Testicular neuroendocrine tumor in a 32-year-old man: A case report.

Key Clinical Message: A 32-year-old male with painful scrotal swelling who underwent radical orchiectomy and was diagnosed with a testicular neuroendocrine tumor. Determining whether testicular neuroendocrine tumor is primary or metastasis from another origin is crucial. Abstract: Testicular neuroendocrine tumors (TNET) are one of the rarest human neoplasms, with about 132 identified cases until 2015. Testicular neuroendocrine tumors are frequently manifest with painless scrotal swelling or mass. In this study, we present a 32-year-old male with a chief complaint of painful progressive swelling of the right testicle without any history of trauma. All laboratory tests were within the normal range. Ultrasound revealed two hyper-vascular masses in the right testicle. Computed tomography was performed, and patients had no evidence of metastases. The patient underwent right radical orchiectomy, and a histopathological examination diagnosed the specimen with a well-differentiated testicular neuroendocrine tumor. Because of the rarity of TNET, there are many controversial issues in the treatment, especially in cases with metastatic TNET. Determining whether testicular neuroendocrine tumor is primary or metastasis from another origin is crucial. Further studies are required to achieve optimum treatment for TNET.

Cushing's syndrome as a paraneoplastic feature of renal cell carcinoma: A case report.

Cushing's syndrome has been believed to be a paraneoplastic syndrome of renal cell carcinomas. However, there appears to be a dearth of compelling evidence to substantiate this notion. The only eligible documentation of Cushing's syndrome due to ectopic adrenocorticotropic hormone secretion by renal cancer in English literature dates back to 1988, and it pertains to a deceased patient discovered during an autopsy. Here, we present the first case of Cushing's syndrome as a paraneoplastic feature of renal cancer which showed complete resolution following surgical removal of the tumor. Additionally, we conduct review of the literature on this particular subject.

Pharmaceutical industry funding and chemotherapy trials for prostate cancer: A systematic review.

INTRODUCTION: Clinical trials are increasingly supported by industries while previous studies have shown that industry-supported studies have more favorable results than studies with other sources of funding. In the present study, we investigated the association of industrial funding on the results of clinical trials regarding chemotherapy in prostate cancer. METHODS: A systematic literature search was performed in the Cochrane Library, MEDLINE, and EMBASE to identify clinical trials comparing chemotherapy with treatments such as hormone therapy, surgery, radiotherapy, and placebo in patients with metastatic or non-metastatic prostate cancer. Data were extracted by two reviewers on the financial resources and the positive or negative results of chemotherapy in each study. The quality of articles was evaluated and compared based on Cochrane Critical Appraisal Tool. The trials were divided into two groups; industry funded and those not funded by industry. Association of industry funding and positive outcome was presented as odds ratio. RESULTS: In this study, out of the 91 studies, 80.2% were funded by pharmaceutical companies and 19.8% were funded by government agencies. The end result of 61.6% of the studies funded by pharmaceutical companies was an increase in survival due to chemotherapy, whereas only 27.8% of the studies sponsored by government agencies reported positive results (P-value=0.010). In fact, industry-funded trials more often presented statistically significant positive results for survival (OR: 4.17; CI, 1.34-12.99). In general, there was no significant difference in the degree of bias between the two groups. CONCLUSION: According to this study, despite of the similar quality of studies funded by pharmaceutical companies and government agencies, positive results were more common in studies related to pharmaceutical companies. Therefore, this point should be taken into account when making a decision on the best treatment approach.

Acute left side varicocele as primary presentation of renal cell carcinoma.

A 68-year-old man was referred with acute left side varicocele scrotum. Abdominal computed tomography showed a mass lesion in left kidney. The patient underwent radical nephrectomy. Microscopic histopathology confirmed the diagnosis of renal cell carcinoma. The majority of varicocele have a non-pathological etiology but acute varicocele may indicate retroperitoneal mass.

Simultaneous Bilateral Testicular Metastases from Renal Clear Cell Carcinoma: A Rare Presentation in Von Hippel-Lindau disease.

In this article, we present a Von Hippel-Lindau (VHL) patient with synchoronus bilateral testicular metastasis from renal cell carcinoma (RCC). A 50 year-old man, a known case of VHL syndrome was referred with palpable masses in both the testes. His medical history demonstrated that he had undergone the brain surgery for cerebellar hemangioblastoma. He had undergone simultaneous Whipple's pancreatectomy and left radical nephrectomy becuase of well-differentiated neuroendocrine tumors in head and body of the pancreas and a 6-cm clear cell-type grade-3 RCC in the left kidney. Scrotal sonography demonstrated vascular and heteroechogen masses measuring 19×14 mm in lower pole of the right testicle, 19×16 mm in upper pole of the right testicle, and 23×16.5 mm in upper pole of the left testicle. After having patient's consent, bilateral orchiectomy was performed by inguinal incision. Histopathologic examination and immunohistochemistry staining revealed metastasis from RCC. The most common neoplasm of reproductive system in VHL patients is epididymal papillary cystadenoma. Owing to it's benign nature, the management is conservative with routine physical examination and ultrasonography. Our patient indicated that every scrotal mass in patients with VHL is not to be considered as epididymal papillary cystadenoma.

