Penile cancer: prognostic and predictive factors in clinical decision-making.

Penile cancer (PC) is a typical tumor of non-industrialized countries. The incidence is 20-30 times higher in Africa and South America, considering the elevated prevalence of sexually transmitted diseases. Histologically, PC includes squamous cell carcinoma (SCPC), the most frequent, and nonsquamous carcinoma (NSCPC). Early diagnosis is the goal, whereas later diagnosis relates to poor functional outcomes and worse prognosis. The 5-year survival rate is 85% for patients with histologically regional negative lymph nodes, compared to 29%-40% for those with histologically regional positive lymph nodes. To date no new drugs are approved, and there are few new data about molecular mechanisms underlying tumorigenesis. The SCPC remains a rare tumor and the current therapeutic algorithm is based principally on retrospective analysis and less on prospective trials. In this review article, biomarkers of prognosis and efficacy of current treatments are summarized with a focus on those that have the potential to affect treatment decision-making in SCPC.

Advanced/metastatic bladder cancer: current status and future directions.

In 2015 bladder cancer was the fourth most frequent malignancy and the eighth cause of death for cancer. At diagnosis, about 30% of bladder cancer (BC) patients present a muscle-invasive bladder cancer (MIBC) and 5% a metastatic bladder carcinoma (MBC). For fit MBC patients, combination chemotherapy (CC) is the standard of care for first-line treatment. CC includes both the treatment with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) either the classical or the dose-dense MVAC regimen, and the doublet therapy with cisplatin and gemcitabine (CG). Median progression free survival (PFS) was 7 months and median overall survival (OS) was 15 months. The present review provides an update on the management of MBC, with focus on target therapies, immune checkpoint inhibition, looking for prognostic and predictive factors.

[Retroperitoneal dedifferentiated liposarcoma (DDLS) with hyperglycemic activity: case report and literature review]. / Liposarcoma dedifferenziato retroperitoneale con attivita ipergligemica: caso clinico e review della letteratura.

The authors describe a Retroperitoneal De Differentiated LipoSarcomas (DDLs), that for its clinical behavior shows peculiar characteristics and original aspects: typical is the recurrence due to local invasiveness, but absolutely original seems to be the surviving time, maybe correlated to its histological evolution (dedifferentiation from leiomyosarcoma to liposarcoma) and an interesting correlation from the tumor recurrence and the glycemic curve first and after the surgical treatments. A 66-year-old woman, presenting typically with very big abdominal masses, treated three times in almost three years, every time with aggressive surgical treatments. Histological response was leiomyo-sarcoma in the first two operations and liposarcoma in the last treatment and in every preoperative phase the patient, normally prediabetic, started to have problem of glycemia balancing, needing an insulin support until the postoperative phases when its glycemia was coming back in normal value without insulin needs, of course until a new tumor recurrence. This last aspect, not depending on pancreas involvement or hormonal activity (immune-histo-chemistry was never conforming a neuro-endocrine activity), seems probably due directly to a mass and metabolic effect of the tumor. Beginning from the description of this case and its interesting biology and reviewing most of the literature on the argument, authors hope to give our support to still debated and partially unknown aspects of these kinds of tumors.

Biliary tract injuries during laparoscopic cholecystectomy: three case reports and literature review.

