Aspectos epidemiológicos de tumores malignos atendidos en el hospital de Solca - Guayaquil, periodo 2015 - 2019 / Epidemiological aspects of malignant tumors treated at the Solca - Guayaquil hospital, period 2015 - 2019

Los tumores malignos vienen incrementándose en los últimos años, por lo que se viene determinando el grupo más frecuente y su impacto para mejorar las estrategias de acuerdo a los escenarios locales. Determinar los aspectos epidemiológicos de los tumores malignos atendidos en el hospital de la Sociedad de Lucha Contra el Cáncer en el Ecuador (SOLCA) ­ Guayaquil. Se realizó un estudio observacional de diseño de investigación tipo corte transversal descriptivo, en los pacientes diagnosticados con tumor maligno; tomando una población de 19871 pacientes, diagnosticados en el hospital de SOLCA ­ Guayaquil, período 2015 ­ 2019. Los sujetos fueron los pacientes con tumor maligno. Aplicando estadísticas descriptivas y comparación entre variables. Los tumores malignos en ambos sexos presentan al de Mama con 16,39% como el más frecuente. La mayor proporción de los tumores en hombres fue el de órganos genitales con 25,73%; mientras que en mujeres fuera Mama con 27,05%- La población más afectada fueron las mujeres con el 60,35%. El grupo etario más afectado en hombres fue de 65 ­ 69 años con 12,56%, y en mujeres de 50 ­ 54 años con 11,44%. Conclusiones. El comportamiento epidemiológico en este quinquenio, evidenció que el Tumor de Mama en la mujer y de órganos genitales masculinos en el hombre son los más frecuentes; siendo las mujeres más afectadas; y en ambos sexos en los grupos etarios de 50 a 69 años; constituyendo una herramienta para destacar el papel del registro de cáncer hospitalario y su uso en los programas de prevención y control.

Malignant tumors have been increasing in recent years, so the most frequent group and its impact have been determined to improve strategies according to local scenarios. Determine the epidemiological aspects of malignant tumors treated at the hospital of the Society for the Fight Against Cancer in Ecuador (SOLCA) ­ Guayaquil. Observational study of a descriptive crosssectional research design was carried out in patients diagnosed with a malignant tumor; taking a population of 19871 patients, diagnosed in the SOLCA hospital ­ Guayaquil, period 2015 ­ 2019. The subjects were patients with malignant tumor. Applying descriptive statistics and comparison between variables. Malignant tumors in both sexes present the breast tumor with 16,39% as the most frequent. The highest proportion of tumors in men was the genital organs with 25,73%; while in women it was Mama with 27,05% ­ The most affected population was women with 60,35%. The age group most affected in men was 65-69 years with 12,56%, and in women 50-54 years with 11,44%. Conclusions. The epidemiological behavior in this five-year period showed that the Breast Tumor in women and of the male genital organs in men are the most frequent; being the women most affected; and in both sexes in the age groups from 50 to 69 years; constituting a tool to highlight the role of the hospital cancer registry and its use in prevention and control programs.

Summary and considerations in genitourinary cancer patient care during the COVID-19 pandemic

ABSTRACT Purpose: To provide a summary and recommendations for the set-up of strategies for cancer patients care in genitourinary oncology clinics during the pandemic and in the recovery period. Material and Methods: A non-systematic review of available literature on the management of urological malignancies during the COVID-19 pandemic was performed to summarize recommendations to improve the diagnosis and treatment of urological cancers during and after the contingence, including clinical and research aspects. Results: Urological cancer diagnosis and management should be tailored according to the severity of the COVID-19 crisis in each region and the aggressiveness of each tumor. Clinicians should adhere to strict protocols in order to prioritize the attention of patients with high-risk malignancies while optimizing resources to avoid the saturation of critical care services. Conclusions: During the COVID-19 pandemic urological cancer care has been severely impaired. For proper patient management, multidisciplinary approach is encouraged tailoring therapy according to COVID-19 regional behavior and local institutional resources. Patients with high-risk malignancies should be prioritized.

