Synergistic Antitumor Effects of Combined Treatment with HSP90 Inhibitor and PI3K/mTOR Dual Inhibitor in Cisplatin-Resistant Human Bladder Cancer Cells

Purpose@#The current study aimed to investigate the synergistic antitumor effect of combined treatment with 17-DMAG (HSP90 inhibitor) and NVP-BEZ235 (PI3K/mTOR dual inhibitor) on cisplatin-resistant human bladder cancer cells. @*Materials and Methods@#Human bladder cancer cells exhibiting cisplatin resistance (T24R2) were exposed to escalating doses of 17-DMAG (2.5–20 nM) with or without NVP-BEZ236 (0.5–4 μM) in combination with cisplatin. Antitumor effects were assessed by CCK-8 analysis. Based on the dose-response study, synergistic interactions between the two regimens were evaluated using clonogenic assay and combination index values. Flow cytometry and Western blot were conducted to analyze mechanisms of synergism. @*Results@#Dose- and time-dependent antitumor effects for 17-DMAG were observed in both cisplatin-sensitive (T24) and cisplatin- resistant cells (T24R2). The antitumor effect of NVP-BEZ235, however, was found to be self-limiting. The combination of 17- DMAG and NVP-BEZ235 in a 1:200 fixed ratio showed a significant antitumor effect in cisplatin-resistant bladder cancer cells over a wide dose range, and clonogenic assay showed compatible results with synergy tests. Three-dimensional analysis revealed strong synergy between the two drugs with a synergy volume of 201.84 μM/mL2%. The combination therapy resulted in G1-phase cell cycle arrest and caspase-dependent apoptosis confirmed by the Western blot. @*Conclusion@#HSP90 inhibitor monotherapy and in combination with the PI3K/mTOR survival pathway inhibitor NVP-BEZ235 shows a synergistic antitumor effect in cisplatin-resistant bladder cancers, eliciting cell cycle arrest at the G1 phase and induction of caspase-dependent apoptotic pathway.

Female Urethral Condyloma Causing Bladder Outlet Obstruction / 대한배뇨장애요실금학회지

In women, urethral condyloma rarely leads to a bladder outlet obstruction. A 39-year-old woman who presented with frequency, urgency, and residual urine sensation was found to have a condyloma in her urethral meatus. Urodynamic study indicated bladder outlet obstruction. After condyloma excision, she returned to normal voiding, and the free maximum flow rate improved. In women, excision of urethral condylomas that cause obstruction can be an effective treatment with early recovery of voiding function.

The Prescribing and Dispensing of Phosphodiesterase Type 5 Inhibitors in South Korea: A Questionnaire Survey of Patient Discomfort

PURPOSE: This study was performed to investigate the discomfort reported by patients taking phosphodiesterase type 5 inhibitors (PDE5Is) in clinical practice. MATERIALS AND METHODS: From September 2011 to March 2012, we surveyed patients who were prescribed PDE5Is for erectile dysfunction (ED). The questionnaire elicited information concerning: patient characteristics, medication counseling received and inconveniences experienced in hospitals and at pharmacies, effects of PDE5Is, and the separation of the prescribing and the dispensing of PDE5Is. RESULTS: A total of 237 patients completed the questionnaire (mean age: 58.81+/-9.14 years). Among the 62 patients (26.0%) who reported having encountered some inconveniences in hospitals, the most frequently expressed concerns 'assistant staff,' including nurses (38.7%), 'testing procedures' (27.4%), and 'the issuing of prescriptions' (22.6%). Of the 137 patients (57.8%) who noted inconveniences in obtaining medications from pharmacies, 60.6% cited 'self-consciousness' as the most common reason, followed by 'insufficient medication counseling' (22.6%), and 'absence of consultation' (11.6%). In contrast, 82% of the patients were satisfied with the medication counseling that they had received in hospitals, covering drug usage, side effects, and precautions regarding PDE5Is; this proportion was only 30% for pharmacies. Further, most patients (89%) indicated that they preferred to obtain their prescriptions and medications for ED from the hospital at the same time. CONCLUSIONS: Treatment of ED is a highly private matter. According to the survey, ED patients more often felt that obtaining medication from pharmacies was inconvenient. The sociocultural aspects of ED necessitate that exceptions to separating the prescribing and the dispensing of medication be considered.

