Comparative study of conventional urothelial carcinoma, squamous differentiation carcinoma and pure squamous carcinoma in patients with invasive bladder tumors.

PURPOSE: Treatment results evaluation (radical cystectomy and adjuvant chemo/radiotherapy) in patients with urothelial carcinoma, squamous differentiation carcinoma and pure squamous bladder carcinoma. MATERIAL AND METHODS: The study included 361 patients with invasive bladder carcinoma treated between 1990-2013. Histology showed 296 cases of urothelial carcinoma (82% - group A), 52 cases of urothelial divergent differentiation (squamous and urothelial carcinoma 14.4% - group B) and 13 cases of squamous cell carcinoma (3.6% - group C). All patients benefited from radical cystectomy. Adjuvant chemotherapy was undergone in 68 patients. RESULTS: Group A - urothelial carcinoma - had a 44% rate of patients alive with a mean survival period of 73 months. About 56% of the patients died, the mean survival period being 4 years. Group B - urothelial carcinoma with squamous differentiation - had a mean survival period of 36 months (between 1-156 months). 17 patients (33%) are alive at 50 months postoperatively. Group C - squamous carcinoma - had a mean survival period of 9.4 months. DISCUSSIONS: Locally advanced disease was diagnosed in 50% of the patients in group A, while in group B the rate was 84.6% and 70% in group C, respectively. CONCLUSIONS: Squamous pattern detected in the histopathological specimen represents a negative prognostic factor. It seems that the squamous component influences the outcome of the disease due to its biological characteristics in the evolution of squamous carcinoma, with advanced local stage disease at diagnosis - late onset of symptoms and lack of response to adjuvant treatment.

[An inclusion cyst of the anterior chamber]. / Chist de invazie al camerei anterioare.

Our paper present a clinical case of inclusion cyst of the anterior chamber. We discuss the clinical course, the specific investigations, the surgical management and the histopathologic diagnosis.

[Cystic dilatation of main biliary tract]. / Dilatatia chistica a caii biliare principale.

UNLABELLED: The choledochal cyst (particularly with congenital origin) is a clinical form from a complex syndrome of ecstasies of the intra-, extra-, or both situations of biliary tree. The disease has until now an unsure etiopathogeny. Very frequent to child, teen-ager and young adult the incidence decreases through the third age. During the period 1960-1998, 13 patients were operated on (annually rate 0.3). The extreme ages of our patients were 5 and 72 years; being operated six children and 7 adults (two of them being 63 and 72 years old). The clinical presentation was nonspecific. The jaundice (with or without cholangitis) (n: 7), right upper quadrant pain (n: 11), a palpable abdominal mass (n: 5) were registrated but the classic triad (Sénéque--Thailhefer) was in out series the exception rather than the rule. Concomitantly there were discovered different complications of the disease: hepatic biliary cirrhosis (n: 3--two macroscopic diagnosed and one microscopic confirmed), portal hypertension (n: 8), biliary lithiasis (including the intracystic stones) (n: 6) and cholangio-carcinoma (n: 1). The clinic and biologic preoperative diagnosis is up to date difficult and not sure like in our experience too. In our series, especially in the last 20 years, the accurate imaging diagnosis was helpful (the ultrasonography, CT, hepatic scintigrams). ERCP was not available for us until now. In concordance with Todani--Watanabe classification our patients were included in the following types: I-a (n: 6), I-b (n: 1), I-c (n: 2), II (n: 2), IV-a (n: 2). All patients were operated on: cysts-digestive derivations or partial excision of the cyst with billio-digestive reconstruction were the choice procedures at a beginning of our experience or for the very fragile patients (n: 5). The total excision of the cyst with choledochal--jejunostomy (Roux-en-Y) is the preferred method now (n: 8) when it is possible. The microscopic pathology of the disposable specimens (cystic wall) showed:--chronic intra- and perimural inflammation (n: 7);--severe displasia and metaplasia (n: 2); cholangiocarcinoma islands (n: 1); additional lesions: hepatic chirrosis (n: 1); hepatic fibrosis (n: 3). RESULTS: The postoperative morbidity--three patients--one of them died with a peritonitis. Long-term follow-up, effective for only 10 patients, reveled recurrent cholangitis in two cases treated by the reoperation of the former anastomosis; the other 8 patients had a normal evolution. CONCLUSION: The choledochal cyst is an exclusive indication for surgery as soon as it was discovered.