Carcinoma urotelial del tracto urinario superior: a propósito de un caso y revisión de la literatura / Upper urinary tract urothelial carcinoma: case report and review of the literature

El carcinoma urotelial (CU) del tracto urinario superior es infrecuente y representa solo del 5%-10% de todos los CU. Estas neoplasias crecen a partir del urotelio de los cálices renales hasta el tercio distal del uréter. Se reporta el caso de un paciente masculino de 68 años de edad quien presenta enfermedad actual de 3 meses de evolución caracterizada por dolor lumbar izquierdo, tipo cólico, de leve a moderada intensidad, el cual atenúa parcialmente con el uso de AINES, asociado a hematuria visible total de predominio nocturno. El uroanálisis mostró hematuria macroscópica y la citología urinaria evidenció atipias sugerentes de carcinoma. La TAC abdomino-pélvica contrastada evidenció un defecto de llenado en relación al cáliz inferior de riñón izquierdo y plastrón ganglionar paraaórtico izquierdo. Se practicó nefroureterectomía radical izquierda evidenciando tumor de 3 x 3 x 1 cm en relación a pelvis renal extensiva a cáliz inferior invadiendo parénquima renal. El estudio histopatológico mostró un carcinoma urotelial papilar infiltrativo de alto grado con márgenes sin lesiones y ganglios linfáticos con metástasis. El paciente evoluciona satisfactoriamente durante el período postoperatorio y actualmente recibe terapia adyuvante. A pesar de ser una patología poco frecuente, puede presentarse y el urólogo debe estar en capacidad para poder enfrentarla(AU)

Upper urinary tract urothelial carcinoma (UC) is infrequent and represents only 5%-10% of all UCs. These neoplasms grow from the urothelium of renal calyces to the distal third of the ureter. A case of UC of the upper urinary tract is reported in a 68-year-old male patient with a 3-month history of left lumbar mild to moderate pain, which partially mitigates with the use of NSAIDs associated with visible total predominantly nocturnal hematuria. Macroscopic hematuria was evident and urinary cytology reported carcinoma suggestive atypias. Contrasted CT of abdomen and pelvis showed filling defect in relation to lower calyx of the left kidney and left para-aortic ganglion plastron. Radical left nephroureterectomy was performed showing a 3 x 3 x 1 cm tumor in relation to the renal pelvis extending to the lower cavity and invading renal parenchyma. Histopathology showed high grade infiltrative papillary CU with margins without lesions and lymph nodes with metastasis. Patient evolves satisfactorily in the postoperative period and is currently in adjuvant therapy. Although this pathology is rare, it can occur and the urologist must be able to face it(AU)

Benign multicystic peritoneal mesothelioma: literature review and update

Benign multicystic peritoneal mesothelioma (BMPM) is a rare peritoneal tumor diagnosed predominantly in pre-menopausal women. Associated risk factors include endometriosis and pelvic inflammatory disease in women, and prior abdominal surgery in both genders. To date, the pathogenesis of this disease remains controversial with possible etiologies, including a neoplastic versus a reactive process. Given the risk factors, some authors believe that this disease is secondary to a reactive process. However, because some studies describe cases where there is no prior surgical history or inflammatory milieu present, and because of this entity's predilection for recurrence, some authors believe the origin to be neoplastic. Some genetic and familial associations have also been reported. Malignant transformation is extremely rare, with only two cases reported in the literature, despite the recurrence potential. Like the etiology, the name of this entity is also controversial. Some authors prefer the term "peritoneal inclusion cyst (PCM)" instead of "benign cystic mesothelioma" and argue that the term mesothelioma should only be used when there is evidence of atypia. Most cases of BMPM are discovered incidentally. Others reflect sequela of tumor mass effect. It appears intra-operatively as large, multi-focal, cystic lesions in the peritoneal and pelvic cavity. Diagnosis is achieved through surgical sampling with histopathological examination. Immunobiologically, BMPM exhibits multiple small cystic spaces with flattened lining containing calretinin positive cells without atypical features, mitotic figures, or tissue invasion. Treatment includes cytoreductive surgery. Here we present a case of BMPM in a 60-year-old male - a rare disease in an uncommon patient population.

Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients

ABSTRACT Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.

Egresos hospitalarios por cáncer urogenital en Chile: cuarta parte / Hospital discharges because of genitourinary cancer in Chile: fourth part

RESUMEN El objetivo del presente trabajo es actualizar el análisis de los egresos hospitalarios (EH) por cáncer genitourinario (CGU), específicamente cáncer de próstata, testículo, vejiga y riñón en nuestro país. Para estos efectos se obtuvieron os datos del Boletín de Egresos Hospitalarios del Ministerio de Salud (MINSAL) del año 2010 y 2015, utilizándose los códigos de la clasificación internacional de enfermedades de la Organización Mundial de la Salud (OMS CIE-10). Los distintos diagnósticos fueron caracterizados según su composición geográfica y demográfica, comparándose con la información publicada en los reportes anteriores.(AU)

ABSTRACT The aim of the study is to update the analysis of hospital discharges for genitourinary cancer, specifically prostatic, testicular, bladder and renal cancers in our country. For this purpose, data was obtained from the registers of the Chilean Ministry of Health (MINSAL) for the years 2010 and 2015, using the international classification codes of diseases from the World Health Organization (WHO ICD-10). The different diagnoses were characterized according to their geographic and demographic distribution, comparing them to the information published in the previous reports.(AU)

The Comprehension of Hospice-Palliative Care and Self-determination Life Sustaining Decision-Making Act as Uro-Oncologist

Every year in Korea about 50,000 terminally ill patients pass away in pain and more than 90% of the elderly oppose medical treatment to keep terminally ill patients alive. In medical ethics, the patient's right to self-determination is important, but he or she is unconscious or older and cannot express himself/herself, then his/her family should decide whether or not prolong treatment. From February 4, 2018, Hospice-palliative care and self-determination life sustaining decision-making Act will extend the life of the terminally ill patient. A specialist in the treatment of genitourinary cancer, focuses on prevention and treatment of cancer. However, by understanding this law, including terminology and how to implement of process of decision and stop life-sustaining treatment, a uro-oncologist has to counsel and perform education for terminally ill patients. A revision law has been forwarded to simplify the procedure. The Assembly should make haste with reviewing the law to help reduce the pain of terminally ill patients and their families.

Alopecia androgenética masculina de inicio precoz asociada a cáncer de próstata / Early-onset male androgenetic alopecia associated with prostate cancer

Contexto: La alopecia androgenética masculina es usual en hombres entre 30 a 70 años de edad; su presentación precoz ocurre en varones menores de 31 años, relacionada a andrógenos y herencia, factores importantes en su etiopatogenia. Tiene repercusión estética, sin embargo, se asocia a riesgo cardiovascular y cáncer de próstata; se postula que la influencia hormonal en la alopecia androgenética masculina favorece el desarrollo de cáncer prostático y determina su severidad. Objetivo: determinar la asociación entre alopecia masculina precoz y cáncer de próstata. Sujetos y métodos: hombres mayores a 18 años con cáncer de próstata confirmado; el grupo control lo conforman hombres mayores a 18 años sin neoplasias con determinación negativa de antígeno prostático. El estudio se efectuó en el Hospital Carlos Andrade Marín HCAM, en el periodo mayo a septiembre de 2015. Resultados: relación entre alopecia androgenética antes de los 31 años y cáncer de próstata, con un OR de 4,25 (IC 95% 1,7-10, p=0.001). No se observó diferencia estadística entre la severidad del cáncer prostático y el patrón clínico alopécico. Conclusión: los pacientes con alopecia androgenética masculina precoz (31 años), tienen un mayor riesgo de presentar cáncer de próstata, por lo que podría considerarse a la alopecia androgenética precoz como un indicador de riesgo para cáncer prostático, ameritando su tamizaje en pacientes con esta calvicie precoz (AU)

Context: Male androgenetic alopecia is usual in men between 30 to 70 years of age; Its early presentation occurs in males under 31 years, related to androgens and inheritance, important factors in its etiopathogenesis. It has aesthetic repercussion, however, it is associated with cardiovascular risk and prostate cancer; It is postulated that the hormonal influence in male androgenetic alopecia favors the development of prostate cancer and determines its severity. Objective: To determine the association between early male alopecia and prostate cancer. Subjects and methods: men older than 18 years with confirmed prostate cancer; The control group consists of men older than 18 years without neoplasms with negative determination of prostate antigen. The study was carried out at the Carlos Andrade Marín HCAM Hospital, from May to September 2015. Results: relationship between androgenetic alopecia before 31 years and prostate cancer, with an OR of 4.25 (95% CI 1.7-10, p = 0.001). No statistical difference was observed between the severity of the prostate cancer and the clinical alopecic pattern. Conclusion: patients with early male androgenetic alopecia 31 years, have a higher risk of developing prostate cancer; Early androgenetic alopecia could be considered as an indicator of risk for prostate cancer, deserving its screening in patients with this early baldness. (AU)

