[Sporadic case of desmoid tumor in outcomes of lombotomic nephrectomy]. / Un caso raro di lesione desmoide in esiti di nefrectomia con accesso lombotomico.

UNLABELLED: The desmoid tumor is a rare tumor with an incidence of 2-4 cases per million people each year, and represents 0.03% of all cancers. The tumor is composed of fibrous tissue that produces masses of well-differentiated hard elastic consistency. According to their site of onset, the desmoid tumors are classified in abdominal, intra-abdominal, and extra-abdominal. The abdominal cases develop inside the abdominal muscles of the abdominal wall upright, especially in women in their 2nd - 4th decade of life, particularly in those who have been pregnant. METHODS: A 66-year-old patient underwent nephrectomy in 2006 for the detection of a massive tumor in the right kidney (EI: pT1bNx). The patient came to our observation for the radiological tracking (CT) of a solid lesion of 4 cm below the right arch, 2 years after surgery. For this reason it was decided to refer the patient to a series of percutaneous biopsies. The report describes a histologic lesion of fibromatosis. After one year a new CT exam showed a significant increase of the size of the lesion, with a diameter of 11.6 x 7.9 cm, and abdominal involvement to ascending colon. Given the discrepancy between the CT data and the histological report, it was decided to refer the patient to a lombotomic exploration and the subsequent removal of the lesion, which appeared of hard, elastic consistency and well capsulated. The final histology test confirmed the fibromatosis lesion. CONCLUSIONS: The desmoid tumor is a rare tumor characterized by the proliferation of fibrotic tissue. The tumor is composed of well-differentiated fibrous tissue and has a hard-elastic consistency. Regarding the development of dermoid tumors, several risk factors were identified, including extra-abdominal fibromatosis, genetic factors, endocrine factors. Other causes may arise from trauma or abdominal injury in surgical outcomes of appendectomy, laparotomy and other surgical scars (scar fibromatosis) or genetic predisposing factors. The surgical resection of dermoid tumors should be the therapy of choice, complete and radical, to cover the possible excision of a wide margin of surrounding structures concerned, and those arrangements should ensure a low rate of relapse. However, in cases of inoperable cancer due to extension, anti-estrogen therapy may have an important therapeutic and well-tolerated effect, besides being relatively non-toxic, even at high doses. A close follow-up is indicated, however, and warmly recommended.

[Comparison of low-power laser and ultrasound litotripsy in the management of middle-distal ureteral stones]. / Confronto tra la litotrissia laser a bassa potenza e mediante ultrasuoni nel trattamento endoscopico della calcolosi ureterale medio-distale.

OBJECTIVE: To compare the success rates and complications of ultrasound and low-power Holmium laser-assisted ureteroscopy (URS) in managing middle-distal ureteral stones. MATERIALS AND METHODS: We retrospectively analyzed the records of 90 patients with middle-distal ureteral stones who underwent ureteroscopic lithotripsy at our institution from May 2006 to April 2010. 45 patients were treated with ultrasound (mean size 6.7 mm), 45 patients with low-power Holmium laser (mean size 7.4 mm). The same ureteroscope (9.5/8ch rigid-Storz) was used to treat all the patients. Patients were monitored before the hospital discharge with abdominal radiograph and ultrasonography, and as outpatients after 3 months with abdominal radiograph, ultrasonography and urography in selected cases. RESULTS: We obtained a complete immediate fragmentation of stones in 27/45 (60%) patients with ultrasound, and in 36/45 (80%) patients after laser treatment. A proximal migration of stones was observed in 12/45 (26.8%) patients with ultrasound and 3/45 (6.6) with laser. We observed a ureteral perforation after laser treatment and no patient developed urosepsis. 6/45 (13.3%) patients who were treated with ultrasound underwent auxiliary therapy such as alkalizing therapy, 9/45 (20%) patients a second ureteroscopy, 9/45 (20%) a shockwave lithotripsy. No patient underwent an auxiliary shockwave treatment after laser, 6/45 (13.4%) patients underwent a second ureteroscopy. Operating time (20.33 vs 28.85 minutes) and hospitalization (3.6 vs 5.1 days) were shorter with laser if compared with ultrasound treatment. CONCLUSION: In our study the fragmentation rates of Holmium laser-assisted ureteroscopy were significantly better than with ultrasound in the middle-distal ureteral stones management. We did not have relevant complications using both procedures, and the need for auxiliary procedures was significantly less for Holmium laser-assisted ureteroscopy when compared with ultrasound.

[US-guided percutaneous radio frequency in kidney cancer: our experience]. / Radiofrequenza eco guidata percutanea nei tumori del rene: la nostra esperienza.

UNLABELLED: The radio frequency ablation of kidney cancer showed satisfactory results at a short follow-up with the use of a new RF generator system. Radio frequency is an alternative procedure with the intention of producing heat damage to tissue by electromagnetic energy. METHODS: From January 2009 to July 2010, at our operative unit, ten patients (age range: 50-83 years) underwent percutaneous radio frequency. All tumors were primitive without secondarism. The lesion diameter ranged from 15 to 35 mm. Only in two cases the treatment was open due to difficulties in finding the lesion. RESULTS: At six months' treatment, two patients had a complete remission and one patient an incomplete one; at eight months, five patients are with a complete remission and one patient with complete remission; at twelve months, one patient showed an incomplete remission. CONCLUSIONS: There are no studies with a long-term follow-up and it is prudent to limit this therapy to those patients who can not undergo surgical treatment. A correct post-operative imaging evaluation is essential to ensure an effective treatment.

Clear cell adenocarcinoma of the bladder in a male patient: clinicopathologic analysis of a case.

Clear cell adenocarcinoma arising in the lower urinary tract is unusual. We report a case of clear cell adenocarcinoma of the bladder in a 54-year-old male. Cystoscopic examination revealed a tumour arising from the dome of the urinary bladder. Histologically, the tumour was chiefly composed of tubulocystic and papillary glands lined by glycogen-rich, cubical or hobnail cells with clear to eosinophilic cytoplasm. The tumour infiltrated into the inner muscular layer. The patient was treated by partial cystectomy.