, rest, presence of risk factor(s), health evaluation and attitude toward personal responsibility, trust in physicians etc. The predictors of contraception involved satisfaction with one's own health, serious health problems, health evaluation. The presence and number of abortions were determined by personal psychological maturity, rest, risk factors, life-style, health evaluation and its manifestations, and the continuity and timely healthcare.The predictors of adequate protection of reproductive health involved the cultural level of the community, financial standing of the household, satisfaction with one's own life, tidiness and rest, presence of risk factors, health evaluation, attitude towards personal responsibility, and trust in physicians. HIV control was determined by satisfaction with one's own life, physical activity of women, presence of serious health problems, and the content of primary healthcare. Postpartal protection was determined by the cultural level of the community, reasons for dissatisfaction with one's own life, presence of risk factors and deficiencies, and timely contraception. The predictors of reproductive period duration are availability of health care in a community and personal tidiness of women. CONCLUSION: The study confirmed predictive impact of most of the studied characteristics.