Mujeres inmigrantes y tamizaje de cáncer cervical en un centro ginecológico privado de Quito - Ecuador / Immigrant women and cervical cancer screening in a private gynecology center in Quito - Ecuador

Objetivo: las mujeres inmigrantes enfrentan problemas para acceder a programas de salud, en relación al tamizaje del cáncer cervical y su prevención. Estudios demuestran que mientras más reciente es la migración (<10 años), es menos probable la realización de exámenes para detectar cáncer cervical. Se plantea la hipótesis de que las mujeres inmigrantes tendrán índices menores de tamizaje de lesiones cervicales causadas por el virus del papiloma humano (HPV) comparadas con las mujeres ecuatorianas. Métodos: se realizó un estudio observacional en 113 mujeres de 17 a 55 años de edad: 56 mujeres inmigrantes/refugiadas y 57 mujeres ecuatorianas Se usó citología cérvico-vaginal y una prueba de detección de ADN del HPV basada en Captura Híbrida II. Las participantes fueron reclutadas mediante selección no probabilística (desde mayo 2014 hasta junio 2015). Las mujeres ecuatorianas fueron incluidas por solicitud voluntaria una vez que recibieron toda la información del proceso; mientras que las mujeres inmigrantes se incluyeron mediante información gráfica y entrevistas, lográndose alianzas entre organizaciones comunitarias dedicadas a ayudarlas y proveedores médicos privados. Resultados: tanto las ecuatorianas (14.15%, n=16) como las inmigrantes (5.3%, n=6) que nunca se realizaron un examen de citología, presentan resultados positivos en el examen de ADN-HPV (alto o bajo riesgo). Las ecuatorianas acceden a la citología cérvico-vaginal, independientemente de su edad, mientas que las mujeres inmigrantes menores de 30 años no han conseguido, hasta el momento del estudio, acceder a este servicio (p < 0.05). Conclusiones: existe una diferencia significativa en los índices de tamizaje de cáncer cervical entre los grupos de inmigrantes /refugiadas y residentes, de acuerdo al lugar de nacimiento y la duración de su estadía en Ecuador.

Objective: immigrant women face health problems and challenges to access health care, no matter what destination country they choose. Regarding cervical cancer screening and prevention, migrant women access to a health care programme is an important issue. Some studies have shown that while migration is recent (under 10 years), is less likely to get cervical cancer examination services comparing with non-immigrant women. The hypothesis stated that immigrant women would have lower rates of screening and a higher prevalence of HPV related lesions, compared to those women from Ecuador. Methods: a 12 months period study was performed including 113 women age 17 to 55, split into two groups: 56 migrant/refugee and 57 Ecuadorian residents, using cervical cytology and a DNA for HPV test based on hybrid capture II. Agreements between community organizations and private providers were reached to help the groups. Results: both groups, Ecuadorian women (14.15%, n=16) and immigrant women (5.3%, n=6) that never had a Papanicolaou test, have HPV-DNA test positive for high and low risk types. Ecuadorian residents have access to cervical cytology regardless their age, while immigrant/refugee women under 30 years have not access to the test, the difference is statistically significant. Conclusions: there is a significant difference in screening levels for cervical cancer between immigrant/refugee women according to place of origin and duration of stay in Ecuador.

Hemangiopericitoma de Bexiga: relato de uma patologia rara / Hemangiopericytoma of the bladder: report of a rare disease

A maioria dos tumores da bexiga é formada por células transicionais. Hemangiopericitoma é um tumor de tecidos moles e apresenta grande variabilidade histológica e ocorrência extremamente rara na bexiga. Neste trabalho é relatado um caso de hemangiopericitoma de bexiga em um paciente de 23 anos. Os achados clínicos e anatomopatológicos deste tumor são discutidos no presente relato, com revisão da literatura(AU)

Most bladder tumors are formed by transitional cells. Hemangiopericytoma is a soft tissue tumor which presents great histologic variability and extremely rare occurrence in the bladder. Here the authors report a case of hemangiopericytoma of the bladder in a 23-year-old patient. The clinical and pathological features of this tumor are discussed in this report with a literature review(AU)

What is new in Genitourinary Pathology? Recent developments and highlights of the new 2016 World Health Organization classification of tumors of the urinary system and male genital organs

The recently published 2016 World Health Organization (WHO) Classification of Tumors of the Urinary System and Male Genital Organs stems from the accumulated knowledge and data collected during the last 12 years, since the previous edition of the WHO "blue book" 2004. The major changes in prostate pathology include the introduction of a novel grading system for prostate cancer (Grade Groups/International Society of Urological Pathology (ISUP) grades 1­5), the recognition of intraductal carcinoma as a new entity, and the terminological changes regarding the neuroendocrine prostatic neoplasms. In bladder and urothelial tract, within the spectrum of flat and non-invasive lesions, a newly introduced term "urothelial proliferation of uncertain malignant potential" replaced the term "urothelial hyperplasia", and the term "urothelial dysplasia" was better defined. A category of "invasive urothelial carcinoma with divergent differentiation" was introduced for tumors showing a component of "usual type" urothelial carcinoma combined with other morphologies. A new WHO/ISUP renal tumor grading system was recommended (Grade 1­4). The definition of renal papillary adenoma was modified and expanded to include papillary neoplasms measuring up to 1.5 cm. Several new epithelial renal tumors were recognized as new entities including: hereditary leiomyomatosis and renal cell carcinoma (RCC) syndrome­associated RCC, succinate dehydrogenase­deficient RCC, tubulocystic RCC, acquired cystic disease­associated RCC, and clear cell papillary RCC. In testis pathology, intratubular proliferations of testicular germ cell tumors were renamed as "germ cell neoplasia in-situ" (GCNIS), and the testicular neoplasms were divided into two main groups: derived from or unrelated to GCNIS. A major change in penile pathology was the introduction of a new classification of penile squamous cell carcinoma, based on the presence of human papillomavirus (HPV), which characterizes penile tumor subtypes as HPV-related or non-HPV-related. A similar distinction was introduced for the preneoplastic penile intraepithelial precursor lesion (PeIN) into non-HPV related (differentiated PeIN) and HPV-related types (undifferentiated PeIN). In this review, we provide a summary and highlight the changes in the genitourinary pathology introduced by the 2016 WHO blue book, and we also discuss some recent developments that may impact the practice of genitourinary pathology in the near future (AU)

Trends in Urogenital Cancer Incidence in Jeju (1999-2012)

PURPOSE: Incidence of cancer has been increasing each years. The incidence of genitourinary cancer are also being increased. We aim to describe the time trends in genitourinary cancer incidence in Jeju province. MATERIALS AND METHODS: Age-standardized rates for incidence of genitourinary tract cancer in Korea and world standard population were calculated using the databases from the Jeju Cancer Rigistry from 1999 to 2012. RESULTS: Cancer incidence in Jeju was increased approximately 2-fold from 1217 cases 1999 to 2376 cases in 1999. Prostate cancer occurred most frequently followed by bladder tumor, and kidney cancer in 2012. In the prostate cancer, incidence was increasing every year from 18 cases in 1999 to 110 cases in 2012. Age-standardized incidence rate (ASR) was approximately four time increased, from 3.0 cases in 1999 and 11.2 cases in 2012. Incidence of bladder cancer were 43 cases in 1999 and 27 cases in 2012, ASR of bladder cancer was increased from 5.0 cases in 1999 to 7.5 cases in 2012. Kidney cancer showed constantly reducing the incidence. Peak is 60 cases in 2009 and recent incidence was 37 cases in 2012. There was no significant change in the incidence of testicular cancer, ureter cancer, renal pelvis cancer from 1999 to 2012. CONCLUSIONS: Incidence of cancer has been increasing in Jeju, similar to other area In Korea. Prostate cancer is the most common urological cancer in Jeju province, and kidney cancer incidence is recently decreasing. We should try to prevent genitourinary tract cancer caused obesity and smoking.

Uso del enfoque bayesiano para la estimación y proyección de tasas / Use of a bayesian approach to rate estimation and projection

