Lymphadenectomy before and after radical cystectomy: does this affect the radicality? A prospective randomized comparative study.

PURPOSE: To compare the oncological outcome of performing ePLND before or after RC in 200 patients in a prospective randomized manner. MATERIALS AND METHODS: From January 2014 to December 2019, 200 patients with T2-T3b N0M0 BCa were included in the current study after signing an informed consent. Patients were divided into two groups, 100 in each one. Group I underwent ePLND before RC, whereas group II underwent ePLND after RC. Postoperative evaluation included clinical, laboratory, and radiographic studies. RESULTS: Patients' characteristics were comparable between both groups. The mean operative time excluding that of urinary diversion was significantly shorter in group II than in group I (p = 0.01). The mean number of LNs removed was 25 ± 6 in group I and 32 ± 8 in group II (p = 0.141). Intraoperative complications occurred in four patients in the form of external iliac artery and vein injury [two in each group (p = 0. 245)]. Postoperative complications were comparable between both groups with no statistically significant difference (p = 0.375). Oncological failure occurred in 28 patients [16 (17.6%) in group I and 12 (22%) in group II (p = 0.389)]. CONCLUSIONS: EPLND before and after RC has comparable oncological outcomes. The stage of the disease, the time since the first diagnosis till RC and the surgeon experience in performing meticulous ePLND are more important. In absence of oncological superiority, the timing of ePLND should be judged according to the patient-related factors to facilitate safe RC with minimal morbidity.

Wandering spleen in the pelvic region in an adult man with symptoms of acute abdomen.

UNLABELLED: Wandering or ectopic spleen is a condition characterised by migration of spleen in the abdomen or pelvis. This anomaly is rare, with a reported incidence of <0.2%. It occurs mostly in women between 20 and 40years of age. Clinical diagnosis is difficult because of lack of precise signs, symptoms, and nonspecific laboratory data. Diagnosis of a wandering spleen highly depends on the results of imaging studies such as abdominal ultrasound and abdominopelvic computed tomography (CT) scanning. Treatment includes surgery with the choice between splenopexy in a noninfarcted spleen and splenectomy when infarction has occurred. We report a rare case of wandering spleen in a 27-year-old man with infarction due to torsion of its pedicle, which was diagnosed by CT and treated by splenectomy. CONCLUSION: Despite the rarity of wandering spleen, the possibility of torsion of its long pedicle with acute splenic infarction should be considered in the differential diagnosis of acute abdomen.

Gastric metastases from invasive primary mucosal epithelioid malignant melanoma of the hard palate: report of the first case in the English literature.

Melanocytes arise from the neural crest and migrate to the epidermis, meninges, uveal tract and ectodermal mucosa. Normal gastric mucosa lacks melanocytes. A 64-year-old woman presented to us with nausea and vomiting. She had a past history of invasive primary mucosal epithelioid malignant melanoma of the hard palate 21 months ago, treated by a wide surgical excision. Gastroscopy revealed multiple punched out ulcers involving the stomach and the first part of duodenum. Immunohistology and clinicopathologic correlation established the diagnosis of metastatic gastric malignant melanoma. To our knowledge, this is the first report in the English literature about gastric metastases arising from primary palatal mucosal melanoma.