Prostate stromal sarcoma mimicking benign prostate hyperplasia: A case report.

INTRODUCTION & OBJECTIVES: Prostate stromal sarcoma is extremely rare and aggressive malignancy accounting for less than 1 % of all type of prostate cancers. It is frequently misdiagnosed from other lower urinary tract symptoms (LUTS) problems. CASE PRESENTATION: We present a case report of 45-year-old male complaining with LUTS problems. Patient also suffers anorexia and weight loss. He was first diagnosed with benign prostate hyperplasia (BPH). Patients had done transurethral resection of prostate (TURP) to alleviate the complaint, but the symptoms worsened and recurred. Histopathological examination findings confirmed prostate stromal sarcoma (T4N0M0). Patient was further examined using MRI and then radical prostatectomy procedure was performed. DISCUSSION: Incidence of prostate stromal sarcoma is very low and most commonly presents with obstructive LUTS symptoms. This could mimic other disease such as BPH or other type of prostate cancer. Therefore, clinicians require a high suspicion in patient with recurrent LUTS. CONCLUSION: Prostate stromal sarcoma diagnosis is a challenging disease entity that necessitates histopathology examination. Timely and accurate diagnosis of prostate stromal sarcoma is needed to achieve better outcome and prognosis for the patients.

Role of ureteral stent material and coating to prevent ureteral stent related issue: A systematic review and meta analysis.

INTRODUCTION: Ureteral stents require materials that balance bulk and surface properties. Achieving both can be challenging, as ideal bulk properties may not align with optimal surface properties. Thus, researching coatings and biomanufacturing methods for ideal materials is essential. METHODS: A systematic review and meta-analysis, following PRISMA Guidelines, involved literature searches across five databases: PubMed, Scopus, Embase, ClinicalKey, and Cochrane. From 417 screened articles, eight studies were deemed eligible for qualitative and quantitative analysis. The selected articles underwent bias assessment using ROB Tools 2. RESULTS: The systematic review analyzed 1.356 participants. Findings revealed that firm ureteral stents significantly increased risk of infection, hematuria, and lower body pain. On the contrary, soft stents reduced infection (OR: 0.62; p=0.004), hematuria (OR: 0.60; p<0.001), and lower body pain (OR: 0.63; p=0.0002). However, infection reduction effect was uncertain due to heterogeneity. Coated vs non-coated material analysis found no difference in encrustation (OR: 1.26; p=0.52) or infection (OR: 1.67; p=0.99). Stent firmness did not affect encrustation on double J stent (OR: 0.97; p=0.17). CONCLUSIONS: Softer materials like silicone are preferred for ureteral stents to reduce symptoms like hematuria and lower body pain. Coatings like silver nanoparticles and triclosan, while enhancing antimicrobial properties, did not effectively lower infection risk.

Comparison of Early Inguinal Lymph Node Dissection and Neoadjuvant Chemotherapy in Penile Cancer Patient with Bulky Nodal Metastasis: A Cohort Study.

PURPOSE: Penile cancer is a rare malignancy, where extranodal extension in inguinal or pelvic lymph nodes is associated with decreased 5-year cancer-survival rate in this study, we try to assess survival and quality of life in a penile cancer patient with bulky lymph node. METHODS: We retrospectively reviewed data from penile cancer patients with bulky lymph nodes who underwent treatment between July 2016 and July 2021 at tertiary referral hospital care. The inclusion criteria (age >18 yr, histologically proven penile cancer, and completion of last treatment 6 months prior to this study) yielded a cohort of 20 eligible penile cancer patients with bulky lymph nodes (> 4 cm/bilateral mobile/unilateral fixed). Only patients who had completed therapy at least 6 months prior to the study were included. After obtaining consent, they were asked to complete the EORTC QLQ-C30 questionnaire to evaluate the patient's quality of life. RESULTS: Out of 20 patients, 5 patients underwent direct ILND and 15 patients underwent chemotherapy. Median follow-up after primary diagnosis was 114+32 months in patients with early ILND and 52+11 months in patients who underwent delayed lymph node dissection. Out of 5 patients who underwent early ILND, all of them survived during follow-up, and achieved cancer-free status without residual tumor and with excellent functional outcomes (Karnofsky 90). There was no significant difference in social function (p-value = 0.551), physical function (p-value = 0.272), role function (p-value = 0.546), emotional function (p-value = 0.551), cognitive function (p-value = 0.453), and global health status (p-value = 0.893) between patient which treated with early ILND and Neoadjuvant Chemotherapy. However, patients who underwent early ILND showed a relatively better clinical outcome. CONCLUSION: Early ILND followed by adjuvant chemotherapy for penile cancer with palpable lymph nodes is more favourable than neoadjuvant TIP chemotherapy.