Castleman disease mimicking an adrenal tumor: A case report.

Castleman disease is a benign complex lymphoproliferative disease. The most common site is the mediastinum. In this paper, we present a case of Castleman disease in the adrenal gland, as a very rare region. A 29-year-old woman was referred to our clinic due to a well-defined right adrenal mass. She underwent laparoscopic adrenalectomy with the transperitoneal approach. Microscopic histopathology confirmed the hyaline vascular type of Castleman disease. In conclusion, Castleman's disease, as a rare disorder, must be considered in the differential diagnosis of an adrenal mass especially in cases with an enhancing well-defined, nonfunctional solid adrenal mass with lymphadenopathy.

Quality assessment of case reports in high-impact urology journals using SCARE guideline.

BACKGROUND AND AIMS: The usefulness of case reports is dependent on the complete, consistent, and rigorous reporting of these cases. In order to provide a standard guideline for reporting surgical case reports, the SCARE (Surgical CAse REport) guidelines were developed in 2016. The present study evaluated the completeness and transparency of published case reports in high-impact urology journals based on the SCARE guideline. METHODS: This cross-sectional study was performed on 100 case reports published in Urology, Urology Journal, BMC Urology, and Urology Case Reports journal. Two independent reviewers performed the scoring using the last version of SCARE statement. Each of the 34 items of SCARE guideline were classified as "yes" if the item was reported in the case report text. The SCARE items were classified as "no" when the authors of case reports had not reported that item or could not tell something about reporting the item. Completeness of reporting (COR) score was calculated for each case report. COR score (%) is defined as ["yes" answers/("yes" answers + "no" answers)] × 100 for each case report. RESULTS: The mean COR score for all the assessed case reports was 49%, ranging from 21% to 79%. Topics with the highest mean COR score were introduction (77% ± 42%), additional information (75% ± 43%), patient information (65% ± 19%), and abstract (66% ± 24%). In contrast, topics with the lowest mean COR were patient perspective (1% ± 10%) and keywords (3% ± 17%). CONCLUSION: The present study showed that case reports published in urology journals suffer from insufficient reporting. SCARE or CARE guidelines can provide a framework for assessing the reporting quality of case reports before publication. Nevertheless, further studies are highly recommended to better evaluate the efficacy of these guidelines' endorsement on the quality of case reports published in urology journals.

Xanthogranulomatous cystitis mimicking bladder tumor: A case report.

Xanthogranulomatous inflammation, as a type of chronic granulomatous inflammation, typically occurs in the gall bladder and kidneys. In this paper, we present a 56-year-old man with Xanthogranulomatous cystitis mimicking bladder malignancy. He was referred to our clinic with the chief complaint of a one-year history of urgency and frequency. CT scan showed a solid lesion in the bladder. The patient underwent complete transurethral resection of the bladder tumor. Microscopic histopathology revealed xanthogranulomatous cystitis. The patient received a course of antibiotic therapy. Follow-up Cystourethroscopy showed normal bladder.

Best time to wait for the improvement of the sperm parameter after varicocelectomy: 3 or 6 months?

OBJECTIVE: To estimate the duration of time required following varicocelectomy to wait for the improvements of semen parameters. Therefore, we characterized the changes with the time in sperm parameters in men after varicocelectomy. MATERIALS AND METHODS: In this prospective cohort study we included consecutively observed men who underwent varicocelectomy between September 2017 and September 2018 in a referral academic hospital. Clinical data of the patients, as well as their semen parameters, were measured before surgery and at 3 and 6 months afterward. RESULTS: In this study, a total of 100 men with average age of 29.5 ± 6.2 years were included. Mean sperm concentration and sperm motility significantly improved by 3 (p < 0.05), but not by 6 months following varicocelectomy. The semen volume and sperm with normal morphology were the same before and after surgery (p > 0.05). There was no statistically significant difference in the improvement of semen parameters when comparing 6 months to 3 months postoperatively (p > 0.05). CONCLUSIONS: Sperm parameters (concentration and motility) improve by 3 months after varicocelectomy without further improvements. Consequently, physicians should decide quickly after 3-month of varicocelectomy if surgery has been not helpful and then plan other therapies, like assisted reproductive technology (ART) for managing infertility in couples.

Bladder Lymphangioma Treated by Holmium Laser: Extremely Rare Case Report.

