Bilateral testicular lymphoma treated with chemotherapy and radiation without orchiectomy: complete response relapsed at 52 months in the vitreous humor.

We report the first detailed case of testicular lymphoma managed with chemotherapy and radiation without orchiectomy. A 60-year-old man with Stage II extralymphatic bilateral testicular lymphoma refused orchiectomy, but underwent cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy and radiation. He remained disease free for 52 months, when a solitary central nervous system relapse to the vitreous humor was diagnosed. The optimal therapy for testicular lymphoma is unclear but often includes orchiectomy with adjuvant chemotherapy and radiation. Stage I testicular lymphoma can be cured by surgery alone; however, the relapse rates for all stages of testicular lymphoma are high despite systemic therapy. For Stage II disease and higher, chemotherapy/radiation is recommended; orchiectomy may not be mandatory.

Overexpression of p53 in prostate carcinoma is associated with improved overall survival but not predictive of response to radiotherapy.

p53 gene mutations are among the most common specific genetic alterations in human cancer. Inactivation of p53 and subsequent protein accumulation has been implicated in a variety of human malignancies and associated with prostate cancer progression. In this study, we assessed p53 protein overexpression and gene mutations in prostate carcinoma and investigated associations between p53 alterations and clinicopathological parameters, survival, and response to radiotherapy. We evaluated 58 archival formalin-fixed, paraffin-embedded prostate carcinomas to detect abnormal p53 nuclear protein accumulation using immunohistochemistry. p53 mutational status of tumor DNA was evaluated using polymerase chain reaction-single-strand conformation polymorphism analysis of exons 5-9 and confirmed by direct DNA sequencing. Univariate and multivariate statistical analysis was used to determine the association of p53 status with clinical characteristics and response to radiotherapy. Overexpression of p53 was detected in 42 (72%) of 58 primary prostate carcinomas, but was undetectable in 7 samples of benign prostatic hyperplasias or 5 samples of normal prostate tissue. p53 exon 5-9 mutations were detected in 8 (14%) of 58 patient specimens. p53 mutational status, but not overexpression, was associated with higher Gleason scores (p=0.0145). Neither p53 overexpression nor mutation was associated with clinical stage, biochemical disease-free probability, or predictive of response to radiotherapy. p53 protein accumulation was inversely associated with improved overall survival (p=0.0108). Our studies demonstrate that p53 protein accumulation is a frequent alteration in prostate cancer. The disparity between p53 protein overexpression and p53 exon 5-9 mutations suggests the possibility of mutations outside this region or stabilization of wild-type p53 by alternative mechanisms. In our patient population, p53 protein overexpression or mutational status was not predictive of outcome in patients treated with radiation therapy. Additional studies are needed to further evaluate the association between p53 protein overexpression and improved overall survival.

Intravesical dimethyl sulfoxide for primary amyloidosis of the bladder.

Primary bladder amyloidosis is a rare disease. Treatment recommendations are necessarily anecdotal. We report a case of a 52-year-old woman treated successfully with intravesical dimethyl sulfoxide instillation.

Malignant pericardial effusion as initial solitary site of metastasis from transitional cell carcinoma of the bladder.

A patient is presented whose first and sole evidence of metastatic transitional cell carcinoma of the bladder was pericardial metastasis with life-threatening cardiac tamponade. Definitive diagnosis and management was achieved with fluid cytology and video-assisted thoracic surgical pericardial biopsy and pericardial window.

Intravesical bacillus Calmette-Guerin for the treatment of superficial transitional cell carcinoma of the prostatic urethra in association with carcinoma of the bladder.

Between 1981 and 1989, 83 male patients with stages Ta, Tis and T1 transitional cell carcinoma were treated with bacillus Calmette-Guerin (BCG). Of 17 patients with carcinoma in situ of the prostatic urothelium 13 had identifiable prostatic ducts and periurethral ductal transitional cell carcinoma was identified in 7. At a median followup of 64 months (range 29 to 90) 12 of 17 patients (70%) had a complete response in the prostatic urethra. Among the 10 patients with mucosal carcinoma without ductal involvement 8 responded as did 4 of the 7 with mucosal and ductal involvement. A total of 9 patients had persistent tumor or recurrence in the bladder or prostate. Two men had recurrence in the prostatic urethra and, due to age and co-morbidity, both were treated by transurethral resection and fulguration. Cystectomy was performed in the remaining 7 patients. Three of 31 patients (10%) whose prostate urethral biopsies were negative before BCG therapy had a positive biopsy afterwards. After treatment with BCG, the actuarial curves for cancer specific, progression-free and overall survivals showed no statistical difference between male patients with an initially positive or initially negative prostatic urethral biopsy. BCG is a reliable agent for initial therapy of superficial prostatic transitional cell carcinoma. Careful followup can identify persistent tumor, recurrences or progression that identifies patients for whom cystectomy is appropriate.