Prognostic significance of tumor suppressor protein p53 in prostate cancer.

INTRODUCTION: The p53 gene mutation is one of the most common genetic alterations in many cancers. In prostate cancer (PCa), it has been associated with a poor prognosis, tumor progression and aggressiveness. P53 mutation induces an abnormal protein expression in related tissues. AIM: This study aimed to assess p53 expression using immunohistochemistry in PCa and to discuss its prognostic value. METHODS: We have retrospectively collected all cases of PCa diagnosed in our pathology department between 2012 and 2022. An automatized immunohistochemical analysis was performed using monoclonal p53 antibody. For each case, we assessed the proportion of positive cells and the intensity of staining. P53 expression was considered abnormal when it was totally negative or overexpressed (>=50% of positive cells). RESULTS: Twenty-four cases have been selected. Abnormal p53 expression was found in 42% of cases (P53 was overexpressed in 6cases and totally negative in 4 cases). Mean age of patients with p53 abnormal expression was 70years old. Patients with p53 abnormal expression had Gleason score >7 in 5 cases, ISUP grade >2 in 3 cases, peri-neural invasion in 8cases, capsule invasion in 9cases. All patients with p53 overexpression developed androgen resistance (p<0.01). CONCLUSION: An aberrant expression profile of the p53 protein was observed in 42% of cases, and a statistically significant association was found with androgen resistance. Our results suggest a potential prognostic role of p53 in PCa.

Prognostic significance of E-Cadherin and B-Catenin in non-muscle invasive bladder cancer.

Non muscle invasive bladder cancer (NMIBC) has unpredictable outcomes with a variable risk of recurrence and progression. Many clinic-pathological prognostic factors have been identified but remain insufficient, raising the need to investigate new biomarkers. The aim of our study was to assess the prognostic value of the immunohistochemical (IHC) markers E-Cadherin and B-Catenin in NMIBC. All cases of NMIBC were collected between 2008 and 2013. IHC analysis was performed using E-Cadherin and B-Catenin. Reduced or loss of E-Cadherin expression was assessed as abnormal. Only cases with B-Catenin intense membranous staining were considered normal. A correlation was found between abnormal E-Cadherin expression and stage (p = 0.001), grade (p = 0.0000000), recurrence (p = 0.0000000), progression (p = 0.01), recurrence-free survival (p = 0.00000001), and progression-free survival (p = 0.01). A statistically significant association was found between B-Catenin and stage (p = 0. 05), grade (p = 0.02), and recurrence (p = 0.02). The abnormal expression of these markers could help to identify a high-risk subgroup of NMIBC that might benefit from either more accurate follow-up or more aggressive treatment.

Immunochemistry-based quantification of tumor-infiltrating lymphocytes and immunoscore as prognostic biomarkers in bladder cancer.

BACKGROUND: Tumor-infiltrating lymphocytes (TILs) and the derived immunoscore (IS) have gained considerable attention over the last decade as prognostic markers in many solid cancers. However, in bladder cancer (BC), their prognostic value is not clearly established. METHODS: The present study aimed to quantify the TILs rates in BC, assess the derived immunoscore, and investigate their prognostic value. An immunochemistry-based quantification of the different subtypes of TILS was performed on paraffin-embedded blocks from patients with invasive urothelial carcinoma of the bladder. We have assessed the rates of TILs, respectively, on peri-tumoral (PT) and intra-tumoral (IT) areas and calculated for each case the corresponding IS which is the index: CD8+/CD3+ TILs. The IS was then classified as low (I0, I1) or high (I2, I3, I4). We included 30 cases in the analysis. RESULTS: The median age of patients was 65 years with a sex ratio of 9. TILs densities and distribution were significantly variable between IT and PT areas CD3+ (p = 0.03) and CD8+ (p = 0.004) with the highest rates on the PT areas. In univariate analysis, a low density of CD8+ TILs was significantly associated with an advanced age (p = 0.05), with the presence of lympho-vascular invasion (p = 0.02) and with the absence of specific histological subtype (p = 0.05). A low immunoscore was significantly associated with the presence of lympho-vascular invasion (p = 0.004). No significant association was found between TILs subpopulations, the IS, and the other clinicopathological and survival data. The overall survival (OS) and disease-free survival (DFS) medians were slightly superior in highly T (CD3+/CD8+)-cell infiltrated tumors as well as tumors with a high IS densities. However, the univariate analysis showed that TILs and immunoscore did not impact overall survival (OS) and disease-free survival (DFS). CONCLUSION: TILs and immunoscore might be effective prognostic tools in BC. However, standardized quantification methods and further investigation on larger samples are highly recommended to definitively attest the prognostic value of TILs and IS in BC.

