Internal pudendal artery stenoses and erectile dysfunction: correlation with angiographic coronary artery disease.

OBJECTIVES: To describe the angiographic characteristics of pelvic arterial disease in patients with erectile dysfunction (ED) nonresponsive to phosphodiesterase-5 inhibitors (PDE5i) and suspected coronary artery disease (CAD). BACKGROUND: ED and CAD share common risk factors which can result in endothelial dysfunction, atherosclerosis and flow-limiting stenoses in the coronary and internal pudendal arteries. METHODS: Ten patients undergoing cardiac catheterization with ED and a history of unsatisfactory response to a PDE5i were studied. ED severity was quantified using the International Index of ED scoring system. We performed angiography and quantitative vessel analysis of the coronary arteries, bilateral common and internal iliac arteries, and internal pudendal arteries (IPAs). RESULTS: In this pilot observational study, we found a high correlation between the presence of angiographic CAD and IPA disease. The reference IPA diameters at the point of maximal stenosis were 2.7 ± 0.4 mm (right IPA) and 2.7 ± 0.5 mm (left IPA). In the nine patients with IPA disease, the average stenosis severity was 55 ± 31% (right) and 66% ± 25% (left), and average lesion length was 12.4 ± 5.2 mm (right) and 10.0 ± 3.5 mm (left). Four patients had unilateral IPA total occlusions, three of whom had moderate contralateral disease. The majority of IPA stenoses occurred in the mid to distal IPA and appears amenable to percutaneous revascularization. CONCLUSIONS: This represents the first angiographic report of CAD correlated with IPA disease in patients with ED. Further investigation is required to determine whether the development of macrovascular disease in the IPA causes ED and whether endovascular treatment is safe and effective in this population.

Granular cell tumor of the urinary bladder with pseudoepitheliomatous hyperplasia and colocalization with adenocarcinoma.

Granular cell tumor of the bladder is exceptionally rare, with only 11 cases reported in the published reports. Pseudoepitheliomatous hyperplasia of the overlying squamous epithelium has been observed in non-bladder granular cell tumors. We herein report the first case of bladder granular cell tumor to exhibit pseudoepitheliomatous hyperplasia. This phenomenon is significant as it may potentially lead to difficulty in the distinction between infiltrative squamous cell carcinoma and pseudoepitheliomatous hyperplasia in cases of granular cell tumor of the bladder. This case also represents the first granular cell tumor to demonstrate colocalization with adenocarcinoma of the bladder. Based on our findings and a review of the published reports, management for granular cell tumor of the bladder should involve a course of local resection combined with active surveillance given its typical benign course, albeit with the potential for local recurrence.

Penile paraffinoma: the delayed presentation.

The injection of foreign substances into the penis for the purpose of augmentation may result in erectile dysfunction, voiding difficulties, and severe deformity. We report a case of penile paraffinoma in a 71-year-old man that developed nearly 40 years after undergoing a series of penile injections with an unknown substance. Penile paraffinoma can therefore present a diagnostic dilemma given its protracted latency period, after which time the initial injections have faded into distant memory.

Clinical interpretation of the prostate biopsy.

Pathologic evaluation of the prostate biopsy provides the clinician with a wealth of information. Identifying needle biopsy parameters predictive of pathological stage and tumor volume at radical prostatectomy has become a major focus in the field of prostate pathology. From a review of the literature, the following factors are strongly predictive of extraprostatic disease; tumor involvement of greater than 25%, greater than two positive cores, cancer involvement greater than 3 mm, and perineural invasion. Such information could prove useful in patient counseling and identifying high-risk patients who may be good candidates for adjuvant therapy trials.

Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases.

Just two and a half decades ago adult renal cell neoplasms, i.e., those arising from the renal tubules or collecting duct epithelium, were subdivided into two major subtypes: "clear cell carcinoma" and "granular cell carcinoma." Subsequent detailed morphologic and/or cytogenetic studies have resulted in the recognition of several distinctive subtypes of adult renal epithelial neoplasms, which has led to the promulgation of a refined contemporary histologic classification of these tumors. This study examines the prognostic significance of histologic subtyping in accordance with the new classification in a consecutive series of 405 cases treated at a single institution. Cases were histologically classified into 28 (7%) benign tumors [27 (6.7%) renal oncocytomas, 1 (0.2%) metanephric adenoma] and 377 (93%) malignant tumors [255 (63%) conventional (clear cell) renal cell carcinoma, 75 (18.5%) papillary renal cell carcinoma, 24 (5.9%) chromophobe renal cell carcinoma, and 23 (5.7%) renal cell carcinoma, unclassified]. A total of 25 (6.6%) malignant tumors showed evidence of sarcomatoid change. Kaplan-Meier survival analysis with log-rank test showed histologic type (p = 0.002), Fuhrman's nuclear grade (p = 0.001), TNM stage (p = 0.001), vascular invasion (p = 0.001), and necrosis (p = 0.001) to be significantly associated with disease-specific survival and progression-free survival, based on follow-up of 368 patients (mean 64.5 months, median 56 months). The 5-year disease-specific survival for chromophobe renal cell carcinoma, papillary renal cell carcinoma, conventional (clear cell) renal cell carcinoma, and renal cell carcinoma, unclassified was 100%, 86%, 76%, and 24%, respectively; no patient with a benign tumor diagnosis progressed or died of disease. The 5-year progression-free survival for chromophobe renal cell carcinoma, papillary renal cell carcinoma, conventional (clear cell) renal cell carcinoma, and renal cell carcinoma, unclassified was 94%, 88%, 70%, and 18%, respectively. Malignant tumors with sarcomatoid change had a 35% and 27%, 5-year disease-specific and progression-free survival, respectively. Cox proportional hazards regression analysis showed TNM stage (p = 0.001), nuclear grade (p = 0.01), and necrosis (p = 0.05) to be significant predictors of disease-specific survival. In conclusion, our study shows that the histologic categorization of adult renal epithelial neoplasms performed by routine light microscopic hematoxylin and eosin-based examination in accordance with the contemporary classification scheme has prognostic utility.