The Prescribing and Dispensing of Phosphodiesterase Type 5 Inhibitors in South Korea: A Questionnaire Survey of Patient Discomfort

PURPOSE: This study was performed to investigate the discomfort reported by patients taking phosphodiesterase type 5 inhibitors (PDE5Is) in clinical practice. MATERIALS AND METHODS: From September 2011 to March 2012, we surveyed patients who were prescribed PDE5Is for erectile dysfunction (ED). The questionnaire elicited information concerning: patient characteristics, medication counseling received and inconveniences experienced in hospitals and at pharmacies, effects of PDE5Is, and the separation of the prescribing and the dispensing of PDE5Is. RESULTS: A total of 237 patients completed the questionnaire (mean age: 58.81+/-9.14 years). Among the 62 patients (26.0%) who reported having encountered some inconveniences in hospitals, the most frequently expressed concerns 'assistant staff,' including nurses (38.7%), 'testing procedures' (27.4%), and 'the issuing of prescriptions' (22.6%). Of the 137 patients (57.8%) who noted inconveniences in obtaining medications from pharmacies, 60.6% cited 'self-consciousness' as the most common reason, followed by 'insufficient medication counseling' (22.6%), and 'absence of consultation' (11.6%). In contrast, 82% of the patients were satisfied with the medication counseling that they had received in hospitals, covering drug usage, side effects, and precautions regarding PDE5Is; this proportion was only 30% for pharmacies. Further, most patients (89%) indicated that they preferred to obtain their prescriptions and medications for ED from the hospital at the same time. CONCLUSIONS: Treatment of ED is a highly private matter. According to the survey, ED patients more often felt that obtaining medication from pharmacies was inconvenient. The sociocultural aspects of ED necessitate that exceptions to separating the prescribing and the dispensing of medication be considered.

Prostate-Specific Antigen Mass and Free Prostate-Specific Antigen Mass for Predicting the Prostate Volume of Korean Men With Biopsy-Proven Benign Prostatic Hyperplasia

PURPOSE: It has been reported that prostate-specific antigen (PSA) correlates with prostate volume. Recently, some studies have reported that PSA mass (PSA adjusted for plasma volume) is more accurate than PSA at predicting prostate volume. In this study, we analyzed the accuracy of PSA and the related parameters of PSA mass, free PSA (fPSA), and fPSA mass in predicting prostate volume. MATERIALS AND METHODS: We retrospectively investigated 658 patients who underwent prostate biopsy from 2006 to 2012 and had a confirmed negative biopsy result. International Prostate Symptom Score (IPSS) questionnaire, PSA, fPSA, and prostate volume were investigated. PSA mass and fPSA mass were calculated by use of established formulas. The association between PSA-related parameters and IPSS and prostate volume was assessed by using Pearson correlation coefficient and receiver operating characteristic curves. RESULTS: There was no significant difference between PSA and PSA mass, fPSA, or fPSA mass in predicting prostate volume except in obese patients (p-value of PSA-PSA mass for 40 cm3, 0.54; p-value of fPSA-fPSA mass for 40 cm3, 0.34). fPSA performed significantly better than PSA at predicting prostate volume (p-value for 40 cm3, <0.001). IPSS and the aforementioned PSA-related parameters were not significantly correlated. CONCLUSIONS: PSA mass was not a better predictive value than PSA for estimating the prostate volume in Korean men except in obese men. This finding was also applicable to the relationship of fPSA and fPSA mass, which appeared to be more accurate predictors of prostate volume than either PSA or PSA mass.

