Double Retroperitoneal Hydatid Localization: A Case Report

The hydatid cyst is a parasitic pathology which is endemic in Tunisia and presents a public health problem. Hydatid cysts located in the retroperitoneum, especially around or in the kidney, are rare and only represent 5% of visceral locations. The kidney is the most commonly affected organ of the urinary tract. The psoas muscle is an uncommon location and not less than 70 cases have been cited. We report the case of an unusual presentation of a right kidney hydatid cyst associated with a psoas muscle location. To our knowledge, this association of double retroperitoneal location has not been reported in the literature.

[Papillary renal cell carcinoma; clinic and pathological study about 27 cases]

Background: Papillary renal cell carcinoma [PRCC] represent 10 to 15% of renal tumours in adults. They contain more than 75% of tubule-papillary structure and are divided histologically into two subtypes. The distinction between these two sub-types is essential because of different prognosis

Aim: To describe the main clinical, radiological, therapeutic and prognostic features of these tumors. A comparative analysis between the two sub histological types was performed. Methods: This is a retrospective study, from January 2000 to December 2010, concerning 27 patients operated for PRCC. Clinical data was taken from medical observations and radiological analysis was based on CT findings. A second analysis of blades was made in doubtful cases to clarify the histological subtype

Results: PRCC represented 11.3% of renal tumors operated during this period. Mean patients' age was 62 years with a male predominance [sex ratio 3.5]. All tumors were unilateral and mean tumor size was 7 cm. There was no clinical or radiological sign suggestive of this histological type. Treatment consisted of radical nephrectomy in 74% of the cases and nephron sparing surgery in 26% of the cases. We found 17 subtype 1 tumors and 10 subtype 2 tumors. The five year overall and disease-free survival rate were, respectively 86% and 90% in type 1 tumors and 57% and 54% in type tumors

Conclusion: PRCC is the second most common renal cancer in adults. They have no clinical or radiological specific signs suggesting their diagnosis. The distinction between these two sub histological types is essential as subtype 1 tumors have a better prognosis

[Atypical renal cysts]

Background: Atypical renal cysts are suspicious for malignancy. It is hard in some cases to give a sharp radiological diagnosis and propose an appropriate management

Aim: To give the histological results of the operated atypical renal cysts and to establish a correlation between the radiological findings and histological features

Methods: Between January 2001 and December 2012, 22 patients have been operated in our department for atypical renal cysts. There were 10 type III and 12 type IV Bosniak lesions. We have reported clinical, epidemiological and radiological findings. We have analyzed the histological results taking into consideration the radiological findings

Results: According to histological findings, 7 among the 10 type III lesions were benign [70%]. However, only one case of benign tumor was noted in type IV lesions [8.3%]. There was no evident correlation between tumors size and histology. With a median follow up of 48 months, three patients died because of locally advanced tumors

Conclusion: Management of atypical renal cysts remains difficult. A careful computed tomography staging is essential before treatment. Type III and type IV Bosniak cysts were malign in 30% and 91% of cases, respectively. There was no correlation between tumor size and malignancy. A nephron sparing surgery should be proposed whenever possible

Psma-Psa clones drived by full akt phosphorylation [t308+,s473+] recapitulate molecular features of human prostate cancer

Background: [PSMA+,PSA+] and [PSMA+,PSA-] are the two most individual clones that we have previously identified during prostate cancer [PC] progression. However, molecular signatures associated with these distinct PSMA-PSA prostate clones and their specific correlation with disease outcome is yet to be defined

Aim: Since Akt is a major pathway involved in the critical activating events that leads to malignant form of the disease, we studied the involvement of full Akt activation [T308+,S473+] connected with serum PSA levels, tissue PSMA expression and angiogenic activity on the emergence of [PSMA+,PSA+] and [PSMA+,PSA-] PC clones

Methods: The study was carried out in 6 normal prostate, 25 benign prostate hyperplasia [BPH] and 23 [PC]. Immunohistochemical analysis was performed to study the expression of PSMA, PSA, pAkt[T308], pAkt[S473] and CD34 in prostate tissues. The evaluation of angiogenesis was made by CD34 immune marker. Serum levels of PSA were assayed by Immulite autoanalyser