Introduction: Lymphangioma is a sporadic benign tumor of the bladder. It is a congenital disorder and based on the size of lymphatic spaces, it is divided into 3 types of capillary, cavernous, and cystic. Case Report: In this paper, we presented a 40-year-old woman with microscopic hematuria and a normal urinary ultrasound. Urethrocystoscopy showed a flat 4 mm highlighted strawberry-like lesion on the right lateral wall of the bladder. After a cold cup biopsy, the lesion was coagulated by the holmium: YAG (Ho: YAG) laser. Conclusion: In Bladder Lymphangioma Based on the size of the lesion, partial cystectomy or minimally invasive surgeries such as laser modality would be the principal treatment.

Spontaneous Retroperitoneal Hematoma and Membranous Glomerulonephritis; a Case Report.

Spontaneous retroperitoneal hematoma (SRH) is a rare finding which is usually accompanied with anticoagulant and/or antiplatelet aggregation therapy. We describe a patient with a rare presentation of SRH and membranous glomerulonephritis with diffuse visceral arterial micro aneurysms due to medium to small size vasculitis and weakly positive antinuclear antibody (ANA). To the authors' knowledge, this is a unique report, which does not have any serologic confirmation of specific vasculitis.

Vaginal bleeding as primary presentation of renal cell carcinoma.

Vaginal metastases from renal cell carcinoma has been recorded as extremely rare. We present a patient with vaginal bleeding as primary manifestation of renal cell carcinoma. A 40-year-old woman presented to a local private clinic with intermittent vaginal bleeding for approximately one month. Gynecological examination revealed a mass on the vaginal wall at approximately 8 o'clock. She underwent dilation and curettage (D&C) and mass excision. Microscopic histopathology and immunohistochemical stains showed vaginal metastases of clear cell RCC. The patient was referred to our urology clinic. Magnetic Resonance Imaging (MRI) of abdomen and pelvic showed a well-defined solid mass lesion measuring 16 × 12 × 11 cm in left kidney. Patient underwent left side radical nephrectomy through a left subcostal intraperitoneal incision. Histopathological results and metastasis workup confirmed the diagnosis of RCC with solitary metastatic vaginal lesion. After radical nephrectomy, she was treated with Sunitinib. No local relapse or distant metastasis was recognized 5 months after radical nephrectomy. In conclusion, the incidence of RCC metastasis to the vagina is extremely rare; but, in cases of vaginal bleeding or lesions we have to keep in mind the possibility of metastatic RCC.

A systematic review and meta-analysis on incidence of prostate cancer in Iran.

Background: Prostate cancer is a global health concern. In Iran, its epidemiology is not precisely recognized. We aimed to evaluate incidence of prostate cancer among Iranian populations. Methods: In this systematic review, we searched the databases PubMed, Web of Sciences, Scopus and Google Scholar for English studies and the databases Magiran, Scientific information Database, IranMedex and IranDoc for Persian studies, using related keywords. The cross sectional articles published from inception to 31 December 2018 were included. Meta-analysis was conducted on the collected data with STATA software using random effects model. Results: Out of 763 articles initially obtained, 9 articles were finally included after applying the predefined exclusion criteria. Analysis of 9 studies on the incidence of prostate cancer showed a crude rate of 7.1 per 100000 population (95% confidence interval [CI]: 5.6-8.6). Also, the pooled age-standardized incidence rate was 8.7 per 100000 (95% CI: 6.7-10.4). Studies performed in the period 2004-2012 had significantly a higher pooled estimate of the crude incidence rate (9.2 per 100000 [95% CI: 7.9-10.4]) compared with those conducted in the period 1996-2003 (4.5 per 100000 [95% CI: 2.8-6.2]). This trend was also observed based on the age-standardized incidence rate (11 per 100000 [95% CI: 9.4-12.5] versus 6.3 per 100000[95% CI: 4-8.5]). Conclusion: Despite low rate of prostate cancer occurrence in Iran, it is recommended that preventive measures be taken against this disease by health policymakers. Also, more epidemiological studies are needed to better find out the pattern of prostate cancer among Iranian populations.

Does inhibin-B help us to confidently refuse diagnostic testicular biopsy in azoospermia?

