Predictors of viable germ cell tumor in postchemotherapeutic residual retroperitoneal masses

The aim of this study was to identify predictors of viable germ cell tumor [GCT] in postchemotherapeutic residual retroperitoneal masses. The pertinent clinical and pathologic data of 16 male patients who underwent postchemotherapeutic retroperitoneal lymph node dissection [PC-RPLND] at King Faisal Specialist Hospital and Research Centre between 1994 and 2005 were reviewed retrospectively. It was found that all patients received cisplatin-based chemotherapy for advanced testicular GCT. Out of the 16 male patients, 2 [13%], 8 [50%], and 6 [37%] had viable GCT, fibrosis, and teratoma, respectively. Ten [10] of the patients with prechemotherapeutic S1 tumor markers did not have viable GCT, and two of the six patients who had prechemotherapeutic S2 tumor markers have viable GCT. All tumor marker levels normalized after chemotherapy even in patients with viable GCT. Four patients had vascular invasion without viable GCT. Furthermore, four patients had more than 60% embryonal elements in the original pathology, but only 1 had viable GCT at PC-RPLND. Four of the five patients with immature teratoma had teratoma at PC-RPLND but no viable GCT; however, out of the four patients with mature teratoma, one had viable GCT and two had teratoma at PC-RPLND. Of the two patients with viable GCT, one had 100% embryonal cancer in the original pathology, prechemotherapeutic S2 tumor markers, history of orchiopexy, and no vascular invasion; the other patient had yolk sac tumor with 25% embryonal elements and 40% teratoma in the original pathology, and prechemotherapeutic S2 tumor markers. None of the clinical or pathological parameters showed a strong correlation with the presence of viable GCT in PC-RPLND. However, patients with >/= S2 may be at higher risk to have viable GCT. Further studies are needed to clarify this

Isolated ureteric endometriosis presenting as a ureteric tumor

A 32 year old lady presented with recurrent left flank pain for 4 weeks and chronic lower back pain. CT without contrast showed no stones and mild left hydronephrosis. CT of the spine suggested an inflammatory process at L5-S1 vertebra. The diagnosis was supported by a bone scan. Incidentally, the scan showed nonfunctioning left kidney. Diuretic renography confirmed poor perfusion and no excretion. A retrograde study showed narrowing of the ureter at the pelvic brim. Ureteroscopy showed a papillary mass in the lumen of the ureter from which multiple cold cup biopsies were taken. The pathology however was not conclusive. A robotic nephroureterectomy was carried out. Definitive pathology showed intrinsic endometriosis of the ureter. We conclude that endometriosis should be considered in the differential diagnosis of unexplained ureteric obstruction and ureteric lumen filling defects in young women

Prospective randomized trial of 100u vs 200u botox in the treatment of idiopathic overactive bladder

To evaluate the clinical outcomes of two different doses of BTX-A in patients with refractory idiopathic overactive bladder. Thirty nine patients with refractory idiopathic overactive bladder from 1/1/2008 till 30/3/2009 were evaluated in a tertiary care hospital. Patients were evaluated using urodynamic studies, voiding diary, UDI-6 and IIQ-7 questionnaires prior to being prospectively randomized [alternate randomization] to the BTX-A applications and three months after treatment. Voiding diary and residual volume were followed two weeks later. All patients received intradetrusorial injections of BTX-A [Botox, Allergan, Irvine, CA] of 100u or 200u under cystoscopic control on an outpatient basis. The primary endpoint was assessed for the improvement of urodynamic parameters and adverse events at three months after the initial treatment. Secondary end points included urinary frequency, urgency and UUI episodes as assessed by voiding diary and QoL. Eleven patients were enrolled to each arm of the study. There were no significant differences in demographic characteristics between the two groups. Urodynamic assessment at the end of the third month showed significant improvement in urodynamic variables in both groups. There was no statistically significant difference in urodynamic parameters and in the voiding diary between the two groups. QOL was significantly improved in both groups with no statistically significant difference between the different doses. Only three patients developed acute urinary retention. BTX-A at 100u and 200u appears to improve symptoms, urodynamic parameters and QoL with no statistical significance between the two groups

