[Urothelium cancer with trophoblastic differentiation. An unusual case of a 77 year old patient]. / Das Urothelkarzinom mit trophoblastischer Differenzierung. Eine seltene Tumorvariante am Beispiel einer 77-jährigen Patientin.

Urothelium carcinomas with beta HCG positive markers are a rarity in tumour differentiation. Syncytiotrophoblastic and, in a few cases, cytotrophoblastic giant cells are typical for this carcinoma. Such differentiation has an intensified potential for invasiveness and is accompanied by increased angiogenesis. In the present case, the mixture of trophoblastic cells indicates a common stem cell. In comparison with beta HCG negative transitional cell carcinoma, the prognosis is bad for beta HCG positive carcinoma. For this reason, a radical operation should be taken into consideration as early as possible.

Pilot study of the practical relevance of a one-step test for prostate-specific antigen in capillary blood to improve the acceptance rate in the early detection program of prostate carcinoma.

OBJECTIVE: Current studies have proven that early, organ-confined stages of prostate cancer can be diagnosed through screening based on PSA levels, thus reducing cancer mortality. Here we report about our experience using an innovative one-step test for PSA in capillary blood. METHODS: The incubation time for a 50 microl blood sample with the indicator strip is 12 minutes until the qualitative visual results (<4.0 ng/ml or > or = 4 ng/ml) appear. In cooperation with urologists and accompanied by an extensive information campaign, the one-step test was made available free of charge to all men between the ages of 45 and 75 in all 28 pharmacies of our city (100,000 inhabitants). RESULTS: The test's acceptance rate among the 2,119 participants between the ages of 45 and 75 years amounted to 13.0%. Fifteen percent of all the tests conducted showed a positive PSA result (> or = 4 ng/ml). Prostate carcinoma was histologically confirmed in 14 (0.66%) of the men, nine times in the early stage (T2) and five times in the clinical stage (T3), corresponding to an incidence of circa 650 cases per 100,000 men in the target age group. CONCLUSIONS: This newly developed PSA test system can enhance the acceptance rate and effectiveness of medical check-ups for prostate cancer, because it is easy-to-use, cost-effective and accurate (specificity 81.3%, sensitivity 91.1%). The test should be always conducted by an experienced physician or pharmacist. It is not a substitute for a regular physical examination (DRE, TRUS, biopsy...).

Possibility of improving the acceptance rateof early detection testing for prostate cancerwith a one-step test for prostate-specific antigen in whole blood.

In order to increase the acceptance rate of early detection testing for prostate cancer, a qualitative prostate-specific antigen (PSA) one-step test has been developed. Determining the PSA level with this test system takes 10 min. The blood samples of 190 men were tested in this qualitative assay, which uses 50 microl of EDTA whole blood and in which the results are ascertained visually. Parallel samples were tested in serum-based, quantitative assays (Abbott Imx, EIA). The findings of the two kinds of assays were compared and evaluated regarding their correspondence (<4.0 and > or = 4.0 ng/ml). For the 74 blood samples in which the quantitative assay showed PSA levels <4.0 ng/ml, the PSA one-step test showed 83.8% correct negative results (corresponds to diagnostic specificity). For the 116 samples in which the classic assay showed PSA levels > or = 4.0 ng/ml, the one-step test showed 90.5% correct positive results (sensitivity). The noted deviations appear especially around the cut-off value of 4.0 ng/ml, i.e. within the PSA concentration range of 3.0 < 4.0 and 4.0 < 5.0 ng/ml. The qualitative PSA one-step test presented here demonstrates good reproducibility. It can be conducted by the patient and is easy to use. The test offers a simple, feasible method for early detection programs for prostate cancer.

[Primary primitive neuroectodermal tumor of the urinary bladder. Clinicopathologic case report and differential small cell tumor diagnosis of this site]. / Primärer primitiver neuroektodermaler Tumor der Harnblase. Klinisch pathologischer Fallbericht und Differentialdiagnose kleinzelliger Tumoren in dieser Lokalisation.

We report a rare case of primary primitive neuroectodermal tumour of the bladder in an adult. A huge tumour with extensions into pelvic and retroperitoneal tissue was found radiologically in a 62-year-old man. The patient did not complain about remarkable clinical symptoms until 4 days before admission to hospital. Histology of diagnostic transurethral tumour resection showed a small round-cell tumour with focal necrosis and scattered Homer-Wright rosettes. Immunohistochemical analysis revealed that tumour cells stained positively with 013, a monoclonal antibody which recognizes the membrane glycoprotein p30/32MIC2. Focally, tumour cells stained positively for vimentin, NSE, S-100 protein and synaptophysin. The patient died 3 weeks later because of fulminant pulmonary embolism and autopsy revealed a huge, partly exophytic but mainly endophytic tumour of the bladder with extensions into the rectum and retroperitoneal tissue. The differential diagnosis of small round-cell tumours in this location is discussed.

[Is there a renaissance of conservative therapy in plastic penile induration?]. / Gibt es eine Renaissance der konservativen Therapie bei der Induratio penis plastica?

The management of Peyronies's disease should include an exact pretherapeutic staging. Diagnostic methods like ultrasound imaging, X-ray using "mammography technique" and magnetic resonance imaging are modalities of choice. The good results of new conservative therapy options have to be evaluated in randomized multicentric studies. Surgical therapy shows good results in patients with calcified plaques.