Stuttering Priapism in a Patient with Neurosyphilis

We recently encountered a case of stuttering priapism in a 41-year-old patient with neurosyphilis. Priapism very rarely has a neurogenic cause, and to our knowledge, priapism caused by neurosyphilis has not been reported previously in the literature. Our aim was to report this case and systematically review the related literature.

Comparative Analysis Between Thoracic Spinal Cord and Sacral Neuromodulation in a Rat Spinal Cord Injury Model: A Preliminary Report of a Rat Spinal Cord Stimulation Model

OBJECTIVE: The purpose of this study is to compare a neuroprotective effect of thoracic cord neuromodulation to that of sacral nerve neuromodulation in rat thoracic spinal cord injury (SCI) model. METHODS: Twenty female Sprague Dawley rats were randomly divided into 4 groups: the normal control group (n=5), SCI with sham stimulation group (SCI, n=5), SCI with electrical stimulation at thoracic spinal cord (SCI + TES, n=5), and SCI with electrical stimulation at sacral nerve (SCI + SES, n=5). Spinal cord was injured by an impactor which dropped from 25mm height. Electrical stimulation was performed by the following protocol: pulse duration, 0.1ms; frequency, 20 Hz; stimulation time, 30 minutes; and stimulation duration at thoracic epidural space and S2 or 3 neural foramina for 4 weeks. Locomotor function, urodynamic study, muscle weights, and fiber cross sectional area (CSA) were investigated. RESULTS: All rats of the SCI + TES group expired within 3 days after the injury. The locomotor function of all survived rats improved over time but there was no significant difference between the SCI and the SCI + SES group. All rats experienced urinary retention after the injury and recovered self-voiding after 3-9 days. Voiding contraction interval was 25.5+/-7.5 minutes in the SCI group, 16.5+/-5.3 minutes in the SCI+SES group, and 12.5+/-4.2 minutes in the control group. The recovery of voiding contraction interval was significant in the SCI + SES group comparing to the SCI group (p<0.05). Muscle weight and CSA were slightly greater in the SCI + SES than in the SCI group, but the difference was not significant. CONCLUSION: We failed to establish a rat spinal cord stimulation model. However, sacral neuromodulation have a therapeutic potential to improve neurogenic bladder and muscle atrophy.

Neuroprotective Effects of Sacral Epidural Neuromodulation Following Spinal Cord Injury : An Experimental Study in Rats

OBJECTIVE: The purpose of this study is to evaluate neuroprotective effect of sacral neuromodulation in rat spinal cord injury (SCI) model in the histological and functional aspects. METHODS: Twenty-one female Sprague Dawley rats were randomly divided into 3 groups : the normal control group (CTL, n=7), the SCI with sham stimulation group (SCI, n=7), and the SCI with electrical stimulation (SCI+ES, n=7). Spinal cord was injured by dropping an impactor from 25 mm height. Sacral nerve electrical stimulation was performed by the following protocol : pulse duration, 0.1 ms; frequency, 20 Hz; stimulation time, 30 minutes; and stimulation duration, 4 weeks. Both locomotor function and histological examination were evaluated as scheduled. RESULTS: The number of anterior horn cell was 12.3+/-5.7 cells/high power field (HPF) in the CTL group, 7.8+/-4.9 cells/HPF in the SCI group, and 6.9+/-5.5 cells/HPF in the SCI+ES group, respectively. Both the SCI and the SCI+ES groups showed severe loss of anterior horn cells and myelin fibers compared with the CTL group. Cavitation and demyelinization of the nerve fibers has no significant difference between the SCI group and the SCI+ES group. Cavitation of dorsal column was more evident in only two rats of SCI group than the SCI+ES group. The locomotor function of all rats improved over time but there was no significant difference at any point in time between the SCI and the SCI+ES group. CONCLUSION: In a rat thoracic spinal cord contusion model, we observed that sacral neuromodulation did not prevent SCI-induced myelin loss and apoptosis.

Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women

PURPOSE: To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) < or =12 ml/s combined with a detrusor pressure at Qmax < or =10 cmH2O for men and women, respectively. RESULTS: Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU. CONCLUSIONS: DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.

Survey on the Perception of Urogenital Complications in Diabetic Patients

PURPOSE: Retinopathy, neuropathy, and nephropathy are well-known complications of diabetes; they are often expected to occur and, therefore, are usually tested for. However, urogenital complications, such as sexual and voiding dysfunctions, are less well known, and consequently, many patients are not treated appropriately despite their symptoms. Thus, we surveyed diabetic patients with regard to their perception of urogenital complications. MATERIALS AND METHODS: We designed a survey for patients in our hospital who were being treated for diabetes mellitus (DM). The questionnaire included items on age, sex, treatment duration, treatment options for and the level of perception of urogenital symptoms, the presence of urogenital symptoms, and whether treatment was intended or had been initiated. RESULTS: In total, 275 patients participated in the survey. The perception questions on DM-associated urogenital complications showed that 89 patients (32.4%) had no knowledge, 84 patients (30.5%) had some knowledge, and 102 patients (37.1%) had detailed knowledge about these complications. A total of 124 patients (45.1%) reported urogenital symptoms: 93 patients (75.0%) reported voiding dysfunction and 61 patients (49.2%) reported sexual dysfunction. Common symptoms of voiding dysfunction were urinary frequency, nocturia, sense of residual urine, weak stream, and urinary incontinence. Common symptoms of sexual dysfunction were reduced libido, and erectile and ejaculatory dysfunction. CONCLUSIONS: The survey showed that the subjective prevalence rate of urogenital symptoms in diabetic patients was 45.1%. However, only a small percentage (37.1%) of the patients cognized that these symptoms were associated with DM. Therefore, it is necessary to properly inform and educate diabetic patients on possible urogenital complications that may occur.

Sunitinib Malate Synergistically Potentiates Anti-Tumor Effect of Gemcitabine in Human Bladder Cancer Cells

PURPOSE: Sunitinib malate (Sutent; Pfizer, New York, NY, USA) is a highly selective multi-targeted agent and has been reported to have potent anti-tumor effects against various tumors, including renal cell carcinoma and gastrointestinal stromal tumors. In this study, we explored in vitro the anti-tumor effect and related molecular mechanisms of sunitinib malate against human bladder cancer cell lines. We also determined the synergistic anti-tumor effect between sunitinib and conventional cytotoxic drugs, cisplatin and gemcitabine, in bladder cancer cells. MATERIALS AND METHODS: Six human cancer cell lines (HTB5, HTB9, T24, UMUC14, SW1710, and J82) were exposed to an escalating dose of sunitinib alone or in combination with cisplatin/gemcitabine, and the cytotoxic effect of the drugs was examined by CCK-8 assay. The synergistic effect between sunitinib and cisplatin/gemcitabine was determined by the combination index (CI) and clonogenic assay. Alterations in cell cycle (cyclin D, B1), survival (p-Akt, t-Akt), and apoptosis (Bax, Bad) regulator expression were analyzed by Western blotting. RESULTS: Like cisplatin and gemcitabine, sunitinib exerted a dose- and time-dependent anti-tumor effect in bladder cancer cells. However, sunitinib exhibited entirely different sensitivity profiles from cisplatin and gemcitabine. Sunitinib suppressed the expression of cyclin B1, p-Akt, and t-Akt while augmenting the expression of cyclin D and pro-apoptotic Bax and Bad in HTB5 cells. Analysis of the drug combination by the isobolic method and clonogenic assay revealed that sunitinib acts in synergy with gemcitabine in HTB5 cells. CONCLUSIONS: These results indicate that sunitinib malate has a potent anti-tumor effect and may synergistically enhance the anti-tumor effect of gemcitabine in human bladder cancer cells.