Changes in thyroid function in prostate cancer patients receiving docetaxel chemotherapy at Haji Adam Malik Hospital, Indonesia.

Background: Prostate cancer treatment is determined based on several factors, namely tumor grading, staging, co-morbidity, patient preferences, life expectancy at diagnosis. Today, taxanes are commonly prescribed to treat several types of cancer and have been shown to have antitumor effects in many cancers. This research has never been done in prostate cancer patients but similar studies have been done before in breast cancer patients. Materials and methods: The research design was observational analytic where this type of research was a prospective cohort where data was collected to record prostate cancer patients who received docetaxel chemotherapy which were then examined for thyroid function in cancer patients at the Adam Malik Hospital, Medan, Indonesia. Result: In this study, data were collected regarding the thyroid function of the study sample in the form of free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels before chemotherapy with the docetaxel regimen. The mean of fT4 in all research subjects was 1.05 with a standard deviation of 0.26. The mean TSH in all study subjects was 1.52 with a standard deviation of 1.21. Thyroid function was examined after 3 cycles of docetaxel chemotherapy. The mean of fT4 in all research subjects was 0.91 with a standard deviation of 0.23. The mean TSH in all study subjects was 1.69 with a standard deviation of 1.09. Conclusion: There are traces of the use of docetaxel chemotherapy in prostate cancer patients on decreased thyroid function at the Adam Malik Hospital in the form of decreased fT4 levels and increased TSH.

Nephrolithiasis-Associated Renal Cell Carcinoma in Patients Who Underwent Nephrectomy: A Single-Center Experience.

Background: Kidney stones (nephrolithiasis) affect around 5% of the world's population. Some medical disorders, like obesity or diabetes, have increased the incidence and prevalence of nephrolithiasis. In addition, chronic inflammation and infection are frequently linked to kidney stone formation. Urothelial cell proliferation may change as a result of chronic inflammation, tumors will therefore develop as a result of this. The correlation between nephrolithiasis and renal cell cancer can also be explained by shared risk factors. At Adam Malik General Hospital, we strive to identify the risk factor for stone-induced renal cell cancer. Methods: This study was carried out at Adam Malik General Hospital by collecting medical record reports from patients who had nephrectomy for nephrolithiasis between July 2014 and August 2020. A variety of information was obtained, including identification, smoking status, body mass index (BMI), hypertension, diabetes mellitus, and nephrolithiasis history. The histopathological examination of cancer patients was used to determine adjusted odds ratios (ORs) both separately and in combination with other variables. Age, smoking status, BMI, hypertension, and diabetes mellitus all influenced the OR. The single variable was examined using Chi-square test, and the multivariate analysis was carried out using linear regression. Results: A total of 84 patients who underwent nephrectomy due to nephrolithiasis were included in the study, with an average age of 48.77 ± 7.23 years old; 48 (60%) of those were aged < 55 years old. In this study, 52 male patients (63.4%) and 16 patients (20%) were found to have renal cell carcinoma. Univariate analysis showed that the OR of patients with familial history of cancer was 4.5 (95% confidence interval (CI) 2.17 - 19.8), and the OR for smokers was 1.54 (95% CI 1.42 - 1.68). Similar results were shown in patients with hypertension and urinary tract infections due to stones. Nephrolithiasis patients with hypertension were 2.56 (95% CI 1.075 - 6.106) times more likely to develop a malignancy, while patients who had an infection due to a urinary tract stone were 2.85 (95% CI 1.37 - 5.92) times more likely to develop renal cell carcinoma compared to its counterpart. Both have a P-value of less than 0.05. Contrarily, alcoholism and frequent nonsteroidal anti-inflammatory drugs (NSAIDs) user results were different. Both have a P-value of 0.264 and 0.07, respectively. Furthermore, diabetes mellitus type 2 and BMI over 25 are not statistically significant, with a P-value of 0.341 and 0.12, respectively. In multivariable-adjusted analyses, participants with a family history of cancer and recurrent urinary tract infection due to urinary tract stones had a statistically significant increase in overall renal cell carcinoma risk (hazard ratio (HR): 1.39, 95% CI 1.05 - 1.84 and HR: 1.12, 95% CI 1.05 - 1.34). Conclusion: Kidney stone and renal cell carcinoma are significantly correlated due to recurrent urinary tract infection and familial history of cancer, which increases renal cell carcinoma risk.

Bilateral synchronous testicular cancer: A case report.

INTRODUCTION AND IMPORTANCE: Testicular cancer is the most common type of malignancy in young adult males, accounting for 1 % of all cancer diagnosis in men and 5 % of all urologic tumors. It is one of the malignancies with the highest cure rate. Bilateral germ cell tumor of the testicles is rare, representing only 1 % of all new cases of testicular cancer, around 30 % of which occur synchronously. Interestingly, there is not yet an occurrence where the bilateral synchronous testicular cancer has different histopathological type. CASE PRESENTATION: In this paper, we performed bilateral radical orchiectomy in different occasion, followed by adjuvant chemotherapy (BEP regiment). CLINICAL DISCUSSION: Since the clinical result is excellent, this finding could be a breakthrough in testicular cancer study. A cellular communication between different cancer cell type through chemokine which could affect response to chemotherapy. CONCLUSION: Treatment with surgery and chemotherapy is well tolerated and received. A further specific clinical study needs to be performed to investigate this finding in the future.

Poor prognosis of urothelial carcinoma in patients presented with persistent paraneoplastic leukocytosis with anemia.

Introduction: Paraneoplastic leukocytosis is a rare manifestation of urological cancer. This condition is well associated with the poor prognosis in other solid tumors. Anemia is the most common hematological manifestation of cancer, affecting 40%-64% of patients with cancer. This condition is also well associated with a poor prognosis. The goal of this research is to determine the clinical presentation and fate of individuals with urothelial carcinoma who have persistent paraneoplastic leukocytosis and anemia. Methods: From January 2014 to December 2020, a retrospective cohort of patients with a histological result of urothelial carcinoma was collected. Data were extracted from a single National Cancer Center Hospital in Indonesia. Persistent leukocytosis is defined as a leukocyte count ≥20,000/mL on at least two occasions with a minimum interval of 30 days. Anemia is defined using the WHO definition of anemia. Urinalysis, chest X-ray, and other blood tests were performed to exclude other probable causes of leukocytosis. Results: Thirteen of 123 patients screened presented with persistent paraneoplastic leukocytosis and anemia. All patients presented with bladder cancer, with two patients (15.4%) presented with a mixed histological urothelial carcinoma. During the trial, all of the patients died, with a median survival of 20 days after the beginning of paraneoplastic leukocytosis with anemia. Conclusions: Persistent paraneoplastic leukocytosis and anemia in a patient with urothelial carcinoma are a rare condition that is associated to a poor prognosis and a lower median overall survival time.

First reported case of adult paratesticular myxofibrosarcoma in Indonesia: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Myxofibrosarcoma is one of the rarest sarcoma types, found in para-testicular regions of the elderly. Although this tumor is detectable by MRI, there has been no specific guideline for managing its recurrence. CASE PRESENTATION: A 49-year-old male with a painless scrotal mass was studied. The patient had no other complaint, and the laboratory results showed unremarkable testicular tumor markers. Ultrasound examination of the right hemiscrotum shows a solid mass in the scrotum and right inguinal that compressed the right hemitesticle. MRI examination of the scrotal region revealed a homogeneous solid mass, while at the lower abdomen, it showed a mass extending from the inguinal canal to the penis shaft and right testis. The patient had no signs of metastatic disease, but after high ligation orchidectomy, a rare paratesticular myxofibrosarcoma was revealed from histopathology examination. CLINICAL DISCUSSION: Based on existing data and patient MRI imaging, total surgical excision with high ligation orchidectomy is the only curative therapeutic option for low-grade tumors. Furthermore, no recurrent mass was identified during follow-up, and adjuvant chemotherapy or radiotherapy was not administered. The patient was satisfied with the surgery and is on a 6-month routine follow-up to observe the physical symptoms. CONCLUSION: This is the first adult paratesticular myxofibrosarcoma case in Indonesia, and it was performed with radical orchidectomy with high ligation due to its invasiveness. However, adjuvant chemotherapy was not provided because the benefit remained inconclusive. The result showed that this approach produces excellent outcome without any relapse.

