Correlation of Prognostic Gleason Grade Grouping and Histopathological Parameters: Can the "New System" Reflect the Pathological Perspective for Prognosis?

BACKGROUND: Gleason score is one of the strongest prognostic predictors of prostate cancer;however, a change was published which is a 5 step grouping system of prostatic adenocarcinomas according to their Gleason scores. The aim of this study is to determine the relationship between histopathological findings and prognosis of tumors subgrouped according to the new Gleason grade grouping system. METHODS: A total of 163 radical prostatectomies subgrouped into 5 prognostic groups were investigated for prognostic features such as pathological stage, extraprostatic extension, surgical margin status, involvement of seminal vesicles, perineural invasion, necrosis, vascular invasion, ganglionic involvement, concomitant high grade prostatic intraepithelial neoplasia (HPIN) in addition to other microscopic features of tumors such as the presence of mucin and foamy cytoplasmic change between groups. RESULTS: The mean age of patients was 65.72 ± 6.67 (min = 46, max = 82). Among 131 patients who completed the study, the mean prostate specific antigen (PSA) value was 11.29 ± 10.88. The statistically significant factors were significantly related to both the original Gleason and the prognostic grade groups.The recurrence rate of grade group 4 patients (57%) was significantly higher than grade group 3 patients (8%) (P = 0.038). But no significant difference was found between grade group 4 and 5 (P = 0.25). CONCLUSION: Grade grouping systems reflect prognostic differences but adapting this new system into routine evaluation of patients may confuse the clinicians; however, pathology reports stating both the traditional Gleason score and the new prognostic group may soften the transition.

The Histopathological Parameters Affecting Biochemical Recurrence in Radical Prostatectomies.

OBJECTIVE: To determine the relationship between biochemical recurrence and other histopathological factors in prostate cancer. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Pathology and Urology Departments, Izmir Ataturk Training and Research Hospital, between 2001 - 2013. METHODOLOGY: 117 cases diagnosed with prostatic adenocarcinoma and treated by radical prostatectomy were reviewed retrospectively for histopathological features; whereas, other prognostic findings were noted. PSA levels and many other histopathological parameters were assessed in order to put forth their effect on biochemical recurrence. RESULTS: PSA level (p<0.001), tumor volume (p<0.001), Gleason score (p<0.001), extraprostatic extension (p<0.001), perineural invasion (p<0.001), ganglion involvement (p=0.040), vascular invasion (p<0.001), positive surgical margins (p<0.001), presence of tertiary pattern (p=0.004) and the involvement of the seminal vesicles (p<0.001) were found to be statistically related to the pathological stage. Age, perineural invasion, high grade tertiary pattern, intraluminal mucin, collagenous micronodules and foamy cytoplasmic changes were unrelated to recurrence. CONCLUSION: Histopathological features can be helpful in predicting prognosis in prostatic adenocarcinomas. However some of the histopathological factors such as intraluminal mucin and foamy cytoplasmic changes may not reflect high recurrence.

The association of nocturia with sleep disorders and metabolic and chronic pulmonary conditions: data derived from the polysomnographic evaluations of 730 patients.

AIM: To evaluate the prevalence of nocturia among different degrees of obstructive sleep apnea (OSA) and its association with various clinical conditions. MATERIALS AND METHODS: In 730 OSA patients, the prevalence and frequency of nocturia was determined, and the association of nocturia with clinical and laboratory variables such as the apnea-hypopnea index (AHI), apnea duration, and minimum oxygen saturation and clinical conditions such as diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease (COPD) was determined. RESULTS: The overall prevalence of nocturia (≥2 wakes/night) was 50.9%. Prevalences ofnocturia in simple snoring and mild, moderate, and severe OSA patients were 40.6%, 44.4%, 58.6%, and 57.1%, respectively (P < 0.005). The frequency of nocturia significantly increases with the severity of OSA (1.4 ± 1.0 wakes/night in mild OSA vs. 2.0 ? 1.4 wakes/night in severe OSA, P = 0.001). Age, AHI, average oxygen saturation, and presence of diabetes mellitus, hypertension, and COPD were found to be significant risk factors associated with nocturia (P <0.001). CONCLUSION: The frequency of nocturia increases as the severity of OSA increase. The increased prevalence of nocturia in patients with OSA, diabetes mellitus, hypertension, and COPD indicates the complex physiological background of this bothersome urologic symptom.