Limited Expression of Cytochrome P450 17alpha-Hydroxylase/17,20-Lyase in Prostate Cancer Cell Lines

PURPOSE: Cytochrome P450 17alpha-hydroxylase/17,20-lyase (CYP17A1) is a key enzyme in the androgen biosynthesis pathway. CYP17A1 has been focused on because of the promising results of a potent CYP17A1 inhibitor in the treatment of castration-resistant prostate cancer (CRPC). A hypothesis that intratumoral androgenesis may play a role in the progression of CRPC has recently been postulated. Thus, we evaluated whether commonly used prostate cancer cell lines express CYP17A1. MATERIALS AND METHODS: Androgen-sensitive LNCaP and androgen-insensitive PC-3 and DU145 cells were used. To evaluate the expression of CYP17A1 protein and RNA, we performed Western blotting and RT-PCR, respectively. RESULTS: We were unable to detect either CYP17A1 protein or RNA in any of the cell lines tested. We failed to detect any expression of CYP17A1, despite several repetitions of these techniques under different conditions. CONCLUSIONS: The expression of CYP17A1 protein and RNA in LNCaP, PC-3, and DU145 cells appears to be either absent or too low for detection. The mechanism of action of abiraterone acetate, a CYP17A1 inhibitor, may be related more to adrenal androgen blockade than to intratumoral androgenesis.

Pathogenesis of Prostate Cancer

Prostate cancer is one of the most frequent cancers in Western countries and has been also one of the most rapidly increasing malignant diseases in Korean men. This disease shows diverse features in clinical course ranging from an indolent disease to a lethal one. Accordingly, underlying molecular mechanisms and genetic changes involved in the development and progression of various types of prostate cancer are very heterogeneous. Thus, investigation of pathogenesis of prostate cancer is very challenging, and, at this point of time, only a handful of molecular and genetic factors were identified as pathogenic factors for prostate cancer. Plenty of data support the strong relationship between age, race and family history and the development of prostate cancer. In addition, androgen related factors such as androgen metabolism and receptor signaling are highly correlated with tumor development and progression. Numerous genetic or epigenetic changes including gene mutation and methylation contribute to the development and progression of prostate cancer. In this article, we summarize the current understanding of the pathogenesis of prostate cancer, with a special focus on underlying genetic and epigenetic alterations.

Alteration of Antithrombin III and D-dimer Levels in Clinically Localized Prostate Cancer

PURPOSE: We performed a comparative analysis of the plasma levels of antithrombin (AT) III, plasminogen, fibrinogen, and D-dimer among patients with and without clinically localized prostate cancer to investigate the clinical significance of the coagulation profile in prostate cancer. MATERIALS AND METHODS: A prospective study was performed in which plasma levels of AT III, plasminogen, fibrinogen, and D-dimer were assessed in patients before they underwent prostate biopsy. According to the results of the biopsy, the patients were categorized into the cancer group or the control group. Levels of the four coagulation factors were then compared between the cancer and control groups. Also, levels of the four coagulation factors were correlated with tumor stage and grade in the cancer group. RESULTS: The cancer group had significantly lower levels of AT III activity and higher plasma D-dimer levels than did the control group (p=0.007 and p=0.018, respectively). Within the cancer group, no significant differences were observed in the levels of AT III, plasminogen, fibrinogen, or D-dimer between those with a pathological Gleason score of > or =7 and otherwise. Regarding pathologic stage of prostate cancer, the subjects with organ-confined disease and those with extraprostatic extension of a tumor demonstrated no significant differences in the preoperative levels of the four coagulation factors analyzed. CONCLUSIONS: Our results suggest that plasma levels of AT III and D-dimer are altered in patients with prostate cancer. Further study is needed to elucidate the underlying mechanism and clinical significances of such a phenomenon among patients with clinically localized prostate cancer.