Prognostic significance of CKAP2L expression in patients with clear cell renal cell carcinoma.

Background: Cytoskeleton-associated protein 2-like protein (CKAP2L) is thought to promote the progression of glioma, breast cancer, and ovarian cancer. However, the role of cytoskeleton-associated protein 2-like protein in clear cell renal cell carcinoma (ccRCC) is still unclear. The study aimed to investigate the roles and mechanisms of cytoskeleton-associated protein 2-like protein in clear cell renal cell carcinoma. Methods: The level of cytoskeleton-associated protein 2-like protein in tumors was explored by using UALCAN and Oncomine databases. Gene expression datasets of clear cell renal cell carcinoma from The Cancer Genome Atlas and Gene Expression Omnibus (GEO) were also used to validate the cytoskeleton-associated protein 2-like protein level in clear cell renal cell carcinoma. Survival analysis was performed to investigate the relationship between cytoskeleton-associated protein 2-like protein level and prognosis of clear cell renal cell carcinoma patients. Cox regression analysis was used for identifying the independent prognostic factors. Gene set enrichment analysis (GSEA), gene set variation analysis (GSVA), protein-protein interaction analysis, co-expression analysis, and immune infiltration analysis were used to explore the potential mechanisms of cytoskeleton-associated protein 2-like protein in clear cell renal cell carcinoma. Moreover, the levels of cytoskeleton-associated protein 2-like protein in clinical clear cell renal cell carcinoma tissues were also measured using RT-PCR, immunohistochemical analysis, and Western blotting. M1 macrophages and CD4+ T cells were also detected by immunohistochemistry between tumor and normal tissues. Results: The level of cytoskeleton-associated protein 2-like protein was upregulated in clear cell renal cell carcinoma according to multiple databases and experimental verification. Upregulated cytoskeleton-associated protein 2-like protein is an independent prognostic factor, which might activate the JAK-STAT signaling pathway, the P53 signaling pathway, the TGF-ß signaling pathway, the WNT signaling pathway, etc., in clear cell renal cell carcinoma. Protein-protein interaction analysis and co-expression analysis suggest that cytoskeleton-associated protein 2-like protein might interact with some proliferation proteins. Immune infiltration analysis indicates that cytoskeleton-associated protein 2-like protein may affect the level of activated CD4+ memory T cells, M1 macrophages, CD8+ T cells, and neutrophils in clear cell renal cell carcinoma. More M1 macrophage infiltrations in tumor tissues with higher cytoskeleton-associated protein 2-like protein were validated by clear cell renal cell carcinoma tumor tissues. Conclusion: Cytoskeleton-associated protein 2-like protein is upregulated in clear cell renal cell carcinoma tissues, which may promote progression of the disease. Cytoskeleton-associated protein 2-like protein is a potential target for prognostic markers and a potential treatment target in clear cell renal cell carcinoma.

Intraabdominal mass in adult men with unilateral UDT revealed as seminoma: A case report.

Undescended testis is most common congenital malformation in boys. Most common location is inguinal canal but rarely it is found in intraabdominal. 10% of them will grow become mass if left untreated. This case report describes cases of men of 40s with unilateral UDT and not noticeable until they felt heavy and feel palpable mass in abdomen revealed as seminoma. He is sterile and not be able to reproduce. Chemotherapy was done and the response was remarkable. This case report reiterates the need for a scrotal examination in men presenting with an abdominal mass, so as to rule out an intra-abdominal seminoma.