Results:The most relevant result showed that, among PC patients with pAkt [T308+,S473+] profile, patients that exhibit the [PSMA+,PSA+] clone have higher serum PSA levels, tissue PSMA expression and angiogenic activity than those with [PSMA+,PSA-] clone. Although have the same [PSMA+,PSA+] prostate clone, BPH patients have distinct molecular-biological features compared to PC patients among pAkt [T308+,S473+] profile. In fact, among patients with maximal Akt activation, the [PSMA+,PSA+] PC clone is characterized by higher serum PSA levels, tissue PSMA production and intensive angiogenic activity than [PSMA+,PSA+] BPH clone

Conclusion: These findings emphasize the potential role of the full Akt activation [T308+,S473+] in expansion of several PSMA-PSA prostate clones capable of driving both human PC initiation as well as progression to a metastatic phenotype. Pinpoint patients according to PSMA-PSA clones could recapitulate the histological and molecular features of human PC and may offer a novel approach for controlling metastasis

[Endoscopic realignment versus delayed urethroplasty in the management of post traumatic urethral disruption: report of 30 cases]

Post traumatic posterior urethral disruption is a common condition, its treatment is controversial. To assess the long term results of endoscopic realignment compared with delayed urethroplasty, in the management of post traumatic urethral disruption. Between February 2002 and March 2009, 30 patients have been operated for post traumatic posterior urethral disruption. 20 have had a primary endoscopic realignment and 10 have had delayed urethroplasty. Analysis of the results took into consideration, the quality of micturition, the continence and the erectile function. Median follow-up was 21 months, good results were recorded in 13 patients among the group of realignment [65%]. 0f the failure cases [7], 3 underwent urethroplasty and 4 were managed by endoscopic treatment. Endoscopic realignment could avoid open surgery in 17 patients [85%]. Among the 10 patients that underwent urethroplasty, 7 patients had good results [70%]. No patient had urinary incontinence. A post operative erectile dysfunction was noted in one patient from the realignment group and two other patients from the urethroplasty group. The endoscopic urethral realignment could be used as a primary therapeutic management of post traumatic urethral disruption. It could be recommended for recent trauma, between one and two weeks, and for patients that can support exaggerated lithotomy position. Endoscopic realignment is an effective safe therapeutic mean that does not contraindicate a second-line urethroplasty

Cellular distribution and heterogeneity of PSA and PSMA expression in normal, hyperplasia and human prostate cancer

As promising targets for in vivo diagnostic, prognostic and therapeutic approaches, the distribution and staining pattern of prostate specific antigen [PSA] and prostate specific membrane antigen [PSMA] in tumors are of significant interest. To compare the cellular distribution and heterogeneity of PSA and PSMA expression in normal prostate [NP], benign prostatic hyperplasia [BPH] and primary prostatic tumors and to analyze their relation with the angiogenic activity according to Gleason grade [low, medium and high] in primary PC. The study was carried out in 6 NP, 44 BPH and 39 PC. Immunohistochemical analysis was performed. Monoclonal antibodies 3E6 and ER-PR8 were used to assess PSMA and PSA expression respectively. The evaluation of angiogenesis was made by CD34 immune marker. In our study we noticed differences in the intracellular localization of the PSMA immunostaining which seem to be related to the normal and pathological context. A significant number of primary tumors presented with apical pattern of PSMA [28/39]; whereas a relevant part of NP samples and BPH samples showed cytoplasmic localization [4/6 and 30/44, respectively] in luminal epithelial cells. Compared to PSMA, PSA was preferentially localized in cytoplasmic compartment in all type of prostate. A direct correlation between histological grade, PSMA expression and angiogenic activity could be demonstrated in primary PC. Simultaneous stains with PSA and PSMA in individual prostate tissue will greatly improve the detection rate and identify a high risk PC that could progress to metastatic phenotype. Our findings clearly support the feasibility but also direct the potential of PSMA-targeted in vivo therapeutic approaches in PC patients rather than PSA especially those with poorly differentiated adenocarcinoma

[adult's cryptorchidism: clinical and therapeutic aspects about 100 cases]

Cryptorchidism is a pathological condition defined as the failure of the testis descending into the scrotum. It is a rare condition in adults. To study clinical and therapeutic aspects of cryptorchidism in adults. A retrospective study of a series of 100 adult patients [mean age: 25.1 years; 19-50 years] with cryptorchid testis admitted in an urology department in Tunis. The main reasons for consultation were the finding of an empty purse, inguinal pain and primary sterility. The testicle was palpable in 84 cases. The treatment consisted of an orchidopexy in most cases and in 14 cases orchydectomy. Finding of cryptorchidism in adult is a real diagnostic failure. Surgical treatment is indicated to facilitate surveillance

[Sclerotherapy of idiopatic hydrocele with polidocanol: a study about 190 cases]