OBJETIVO: Aplicar y valorar el enfoque bayesiano para realizar proyecciones de tasas de mortalidad por cáncer a través del ajuste de modelos edad-período-cohorte (EPC). MÉTODOS: El método de estimación bayesiano se aplica a datos de mortalidad por cáncer de vejiga en Argentina. Se adopta un esquema autorregresivo de segundo orden para la especificación a priori de los coeficientes del modelo EPC. Se comparan las estimaciones obtenidas con toda la información disponible y excluyendo los grupos de edad con tasas de mortalidad bajas, a fin de valorar el comportamiento del enfoque ante datos esparcidos. Se proyectan las tasas de mortalidad a dos períodos sucesivos a los observados. RESULTADOS: Se comprueba la robustez del método, lo cual evita excluir los grupos de edad con tasas de mortalidad nulas o bajas. Las tasas observadas caen todas dentro de las bandas de credibilidad y confirman la bondad del ajuste del modelo. Se observa una tendencia general decreciente de las tasas de mortalidad por cáncer de vejiga. Las estimaciones y proyecciones de estas tasas resultan más precisas en los grupos etarios que presentan mayor incidencia de mortalidad. CONCLUSIONES: La formulación bayesiana utilizada permite reducir la variación aleatoria entre estimaciones adyacentes al especificar que los efectos de cada escala dependan de los inmediatos anteriores. Se demuestra la capacidad del enfoque para manejar frecuencias bajas y obtener estimaciones confiables de las tasas de mortalidad, como así también proyecciones precisas sin necesidad de realizar supuestos adicionales como sucede en el ajuste clásico de un modelo EPC.

OBJECTIVE: Apply and assess a Bayesian approach to projecting cancer mortality rates by fitting age-period-cohort (APC) models. METHODS: The Bayesian estimation method was applied to bladder cancer mortality data in Argentina. A second-order autoregressive model was adopted for a priori specification of APC model coefficients. The estimates obtained were compared with all available information and excluding age groups with low mortality, to assess behavior of the approach in light of scattered data. Mortality was projected for two successive periods following the ones observed. RESULTS: Robustness of the method was verified, which avoids excluding age groups with null or low mortality. Observed rates all fall within the credibility bands and confirm the model's goodness of fit. An overall downward trend in bladder cancer mortality was observed. Estimates and projections of these rates are more precise in age groups that have greater incidence of mortality. CONCLUSIONS: The Bayesian formulation used herein makes it possible to reduce random variation between adjacent estimates by specifying that the effects of each scale depend on the immediately preceding ones. It was demonstrated that the approach has the capacity to handle low frequencies and obtain reliable mortality estimates, as well as precise projections, without the need for making additional assumptions, as happens in classical APC model fitting.

Incidence of kidney, bladder, and prostate cancers in Korea: An update

The incidence of cancer is sharply increasing. Cancer is a leading cause of death as well as a significant burden on society. The incidence of urological cancer has shown a higher than average increase and will become an important concern in the future. Therefore, an overall and accurate understanding of the incidence of urological cancer is essential. In this study, which was based on the Korea National Cancer Incidence Database, annual incident cases, age-standardized incidence rates, annual percentage change (APC), and distribution by age group were examined in kidney, bladder, and prostate cancers, respectively. From 1999 to 2011, the total number of each type of urological cancer was as follows: kidney cancer (32,600 cases, 25.5%), bladder cancer (37,950 cases, 29.7%), and prostate cancer (57,332 cases, 44.8%). The age-standardized incidence rates of prostate cancer showed a significant increase with an APC of 12.3% in males. Kidney cancer gradually increased with an APC of 6.0% for both sexes and became the second most frequent urological cancer after 2008. Bladder cancer showed no significant change with an APC of -0.2% for both sexes and has decreased slightly since 2007. The distribution of kidney cancer according to age showed two peaks in the 50- to 54-year-old and 65- to 69-year-old age groups. Bladder and prostate cancers occurred mostly in the 70- to 74-year-old age group. The proportions of male to female were 2.5:1 in kidney cancer and 5.6:1 in bladder cancer. We have summarized the incidence trends of kidney, bladder, and prostate cancers and have provided useful information for screening and management of these cancers in the future.

Male Genitourinary Tumors : 14 Years Experience in Garhwal Region of India.

Genitourinary tumors may show varied clinical presentation and frequency in different regions of the world. The present study was therefore conducted to analyze the frequency, clinical presentation and the histopathological types of the various male genitourinary tumors diagnosed over a period of 14 years in a major teaching institute of north Himalayan region of India. Material and Methods: Retrospective study was undertaken in the Pathology department of the Institute which included all the cases of male genitourinary tumors which were diagnosed on histopathology from the time period between 1 Jan 1997 till 31st Dec. 2010. Results: The study showed that prostate was the most common site for male genitourinary tumors with prostatic adenocarcinoma as the most common histopathological type of tumor. Testicular Non- Hodgkin’s lymphoma constituted about 8% of total tumors in testes which mostly presented in elderly age group. Renal cell carcinoma (66.2%) was the most common tumor in kidney with much lower frequency of Wilm’s tumor (16.9%). Occasional rare tumors such as hemangioma of urinary bladder and schwannoma of penis were also seen over 14 years. Conclusion: The study concludes clinically patients were associated with more severe symptoms as they presented late to the hospital from the remote areas of this Himalayan region leading to late detection of tumors. Prostatic adenocarcinoma was the most common tumor while renal cell carcinoma was most common tumor in kidney. The present study provides valuable information to clinicians and pathologists regarding frequency, clinical presentation and histopathological types of male genitourinary tumors in this region which can be further used to formulate strategies for better management of these tumors.

