Oncometabolites in urine - a new opportunity for detection and prognosis of the clinical progress of verified prostate cancer-a pilot study.

BACKGROUND: Oncometabolites provide a new approach towards the diagnostics and prognosis of the clinical progress of prostate cancer (PCa). This study is about the diagnostic and predictive value of a panel of urinary oncometabolites (ethanolamine, kynurenine, ß-alanine, α-alanine, leucine, isoleucine, γ-aminobutyric acid, and sarcosine) and correlation with prostate-specific antigen (PSA) and Gleason score in patients diagnosed with prostate cancer. METHODS: The participants in this cross-sectional study were divided into PCa group (101 patients who matched the including criteria, average age 71) and control group (52 individuals, with no evidence of malignancy, without oncological and other chronic diseases, and without prostate gland pathology, average age 40). The criteria to be included in the PCa group were as follows: i) being diagnosed with prostate cancer, based on digital rectal examination (DRE), prostate ultrasound investigation, or biopsy; ii) not being subjected to a surgical or any other treatment; iii) not having any other concomitant oncological diseases, renal failure, diabetes mellitus. The urinary concentration of the selected metabolites was established through high-performance liquid chromatography with tandem mass spectrometry detection (HPLC-MS/MS). RESULTS: The comparison of both groups established a significantly different elevated concentration of ethanolamine, sarcosine and kynurenine, and a significantly different decreased concentration of ß-alanine and isoleucine in PCa group. No changes of the values were detected in the PCa group with PSA levels below and above 10 ng/mL and Gleason score below and above 6 (p > 0.05). To test whether combination of several variables is more powerful in discriminating between PCa and control group multiple logistic regression analysis was performed. A model including ethanolamine, sarcosine, kynurenine, ß-alanine, and isoleucine demonstrated negative predictive power (NPP) 76.2% and positive predictive power (PPP) 81.8%. DISCUSSION: Urinary concentrations of ethanolamine, sarcosine, kynurenine, ß-alanine, and isoleucine in PCa group differ significantly from that of control group. New expanded population studies are needed to discuss our results.

Changes in the Level of DNA Fragmentation in Sperm Cells detected by Acridine Orange Test in Men with Sub/infertility Treated with Nutritional Supplement PAPA.

BACKGROUND: When diagnosing and treating male infertility it is important to determine whether there are defects in the maturation process of sperm nuclei. Using nutritional supplements can improve the morphological and physiological condition of the spermatozoa. In recent years there has been an increase in the usage of supplements with different compositions which strives to determine the best combination and avoid side effects. AIM: To study the effect of PAPA nutritional supplement on the levels of DNA fragmentation of sperm cells tested with acridine orange test (single stranded DNA against double stranded DNA) in men with sub/infertility. MATERIALS AND METHODS: 48 men with confirmed sub/infertility underwent treatment for three months with nutritional supplement PAPA containing 9 micronutrients. The differences in levels of DNA fragmentation were determined with acridine orange test, which was conducted before and after the treatment. RESULTS: The results were statistically significant (p<0.001) showing an increase in the number of green spermatozoa (normal DNA), and a decrease of damaged ones (orange and red). After treatment the level of sperm DNA fragmentation decreased by 10.2%. CONCLUSION: Men with confirmed sub/infertility that took nutritional supplement PAPA for three moths showed a decrease in DNA fragmentation levels of 10.2% determined by AO test which implies an improvement of male fertility levels.

Paratesticular well-differentiated liposarcoma initially diagnosed as fibrous pseudotumour.

Paratesticular tumours are relatively rare and mostly of the mesenchymal origin. Due to its rarity, general surgical pathologists might have limited experience on the diagnostic entities and relevant differential diagnoses related to mesenchymal paratesticular tumours. This may likely cause diagnostic difficulties in a daily pathology practice. Paratesticular liposarcoma is a highly heterogeneous tumour and may be misdiagnosed as a benign fibromatous lesion. Herein we present a case of well-differentiated paratesticular liposarcoma of the sclerosing type initially diagnosed as a fibrous pseudotumour. Main differential diagnostic considerations are highlighted.

Sarcomatoid Squamous Cell Carcinoma of the Penis - a Report of Two Cases.

BACKGROUND: Sarcomatoid (spindle cell) squamous cell carcinoma is a rare, highgrade, aggressive tumor consisting of the squamous cell carcinoma admixed with the malignant spindle cell (sarcomatoid) elements. These tumors are relatively uncommon in the genitourinary system and particularly in the penis. MATERIALS AND METHODS: Two sarcomatoid squamous cell carcinomas of the penis were diagnosed in our hospital between 2012 and 2015. Clinical histories, pathology reports, hematoxylin and eosin-stained and immunohistochemical slides were reviewed. RESULTS: In both cases, the tumors presented as single, pedunculated, extensive masses with surface ulceration; histology study showed a mixture of high-grade squamous cell carcinoma component and spindle cell neoplastic component in different proportions. Immunohistochemical stains of CK AE1/AE3, p63 and CK903 showed positive immunoreactivity in both components in both cases. Vimentin was positive in spindle cell component and negative in squamous cell carcinoma areas. CONCLUSION: Sarcomatoid squamous cell carcinoma of the penis is an uncommon tumor of this site with aggressive behavior and bad prognosis which might be related to the delay in medical examination and diagnosis. A correct and thorough morphological study is of great importance for the staging of the disease, treatment and follow up of patients.

Sexual Fears and Avoidant Sexual Behavior in Medical Students.