INTRODUCTION: Biliary tract injuries (BTI) represent the most serious and potentially life-threatening complication of cholecystectomy. During open cholecystectomies (OC), the prevalence of bile duct injuries has been estimated at only 0.1-0.2%. We report 3 cases of BTI during laparoscopic cholecystectomy (LC). CASE 1: Ascalesi Hospital, Naples 2003-2007, 875 LC (BTI 0,11%). During the dissection of triangle of Calot a partial resection of biliary common duct was made. Immediately the lesion was evident and sheltered in laparoscopy, suturing with a spin reabsorbable, without biliar drainage. The post-operative outcome was good, without alteration of the some parameters, and the patient was discharged after three days. At the last follow-up (January 2006) the cholangiography didn't show stricture or leakage. CASE 2: General and Laparoscopic Surgical Unit San Giovanni di Dio Hospital Frattamaggiore 2004-2007, 720 LC (BTI 0,13%). Patient affected by cholecystitis with gallstones. The patient did not present jaundice, but abdominal pain, leucocitosis, fever and US evidence of parietal gallbladder inflammation. LC was performed after 36 h; during operation, common biliar duct was misidentified for subverted anatomy caused by inflammation. The common bile duct was clipped, and the patient presented jaundice after three days after operation. The colangiography was performed showing the stop. Therefore a reoperation was needed and laparotomic Roux-en-Y hepaticojejunostomy was performed. CASE 3: Dpt of Emergency Surgery, Second University of Naples 2000-2007, LC 520 (BTI 0,19%). Patient affected by more than 20 years symptomatic cholelithiasis, with only obesity risk factor; she underwent laparoscopic cholecystectomy and sudden bleeding of the cystic artery, poor vision and probably the long history of symptoms, producing a flogistic alteration of the anatomy, caused a misidentification of the cystic duct and the common bile duct with complete or lateral clipping of the common hepatic duct. The error was unrecognized intra-operatively but after progressive jaundice the postoperative colangiography showed a nearly complete stop by two clips. Roux-en-Y hepaticojejunostomy with intraoperative cholangiographic control was performed. DISCUSSION: The most common cause of BTI is the failure to recognize the anatomy of the triangle of Calot. This is attributed to factors inherent to the laparoscopic approach, to inadequate training of the surgeon and to local anatomical risk factors. The laparoscopic "learning curve" of the surgeon is the most important factor of bile ducts injury. But also local anatomical risk factors are important such as acute cholecystitis, severe chronic scarring of the gallbladder and bleeding or excessive fat in the hepatic hilum. These local risk factors seem to be present in 15% to 35% of BTI. Abnormal biliary anatomy, such as a short cystic duct or a cystic duct entering into the right hepatic duct also may increase the incidence of BTI. Schematic representation of the common mechanisms of BTI during LC are: misidentification of the cystic duct and the common biliary duct, lateral clipping of the common biliary duct, traumatic avulsion the cystic duct junction, diatermic injury of common biliary duct during dissection of the Calot triangle or during the cholecystectomy, injury of anomalous right hepatic duct. CONCLUSION: Conversion to laparotomy, in difficult cases involving inflammatory changes, aberrant anatomy or excessive bleeding, is not to be considered as a failure but rather as good surgical decision in order to ensure the patient's safety.

[Inflammatory pseudotumor of the bladder: etiopathologic and clinical features]. / Pseudotumore infiammatorio vescicale: aspetti etiopatologici e clinici.

The Authors present a case of inflammatory pseudotumour (IPT) of the urinary bladder occurring in a 57-year-old female patient, who was referred to our department with haematuria, stranguria and hypogastric pain. Ultrasonographic, radiological and endoscopic examinations showed a sessile, ulcerated, easily bleeding bladder formation; urinary cytology revealed no atypical transitional cells. Abdomino-pelvic computed tomography analysis showed thickening of the bladder walls and infiltration of the perivesical fat. Histopathologically, the formation was indicated as an inflammatory pseudotumour (IPT) of the bladder. The patient underwent TURB (transurethral resection of the bladder) and was discharged clinically healed on postoperative day 4. A one-year follow up revealed no evidence of recurrence. On the basis of their experience and a thorough review of the literature review, the Authors discuss the clinico-pathological features of IPT of the bladder and the possible factors involved in the malignant transformation of IPT. In conclusion, the benign nature of the lesion is stressed.

["Difficult" venous ulcers of the legs]. / Le ulcere venose "difficili" degli arti inferiori.

The aim of the study was to analyze the diagnostic and surgical criteria in cases of "critical" venous leg ulcers. This report describes the management of 200 patients with trophic lesions of the lower limbs. Patients with venous leg ulcers were identified with the aid of ultrasonography and echocolor Doppler. Among these patients, according to the chronic evolution of the lesions, we identified all those with critical venous leg ulcers. The management of the lesions involved both medical and fairly aggressive surgical treatment with the use of general anaesthesia and deep surgical toilette of the ulcer. In the cases with poor epithelialisation we adopted oxygen therapy and skin grafts using the "mesh graft" technique. Critical venous leg ulcers were identified in 23 patients (19%). After surgical treatment, we observed complete epithelialisation of the lesion only in 5 cases (21.7%). In 13 patients (56.6%) the use of oxygen therapy was necessary and epithelialisation occurred on postoperative day 12. Skin grafts were used in 5 cases (21.7%). Only one recurrence was observed one year after operation in an area adjacent to the site of the graft. The "golden goal" of critical venous leg ulcer management is to establish a correct aetiological diagnosis, distinguishing between venous leg ulcers and other trophic lesions of the lower limbs. The medical and surgical treatment described in this report reduce healing time and the social costs of the disease, without any significant complications for the patient.