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INTRODUCTION AND IMPORTANCE: Rhabdomyosarcoma [RMS] is a malignant soft-tissue neoplasm characterized by skeletal muscle differentiation. It accounts for 7 % of childhood malignancies and is, by a wide margin, the most common sarcoma of childhood (Pappo, 1996). Approximately 20 % of cases of childhood rhabdomyosarcoma occur in the genitourinary tract (vagina, urinary bladder, prostate, paratestis, and uterus), and they are most commonly observed in the head and neck region. CASE PRESENTATION: We reviewed the case of a 42-year-old male who presented with a 2-week history of blood in the urine, which was painless, started on gradual onset, and progressively increased, involving the whole stream of urine. The blood clots were amorphous in shape but had no history of passed tissue shreds, childhood schistosomiasis, cigarette smoking, or working in chemical industries. On physical examination, the patient was anxious and conscious, with normal vital signs. The abdomen revealed distended abdomen shifting dullness, a palpable urinary bladder with suprapubic distension, and a tenderness on palpation, which disappeared upon catheterization 3-way 24F, with normal male genitalia and right lower limb edema. Other systems were essentially normal. On image KUB USS revealed a bladder mass, Cystoscopy showed a broad base bleeding tumor located at dome to the left lateral, fungating, with some necrotic tissue. TURBT was done into completion and histology revealed an embryonal rhabdomyosarcoma of urinary bladder, a botryoid subtype. After TURBT, the patient received adjuvant chemotherapy, the MAID protocol and underwent a 6-cycle cycle. The cycle was repeated every 21 days, and his height was 171.5 c, and his weight was 89 kg. Serial of check cystoscopy for one year revealed no recurrency of tumor. He repeated check CT scan, which showed a radiological improvement compared to the initial image. CLINICAL DISCUSSION: Rhabdomyosarcoma in adults is a rare type of urinary bladder carcinoma that is quite aggressive and is usually reported to be a pediatric malignant urinary bladder tumor. The modality of treatment is not universal because of its rarity. We used a combination of TURB and chemotherapy and performed strict follow-up, with no tumor recurrence occurring at least after one year of follow-up. These patients show significant improvement from the first presentation, both clinically and radiologically. CONCLUSION: The lack of a universal standard treatment approach for adult rhabdomyosarcoma indicates the need for more data on adult rhabdomyosarcoma, with a detailed description of its histological subtype.
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INTRODUCTION AND CLINICAL IMPORTANCE: Brain metastases from prostate cancer are uncommon, occurring in fewer than 1 % of cases of metastatic prostate cancer. Brain metastasis can cause cerebral edema, neurologic symptoms, and may be misdiagnosed as primary brain tumors on imaging if thorough investigations are not done. It is difficult to identify and diagnose brain metastasis from prostate cancer since the intracranial metastatic process and presentation are poorly understood and limited to case studies. Most patients with brain metastases from prostate cancer exhibit a variety of metastatic symptoms; however, this patient's presentation was defined by only isolated intense headache. Our goal is to draw attention to the uncommon instance of brain metastases from prostate cancer in addition to reviewing the literature on the advances in treatment for prostatic cancer with metastasis to the brain. CASE PRESENTATION: We report the case of a 67-year-old male with metastatic prostate adenocarcinoma into the brain, presenting with isolated severe headache with no prostate cancer symptoms. Following extensive radiologic examination, metastatic deposits were detected in the left side of the brain with multiple intracerebral and cerebellar vermis lesions. Multiplanar T2 weighted abdominal pelvic MRI visualized the primary lesion in the prostate which was confirmed by histology. After a month following surgical castration, the patient reported resolved headache and resumed his daily activities. The patient's serum PSA decreased from 7.8 ng/ml to 0.3 ng/ml during a 12-months follow-up with no neurological symptoms. CLINICAL DISCUSSION: Prostate cancer rarely causes brain metastases, and the percentage of all brain metastases that originate from prostate cancer is seldom updated. It can be difficult to distinguish between primary brain lesions and metastatic brain prostate cancer, particularly when there is just one lesion present. Despite the recently developed diagnostic approaches, symptomatic patients exhibit a variety of clinical manifestations that vary depending on the location of the metastatic focus. These manifestations include headache, seizures, and focal neurological deficits, in addition to some common non-focal manifestations like confusion and memory deficits. Our patient had a PSA of 7.8 ng/ml at the beginning and the DRE results were normal, clinically prostate cancer was not thought to be the main cause of brain metastasis. Abdominal pelvic MRI was performed to investigate the primary lesion and confirmed the presence of prostate cancer with extra prostatic extensions. Adenocarcinoma prostate cancer was found to be the main cause when histopathology was done. CONCLUSION: This report reviews the literature on brain metastases from prostate cancer and points out that while very rare, brain metastases from prostatic cancer do occur and should not be overlooked, particularly in light of the recent advancements in prostatic cancer therapies that may extend the patient's survival. Gadolinium-enhanced MRI is necessary to confirm or rule out brain metastases if it is suspected, as well as to monitor prostate cancer patients.
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Background: Surgical Site Infection (SSI) is one of the major hospital acquired infections, highly associated with prolonged hospitalisation, morbidity and mortality. In open urological surgeries, little is known on magnitude and factors associated with development of SSI. Methods and Materials: The intervention was a cross-sectional prospective observational study performed between August 2015 and March 2016 at Muhimbili National hospital (MNH), Dar es Salaam, Tanzania. Patients who underwent open urological surgery at MNH during the study period and met inclusion criteria were consecutively enrolled, and followed up for 30 days. Patients' and operative characteristics were recorded using standard structured questionnaires. Wound/pus swabs were collected from patients with clinical evidence of SSI for bacteriological processing. Data analysis was performed using SPSS version 20. Results: Of 182 patients who underwent open urological surgery, 22% (40/182) developed SSI. Pre-operative urinary tract infection (aOR 9.73, 95%CI 3.93-24.09, p<.001) and contaminated wound class (aOR 24.997, 95%CI 2.58-242.42, p = .005) were independent predictors for development of SSI. Shaving within 30 hrs before surgical procedure was found to be protective for developing SSI (aOR 0.26, 95%CI 0.09-0.79, p=.02). Escherichia coli (20/40) was the most predominant pathogen in SSI followed by Klebsiella pneumoniae (7/40) and S. aureus (6/40). Gram-negative bacteria were highly resistant to ceftriaxone, gentamicin, amoxicillin-clavulanic acid and trimethoprimsulfamethoxazole. Conclusion: Surgical Site Infection was high in open urological interventions. Pre-operative urinary tract infection and contaminated wound class predicted SSI. Bacteria causing SSI were highly resistant to commonly used antibiotics.