The Role of Imaging in the Diagnosis of Recurrence of Primary Seminal Vesicle Adenocarcinoma

Primary seminal vesicle (SV) adenocarcinoma is a rare tumor. A small amount of data about the role of imaging to detect tumor recurrence is available. We report the case of a 58-year-old patient with primary SV clear-cell well-differentiated adenocarcinoma. Clinical and instrumental examinations were negative for the 32 months after treatments when computed tomography scan, [18F]fluoro-D-glucose positron emission tomography/computed tomography and pelvic magnetic resonance imaging showed the appearance of a lesion in the left perineal muscle suspected for recurrence. Patient was symptomless. Cytology of the suspected lesion confirmed SV adenocarcinoma recurrence. The combined approach, using radiological and nuclear medicine techniques, seems to be effective in the follow-up of SV adenocarcinoma. Technological advances, together with awareness of this rare tumor, have the potential of improving patients outcomes not only by providing earlier detection and accurate staging, but also by detecting recurrence and thereby avoiding delays and therapeutic dilemmas.

Evaluación urodinámica en pacientes sometidos a braquiterapia por rabdomiosarcomas genitourinarios / Urodynamic evaluation in patients undergoing brachytherapy for genitourinary rhabdomyosarcoma

Introducción: El rabdomiosarcoma (RMS) es uno de los tumores sólidos pediátricos más frecuentes. Se ha descrito que la braquiterapia es una herramienta prometedora para tratar esta patología, presentando menos secuelas en los tejidos vecinos. Este estudio tiene como propósito objetivar las secuelas de la dinámica vesical, a través de evaluación con estudios urodinámicos (EUD) a pacientes pediátricos sometidos a cirugía conservadora más braquiterapia por RMS de origen uroginecológico.P acientes y Métodos: Revisión de casos de RMS uroginecológicos desde 2004 a 2011, manejados con braquiterapia pre y/o post operatoria, más quimioterapia preoperatoria. Se realiza estudio urodinámico invasivo y/o no invasivo para evaluar secuelas en función miccional. Resultados: Serie de 4 casos de pacientes con RMS genitourinarios sometidos a braquiterapia sola o asociada a cirugía resectiva: 2 de próstata, 1 vaginal y 1 vesical. Los estudios urodinámicos muestran una capacidad vesical disminuida en 1 paciente, mínima disminución en otro y 2 presentan capacidad normal para la edad. La acomodación del detrusor es adecuada en los 4 pacientes y no hay alteraciones en la función esfinteriana. Clínicamente todos los pacientes son continentes y no presentan sintomatología de disfunción miccional. Conclusiones: El RMS genitourinario es un tumor altamente invasivo y secuelante. La braquiterapia ha logrado un nivel de radiación óptimo que se enfoca en el área tumoral sin afectar mayormente tejidos vecinos. Esto implicaría menos probabilidades de producir efectos secundarios en la dinámica vesical. Hemos demostrado en esta serie, con evaluación urodinámica, que estos pacientes con RMS presentan mínimas alteraciones en la evaluación urodinámica y no tienen repercusión clínica post tratamiento. Trabajos futuros están orientados a evaluación urodinámica pre y post braquiterapia.