Pyelonephritis complicated by a perirenal abscess in a pregnant woman: Exceptional cause of fetal death in utero.

Acute pyelonephritis is the most common bacterial infection during pregnancy. If not diagnosed and treated promptly, it can lead to serious maternal and fetal complications. In the literature, a few cases of perirenal abscess complicating acute pyelonephritis during pregnancy have been reported. Herein, we report a case of perirenal abscess in a pregnant woman complicated by intrauterine fetal death and discuss the diagnostic and therapeutic difficulties.

Urothelial carcinoma of the proximal ureter revealed by spontaneous forniceal rupture: A case report.

Spontaneous rupture of the upper urinary tract is a rare and potentially serious pathology. Lithiasis is the most frequent cause. However, other causes are incriminated such as trauma, retroperitoneal fibrosis and especially stenosing tumors. Few cases of excretory tract rupture secondary to tumor obstruction have been reported in the literature. We report a case of spontaneous rupture of renal pelvis secondary to ureteral obstruction caused by urothelial tumor and discusses difficulties of diagnostic and treatment.

An unusual case of spermatocytic seminoma in 80 year-old-patient: A case report.

INTRODUCTION: and importance: Testicular tumors represent 1% of human malignant tumors. Spermatocytic seminoma (SS) is a rare tumor, representing less than 2% of testicular cancers. This Tumor is an uncommon neoplasm first described by Masson in 1946 and rarely occurs before the fifth decade. Around 200 cases of Spermatocytic seminoma have been reported in the literature. CASE PRESENTATION: We present a case of Spermatocytic seminoma in 80 years old men who presented with a right testis mass. Scrotal ultrasonography revealed a well-defined 62 × 32 × 27 mm right testicular solid tumor with heterogeneous echogenicity associated with a small hydrocele. A right inguinal orchiectomy was performed with primary control of the spermatic cord. Following the operation, the patient was followed closely without any adjuvant therapy and was in good condition with no evidence of metastasis 12 months after the operation. CLINICAL DISCUSSION: The spermatocyte seminoma described by Masson in 1946, represents an entity anatomy-clinical which, due to its morphological and biological properties particular, deserves to be distinguished from the classic variety of testicular seminomas. It is an uncommon tumor and, represents less than 1% of all patients and 4.4% of stage I. Homolateral orchiectomy inguinal with upper spermatic cord ligature represented the standard treatment. CONCLUSION: Spermatocytic seminoma is a rare tumor, found mainly in elderly men. It is original by its histological characteristics and its good prognosis.

Xeroderma pigmentosum and renal leiomyosarcoma: A very rare case report association.

INTRODUCTION: Xeroderma pigmentosum (XP) is a rare genetic disorder causing extreme sensitivity to ultraviolet (UV) rays. It is transmitted by an autosomal recessive mode. This disease is classically characterized by a high risk of skin cancer. The occurrence of extra-dermatological cancers in patients followed for XP has been rarely reported in the literature. We present the case of a 14-year-old adolescent with an exceptional association of XP and renal leiomyosarcoma. PRESENTATION OF CASE: A 14-year-old adolescent was presented with an abdominal mass revealed by hematuria and abdominal pain. Computed tomography (CT) of the abdomen showed an enhancing, heterogeneous right renal mass, consistent with the features of renal tumor. After non conclusive biopsy, a total nephrectomy of the right kidney was performed. Based on gross specimen observation and immunochemical analysis, the patient was diagnosed with high-grade renal leiomyosarcoma. An adjuvant chemotherapy was indicated and the patient was referred to medical oncology. At 12 months follow-up, the patient is in total remission; The CT scan did not show any locoregional or distant recurrence CONCLUSION: The risk of renal tumor is increased in patients followed for XP. Attending physicians should ask for renal imaging at the slightest sign of clinical call.