[A case of intraductal multicentric breast carcinoma with bilateral axillary metastases]. / Un caz de carcinom mamar intraductal multicentric cu metastaze axilare bilaterale.

It is recognized that the breast cancer is frequently accompanied by local and regional nodal metastases, but contralateral axillary dissemination is considered a rarity. It is presented a case of a 42 old female patient with intraductal multicentric right mamar carcinoma (T2) with bilateral axillary nodal metastases who had underwent to the complex treatment: surgical, chemotherapy and radiotherapy and hormonal therapy. The prognosis is reserved. It is required a careful supervision from point of view clinical biological, mamography, echography, tomography, RMN for diagnosis of recurrences, metastases and becoming a bilateral cancer at the remaining breast.

[Rectal hemangioma--a pseudoneoplastic form. A case report and review of the literature]. / Hemangiomul rectal--forma pseudoneoplazica. Prezentarea unui caz si revista literaturii.

A patient, 23 years old, is presented. He was admitted on in our clinic for a lower, very bleeding rectal tumor, the macroscopically characters evoking quite sure a malignant neoplasm. Three successive histopathologically examinations remained inconclusive and only the fourth suggested the diagnosis of benign glandular polyp. That conclusion strongly contrasted with all the data obtained by the macroscopically examinations. Nevertheless the therapeutically option was in favor of a sphincter-saving surgery, the practiced operation being a pull-through rectosigmoid resection (Babcock). Recovery of the patient which is in a good condition at present (two years after surgery). The histopathological examination of the operative specimen stipulated like diagnosis: rectal haemangioma with component parts of lymphangioma. Carrying on, the paper presented a review of the literature data referring to the very limited experience of others authors, regarding clinical aspects, diagnostics and therapeutically problems of the rectal haemangioma. In similar cases presenting voluminous rectal (or colonic) possibly benign tumors, haemangioma like, macroscopically diagnostic being difficult or unsure, but also without a certitude for a malignant tumor, it is recommended a sphincter-saving operation, adapted to the general status of the patient. In cases with malignant characters at the final histopathological examination, on the operative specimen, the transformation of the initial intervention in a amputation type surgery may be a possible alternative.

[2 cases of total duodenopancreatectomy with resection of the portal vein in cancer of the pancreas]. / Consideratii asupra a doua cazuri de duodenopancreatectomie totala cu rezectie de vena porta pentru cancer de pancreas.

Two cases of pancreatic cancer with portal vein invasion are presented. In both cases a total duodenopancreatectomy was performed due to the extension of tumour. The portal vein invasion was diagnosed intraoperatively; it was a circular invasion in one case and a lateral invasion in the second case. A segmental resection of the portal vein (2 cm in length) with end-to-end anastomosis was performed in the first case, while a lateral excision with venorrhaphy was sufficient in the second case. The first patient died after six months while the second patient is still alive, without recurrence, at seven months postoperatively.

Wilms' tumor in the adult patient.

One documented case of Wilms' tumor in an adult patient is presented. The patient is diagnosed clinically with renal tumor, probably renal carcinoma. Wilms' tumor is extremely difficult to diagnose preoperatively in an adult patient. The pathologic hallmarks of this neoplasm are distinctive and it is histologically similar to the childhood tumor. The therapeutic guidelines and surgical principles governing childhood Wilms' tumor should be applied to adult Wilms' tumor. This patient is still alive after 15 months.