UNLABELLED: Sexual fears, sometimes in the form of phobias, lead to aversive or sexually avoidant behavior blocking sexual closeness and resulting in deep personal and interpersonal distress. OBJECTIVE: To determine the types of sexual fears and aversive behavior in young people of reproductive age (students) and their degree of markedness as to encourage a further implementation of prevention programs and interventions. MATERIALS AND METHODS: The study included 116 fifth-year medical students in Plovdiv Medical University. Of these, 55 men and 61 women were assessed with the Sexual Aversion Scale, a 30-item self-rating questionnaire. The Diagnostic and Statistical Manual of Mental Disorders criteria of sexual aversion were used. The statistical analyses used were descriptive statistics and independent samples t-test. RESULTS: Sexual fears and aversive or blocking behavior are mild to moderate, mean score of 1.54 ± 0.04, without statistically significant gender differences. Both sexes have established fear-related sexual aversive motives of sexual behavior related to the risk of unwanted pregnancy and HIV infection. Women have significantly higher average scores for the following statements: fear of sexual intercourse (1.61 vs 1.25), avoidance of situations in which they may be involved sexually (1.95 vs 1.51), avoidance of genital sexual contact (1.44 vs 1.16), fear of catching a sexually transmitted disease (2.46 vs 2.09 ), fear of pregnancy (2.61 vs 2.15) and concerns what other people think of them (2.34 vs 1.93 ). CONCLUSIONS: Sexual fears and aversive or blocking behavior were mild to moderate. In both sexes similar fears--aversive or blocking patterns of sexual behavior were found, mainly associated with the fear of unwanted pregnancy and the risk of HIV infection, more expressed in women.

Repeat transrectal prostate biopsies in diagnosing prostate cancer.

UNLABELLED: Patients with negative prostate biopsy and persistent suspicion of prostate cancer (PCa) can pose a serious diagnostic problem. The AIM of our study was to determine the frequency of PCa found on repeat prostate biopsy and the factors leading to higher possibility of cancer positive histological result. PATIENTS AND METHODS: We studied retrospectively 113 patients (82 from University Clinic, Jena, Germany and 31 from Department of Urology, Plovdiv, Bulgaria) with initial negative biopsy for cancer who underwent repeat biopsies. The patients were examined between January 1999 and May 2010. The target group included patients with Prostate Specific Antigen (PSA) level lower than 12.5 ng/ml and without suspicious finding on digital rectal examination (DRE). Different biopsy schemes were used in the initial and the following biopsies, depending on patient age and total prostate volume. RESULTS: Overall PCa detection rate was 22.1% (25 of 113). The repeat biopsy found PCa in 15.9% (18 of 113). In patients with 3 biopsies the PCa detection rate was considerably lower--only 8.6% (3 of 35). PCa was found in only 1 patient of 18 (5.5%) who underwent four or more biopsies. Transurethral resection of the prostate (TURP) was performed in 15 patients with at least two previously negative biopsies. The pathohistological examination of the resected tissue showed PCa in 3 of the patients (20%). CONCLUSION: The interval between biopsies is not a significant predictive factor for positive prostate biopsy. The chance for detecting PCa after the second negative transrectal biopsy procedure is low. Therefore, TURP can be used as an alternative procedure to harvest adequate tissue material for pathologic examination, especially in patients with obstructive voiding symptoms.

Epidemiology, diagnostic and therapeutic problems for carcinoma of the penis in the regions of Plovdiv, Pazardzhik and Smolyan between 1993 and 2002.

INTRODUCTION: Carcinoma of the penis is a malignant tumour which is uncommon in the male population of the Plovdiv, Pazardzhik and Smolyan regions. Recently however, its occurrence in the clinical practice has been on the increase. In the present study we analyse the incidence of penile carcinoma in these regions and address some problems related to late diagnosing of the condition and its therapy. MATERIAL AND METHODS: The study included fifty one patients newly diagnosed with carcinoma of the penis between 1993 and 2002. The patients were registered in the Plovdiv Oncological Centre database. The available data were studied in detail analysing the incidence and mortality rates of the disease. RESULTS: The incidence and mortality rates carried by carcinoma of the penis showed a tendency to simultaneous increase with time--by 0.1355 and 0.0392 per 100000 men per annum, respectively. There is a relatively high number of patients diagnosed with carcinoma of the penis in the stage of invasive local tumor (82.35%). The distribution of the cases by stages is highly unfavourable--over 33% of them were diagnosed very late (stage III and IV). The greatest number of cases (70.59%) received only surgical treatment. The 5-year survival rate of the diagnosed patients is only 58.86%. CONCLUSION: These data about the incidence of the disease and the diagnosis and treatment of penile cancer in the studied regions are indicative of highly unfavourable tendencies for this disease which are reflected in the low efficaciousness of cancer control in the studied localisation.

A rare case of epidermoid cyst of the scrotum with signs of malignization--clinical and morphological features.

Proceeding from the fact that epidermoid cysts of the scrotum are rare and often histologically proven to display evidence of malignization in the underlining epithelium, the authors present a case of scrotal epidermoid cyst from their clinical practice. Epidermoid cysts are given a detailed pathohistologic assessment. The finding was a productive granulomatous inflammation containing multinucleated giant cells of foreign body type in the overlying dermis and intraepidermal "horn pearls" (keratin substance of Queyrat) showing unequivocally signs of malignization of the epidermoid cyst. The authors argue that a histological study should be a must after surgical removal of the cyst as it is the only method to prove beyond any doubt the malignant transformation of the epithelium.