Prognostic value of CD44s expression in urothelial bladder tumors.

Urothelial bladder carcinoma (UBC) includes a large group of malignancies with a variable clinical behavior. Despite remarkable developments in recognition of bladder carcinogenesis and prognostic factors, the recurrence rate is still high. Thus, identification of novel biomarkers involved in tumor cell invasion and metastatic dissemination is a constant challenge. AIM: To assess the prognostic impact of CD44 standard (CD44s) expression in UBT. METHODS: We assessed the immunohistochemical expression of CD44 in 38 samples of endoscopically resected UBT. Only membranous staining was considered positive. We analyzed topographic distribution of CD44s staining. Correlation of CD44s expression, clinicopathological features and disease progression was analyzed by Chi2 and Fisher tests. Kaplan-Meier analysis was used to investigate CD44s prognostic value. RESULTS: The mean age of patients was 61,24 years with male to female ratio of 18/1. CD44s expression was positive in 33 cases (87%). There was no significant correlation between CD44 expression and the parameters:  age, gender, tumor size, focality, tumor site, stage, recurrence and tumor progression. CD44s loss of expression is, nevertheless, correlated with a high tumor grade. Topographic distribution of CD44s staining was associated with focality, grade and stage. Basal/parabasal staining expanded to the tumor layers in homogeneous "laminate" pattern used to be of better prognosis, compared to the heterogeneous "islets" or "dispersed" pattern. CONCLUSIONS: Our results highlighted the prognostic value of CD44 expression in UBT. Focusing especially on staining pattern offers a better understanding of bladder carcinogenesis mechanisms.

Ureteral tumor in an ectopic duplex system: a case report.

INTRODUCTION: Ureteral ectopia is a rarely observed anomaly. It may be totally asymptomatic. An association with a duplex system is exceptional. Diagnostic and therapeutic approaches are challenging. Carcinologic surgery must consider the anatomic variant, mainly related to the ectopic site of the ureteral orifice. OBSERVATION: We report a case of a ureteral urothelial carcinoma in a North African 52-year-old male patient, in a right duplex system. Radiological explorations concluded a non-functional upper right kidney. A suspect mass was observed in the lumbar part of the ureter of the right upper system. The meatus of the tumorous ureter ended in the right lobe of the prostate. A right hemi-nephro-ureterectomy was performed. A histological examination concluded a pT2G2 urothelial carcinoma. CONCLUSION: Even if malignancy is rarely observed in ureteral ectopia, it should be evoked mainly in cases of hematuria with risk factors for urothelial tumors.

Blunt scrotal trauma in adults: A multi-institution study evaluating the American Association for the Surgery of Trauma organ injury grading scale About 107 cases.

PURPOSE: The authors evaluated the usefulness of the American Association for the Surgery of Trauma (AAST) testis injury scale based on preoperative scrotal ultrasonography (US) and physical examination compared to peroperative findings. METHODS: A retrospective review was performed on 107 patients (mean age=29,2±5.8 years) with a testis blunt trauma treated between January 2005 and August 2015. All patients underwent surgical scrotal exploration. Preoperative US was performed in all cases. Testis trauma was classified according to the AAST organ injury scale, preoperatively based on physical examination and scrotal US and then compared to peroperative definitif grading scale. RESULTS: Of the included patients, 14 were found to have abnormal testis contours on US, 25 had a rupture of the tunica albuginea, with a sensitivity of 70,8% and a specificity of 71,2%. Orchidectomy was performed in 12 cases, partial orchidectomy in 32 and tunica albuginea repair in 35 patients. CONCLUSIONS: Through this series, US was not a specific and sensitive exam to really precise the severity grade of testis trauma. Pre- and preoperative findings were significantly different. Thus, we continue to support history and clinical findings and we encourage surgical exploration when testis lesion is suspected.