Survivin immunohistochemical expression in hepatocellular carcinoma: correlation with tumour differentiation and proliferation

Recently, survivin was shown to inhibit apoptosis and accelerate cancer cell proliferation as well. The expression of survivin may be of prognostic significance and therapeutic relevance in many cancers. This study investigated the expression of survivin in hepatocellular carcinoma [HCC]; correlated results with tumour differentiation and proliferation [topoisomerase II alpha] and compared the expression with the surrounding cirrhotic liver tissue. The expression of survivin and topoisomerase II alpha was evaluated by immunohistochemistry in 20 cases of HCC and 20 liver cirrhosis tissues. The relationships between two survivin scoring methods - topoisomerase II alpha nuclear labelling index [LI] and tumour differentiation - were analysed. Eighteen [90%] HCC cases expressed survivin. Median survivin nuclear LI was 75% and 6.5% in HCC and cirrhotic liver tissue, respectively. Median survivin weighted score was 8 and 0 in HCC and cirrhotic liver tissue, respectively. Survivin expression was significantly higher in HCC than in cirrhotic liver tissue [p < 0.001]. Median survivin expression L1 was 83% and the weighted score was 12 in moderately differentiated HCC versus 33% and 4, respectively in well-differentiated HCC with statistically significant P< 0.001. Median topoisomerase II alpha LI was 22.5% and 3% in HCC and cirrhotic liver tissue respectively, with a statistically significant difference [p < 0.001]. Median topoisomerase II alpha was 27.5, 9% in moderately and well-differentiated HCC respectively, with a statistically significant difference [p < 0.001]. The increase in survivin nuclear expression in HCC correlates significantly with the increase in topoisomerase II alpha nuclear expression [p < 0.001, r = 0.987]. Both survivin scoring methods were sensitive in discriminating between studied groups; however, nuclear LI showed more specificity. Both survivin and topoisomerase II alpha expressions were significantly higher in HCC than in cirrhotic liver tissue and correlated significantly with tumour de-differentiation in HCC cases. Survivin nuclear LI correlated significantly with tumour cell proliferation

effect of preoperative delay on survival after radical cystectomy for bladder cancer: a single center experience

Purpose: The advantage of early radical cystectomy for the treatment of bladder carcinoma is controversial. Earlier reports had inconsistent results. This is probably related to different patient selection and end point criteria, having unbalanced number of patients or lacking pathological correlation. We set out to assess the impact of preoperative delay on cancer specific survival after radical cystectomy monotherapy in a single ternary care hospital

Methods: We followed all patients that underwent radical cystectomy for invasive bladder cancer treated from 1980 to 2003. We identified demographic, clinical and pathological data. Treatment delay was defined as time from pathological confirmation of invasive disease to performance of cystectomy. Patients were then divided into two groups on the basis of the median delay cut-off period. The two groups were compared. Univariate and Multivariate analyses were used to determine the effect of the time period on disease-free survival

Results: A total of 227 patients 180 [79%] male and 47[21%] female were involved in the study. The patient's median age was 57 years [rage 21 to 81]. Follow-up ranged from 4 to 223 months [median 34.6 +/- 42 months]. The median treatment delay was 75 days [range 3 to 247]. Disease free survival was significantly better for patients with pretreatment delay 75 days [18%] [P< 0.0001]. Patients with long treatment delay >75 days had a significantly more advanced bladder carcinoma [pt3, pt4] compared to the early treatment group [p<0.0239]. Multivariate analysis revealed that among all the studied clinical and pathological factors, lymph node involvement and preoperative delay were the only significant and independent factors

Conclusion: In a single center experience, patients with bladder cancer whom radical cystectomy is indicated showed significantly more advanced pathological stage and significant decrease in disease free survival if treatment was delayed more than 75 days