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OBJECTIVE: To review the embryological and clinical aspects of the different types of pyelocaliceal diverticula, with special reference to the differential diag-nosis and treatment.METHODS: Images of type I and II pyelocaliceal diverticula are shown. The conditions that cause difficulty in making the differential diagnosis are discussed.RESULTS: Urography continues to be the diagnostic method preferred and is sometimes aided by retrograde ureteropyelography.CONCLUSIONS: Pyelocaliceal diverticula are cystic eventrations of the upper urinary tract lying within the renal parenchyma that communicate through a narrow channel into the main collecting system. They occur in 0.2 to 0.5% of the population and are congenital in origin. Calyceal diverticula are frequently found incidentally on routine excretory urograms, but patients may complain of flank pain, hematuria or recurrent urinary infections. In the past, treatment required open renal surgery. Endourologic procedures are widely utilized today.
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OBJECTIVE: To present our results withbrachytherapy in the treatment of localized cancer of theprostate.METHODS: From September 1999 to April 2000, 20patients with T1 and T2 cancer of the prostate were treatedwith brachytherapy. The method utilized is described andthe results are presented. The advantages of iodine-125implantation using transrectal ultrasound are discussed.RESULTS: The morbidity was low and were mildirritative symptoms of the lower urinary tract that weremanaged without difficulty with medical treatment.Determination of PSA three months after the procedureshowed good results in 80% of the cases.CONCLUSIONS: There is an increasing number ofcases diagnosed with localized cancer of the prostate.Good results have been achieved with radical surgery andradiotherapy. Although the number of patients with 10years follow-up is small, brachytherapy of the prostate hasachieved good results with a low morbidity. This therapeuticmodality should be offered to the patient with localizedcancer of the prostate and the patient allowed to decide onthe type of treatment.
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OBJECTIVE: To determine the loss ofheterozygosity (LOH) on 9p21 (locus D9S1747) in patientswith renal carcinoma by analysis of microsatellitepolymorphisms.METHODS: 40 patients with sporadic renal cancerwere studied. LOH on 9p21 was performed by analysis ofmicrosatellite polymorphisms.RESULTS: 23.7% showed LOH on 9p21. No correlationwas found between this genetic alteration and tumorfeatures.CONCLUSIONS: LOH on 9p21 was found in 23.7% ofthe patients in this series. LOH was found in 26.9% ofrenal cell carcinomas, 25% of papillary carcinomas and25% of Bellini duct carcinomas. LOH was not found in theother histological types.
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OBJECTIVE: To present our experiencewith Bellini duct carcinoma, a rare form of renaladenocarcinoma with well-defined histological,cytogenetic and immunohistochemical characteristics.The literature is reviewed.METHODS/RESULTS: We reviewed the records of 430patients with renal tumor that had been treated over a 10-year period. Only 6 cases with Bellini duct carcinomawere found. The mean age was 60 years, all patients weremale and hematuria and lumbar pain were the mostcommon clinical manifestations. Diagnosis was made byimaging techniques (US, urography, CT). The definitivediagnosis was based on the histological andimmunohistochemical findings following nephrectomy.The one-year and three-year survival rates were 50% and0%, respectively, indicating the aggressive nature of thisvariant of renal adenocarcinoma.CONCLUSIONS: Bellini duct carcinoma is anuncommon variant of renal carcinoma with nonspecificclinical features. It is a very aggressive tumor type whosetreatment is only by nephrectomy and the outcome is poor.
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OBJECTIVE: To analyze retrospectivelythe efficacy of radical cystectomy alone in the treatmentof transitional cell carcinoma of the bladderMETHODS: 125 patients who underwent radicalcystectomy were evaluated. The mean follow-up was 62months. At the time of the study, 65 patients were alive (3with bladder tumor and 1 with a second primary) and 60patients had died (50 from bladder cancer and 10 fromother causes). Nine patients were lost to follow-up. TheKaplan-Meier method was used for the survival analysisand the log-rank test for the comparison of the variables.RESULTS: The overall survival at 5 years was 50% andthe cancer-specific survival was 56%. By tumor stage, thecancer-specific survival at 3 and 5 years were respectively:83% and 85% for pT1, 78% and 70% for pT2, 52% and42% for pT3, 24% and 12% for pT4 and 14% for pN+ (p<0.0001). No differences were found between stages pT2a(73% and 68%) and pT2b (71% and 53%) (p = 0.2). Thesurvival was significantly higher in patients with noresidual tumor in the cystectomy specimen (pT0) (93%and 83%) than in those with residual tumor (60% and53%) (p = 0.03).CONCLUSIONS: Radical cystectomy alone in thetreatment of transitional cell carcinoma of the bladderwas found to be effective in patients with tumor stage pT2.It is less effective in patients with tumor in the advancedstages (pT3 or pT4) or lymph node invasion. Radicalcystectomy is an overtreatment in patients with no residualtumor in the cystectomy specimen.