Pre-existing renal lesions revealed after renal trauma, Difficulties in diagnosis and accountability: About 14 cases.

OBJECTIVE: Pre-existing renal lesions (PERL) may interfere with the patho-physiology of trauma, alter the radiographic imaging and influence the therapeutic approach. The aims of this study were to record the PERL found incidentally during blunt renal trauma, to specify the place for effective conservative management and to determin the estimated partial permanent disability (PPD). PATIENTS AND METHODS: The medical records of 14 patients with PERL and blunt renal trauma were reviewed. In each patient, pre-existing renal abnormalities, clinical symptoms, CT scan study findings, associated injuries, therapeutic approach, the accountability criteria and the estimated PPD were recorded. RESULTS: There were 11 men and 3 women with a mean age of 35,6 years (range 19-66 years). Renal trauma was due to a traffic accident in 8 patients. Renal damage appeared to be disproportionate to the severity of the trauma (minor trauma). They had a lower rate of associated trauma to other abdominal organs (four patients only). Urinary stones were present in 5 patients, pelvi-ureteric junction obstruction in 3, horseshoe kidny in 3, ectopic kidney in 2 and upper urinary tract carcinoma in one case. Early nephrectomy was required in three cases for hemodynamic instability. Ureteral stenting was indicated in 3 cases. Six patients were operated later because of their underlying renal pathology. A conservative treatment was possible only in 7 of cases. The PPD related to renal trauma varide from 0 to 13% in all cases. CONCLUSION: PERL may complicate a negligible renal trauma while in some cases they may be of vital importance for the patient's final outcome. The imaging findings are crucial but may be confusing. The therapeutic approach is, to a large extent, dependent on the type of PERL and the severity of damage, and is often conservative in the hemo-dynamically stable patient. Accountability link may be difficult to establish and the PPD depends on the PERL and the renal injuries severity. FUNDING: We have no involvement with funding in this case. Ethical approval: Not required Conflicts of interest: None.

Epidemiology of nosocomial infections: About 70 cases.

Background - The infections associated with care (IAS) constitute a major public health problem by the morbi- mortality than they generate as well as by their cost to support. The prevention of these infections has become a priority for several years everywhere in the world and in the occurrence in Tunisia. Aim - The purpose of our study is to assess the prevalence of nosocomial infections as well as develop their microbiologic  profiles in the different departments of  the hospital of FSI  Marsa Tunisia and try to highlight the risk factors that can influence these infections Methods - It was a retrospective study about  patients with noscomila infection who were admitted in the different care unit of the Hospital of FSI  Marsa and this on a period of 6 years from 1 January 2009 to 31 December 2014 Results - We have identified seventy(70) patients having contracted a nososcomial infection during the period of study for 24600 hospital admission, with a prevalence rate of 0.28%. The unit of intensive care   had the highest prevalence rate (30%), followed by the general surgery unit (17.1%) and orthopaedics (15.7%). Four bacterial species accounted for almost ¾ of germs isolated: Pseudomonas aeruginosa (22.86%), Staphylococcus  ( 15.71%), Klebsiella pneumoniae (15,71 %) and Escherichia coli in 8.75% of the helth care associated infections. Conclusion - Nosocomial infections represent an important indicator of the quality of care. Serious efforts but simple, especially as regards the respect of the rules of aseptic and hand hygiene are effective to significantly reduce the occurrence of infections in hospital.

Long-term outcome of intravesical bacillus Calmette-Guérin therapy with maintenance for urinary bladder carcinoma in situ: About 47 cases.

