Plasmocytoma of the urethra.

CASE HISTORY AND FINDINGS: A 35-year-old male patient presented with a 1-year history of hesitancy in voiding. An urethrogram revealed urethral stricture, therefore an urethrotomy with biopsies was performed. Histologic results suggested the diagnosis of extramedullary mature plasmocytoma. TREATMENT AND OUTCOME: After external beam radiotherapy with a total dose of 45 Gy the patient is disease-free without any therapy-related late effects after a follow-up of 36 months. CONCLUSION: Primary localization of extramedullar plasmocytomas in the genitourinary tract is very rare. This case report discusses a case of a male patient suffering from plasmocytoma of the urethra, who could be treated successfully by primary external beam radiotherapy.

[Gene expression profiling in prostatic cancer]. / Genexpressions-Analyse des Prostatakarzinoms.

Basic aspects of the biology and molecular alterations in prostate carcinoma remain poorly understood. New diagnostic and prognostic markers for prostate carcinoma may add additional information to current histopathological diagnosis. In order to achieve these goals, a comprehensive gene expression analysis was performed on non-metastasizing, untreated prostate cancer tissues. RNA expression profiles of approximately 12,600 sequences from 26 human prostate tissues (17 adenocarcinomas and 9 normal adjacent to cancer tissues) were investigated using high-density oligonucleotide microarray technology (Affymetrix). We identified 63 genes which were significantly increased (at least 2.5-fold) and 153 genes which were decreased (at least 2.5-fold). Upregulated genes included several which had not yet been described, such as the genes encoding the specific granule protein (SGP28), several members of the histone family, and the alpha-methylacyl-CoA racemase, but also previously reported ones such as hepsin, LIM domain kinase 2, and carcinoma-associated antigen GA733-2. Laser capture-microdissection of epithelial and stromal compartments from cancer and histologically normal specimens followed by an amplification protocol for low amounts of RNA (< 0.1 microgram) allowed us to distinguish between gene expression profiles characteristic of epithelial cells and those typical of stroma. Most of the genes identified in bulk tumor material as upregulated were indeed overexpressed in cancerous epithelium rather than in the stromal compartment. DNA microarray data for up- and downregulated genes were confirmed by quantitative RT-PCR. We demonstrated that development of prostate cancer is associated with downregulation as well as upregulation of genes that show complex differential regulation in epithelia and stroma. Some of the alterations in gene expression identified in this study may prove useful in development of novel diagnostic and therapeutic strategies. Gene expression profiling of microdissected tumor cells in prostate biopsies may supplement histopathologic diagnosis.

Malignant fibrous histiocytoma of the epididymis. Case report and review of the literature.

A 54-year-old patient was found to have a painless ca. 1.5 cm diameter tumor in the region of the right epipidymis. The right testis was exposed from a scrotal incision. The final pathology surprisingly showed malignant fibrous histiocytoma (MFH) of the epipidymis and the patient subsequently underwent radical inguinal orchiectomy. Complete metastatic screening was normal. Postoperatively, 60 Gy external beam radiation was administered. At the least follow-up (6 years), there were no recurrences or metastases. MFH is an extremely rare, highly malignant connective tissue tumor, which may, occasionally, affect the male genital tract. There are no agreed treatment principles. The overall prognosis is poor.

Combined myxoid liposarcoma and angiolipoma of the spermatic cord.

To date, only 14 cases of myxoid liposarcoma of the spermatic cord have been reported in the literature. The growth is a rare, usually highly differentiated malignancy that tends to recur locally, rarely metastasizes, and has a good prognosis following complete removal. We describe a new case of a highly differentiated myxoid liposarcoma of the spermatic cord, combined with an angiolipoma. Left inguinal orchiectomy with high ligation of the cord was performed. Staging revealed no evidence of regional or distal metastases. By the latest visit, at 30 months, the tumor had not recurred. The diagnosis, management, and prognosis of this oncologic entity are discussed in the light of the literature.

[BCG vs interferon A for prevention of recurrence of superficial bladder cancer. A prospective randomized study]. / BCG vs. Interferon A zur Rezidivprophylaxe beim oberflächlichen Harnblasenkarzinom. Eine prospektiv randomisierte Studie.

