Primary testicular non-Hodgkin lymphoma. A 10-year Tunisian single-institute experience

Primary testicular non-Hodgkin lymphoma [NHL] is an uncommon extra nodal presentation, accounting for 1% of all NHL and 1 to 9% of testicular neoplasms. Median age at time of presentation is 60 years old. Anthracycline based chemotherapies are most frequently used. To analyze baseline characteristics, treatment modalities and survival of six cases of primary testicular non-Hodgkin lymphoma. We screened 46 testicular neoplasm cases registered from January 1999 to January 2009 and found six primary testicular lymphoma patients. These six cases were analyzed for baseline clinical features, investigations, treatment and outcome variables. Median age was 50 years old and median duration of symptoms was 4 months. All patients had testicular swelling. Four patients had abdominal lymphadenopathy. Most patients had diffuse large B-cell histology. All patients underwent high inguinal orchidectomy and five were treated with anthracycline based chemotherapy. Four patients completed therapy and one of them relapsed two years later. Primary testicular NHL is an uncommon entity and with current combined modality treatment, the outcome may be as good as nodal NHL

[Is there a link between the occurrence of kidney cancer and hypertension in Tunisian population?]

Kidney cancer is generally asymptomatic and discovered incidentally at a late stage, which is a negative diagnosis because in most cases the disease is incurable at this stage. Some predisposing factors have been revealed by studies such high blood pressure, which is a frequent among the Tunisian population. A study among the Tunisian population to determine if there is a link between the occurrence of kidney cancer and the hypertension. Our work was conducted on 91 patients with confirmed renal cell carcinoma and 91 healthy subjects who consulted the Urology Department at the Charles Nicolle Hospital in Tunis. The study of clinical records has identified the clinical, pathological and therapeutic features of the 182 patients. 59% of individuals with hypertension have developed kidney cancer with a significant p-value equal to 0.03. The more the value of blood pressure increases the more the risk is [p = 0.03]. Smoking in combination with hypertension is a factor favoring the occurrence of cancer with a value of p equal to 0.05. In the Tunisian population hypertension is a risk factor for developing kidney cancer, a factor compounded by the high incidence of this disease. What prompts us to make explorations of kidney lodges of hypertensive patients

NY-ESO-1 expression and immunogenicity in prostate cancer patients

Prostate cancer is the second leading cause of men cancer-related death. Cancer immunotherapy has been investigated as a treatment which might be instituted at the point of detection of androgen-independent metastatic disease. To investigate the expression and humoral response against NYESO-1 in patients with prostate cancer [PC] and to analyze the relationship between expression of NY-ESO-1 and clinicopathological features. NY-ESO-1 mRNA in surgically resected PC and benign prostatic hyperplasia [BPH] were examined by reverse transcriptionpolymerase chain reaction. The antibody response to NY-ESO-1 was examined by enzyme-linked Elisa assay using recombinant NYESO-1 protein. NY-ESO-1 mRNA was detected in 9 of 23 [39%] PC patients. Antibodies against NY-ESO-1 protein were detected in 12 of 23 [52%] sera of PC patients and in 5 of 9 [55%] of NY-ESO-1 expressing tumors. However, no mRNA copy or NY-ESO-1 antibodies were detected in all BPH patients tested. The present study has demonstrated the expression of NY-ESO-1mRNA in prostate Cancer patients and NY-ESO-1 antibody production. Our data suggest that NY-ESO-1 could be used as a tumor marker and constitute a good candidate for vaccine-based immunotherapy for hormonal resistant prostate cancer patients

[Place of percutaneous nephrolithotomy in the treatment of staghorn stones. about 83 cases]

Staghorn stone is considered as a dreadful type of renal stones. The choice of the best treatment is always difficult. To evaluate the results of percutaneous nephrolithotomy in the treatment of staghorn stones. We report 83 cases of staghorn stones that were treated by percutaneous nephrolithotomy during a period of 10 years from 1994 to 2004. The mean age was 44 years and sex-ratio was 2.2. The right kidney was treated alone in 42% of cases, the left one in 56% of cases and both kidneys in only two cases. The mean area of stones was 6,6 cm[2]. One renal puncture was necessary in 97% of cases. The rate of stone free after percutaneous nephrolithotomy only was about 54% and when combined with lithotripsy the rate was 64%. Combined treatment using percutaneous nephrolithotomy and lithotripsy is considered as the best procedure for staghorn stones treatment

utility of alpha-methyl CoA racemase [P504S] expression as a marker of renal cell carcinomas

Renal cell tumours are numerous and heterogeneous. Because of their clinicopathological heterogeneity, their accurate diagnosis may be challenging. In case of an equivocal diagnosis, immunohistochemistry may be a useful mean of diagnosis. Recently, alpha-methyl CoA racemase has been identified as a useful marker in kidney cancers. Our objectives are to highlight the role of alpha-methyl CoA racemase [AMACR] as a diagnostic marker in papillary renal carcinoma and to assess its utility in the other tumour types. A retrospective review was performed on 62 patients who were treated for renal tumours between January 1994 and November 2005. Immunoreactivity was evaluated with a qualitative manner. Positive AMACR staining was defined as a coarse dense cytoplasmic granularity. The 62 renal tumours were diagnosed as papillary tumours in 22 cases, clear cell tumours in 18 cases, chromophobe carcinoma in 12 cases and oncocytoma in 10 cases among the 22 cases of papillary tumours, all the cases [100%] showed cytoplasmic immunoreactivity staining. 4 cases between the 18 clear cell carcinomas [22%] showed positivity with AMACR. The 12 cases of chromophobe carcinoma didn't express AMACR by immunohistochemistry. Only one case between the oncocytomas [1%] expressed AMACR. This study confirms the high sensitivity of AMACR for papillary renal cell carcinomas but we must keep in mind that weak focal AMACR staining could be present in other renal cell carcinomas

[Emphysematous pyelitis: epidemiological, therapeutic and evolutive features]

Emphsematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis. The-data-of six patients- managed-for emphysematous-pyelitis were collected and analyzed. The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned - dedifferentiated - renal parenchyma. Outcome was good. Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy