A Case of Urachal Malacoplakia that Seems Like Urachal Cancer.

BACKGROUND: Urachal masses observed in adults should be considered malignant unless they are confuted. It is very difficult to differentiate between malignant or benign lesions, including especially calcified foci and solid areas. CASE REPORT: Our case was a 63-year-old male patient who was diagnosed as Behçet's Disease 26 years ago. Upon clinical examination, he was also diagnosed with adenocarcinoma of prostate. He was examined by computerized tomography to define the stage of prostatic adenocarcinoma. The existence of a hypodense multiseptated cystic lesion with irregular margins and solid areas located between anterosuperior of bladder and umbilicus was reported. Hence, the lesion was evaluated as urachal carcinoma and locally advanced prostate cancer by the urooncology council. Resection of the mass, partial cystectomy and pelvic lymphadenectomy were performed as one of the surgical approach options in urachal carcinoma. After pathological examination, the mass was diagnosed as malakoplakia and metastasis of prostate adenocarcinoma was also detected in the right obdurator lymph nodule. In the literature, case reports of urachal malakoplakia are extremely rare. It is also interesting to note the absence of specific clinical symptoms for the urachal mass and the existence of concomitant adenocarcinoma in our case. CONCLUSION: Malakoplakia can only be diagnosed by pathological examination. Particularly, urachal malakoplakia should also be taken into consideration in the differential diagnosis of lesions which include solid areas and are located in the urachus.

Value of dynamic contrast-enhanced MRI and correlation with tumor angiogenesis in bladder cancer.

OBJECTIVE: The aim of this study was to investigate dynamic contrast-enhanced MRI (DCE-MRI) for the noninvasive measurement of bladder cancer angiogenesis by correlation with microvessel density, histologic grade, and tumor staging, and to predict the outcome of local recurrence. MATERIALS AND METHODS: Twenty-four patients with bladder cancer were examined using DCE-MRI. Hemodynamic parameters obtained by DCE-MRI included peak time enhancement in the first minute (E(max/1)) after contrast administration, second minute (E(max/2)), third minute (E(max/3)), fourth minute (E(max/4)), and fifth minute (E(max/5)), and the steepest slope. Microvessel density was identified by immunostaining of endothelial cells using FVIII-related antigen. The Mann-Whitney U test, multivariate discriminant analysis, Spearman's correlation coefficient, and analysis of variance were used for statistical analysis. RESULTS: Correlation was seen between DCE-MRI parameters (E(max/1) and steepest slope) and microvessel density (p < 0.05). E(max/1) and steepest slope were found to have a statistically significant correlation with histologic grade (p < 0.05 and p < 0.01, respectively). A significant difference was seen between groups of patients with and without local recurrence with regard to two of the DCE-MRI parameters (p < 0.05 for E(max/1) and E(max/2)). CONCLUSION: The contrast enhancement patterns on DCE-MRI are influenced by tumor angiogenesis, as reflected by elevated microvessel density expression. Therefore, they are valuable indicators for assessing tumor angiogenic activity and tumor neovascularization in bladder cancers.

Pre-treatment hemoglobin levels are important for bladder carcinoma patients with extravesical extension undergoing definitive radiotherapy.

PURPOSE: To evaluate prognostic factors affecting local control (LC), distant metastases-free survival (DMFS) and overall survival (OS) in bladder carcinoma patients undergoing extravesical extension. PATIENTS AND METHODS: We retrospectively reviewed the charts of 61 consecutive patients with T3 or T4 bladder carcinoma, treated with definitive radiotherapy from 1999 through 2007. RESULTS: Median age was 69 years and follow-up was 29 months. The LC rate was 33% at 4 years and was increased in patients with a Hb< 12 g/dl (p= 0.003) or a LDH< 180 U/L (p= 0.021) and in those who received concurrent chemotherapy (p= 0.022) on univariate analysis. DMFS was affected by anemia (Hb< 12 g/dl) (p= 0.039), the absence of chemotherapy (p= 0.034) and the presence of newly-diagnosed disease (p= 0.01). The OS rate was 19% at 4 years. Non-pure transitional cell carcinoma histological type (p= 0.024), anemia (p= 0.004), elevated LDH (p= 0.003), and newly diagnosed disease (p= 0.011) were poor prognostic factors on univariate analyses for OS. Anemia was the only negative prognostic factor for LC (p= 0.03), DMFS (p= 0.002) and OS (p< 0.0001) on multivariate analysis. CONCLUSION: Pre-treatment Hb level is the most important prognostic factor in patients treated with definitive radiotherapy, so that anemia may act as a surrogate biological marker for aggressive disease.

Influence of N-acetylcysteine on renal toxicity of cadmium in rats.

The aim of this study was to investigate the ability of N-acetylcysteine (NAC) to prevent cadmium (Cd)-induced renal damage and whether NAC would reverse cadmium damage to the kidney. Fifty adult male rats were divided into five experimental groups: group 1 received tap water for 3 months and 7 days, group 2 received cadmium chloride (CdCl(2)) for 3 months, group 3 (NAC cotreatment group) received CdCl(2) and 0.5% NAC in tap water for 3 months, group 4 received CdCl(2) in tap water for 3 months and 3 months later received only tap water for 7 days, and group 5 (NAC posttreatment group) received CdCl(2) in tap water for 3 months and 3 months later received 2% NAC in tap water for 7 days. NAC significantly decreased the elevated kidney malondialdehyde levels, as a marker of lipid peroxidation, in both cotreatment and posttreatment modalities. Cotreatment and posttreatment with NAC significantly increased kidney superoxide dismutase enzyme activity and glutathione level but did not change kidney catalase enzyme activity. NAC decreased fractional excretion of sodium in posttreatment group. Neither Cd nor NAC affected the glomerular filtration rate (GFR). Cotreatment and posttreatment with NAC reduced the effects of Cd on proximal tubules. It was found that NAC showed these effects without changing kidney accumulation of cadmium. Exogenously administrated NAC might reduce toxic effects of Cd on the kidney without any reduction in tissue Cd level.

Case report: subcutaneous metastasis from small cell carcinoma of the prostate.

Pure primary small cell carcinoma of the prostate (SCCP) is an extremely rare entity. Natural history of this tumor is similar to that of the bronchogenic small cell carcinoma. Several theories of histogenesis have been proposed. Most widely accepted view is that SCCP arises from pluripotent stem cells of the prostate, which have the ability to differentiate into either epithelial or neuroendocrine type carcinomas. SCCP has an aggressive course, and a majority of patients have distant metastasis at presentation. Since it is a rare entity, no standard treatment regimen has been established. A case of primary pure SCCP with multiple subcutaneous metastases is presented.

Serum, urinary and stone zinc, iron, magnesium and copper levels in idiopathic calcium oxalate stone patients.

Many theories have been put forward to explain the mechanism of stone formation and growth. The aim of this study was to investigate the urinary, serum and stone levels of zinc, iron, magnesium, and copper in patients with calcium oxalate stones and to investigate urinary and serum element levels in healthy controls and to find a possible connection between the elements and calcium oxalate stone formation. A total of 104 patients with calcium oxalate stones ranging in age from 3 to 79 years (mean 44.0 +/- 18.1) and 77 healthy controls ranging in age from 18 to 77 (mean 44.2 +/- 17.9) were included in this study. The mean urinary iron and copper levels in stone patients were significantly higher than healthy controls (P = 0.000). The mean urinary zinc and magnesium levels in healthy controls were significantly higher than stone patients (P = 0.000). There was no significant difference in the serum levels of magnesium and copper in stone patients and healthy controls. Serum zinc and iron level were significantly high in healthy controls as compared to stone patients. Each stone had all 4 elements. Zn and Mg have inhibitory effect on calcium oxalate stone formation. Fe and Cu could be promotor of the calcium oxalate stone formation.

Giant unilateral abdominoscrotal hydrocele in an adult: case report.

Abdominoscrotal hydrocele (ASH) is an apparently highly uncommon clinical entity especially in childhood. While hydrocele is among the commonest inguinal anomaly in adult, its extreme form ASH is infrequently reported form. ASH consists of two large sacs, both abdominal and scrotal, connecting with the inguinal canal. Surgical correction is mandatory. We present a 34-year-old man with giant ASH. He was treated with excision of hydrocele sac through an inguinal approach.

Renal angiomyolipoma with malignant transformation, simultaneous occurrence with malignity and other complex clinical situations.

Renal angiomyolipoma is a benign kidney tumor, which is characterized by the presence of mature or immature fat tissue, thick-walled blood vessels, and smooth muscles. However, there is a rare possibility of transformation to a malignancy. This transformation could be toward sarcoma. And also angiomyolipoma could be associated with renal adenocarcinoma in the same kidney. The aim of this study is to show the association of angiomyolipoma with complex clinical situations such as malign transformation, simultaneous occurrence with adenocarcinoma, bilateral tumors with tuberous sclerosis or Wunderlich Syndrome. Findings of clinical presentation, pathological evaluation, urography, ultrasonography, and computerized tomography of 19 patients who were diagnosed angiomyolipoma in our clinic during 1994-2003 were examined retrospectively. Our records indicated that radical nephrectomy was performed in three cases of angiomyolipoma in which the differential diagnosis from adenocarcinoma could not be made and in another case of angiomyolipoma, which was associated with adenocarcinoma. Simple nephrectomy was performed in four symptomatic angiomyolipoma cases with tumor size larger than 4 cm and partial nephrectomy in another case. In one case, renal angiomyolipoma was associated with adenocarcinoma in the same kidney. In one case, post-operative recurrence of angiomyolipoma developed 7 months after nephrectomy. This patient was diagnosed low-grade leiomyosarcoma. Angiomyolipoma is regarded as a benign tumor of the kidney; however, it may also show aggressive behaviors and rarely transform to sarcoma. It may also exist in the same kidney along with adenocarcinoma or sarcoma.

Giant prostatic urethral calculus associated with urethrocutaneous fistula.

Urethral stones in men are rare clinical entity and most of them migrate from the urinary bladder. Urethral stones are rarely formed primarily in the urethra and are usually associated with urethral strictures or diverticula. We report a 41-year-old man with giant prostatic urethral stone (5.9x3.2x2.8 cm) associated with a urethrocutaneous fistula. The etiological factors, pathogenesis, clinical presentation, complications and management of giant urethral calculi are reviewed.

Multiple primary malignant neoplasms in urologic patients.

METHODS: Second primary cancers constitute approximately 9-10% of malignancies diagnosed in the United States. We aimed to show the risk and incidance of second primary tumor occuring associated to urologic tumors and show the distrubution of tumors in Tracia region. We retrospectively examined the patients' files with the diagnosis of malignant disease between the years 1985-2000. Hazard function analysis was performed to estimate the relative risk of secondary malignancy occuring. Age, sex and tumor number were examined to find out if they affect on mortality rate. RESULTS: A total number of 25 MPMNs were diagnosed. In 52 percent of the cases the second primary neoplasm developed within six months. The relative risk of development of a second neoplasm is found as increasing 1.111 times per month. The incidence of secondary malignancy occuring in the patients with one tumor was found as 6.31%. Age (p < 0.001) and tumor number (p < 0.001) are found as statistically effective predictor on mortality rate where the sex is not. CONCLUSIONS: In the patients with a primary tumor not only the metastasis must be investigated but also second primary tumors should be taken into consideration.

The use of human dura mater as an interposition graft in the treatment of vesicovaginal fistula.

PURPOSE: In this prospective study we aimed to describe our new technique; dehydrated human dura mater as an interposition graft in patients undergoing benign vesicovaginal fistula repair (VVF). PATIENTS AND METHODS: Eleven patients with benign VVFs aged 38-73 years were operated with dura mater interposition technique at our institution between July 1996 and February 2002. In all patients fistula were secondary to abdominal hysterectomies with benign diseases and two had undergone previous transvaginal surgery. Patients were operated 8-15 (mean 12) weeks after previous surgery. A suprapubic cystotomy was performed and the fistula was not excised. The bladder wall is widely dissected from underlying vagina. Dura-mater was placed over the vaginal suture line to close the fistulous tract, cytostomy was inserted and the bladder was closed. An 18 F Foley catheter was left in the bladder for 5 days. A successful repair is defined as no leakage by cystogram at 14 days postoperatively and completely dry by patient report. RESULTS: An overall success rate of 100% was achieved in all patients. All patients remain dry at the follow-up which ranges from 7 to 60 (mean 26) mounts. Patients were discharged at 14 to 26 (mean 16) days postoperatively. No major complications or side effects were observed during the follow-up period. CONCLUSIONS: The use of human dura mater as an interposition graft in the treatment of vesicovaginal fistula is an alternative for VVF repairs because of its excellent tissue compability, stability, good elasticity and absorbability.

Chondrosarcoma of the pubis imitating bladder tumor radiologically: a case report.

Chondrosarcoma is a rare tumor that more frequently involves the pelvic bones, the femur, and the humerus. The rareness of the tumor makes the diagnosis difficult. Malignant cartilage tumors typically have an unstable radiographic appearance. In this report we aimed to point out the difficulties of the radiological differentiation of the pelvic chondrosarcoma and bladder tumor.

A life-threatening infection: Fournier's gangrene.

Fournier's gangrene is a life-threatening disorder in which infection of the perineum and scrotum spreads along fascial planes, causing soft tissue necrosis. If urgent surgery is delayed, the disease will soon result in septic shock, multiorgan failure, and death. In this study, we present 21 patients with Fournier's gangrene who were treated in period between 1994 and 2001. Patients' charts were reviewed retrospectively and are discussed in the light of literature. All patients received aggressive surgical debridment. Penicillin or Ceftriaxone, aminoglicoside and metronidazole were administered intravenously. Of the 21 patients, 5 had scrotal carbuncle, 1 had urethral stricture, 1 had chronic indwelling urethral catheterization, 2 had perirectal abscess, and 1 had hemorrhoidectomy. In eleven patients we couldn't identify any cause. Twelve patients had diabetes mellitus, and two had chronic alcoholism. Escherichia coli was isolated in 12 purulent tissue cultures, and Bacteroides fragilis in eight. Seventeen patients survived, whereas four died. Fourier's gangrene is considered a surgical emergency. Early surgical intervention is essential, as the gangrene can spread rapidly at rates reaching 2 mm per hour. So that Fournier's gangrene is an abrupt, rapidly progressive, gangrenous infection of the external genitalia and perineum and is a real urologic emergency.