To evaluate the efficacy and side-effects of Polidocanol used as sclerosing agent for testicular hydrocele. One hundred and ninety men, with a median age of 55,9 years [40-89], treated for idiopatic hydrocele were assessed. After puncture and aspiration, the empty sac was instilled with 3% Polidocanol. We recorded recurrence, complications and associated pain on a visual analogue scale. With a median follow-up of 19 months, The cure rate of hydroceles after one sclerotherapy session was 62,1%, and the overall cure rate using the procedure was 82,6%. Re-instillation was done for recurrences in 41% of patients. Polidocanol therapy was almost pain-free. A low rate of complications was observed. Polidocanol is a useful sclerosing agent for treating testicular hydrocele. Due to its ease of administration, low frequency of complications, high rate of effectiveness, and excellent tolerability; we recommend sclerotherapy with polidocanol as the primary treatment for hydroceles

[Intradiverticular tumors of the bladder: diagnostic and therapeutic problems about 32 cases]

The transitional cell carcinoma within the bladder diverticular is a rare and poorly known entity. To evaluate diagnostic and therapeutic approaches of transitional cell carcinoma within the bladder diverticular. Thirty men and two women [median: 70 years; 44- 83 years] were included. The main reason for consultation was hematuria. The intra-diverticular tumor was suspected by radiological assessment in 9 patients only. All these patients underwent an endoscopic resection of the tumor. The histological study concluded to a pta stage in 16 patients, pt1 stage in 8 patients and invasive tumors in 8 patients. A complementary endovesical BCG-therapy was performed in patients with superficial tumors and a radical cystectomy in patients with invasive tumors. With an average follow-up of 27 months, seven recurrences were found in the group of superficial tumors, including 3 cases of progression to invasive stage. Bladder intra-diverticular tumors are rare and more common in elderly. In a bladder diverticulum, there are superficial tumors [pta, pt1] which are the most frequent and invasive tumors. Radical cystectomy is the gold standard for invasive tumors.Endoscopic resection combined with endo-vesical immunotherapy should be reserved for superficial tumors

[ female urethral diverticulum analysis of 27 cases]

To assess the clinical, radiological and therapeutic aspects of the female urethral diverticula through a series of 27 cases. Twenty seven women, with a mean age of 36.2 years [range 22 to 62 years] presenting a urethral diverticula, were treated between 1990 and 2008. Clinical examination made diagnosis in all cases. The urethral diverticula were excised via a transvaginal approach in all cases but one who refused surgery. twenty four patients had favorable immediate outcome. Diverticular recurrence was not reposted in any case. After a median follow-up of 22 months only three patients have some urinary urgency that was treated by anticholinergics. Urethral diverticular should be suspected in all cases of female lower urinary tract symptoms. The diagnosis is made by clinical examination and radiologic investigations. Transvaginal surgical excision gives the best results

Circumcaval ureter with a synchronous ipsilateral transitional cell carcinoma of the upper urinary tract and the urinary bladder

We report a case of concomitant ureteral transitional cell carcinoma [TCC] developed in a circumcaval ureter associated to an invasive bladder cancer. Diagnosis was made by intravenous urography [IVU] and contrast-enhanced computed tomography [CT] scanner which showed a typical [J] shaped deformity in the dilated proximal ureteric segment with moderate right hydronephrosis and pelvic filling defect associated to bladder filling defect due to a bladder tumor. The patient underwent a radical cystoprostatectomy and nephroureterectomy; no recurrence was detected after a 12 months period of follow-up

[Family transmission of atopic organ manifestations and allergen sensitizing in 659 Tunisian families]

Focal xanthogranulomatous pyelonephritis is an atypical form of chronic renal infection. It is frequently misdiagnosed preoperatively because of its resemblance to malignancy. We report on a fifty-year-old woman who presented with a right kidney mass. The CT scan showed a solid renal mass with a lithiasis of the upper ureter. The diagnosis of focal xanthogranulomatous pyelonephritis was suspected by clinical and radiological findings and confirmed by histopathologic examination of percutaneous biopsy specimens of the lesion. Successful treatment of the patient was achieved with removal of the lithiasis and antibiotic therapy during eight weeks. Three months later the CT scan was completely normal. The conservative treatment of focal xanthogranulomatous pyelonephritis makes possible to avoid a needless nephrectomy usually on young patients. However a close follow-up must be undergone on these patients because of the possible association of focal xanthogranulomatous pyelonephritis and renal cell carcinoma of the kidney