Splenogonadal fusion: a very rare congenital anomaly in the differential diagnosis of a testicular mass.

Splenogonadal fusion is a rare congenital anomaly characterized by congenital fusion between the spleen and testicular tissue. In the literature, there are approximately 175 reported cases, and most of them are associated with cryptorchidism. In this article, we report an unusual case of splenogonadal fusion that was pre-diagnosed as a solid testicular mass in a patient who underwent orchiectomy.

Large cell neuroendocrine carcinoma of urinary bladder; case presentation.

Large cell neuroendocrine tumor of the urinary bladder is very rare. It is a type of neuroendocrine carcinoma that is morphologically different from small cell carcinoma. This manuscript describes a 67-year-old man who presented with hematuria. Ultrasonogrophic and computer tomography revealed a 5 cm mass in right posterolateral wall of the bladder that invaded perivesical tissue and he subsequently underwent transurethral resection. Microscopic examination showed a tumor with a sheet-like and trabecular growth pattern comprising necrotic areas which infiltrated the muscularis propria. Tumoral cells had coarse chromatin, prominent nucleoli, moderate amount of cytoplasm and immunohistochemically stained strongly positive with synaptophysin, chromogranin and CD56. There are only few case reports of large cell neuroendocrine tumor of the urinary bladder so the biological behavior and the treatment protocol of these tumors are still obscure. Appropriate management protocols and prognostic estimation could be achived by the increased number of cases being reported. Therefore in a case of a poorly differentiated tumor in bladder, although rare, it is important to consider large cell neuroendocrine carcinoma in differential diagnosis.

A comparison of balloon and amplatz dilators in percutaneous nephrolithotomy: a retrospective evaluation.

OBJECTIVE: In this study, we compared our experience using balloon and amplatz dilatation in percutaneous nephrolithotomy (PCNL). We also evaluated peri- and postoperative variables, including success rates. MATERIAL AND METHODS: Two hundred renal stone patients (123 men/77 women) underwent PCNL at the Urology Clinic of Izmir Atatürk Training and Research Hospital from September 2005 to May 2011. The nephrostomy tract was dilated using a balloon (128 patients) or amplatz (72 patients) dilator. The groups were compared by age, total operating time, treatment success rate, retreatment rate, pre- and postoperative hematocrit values, mean decrease in hematocrit values, blood transfusion rate, stone burden, tract dilatation failure, hospital stay and nephrostomy removal times, stone localization, previous stone operation and the cost of the dilatation system. RESULTS: There was no statistically significant difference in the operative time (97.9±45.3 minutes in balloon group vs. 98.5±43.4 minutes in the amplatz group; p=0.43), preoperative hematocrit value (39.04±4.21 vs. 38.94±4.49; p=0.87), postoperative hematocrit value (32.74±4.86 vs. 32.48±5.43; p=0.73), decrease in hematocrit values (6.30±2.60 vs. 6.45±2.64; p=0.68), blood transfusion rate (15.6% vs. 16.7%; p=0.84) or treatment success rate (78.9% vs. 79.2%; p=0.96) between balloon and amplatz groups. Differences in other variables were also not observed between the two groups. CONCLUSION: The balloon or amplatz dilatation methods have similar results with regard to efficacy, speed, and safety. However, the cost of the balloon dilator is higher than that of the amplatz dilator.

Sleep analysis of patients with nocturia and benign prostatic obstruction.