BACKGROUND: In the recent years, the use of laboratory blood factors such as FSH and inhibin-B for the assessment of spermatogenesis in different studies has increased; of course, the conflicting results have also been achieved. OBJECTIVE: To investigate if the measurement of inhibin-B can help surgeon to reduce unnecessary diagnostic testicular biopsies in males with azoospermia. MATERIALS AND METHODS: This cross-sectional study was done during July 2006 to September 2007 on 41 patients with azoospermia. FSH and inhibin-B were measured and bilateral open testicular biopsy was performed for all patients. RESULTS: Sperm was seen in 29% of biopsies that in 100% of these samples inhibin-B was more than 100 pg/mL and FSH was less than twice the normal (p=0.001). Inhibin-B had significant correlation inversely with testicular fibrosis and Sertoli cell only syndrome (p=0.043 and p=0.011, respectively) and directly with incomplete spermatocytic maturation arrest and obstructive azoospermia (p=0.027 and p=0.013, respectively). FSH was only correlated with obstructive azoospermia (p=0.001). CONCLUSION: We suggest that if FSH is less than twice the normal, inhibin-B should be measured and if its level is less than 100 pg/mL, we can cancel about the half of unnecessary diagnostic testicular biopsies.

Safety and efficacy of clomiphene citrate and L-carnitine in idiopathic male infertility: a comparative study.

PURPOSE: To compare the effects of L-carnitine with clomiphene citrate in idiopathic infertile men. MATERIALS AND METHODS: Fifty-two men with idiopathic infertility were recruited in this randomized controlled trial. They were randomly assigned into 2 treatment groups, group 1 (n = 20) and group 2 (n = 32), who received L-carnitine 25 mg/day and clomiphene citrate 2 gr/day, respectively, for a period of 3 months. RESULTS: Comparing the effect of L-carnitine and clomiphene on sperm parameters before and after the treatment, both medications had influence on sperm count and motility (P = .01). L-carnitine significantly increased the semen volume (P = .001), while clomiphene citrate was significantly associated with the motility percentage and normal morphology (P = .008). CONCLUSION: It seems that the use of clomiphene citrate and L-carnitine, either individually or in combination, as the first step of idiopathic male infertility treatment is reasonable, safe, and effective.

Prostate-specific antigen doubling time as a predictor of Gleason grade in prostate cancer.

INTRODUCTION: Our aim was to evaluate the value of serum prostate-specific antigen doubling time (PSADT) to identify patients with high-grade prostate cancer who require more aggressive therapy from those with low-grade cancer. MATERIALS AND METHODS: Of 460 patients with extended 12-core transrectal ultrasonography-guided biopsy of the prostate, 59 with confirmed prostate cancer were selected. They had not received any previous treatment for prostate cancer and had at least 2 consecutive serum PSA tests with a rising trend. The PSADT was calculated in patients with 2 serum PSA levels measured with an interval more than 3 months. RESULTS: Of 59 patients with prostate cancer, 35 (59.3%) had low-grade and 24 (40.7%) had high-grade tumors. There was no difference in age between the two groups. The median PSADT in patients with high-grade and low-grade tumors were 12.70 months (range, 0.7 to 44.8 months) and 25.00 months (range, 1.65 to 41.2 months; P = .001). A total of 21 patients with high-grade tumors (87.5%) had a PSADT less than 12 months, while only 9 of those with low-grade tumors (25.7%) had a PSADT less than 12 months. A PSADT cutoff of 12 months provided a sensitivity of 74% and a specificity of 87% for differentiation of high-grade from low-grade cancers. CONCLUSION: We showed that men with a short PSADT (< 12 months) were at a higher risk of harboring a high-grade prostate cancer. Our data suggests PSADT to identify patients with high-grade tumors who require more aggressive therapy.

Pediatric cystine calculi in west of Iran: a study of 22 cases.

INTRODUCTION: Cystinuria is an autosomal recessive disorder which clinically presents as cystine calculi. In this study, we reviewed cystine calculi cases in the west of Iran to determine their common presentations and response to different therapeutic modalities. MATERIALS AND METHODS: Between 1999 and 2005, we had 22 pediatric patients (11 boys and 11 girls) with cystine calculi. The demographic characteristics and clinical data of the patients as well as the treatment results were reviewed. RESULTS: The mean age of the patients was 34.20 +/- 42.99 months (range, 4 to 156 months). They were followed for a mean duration of 23 months (range, 3 to 70 months). Thirteen patients (59.1%) had bilateral and 9 (41%) had unilateral kidney calculi. The sizes of the calculi were between 2 mm and 20 mm. Nine patients (41%) had renal atrophic changes and 1 (4.5%) had obstructive acute renal failure. Hydration and urinary alkalinization were administrated to all of the patients which yielded an excellent result in 54.5% and a poor response in 27.2%. Captopril started for 5 patients was effective only in 1. D-penicillamine had no favorable response. Extracorporeal shockwave lithotripsy was successful in 5 attempts and failed in 4. Surgical interventions were performed for 13 patients (59.1%) and 6 (27.2%) required more than 1 surgical operation. CONCLUSION: We recommend metabolic workup of childhood urolithiasis and appropriate medical management of its underlying disease. We also recommend minimally invasive urologic techniques including shockwave lithotripsy only when there are clear indications for nonmedical procedures.