A total of 78 patients with superficial bladder carcinoma were prospectively randomized to two groups following complete transurethral resection (TUR). Each received 12 intravesical instillations of 10(7) units interferon A or 120 mg BCG Connaught for 1 year starting 6 weeks post-TUR. After a mean observation period of 24 (13-31) months in the BCG and 25 (6-32) months in the IFN group 5/32 (15.6%) recurrences in the BCG versus 21/35 (60%) in the IFN group were observed (P = 0.0003). In the IFN group 18.4% of the patients had dysuria and 2.6% fever; in the BCG group 35% had fever, 60% cystitis, 1 patient granulomatous epididimoorchitis and 1 patient pneumonitis with granulomatous prostatitis. With our instillation regimen interferon A had few side effects but also no prophylactic effect, whereas BCG had tolerable-seldom severe--side effects and was very effective in preventing recurrences. Perhaps IFN should be given earlier after TUR and in a higher dosage.

[Intravesical prevention of recurrence of superficial urinary bladder cancer with BCG and KLH. A prospective randomized study]. / Intravesikale Rezidivprophylaxe beim oberflächlichen Harnblasenkarzinom mit BCG und KLH. Eine prospectiv randomisierte Studie.

In a prospective randomized trial intravesical prophylaxis for recurrence of superficial bladder cancer with BCG versus KLH was performed in 42 patients, 38 of whom were then evaluable. After a mean observation period of 20 +/- 7 months (8-32 months) 41.2% (7/17) of the patients in the KLH and 14.3% (3/21) of the patients in the BCG group developed recurrent bladder tumours. The recurrence rate according to EORTC was 1.95 in the KLH group versus 0.76 in the BCG group. Among the BCG treated patients, 60% (15/25) had cystitis and 28% (7/25) fever, whereas only 1 of 19 (5.3%) patients treated with KLH had cystitis. BCG is a highly effective prophylactic against recurrence of superficial bladder cancer. Intravesical instillation therapy with KLH has only a slight prophylactic effect if treatment is started 6 weeks postoperatively.

Vascularization of malignant testicular tumors.

Recent studies of malignant testicular tumors report a correlation between vascularization, biologic behavior, radiosensitivity, and chemotherapeutic response of the tumor. Postoperative angiographies of malignant testicular tumor specimens (seminoma n = 4, nonseminoma n = 12) showed the following results: Contrary to the symmetric vascularity pattern of normal testes, seminomas were hypovascular, well-defined from normal testicular tissue and not neovascular. Nonseminomas showed isovascularity (n = 5) or hypovascularity (n = 7) but with focal hypervascular areas in the tumor (n = 10), and pathologic neovascularization. Present angiographic studies reveal marked differences in the vasculature pattern of malignant testicular tumors. In nonseminomas, focal hypervascular or neovascular areas as centers of a high-growth rate correlate well with comparable cell kinetic studies. Assuming a similar growth behavior in metastases, the vascularization type of these growth centers theoretically favors the efficient use of chemotherapeutic agents.

High-resolution sonography in experimentally induced scrotal pathology.

Benign and malignant extra- and intratesticular lesions were experimentally induced in the testes of Wistar rats so as to evaluate the significance of high-resolution ultrasonography for the early detection of intratesticular malignancy. The animals were studied using high-resolution sonography (mean frequency = 8 MHz) over 6 weeks. Walker carcinomas could be induced in the testicle in 50% of the cases; 8 of 17 showed a locally limited growth. Tumors over 2 mm in diameter showed a typical change in the normal sonographic pattern of the testes. The overall sensitivity of high-resolution sonography for intratesticular lesions was 88%, the specificity 91%. The detection of small intratesticular lesions has made high-resolution sonography superior to conventional sonographic techniques and may therefore prove to be of major clinical significance.

Detection of neoplastic lymph node involvement in the retroperitoneal space. Diagnostic value of CT, echography and lymphography.