INTRODUCTION: Data concerning the efficacy of intravesical Bacillus Calmette-Guerin (BCG) on carcinoma in situ (CIS) of the bladder are limited. OBJECTIVES: We analyzed long-term outcomes of instillation therapy with BCG to treat bladder CIS, evaluated its effectiveness and safety and searched for prognostic factors that could predict disease recurrence and progression. METHODS: Between March 1994 and December 2010, 47 patients (male: 40; female: 7) with median age of 59,5 years (range 40-76 years), diagnosed with bladder CIS underwent weekly BCG instillations (75 mg of Pasteur strain) for six weeks followed by 6 monthly instillations. Patients were collected from four different institututions.Proven bladder CIS diagnosis was made through random biopsy (n=19), macroscopic lesion (n=28) and urinary cytology (n=6).Primary, concomitant, and secondary CIS was found in 13 (27,6%), 28 (59,6%) and 6 (12,7%), patients, respectively. RESULTS: The median follow up period was 67.5 months (range 60-116 months).The recurence rates were 15,4%, 35,7% and 50% respectively in group I,II and III at 5 years follow-up. The overall complete response rate was 68%.The five-year progression-free survival rate was 87.2%.Several factors, such as age (<60 or >60 years), gender, previous transurethral resection and type of CIS, were examined by multivariate analysis to predict recurrence and progression. None of them was an independent prognostic factor.Bladder irritation symptoms were the main BCG adverse effects. There were no severe adverse effects requiring discontinuation of drug administration.Radical cystectomy was performed in 5 patients. Extravesical involvement was identified in only one patient. During follow-up period, none died of bladder cancer. CONCLUSION: Therapy with BCG is remarkably effective and safe for primary CIS and concomittent CIS, which might be a prognostic factor. We didn't find any significant risk factor. Recurrence and disease progression including extravesical involvement should be carefully monitored over the long-term after BCG therapy.

[Treatment of idiopathic varicocele: comparative study of three techniques about 128 cases]. / Traitement de la varicocèle idiopathique : Étude comparative de trois techniques à propos de 128 cas.

BACKGROUND: Several modalities of varicocele treatment are available, however, no therapeutic technique showed its superiority with regard to the other one. AIM: To compare the results of three techniques of varicocelecomy. METHODS: Retrospective Analytical and comparative study of 128 patients treated by of three techniques of varicocelectomy: the open surgery by retro peritoneal way for 42 patients (GI), the varicocelectomie coelioscopique for 41 patients (GII) and the antegrade scrotal sclerotherapy done for 45 patients (GIII), between march 2001 and January 2009.The mean age was 28 years. The main motive for consultation was represented by the painful varicocele in 67 % of the cases, followed by the hypofertility in 20.3 % of the cases and the association both in 12,5 % of the cases. The varicocele was in leftsider in 71.1 % of the cases, to the right side in 5.4 % of the cases and was bilateral in 23.43 % of the cases. Varicocele was infra-clinical at 6 patients, grade 1 in 16 sides, grade 2 in 105 sides and grade 3 in 31 sides. The numeration, the mobility as well as the morphology of sperm cells were comparable between the three groups Results: The global rate success was 81.2 %, with the highest rate found in the group III which was treated by antégrade scrotal sclerotherapy (84.4 %). The improvement of the parameters of the spermogramme was noted in the three groups, however a statistically significant difference was found only in patients treated by antégrade scrotal sclerotherapy; it mainly concerned numeration and the mobility of spermatozoides. The highest rate of pregnancy was recorded in patients treated by antégrade scrotal sclerotherapy (13.3%). The main postoperative complications were hydrocele (16%) followed by testicular hypotrophy (3 patients). CONCLUSION: Three techniques of varicocele treatment, offer either a similar success rate, and improvement of parameters of the sperm cells. However, antegrade scrotal sclerotherpy seem to be the best treatment of first intention in proposed, regarding its efficiency, of the ease of its realization, its moderate cost and its feasibility in case of recurrence if varicocele was treated with open way'GIII).

[Results of laparoscopic treatment of morbid obesity: report of 27 cases]. / Résultats du traitement laparoscopique de l'obésité morbide: a propos de 27 cas.