The Prevalence of Benign Prostatic Hyperplasia in Elderly Men in Korea: A Community-Based Study

PURPOSE: The incidence of benign prostatic hyperplasia (BPH) is increasing in Korea. However, there are few reports about the prevalence of BPH in elderly men in Korea. We report the prevalence of BPH in elderly men through a community-based study. MATERIALS AND METHODS: We collected data from the Korean Longitudinal Study on Health and Aging (KLoSHA), which was designed as a population-based, prospective study in populations aged>65 years living in Seongnam, Korea. We selected 301 male participants by random sampling. The selected participants were interviewed with the International Prostate Symptom Score (IPSS) questionnaire and were evaluated by physical examination, blood tests, and transrectal ultrasound. The number of analyzed subjects was 236. The definition of BPH was a combination of moderate (8-19) to severe (>19) IPSS and prostate enlargement (>30 g on transrectal ultrasound). RESULTS: The prevalence of BPH was 40% overall and 36% in men in their late 60s (65-69 years), 43% in men in their 70s (70-79 years), and 53% in men over 80 (> or =80 years). BPH prevalence increased according to age but showed no statistically significant differences among the groups (p>0.05). CONCLUSIONS: The overall prevalence of BPH in this study was 40%, which was higher than in other previous epidemiologic studies in Korea. This study suggests an increasing tendency of BPH prevalence in Korea.

Free PSA and the Free PSA to Total PSA Ratio as a Predictor of Response to Hormone Treatment for Metastatic Prostate Cancer / 대한비뇨기과학회지

PURPOSE: In this study we analyzed the changes of fPSA and f-PSA% and its prognostic significance in course of hormone treatment for metastatic prostate cancer. MATERIALS AND METHODS: We retrospectively analyzed 75 patients with metastatic prostate cancer who received maximal androgen deprivation therapy and in whom the fPSA and f-PSA% had been serially checked for at least 1 year. The patients were divided into two groups: those patients with biological recurrence within 1 year, and those patients showing sensitivity to hormone therapy for longer than one year. Changes of the fPSA and f-PSA% in each group were analyzed in correlation with such prognostic factors as the PSA level and the Gleason sum. RESULTS: The initial PSA levels in each group were 508.0+/-331.4ng/ml and 39.8+/-7.6ng/ml, respectively and the fPSA levels were 59.4+/-19.4ng/ml and 6.7+/-4.1ng/ml, respectively; the group with early biological recurrence had significantly higher intial PSA and fPSA levels. The initial f-PSA% was relatively lower in the patients with early recurrence (0.123+/-0.41 vs 0.159+/-0.37, respectively), but the difference was not statistically significant. The PSA nadir and the fPSA nadir in the early recurrence group were 6.1 10.1ng/ml and 0.89 3.9ng/ml, respectively, and these were significantly higher compared to those values of the hormone sensitive group, i.e., 2.4+/-8.4ng/ml and 0.41+/-0.2ng/ml, respectively. In the early recurrence group, the f-PSA% changed from 0.123 to 0.092 and it gradually decreased during treatment. On the contrary, in the hormone sensitive group, the f-PSA% continuously increased during treatment, from 0.159 to 0.172. CONCLUSIONS: These findings suggest that fPSA and f-PSA% are influenced by hormone treatment and the pattern of changes in the fPSA and f-PSA% are different according to the responsiveness to hormone treatment.

