ABSTRACT
@#Infection with adult Ascaris primarily occurs in the gastrointestinal system, but physical migrationother than this has been reported. To date, only a small number of cases have been reported to involvethe urinary system and no report of Ascariasis migration to the retroperitoneal space.This is a case of a 38-year-old female admitted as a case of perinephric abscess, renal mass right.Patient was initially managed conservatively with broad spectrum antibiotics and tube drainage, butwith the deteriorating condition, an exploratory laparotomy, with retroperitoneal exploration wasdone. During exploration, no colonic fistula was noted. The renal parenchyma was noted to bepinkish with a 1cm opening at the mid lateral pole associated with purulent discharge. Interestingly,a 6cm x 1cm wax-like, moving structure was found in the retroperitoneal space The object wasremoved with Debakey forceps and was determined to be Ascaris lumbricoides by histopathology.Fecal analysis of stool for ova and parasites was negative for Ascaris. The patient then had an uneventfulrecovery.Currently, there are only two theories on how Ascaris lumbricoides can be introduced into the urinarysystem. The first includes fistulation between the GI and urinary system and second by retrogrademigration of the adult worm through the urethra. Given the current data, the authors believe that thepatient experienced retrograde invasion of Ascaris through the urethra, and subsequently migrated tothe retroperitoneal space through fistulation.Ascariasis of the genitourinary tract is a rare condition. This is the first reported case of ascariasis inthe retroperitoneum.
Subject(s)
Ascaris lumbricoidesABSTRACT
Background@#The Gleason Sum derived from transrectal ultrasound guided prostate needle biopsy (TRUS-PNB) is critical in the selection of an appropriate treatment and also important in predicting the possible outcome. Scoring is therefore critical in the selection of a proper management. The concordance between prostate needle biopsy and radical prostatectomy histopathology in terms of the Gleason Sum was here in evaluated.@*Methods@#This is a retrospective cohort where a review and analysis of 28 charts were made. All patients who underwent TRUS-PNB and subsequently radical prostatectomy were included in the study. The concordance rates between prostate needle biopsy and radical prostatectomy histopathology were elucidated. @*Results@#With the Gleason Sum 6 upon TRUS-PNB (n=17), 9 (53.9%) matched their postoperative pathological findings, while 8 (47.0%) were upgraded to Gleason Sum 7. No finding of downgrading was observed postoperatively. Tumors graded GS7 on TRUS-PNB upon biopsy (n=11) had the best concordance; with 11 (100%) matched at radical prostatectomy. No over grading or downgrading was observed. @*Conclusion@#GS6 tumors being upgraded to GS7 tumors are still being observed. Owing the diagnosis of prostate cancer relying heavily on biopsy may still yield discordance. Though improvements with regards to biopsy technique may evolve, the usual 12 core biopsy is still being applied. With this, different factors that may predict discordance and strategies to minimize discordance still remain important for the appropriate treatment of prostate cancer.