The diagnostic value of echography, computerized tomography and lymphography in the detection of infiltrating retroperitoneal lymph nodes was assessed in a prospective study. Ninety-six patients suffering from Hodgkin's disease, non-Hodgkin lymphoma, seminomatous and and non-seminomatous tumours of the testis were examined with all three methods. Sixty-two (30 non-seminomas, 32 Hodgkin's diseases) had an exploratory laparotomy at least one week after the diagnostic examinations. Sensitivity and specificity were assessed on the basis of the pathohistological findings. The sensitivity was 92% for CT, 79% for echography and 83% for lymphography. The specificity was 89% for CT, 95% for echography and 84% for lymphography. The presented findings suggest that a re-evaluation of the diagnostic strategy in assessment of lesions involving retroperitoneal lymph node is required.

Microcalcifications in testicular malignancy: diagnostic tool in occult tumor?

Malignant testicular tumor microcalcifications are being reported at an increasing rate. However, whether or not the detection of microcalcifications had any clinical significance has not been clarified. In the the present study testicular specimens from 92 patients (43 with malignant and 49 with nonmalignant testicular diseases) were examined postoperatively by mammographic technique. Microcalcifications were identified in 32 of the testicular tumor specimens (74 per cent), more frequently in teratomas (87 per cent) than in seminomas (60 per cent), and in 3 "burned-out" tumors. In contrast, only 8 of the benign testicular specimens showed microcalcifications (16 per cent). The arrangement of microcalcifications as well as the distinct pattern of distribution may further discriminate nonmalignant from malignant entities. Though the rate of detection and allocation of microcalcifications in malignant testicular tumors was a surprising finding, the general use of orchioradiography seems problematic because of the risk of potential damage to the germinal epithelium. In occult carcinoma, however, preoperative or orchioradiography may be justified.

Organ-related and malignancy-associated reactivity of cancer patients' leucocytes: a leucocyte migration study with tumour and foetal extracts.

Leucocytes from patients with a variety of tumours including gastric, colorectal, lung, kidney and mammary cancer, were tested in the leucocyte migration test (LMT) against organ-related and non-organ-related tumour and foetal extracts. The reactivity of cancer patients' leucocytes against a panel of organ-related tumour extracts was found to be 71-93%, depending on the tumour system tested. Cross-reactivity with a panel on non-organ-related tumour extracts was found in 0-38% of patients. Corresponding patterns of reactivity were obtained by testing patients' leucocytes against human foetal organ extracts; pathological migration indices (MI) were found in 70% of tests in which patients' leucocytes were reacted with organ-related extracts, and in 16% of tests with non-organ-related extracts. The data strongly support the concept that patients' leucocytes are sensitized to cross-reactive foetal determinants of organ-related specificities. Furthermore, it is proposed that foetal extracts as inducers of lymphokine production in presensitized lymphocytes could be used efficiently and reproducibly as a source of foetal antigen, as well as in the clinical application of the LMT procedure.

[Sonographic examination of scrotum and testes with a new scanning technique (author's transl)]. / Echographie des Scrotums und der Testes mit Hilfe einer neuen Untersuchungstechnik.

The subject of this report is an improved technique for sonographic examination of the scrotum and the testes. The method is simple; by using a waterbath, a mechanical compression of the testes is avoided. In all sections the scrotum may be continually observed and a good picture reproduction is possible. The report concerns the results of a prospective examination of 37 patients. The diagnoses of their condition could be confirmed by surgery or by follow-up examinations.

Antibody-coated bacteria in the ejaculate: a possible test for prostatitis.

An immunofluorescence technique was used to study antibody coating of bacteria in ejaculates from 14 healthy individuals and 51 patients with complaints compatible with the diagnosis of prostatitis. Quantitative bacteriological cultures in the ejaculate were positive in 2 healthy individuals (14%) and in 25 patients with prostatic symptoms (49%). Antibody-coated bacteria could be demonstrated in 25 patients with prostatic symptoms (49%), 8 of whom had negative bacterial cultures, but in none of the healthy individuals. All 5 patients with epididymitis had antibody-caoted bacteria in the ejaculate. The 13 patients with antibody-coated bacteria in the ejaculate were given antibiotic treatment and the bacteria disappeared in 8 cases. The results document the presence of a (presumably local) immune response in bacterial prostatitis. Antibody coating of bacteria in the ejaculate seems to be helpful in the diagnosis of bacterial prostatitis.