Introduction: Rhabdomyosarcoma (RMS) is one of the most common pediatric solid tumors. It has been described that brachytherapy is a promising tool to treat this pathology, presenting less sequelae in neighboring tissues. This study aims to objectify alterations in bladder function through evaluation with urodynamic studies (UDS) in pediatric patients undergoing conservative surgery plus brachytherapy due to urogynecological RMS. Patients and Methods: A review of cases of RMS urogynecological from 2004-2011, managed with pre and / or post-operative brachytherapy, and preoperative chemotherapy. Invasive and / or noninvasive Urodynamic Studies are performed to assess sequelae in voiding function. Results: A series of 4 cases of genitourinary RMS patients undergoing brachytherapy alone or combined with resection surgery: 2 prostate cases, 1 vaginal and 1 bladder case. Urodynamic studies show a decreased bladder in 1 patient, minimal decrease in another and 2 show normal capacity for the patients age. Detrusor compliance is adequate in the 4 patients and there are no alterations in sphincter function. Clinically all patients are continent and show no symptoms of voiding dysfunction. Conclusions: Genitourinary RMS are a highly invasive and invalidating tumor. Brachytherapy achieves optimal radiation level that focuses on the tumor area without greatly affecting neighboring tissues.This could imply less likelyhood to cause side effects in bladder dynamics. We have shown in this series, with urodynamic evaluation, that these patients with RMS have minimal alterations in urodynamic Studies and have no post-treatment clinical impact. Future work is aimed at evaluating urodynamics before and after brachytherapy.

Primary Ewing's sarcoma/primitive neuroectodermal tumor of the urogenital tract in children / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Primary Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) of urogenital tract is a rare condition with non-specific clinical presentations, which can make it difficult to diagnose. In this study, we summarize the clinical presentation, pathological features, therapeutic strategies, and prognosis of ES/PNET.</p><p><b>METHODS</b>Clinical information on two cases of ES/PNET in the penis and ureter was analyzed, and relevant literature was reviewed.</p><p><b>RESULTS</b>ES/PNET was confirmed pathologically, immunohistochemically and via molecular biology techniques in the penis (n=1) and ureter (n=1). In one case, a tumor was found at the base of penis, which had invaded the corpus cavernosum, and resulted in a massive enlargement of the penis. This tumor was initially diagnosed as an endocrine disorder. However, a confirmed diagnosis was made 11 months later when massive metastases in both lungs were noted. A tumor biopsy was performed to confirm the diagnosis, and chemotherapy with a CAV (cyclophosphamide+doxorubicin+vincristine)+IE (ifosfamide+etoposide) regimen for 9 months was prescribed. In the second case, a child was admitted due to abdominal pain and a hydroureter in the right kidney, as determined by ultrasonography. A tumor was found in the right ureter at the level of iliac vessels. Removal of the tumor and ureteral anastomosis were performed, and chemotherapy with CAV+IE for 8 months were prescribed. Both patients are currently being followed-up closely.</p><p><b>CONCLUSIONS</b>ES/PNET is a highly malignant tumor and has poor prognosis. Pre-operative diagnosis of ES/PNET of urogenital tract is difficult and largely depends on pathology, immunohistochemistry, and, if applicable, molecular biology. Comprehensive therapy may include surgery, chemotherapy and radiotherapy.</p>

Type Distribution of Unexpected Red Cell Antibodies in Patients with Malignancy / 대한수혈학회지

BACKGROUND: Performance of antibody screening and identification tests before blood transfusion is important because the unexpected presence of red cell antibodies may cause hemolytic transfusion reactions. Many patients with malignancy undergo transfusion in order to overcome pancytopenia due to disease itself or chemotherapy. We investigated the type distribution of unexpected red cell antibodies in cancer patients and compared our results with those of other institutions. METHODS: From January 2008 to June 2011, 30,989 serum samples were screened using a LISS/Coombs card and ID-DiaCell I, II (DiaMed AG, Morat, Switzerland). Data-Cyte Plus Reagent Red Blood Cells (Medion Diagnostics, Dudingen, Switzerland) were used in performance of antibody identification tests. RESULTS: Out of 30,989 serum samples, 180 cases (0.58%) showed screening-positive results, and unexpected antibodies were identified in 72 cases. The type of unexpected antibody observed most often in cancer patients was a member of the Rh antibody group, anti-E in 17 cases (29.8%), followed by anti-Lea in five cases (8.8%) and anti-e in three cases (5.3%). While Rh group antibodies were observed in the colon cancer group, non-Rh group antibodies were observed in the rectal cancer group. And, in the genitourinary cancer group, Lewis group antibodies were more frequently detected than others. CONCLUSION: Findings from our study demonstrated a type distribution of unexpected red cell antibodies that was similar to those reported in previous studies. Compared with non-cancerous patients, no difference in type distribution of unexpected red cell antibodies was observed in cancer patients. Some antibodies were frequently observed in certain cancer groups. Further comprehensive research on unexpected antibodies based on location or histologic type of cancer is needed.