Obesity is an Independent Predictor of Biochemical Failure following Radical Prostatectomy and Androgen Deprivation Therapy (ADT) for Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We explored the prognostic significance of obesity for the surgical and hormonal treatment of prostate cancer in correlation with the other prognostic factors such as Gleason's sum, the clinicopathologic stage, and the pre- and post treatment prostate specific antigen (PSA) changes. MATERIALS AND METHODS: A retrospective review was performed on 132 consecutive patients who had received androgen deprivation therapy (ADT) (108 patients) or radical prostatectomy (24 patients) under the diagnosis of prostate cancer via transrectal prostatic biopsy from July 1993 to May 2003 in our hospital. Obesity was evaluated in terms of the body mass index (BMI), and the patients were categorized into four groups according to the National Institute of Health (NIH) classification. The relationship between the BMI and the other prognostic factors were statistically analyzed by One-way ANOVA test and the Spearman correlation coefficient. RESULTS: There were no significant associations between the BMI and any of the measured clinical and pathological parameters except for the time to hormone failure and biochemical recurrence. In the ADI group, the mean time to hormone failure was significantly longer in case of the low BMI group compared to the normal and overweight groups (p<0.006). Sperman's correlation analysis showed a significant inverse correlation between the BMI and the PSA free survival after radical prostatectomy. CONCLUSIONS: These findings showed that the BMI is closely related to the failure to hormone treatment after ADI and the BMI was also related to the biological failures after radical prostatectomy.

Perineal Recurrence of Langerhans Cell Histiocytosis / 대한비뇨기과학회지

Langerhans cell histiocytosis (LCH) is a rare disorder, characterized by abnormal proliferation of Langerhans cells, which can affect various organ systems. The most common clinical findings are localized bone lesions, with eosinophilic granuloma, which occur at any age, although most patients present under the age of 15 years. We experienced a case of recurrent LCH, invading the bulbous urethra, in the perineal area of a 16-year-old boy. The primary tumor developed in the mastoid bone, and recurred in the ureter, maxillary sinus mucosa and perineum, in the order. The perineal lesion and part of bulbous urethra were surgically removed, through a perineal approach, and the urethra primarily reconstructed.

Sarcomatoid Carcinoma of the Renal Pelvis / 대한비뇨기과학회지

A sarcomatoid carcinoma of the urinary system is a rare malignant tumor, composed of both epithelial and stromal cells, is regarded as a similar disease entity to a carcinosarcoma. In Korea, only 1 case of primary sarcomatoid carcinoma and 4 cases of carcinosarcoma involving the bladder have been reported, but to date, no case of primary sarcomatoid carcinoma involving the renal pelvis has been reported. Recently, we experienced a case of sarcomatoid carcinoma involving the right renal pelvis in a 67-year-old male patient with intermittent gross hematuria. A CT scan demonstrated a 5x4cm sized mass in the right renal pelvis. Under the diagnosis of a right renal pelvic tumor, a right nephroureterectomy, with bladder cuff excision, was performed. The tumor was composed mostly of pleomorphic spindle cells, and in the peripheral part of the tumor and renal pelvis, a high grade transitional cell carcinoma and adenocarcinoma was also found. The tumor was pathologically confirmed as a primary sarcomatoid carcinoma of the renal pelvis.

Primary Vesical Actinomycosis: A Case Diagnosed by Multiple Transabdominal Needle Biopsies

Primary vesical actinomycosis is an extremely rare disease. In most cases it is misdiagnosed as vesical or urachal tumor and usually diagnosed through post-operative pathologic confirmation. Here we report a case of primary vesical actinomycosis confirmed by preoperative repeated multiple transabdominal biopsies. The patient was a 49-yr-old woman who presented with frequency, dysuria, and intermittent gross hematuria for 2 months. Computed tomography and cystoscopic examination showed broad-based, edematous, and protruding mass at the dome and anterior portion of the bladder. The clinical and imaging findings of the patient initially suggested vesical malignancy. Transurethral resection and multiple biopsies of the mass were performed. Pathologic examination demonstrated fibrosis with chronic inflammation. We performed repeated transabdominal multiple needle biopsies for further pathologic confirmation. Histopathologic examination demonstrated typical sulfur granules, which were consistent with actinomycosis.