OBJECTIVE: To analyze the timing of nocturia during sleep and its effect on sleep quality using the polysomnography (PSG) findings from patients with benign prostatic obstruction. METHODS: From August 2009 to August 2010, 20 patients diagnosed with benign prostatic obstruction were enrolled in the present study. The sleep evaluation was performed by PSG. The Epworth index was used to evaluate the sleepiness of the patients. The effect of nocturia on sleep quality is evaluated by sleep efficacy, total sleep time, and rapid eye movement sleep duration, calculated from the hypnograms derived from the polysomnograms. RESULTS: The mean age, total International Prostate Symptom Score, nocturia frequency on International Prostate Symptom Score, and frequency of nocturia recorded during PSG was 60.4 ± 8.5 years (range 44-74), 19.3 ± 4.9 (range 10-28), 3.5 ± 1.05 (range 2-5), and 1.35 ± 1.2 (range 0-4), respectively. In 6 patients (30%), the Epworth sleepiness score was pathologic (score >8). Nocturia correlated positively with increased daytime sleepiness, however it did not correlate with sleep efficacy or total sleep time. These parameters were affected by the apnea-hypopnea index, the major determinant of obstructive sleep apnea. Of the 20 patients, 14 (70%) experienced nocturia during PSG, and in these patients, we recorded 23 nocturia episodes that mostly occurred in the superficial sleep stage (16 [70%] of 23). Only 7 nocturia episodes (30%) occurred in the deep sleep stage. The sleep quality of patients with deep sleep nocturia did not differ from that of patients with superficial sleep nocturia. CONCLUSION: The results of our study have shown that nocturia predominantly occurs during the superficial sleep or rapid eye movement stage and is related to increased daytime sleepiness in patients with benign prostatic obstruction. The timing and frequency of nocturia had no significant affect on sleep quality; however, the presence of obstructive sleep apnea negatively interfered with these parameters.

Association of mast cells with microvessel density in urothelial carcinomas of the urinary bladder.

This study aims to investigate the relation of mast cell (MC) accumulation with tumor grade and stage in urothelial carcinomas of the urinary bladder and to determine its relationship with angiogenesis. A total of 78 urothelial carcinomas obtained by transurethral resection were investigated immunohistochemically by using c-Kit (CD117) and anti-CD34. The correlation between MC counts and microvessels was evaluated and compared with histopathologic parameters including tumor stage and grade. There were significant correlations between MC counts, grade, and stage (P < .05; r = 0.69 and 0.63, respectively). However, MC counts in adjacent nontumoral bladder mucosa significantly were higher than the MC counts in tumoral zone (P < .001). On the other hand, significant correlation was found between the number of MCs in tumoral zone and the microvessel density (P < .05, r = 0.56). The results of our study suggest that c-Kit positive MCs in tumoral zone may contribute to tumor angiogenesis and play a significant role in tumor growth and invasion. Further studies are needed to support these observations.

A case of a sporadic malignant peripheral nerve sheath tumor of the urinary bladder with concomitant in situ urothelial carcinoma treated by transuretheral resection.

Malignant peripheral nerve sheath tumor (MPNST) of the urinary bladder is a very rare clinical entity. The association of such a tumor with urothelial carcinoma is even more unusual. Differential diagnosis between coexisting two distinct primary tumors and carcinosarcoma of the urinary bladder is very important as both the treatment and prognosis vary widely. Herein, we report a case of an MPNST with a concomitant in situ urothelial carcinoma in a 53-year-old man. To our knowledge, this is the first documented case of MPNST of the bladder that is treated by transuretheral resection which is in contrast with the previous reports that used cystectomy.

Sexual functions in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disorder of the axial skeleton. In recent years, several authors reported an increased prevalence of sexual dysfunction among AS patients. We aimed to find out, whether the prevalence of erectile dysfunction among AS patients is different from age-matched healthy controls. Thirty-seven male patients with AS who were diagnosed according to the modified New York criteria and 67 normal healthy controls (NHC) were included in this study. Clinical characteristics of patients including age, disease duration and morning stiffness were noted. Disease activity was evaluated by using Bath AS disease activity index (BASDAI), functional statement was evaluated by using Bath AS functional index, and scores of spinal measurements were done by using Bath AS metrology index. Erectile function is evaluated using the International Index of Erectile Function (IIEF) scoring system. Health-related quality of life was assessed by short form 36. The mean age of the patients and controls were 42.8 + 10.8 and 43.6 + 5.9 years (P = 0.666). The prevalence of erectile dysfunction in AS patients and NHC were 35.1 and 26.9%, respectively (P = 0.335). There was no statistically significant difference between IIEF domain scores of AS patients and NHC except for the sexual desire domain (P = 0.014). Duration of morning stiffness and BASDAI was negatively correlated with sexual desire and overall satisfaction; however, they have no negative impact on erectile function, orgasmic function and intercourse satisfaction domains of IIEF. In this report, we showed that only the sexual desire domain of IIEF was significantly lower in AS patients. The prevalence of erectile dysfunction among AS patients is similar to NHC, which is a finding contrary to previous reports. AS patients do not suffer from erectile dysfunction, they rather have problems of satisfaction from the intercourse.

Papillary renal cell carcinoma with lipocyte-like cells: a rare morphological variant or an indication of aggressiveness?

Papillary renal cell carcinoma (PRCC) is the second most common carcinoma of the kidney, which is classified into two types. Type 1 displays single layer of cells with scanty pale cytoplasm and type 2 has pseudostratified high-grade nuclei with eosinophilic cytoplasm. Recently, apart from these two types, oncocytic PRCC and clear-cell PRCC have been described. To the best of our knowledge, lipocyte-like cells have not yet been reported to accompany any subtypes of renal cell carcinoma. Herein, we report a case of PRCC with lipocyte-like cells and sarcomatoid features. Lipocyte-like cells might represent a special type of PRCC or this feature may be an indication of poor prognosis regarding its association with sarcomatoid change.

Long-term urodynamic and functional analysis of orthotopic "W" ileal neobladder following radical cystectomy.

OBJECTIVES: In this study, we evaluated the long-term functional outcomes and urodynamic results of the "W" orthotopic ileal neobladder. MATERIALS AND METHODS: Twenty patients whose long-term follow-up data were available and willing to participate in this project were enrolled into the study. The operations were performed between 1997 and 2005. Following standard radical cystoprostatectomy and pelvic lymphadenectomy, "W"-shaped orthotopic ileal neobladder with extramural serous-lined tunnel ureteral implantation was performed. Urodynamic evaluation consisted of standard three-channel filling cystometry with 0.09% sodium chloride solution, and uroflowmetry with postvoiding residual (PVR) urine measurement. RESULTS: All patients were men. The mean duration to postoperative urodynamic study was 38.5 months. Mean cytometric capacity (MCC), compliance, maximal pouch pressure (MPP) and PVR were 584.7 ml, 42.4 ml/cmH2O, 34.8 cmH2O, and 83.5 ml, respectively. Seventeen patients (85%) had complete daytime continence. Total continence (nighttime and daytime) rate was 40%. Three patients (15%) were totally incontinent. Pearson correlation test revealed a positive correlation between MCC and compliance (P<0.05). Compliance and urine volume at first sensation was also positively correlated (P<0.01). Urethrapouch anastomosis stricture was found to be significantly related with increased PVR. Continence status was not correlated with any urodynamic parameter. CONCLUSION: In this study, we found that "W" ileal neobladder reconstruction offers similar storage and voiding functions to normal bladder. Urodynamic evaluation of the "W" neobladder revealed similar results to that of a normal bladder. We conclude that "W" ileal neobladder construction results in a near-normal-functioning orthotopic reservoir that can be safely offered to patients.

Prevalence of metabolic syndrome and its association with erectile dysfunction among urologic patients: metabolic backgrounds of erectile dysfunction.

OBJECTIVES: To identify the prevalence of metabolic syndrome (MS) and its association with erectile dysfunction (ED) among urologic patients. METHODS: The study population consisted of 393 male patients aged 40 to 70 years, who were admitted to the urology clinics of four different institutions from February to March 2005. The waist circumference (WC) and triglyceride (TG) and high-density lipoprotein (HDL) cholesterol levels were measured. Patients were divided into two groups: group 1 consisted of patients with a WC greater than 102 cm, and group 2 consisted of patients with a WC of less than 102 cm. The erectile status of the two groups was compared. RESULTS: Of the 393 patients, 157 (39.9%) had MS. Of the 393 patients, 124 with MS (79%) and 146 without MS (61.9%) had ED. The presence of MS was significantly associated with ED (P <0.001). In the presence of an increased WC with normal serum HDL and TG levels, the relative risk of ED was 1.94. If the patient with an increased WC had a pathologic level of HDL or TG, the relative risk of ED increased up to 2.97-fold. The relative risk of ED in the presence of an increased WC, together with pathologic levels of HDL and TG, was 3.38. CONCLUSIONS: In our study, MS was strongly associated with ED. Fasting blood glucose levels, hypertension, and WC are the most significant risk factors predicting the risk of ED. A more pronounced increase in ED risk in the presence of abdominal obesity, together with altered TG and HDL cholesterol levels, may indicate a special metabolic background of ED regarding lipid metabolism.