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OBJECTIVE: To present our experiencewith the Snodgrass technique for primary hypospadiasrepair and for reoperations.METHODS: From May 1996 to August 1998, theSnodgrass technique was performed on 97 patients withhypospadias; 72% were distal, 19.5% were midshaft and8.5% were proximal. Of these patients, 8.5% had aprevious hypospadias repair. The patients were followedfor a period of two years.RESULTS/CONCLUSIONS: Complications, includingfistulas, occurred in 4 patients. The cosmetic results wereexcellent and there were no complications in patients whohad a previous urethroplasty.
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OBJECTIVE: To report a case of a large, bilateral, synchronous renal tumor.METHODS/RESULTS: Treatment by conservative surgery achieved good results. The histological analysis showed two different carcinomas. The most most important steps of the surgical procedure are described. Renal preservation in patients with malignant tumors is discussed.CONCLUSIONS: The case described herein is rare since the tumors were synchronous and of uncommon histological type (one of the tumors was a chromophobic carcinoma). Despite the large size of the tumors, they were successfully managed by conservative surgery.
Case Report
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OBJECTIVE: To report on a rare case of Pacinian neurofibroma of the vulva. METHODS: A 27-year-old patient who presented with a vulvar tumor is described. Patient evaluation showed no other remarkable findings.RESULTS: The nodule was resected without difficulty. The histopathological analysis demonstrated Pacinian neurofibroma with abundant concentric laminar structures. The immunohistochemical (CD34+), ultrastructural and histological analyses showed perineural cells. No signs of neurofibromatosis were found.CONCLUSIONS: Pacinian neurofibroma may present in the vulva and could probably arise from the so-called perineural fibroblasts.
Case Report
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OBJECTIVE: To describe a case of a solitary pulmonary nodule in a patient that had been treated for carcinoma of the renal pelvis. METHODS: A solitary pulmonary nodule was detected on the chest film of a patient that had been treated for carcinoma of the renal pelvis. The characteristics of the nodule are described and its diagnosis, with special reference to metastasis and primary pulmonary carcinoma, is discussed. RESULTS: The anatomopathological study demonstrated a chondroid hamartoma. CONCLUSIONS: A metastatic or a primary tumor is suspected when a solitary pulmonary nodule is detected in a patient that has been previously treated for urothelial carcinoma. However, other types of lesions with a more favourable outcome cannot be discarded, such as chondroid hamartoma as in the case described herein.
Case Report
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OBJECTIVE: To describe an additional case of incomplete sagittal septum of the bladder. METHODS: A case of incomplete sagittal septum of the bladder in a young, asymptomatic patient with paralysis of both lower limbs is presented and literature is briefly reviewed. RESULTS: The diagnosis was made by intravenous urography performed five years after the accident that had caused the paralysis. Radiological evaluation showed an "apple heart" bladder with reduced capacity. No treatment was required. CONCLUSIONS: Incomplete sagittal septum of the bladder is rare. To our knowledge, only 7 cases have been previously reported. Incomplete sagittal septum is like complete septum, but both cavities communicate anteriorly or distally, according to the direction and depth the septum protrudes into the bladder.
Case Report
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OBJECTIVE: To present a case of basal cell carcinomaof the scrotum.METHODS: In a review of 56 scrotal tumors, we found 4 primaryneoplasias, 3 benign mesenchymal tumors and one malignant tumor,the basal cell carcinoma of the scrotum described herein.RESULTS: A 52-year-old patient with no remarkable urologicalor dermatological history, complained of an excrescence in the righthemiscrotum that he had noted for several years. A clinical diagnosisof basal cell carcinoma of the scrotum was made and the lesion wassurgically excised. Pathological analysis of the surgical specimenconfirmed the diagnosis.CONCLUSIONS: Basal cell carcinoma is the most common typeof skin cancer in the middle-aged and elderly, but localization to thescrotum is rare. It is a tumor that grows locally and rarely metastasizes,although scrotal tumors are much more aggressive and patientsshould therefore be followed very closely after resection of the tumor.