BACKGROUND: Prevalence of obesity is increasing steadily. It exposes the patient to numerous complications and represents a serious public health issue. Various treatments were tried. Surgery is actually a credible alternative. Many techniques can be made by laparoscopic approach. AIM: To evaluate early and late results of laparoscopic treatment of morbid obesity by two techniques: gastric banding adjustable and gastric by-pass. METHODS: From May 2001 to July 2007, 27 patients were laparoscopically operated on for severe obesity in our department. Twenty four patients were treated with a gastric banding and 3 patients with gastric bypass. The primary endpoint was: excessive weight loss (EWL), BMI variations and patients' satisfaction. The secondary endpoints were mortality, morbidity and conversion. RESULTS: The mean age was 36 years. There were 4 males and 23 females. The mean preoperative weight was 122.4 kg (range: 87-152) and the mean body mass index (BMI) was 42,5 kg/m2 (range 36.5-52 kg/m2). The mean operating time was 129 minutes (range: 50-300). The mean hospital stay was 4.76 days (range: 3-8). There were no postoperative deaths. Early complication was present in 3 patients. Late complications were present in one patient. No conversion to laparotomy was necessary. BMI decreased from 42.9 to 31 kg/m2 and EWL reached 43%; CONCLUSION: The results of our experience are encouraging with an acceptable complication rate and no death. Laparoscopic treatment can be done with good results.

[Laparoscopic treatment of gastroesophageal reflux: report of 51 cases]. / Traitement coelioscopique du reflux gastro-oesophagien: a propos de 51 cas.

BACKGROUND: The fundoplication to treat gastroesophageal reflux disease have proven themselves in open surgery and are being validated by laparoscopy. BUT: The purpose of this retrospective study was to evaluate the results in the short and medium term treatment of gastroesophageal reflux by laparoscopy in a series of 51 patients and compare our results with those of literature. METHODS: We report the results of a retrospective study of 51 consecutive patients operated by laparoscopy for gastro-esophageal reflux during the period January 2000 to December 2004. The indication for surgery was the drug resistance (persistence of symptoms of reflux on treatment), drug addiction, persistent esophagitis after a well conducted medical treatment and endobrachy-esophagus. All our patients had a total or partial fundoplication. Our outcome measures were mortality, morbidity, specifically, the conversion rate and functional outcome in the short and medium term. RESULTS: These 24 men and 27 women of average age 38 years (range: 17-71 ans). All patients were approached first by laparoscopy. All our patients had a fundoplication: 44 total, including 10 with section of short vessels (Nissen) and 34 without section of short vessels (Nissen-Rossetti). The other 7 patients had a partial posterior fundoplication of 180 degrees. We used the conversion in four patients (7.8%). Mortality was nil. The specific complications were observed in 2 patients (4%), a case of gastroparesis positive trends in gastric aspiration. A case of aphagie requiring reoperation for postoperative J2 to convert a valve type Nissen-Rossetti valve type Toupet. The non-specific complications were dominated by pneumonia in 4 patients (7.8%). In the medium term, gas bloat syndrome was present in 7.8% of cases. Dysphagia, present in (77%) cases, was transient in 40 patients (62%) and persistent in 15 patients including 2 requiring dilation sessions. One patient experienced a recurrence of reflux confirmed by pH monitoring. CONCLUSION: the laparoscopic approach is being validated in the surgical treatment of gastroesophageal reflux. In our series of 51 patients, the results were satisfactory and comparable to those of the literature.

Multiple unusual locations of hydatid cysts including bladder, psoas muscle and liver.

Our case concerns 66-year-old female with a multiple unusual locations of hydatid cysts including bladder, psoas muscle and liver. Coexistence of hydatid cysts in these localizations has not been previously reported. The diagnosis of vesical hydatid cyst was facilitated by the coexistence of other echinococcosis locations. Treatment consists of the excision of the cysts in the same session without any postoperative anthelmintic drugs. In a two-year follow-up no recurrence has occurred.