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OBJECTIVE: To present a rare case of welldifferentiated mucus-producing adenocarcinoma of the renal pelvis.METHODS: Patient history, the results of the complementarytests after surgery, treatment and anatomopathological findings arepresented.RESULTS/CONCLUSIONS: Well-differentiated mucus-producingadenocarcinoma of the renal pelvis is rare and is often associatedwith lithiasis, a long history of obstruction and inflammation. Nestsof tumor cells surrounded by abundant mucus is a characteristichistological finding in this tumor type.
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OBJECTIVE: An incidentally discoveredretroperitoneal ganglioneuroma in a 4-year-old child is presented.METHODS: Ultrasonography and CT were performed. Thesurgical specimen was analyzed by macroscopic, histological andimmunohistochemical techniques.RESULTS: US and CT localized a retroperitoneal massindependent from the left kidney and adrenal gland. The histologicalstudy showed a fascicular proliferation with myxoid and fibrillarareas mixed with mature ganglion cells. These cells were positive forneurofilament and neuron specific enolase. The patient had a favorableoutcome with no signs of tumor recurrence.CONCLUSIONS: Ganglioneuroma is a rare, completely maturetumor that has to be differentiated from neuroblastoma.
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OBJECTIVE: To describe a case of epidermoidcarcinoma of the penis with vertebral metastasis.METHODS/RESULTS:: A patient with epidermoid carcinoma ofthe penis underwent penile resection. One year postoperatively thepatient presented with paraparesia and lumbar pain, and wasdiagnosed as having vertebral metastasis at L3. Surgical resectionof the tumor was performed with resection of L3 and arthrodesis ofL2-L4 via the anterior retroperitoneal approach. Theanatomopathological findings were compatible with metastaticepidermoid carcinoma. The rarity of bony metastases from this tumorand the clinical course of the patient are discussed.CONCLUSIONS: In patients with lumbar pain and a previoushistory of malignant disease, metastasis should be suspected even inthose tumors that are considered to have behave well.
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OBJECTIVE: To evaluate interferon alpha-2b (IFN) in the treatment of Peyronie's disease (PD) sinceIFN exerts antifibrotic action through collagen synthesisinhibition and fibrolysis stimulation.METHODS: The study comprised 34 patients, aged 31to 63, with clinical and ultrasonographic (US) diagnosisof PD, who gave their consent to enter the study. They hadthe disease for 10.1 ± 5.6 (2-22) months. Ten million IU ofIFN were injected intralesionally, twice weekly for 14weeks or less if there was complete remission. Clinicalevaluation included penis angle at erection, sexualdysfunction (pain, possibility of intercourse) and palpableplaque. Plaque size was evaluated by US. Systemic andlocal adverse reactions, and anti-IFN antibodies weremonitored as well.RESULTS: Sexual dysfunction disappeared in 19/24(79.2%) patients with this disorder, palpable lesions in21/34 (62%), angle at erection in 15/32 (47%), and painin 16/17 (94%). Complete clinical response was achievedin 16/34 patients (47%). Ultrasonographic response ratewas 88%, (53% complete). Plaque size decreased from56.7 ± 42.9 (median: 35.4) before treatment to 12.7 ± 22.6mm2 (median: 0) (p<0.00001; Wilcoxon's paired test).Clinical and US responses correlated. No patient showedprogression. Eight of 9 patients in whom other treatmentshad failed responded to IFN therapy (5 complete). Themain systemic adverse reaction in most patients (mild ormoderate) was the flu-like syndrome expected for IFN.Local reactions, more related to the administrationprocedure than to IFN itself, were small hematoma (10patients), edema (3), cysts that were excised surgically(2), and venous leak (1). No patient developed anti-IFNantibodies.CONCLUSIONS: IFN treatment can be a suitableoption for the management of PD. The results appear to bebetter than those achieved with other procedures. Furtherwork should include comparative studies, long-term followupof treated patients, and alternative ways ofadministration.
