Urinary Bladder Nephrogenic Adenoma: A Histopathological Case Report.

Nephrogenic adenomas are benign lesions that develop within the urinary tract. Most often developing within the urinary bladder, these lesions have a debatable etiopathogenesis, with hamartoma, rest hyperplasia, and transplantation of renal tubular cells being the most widely accepted ones. Nephrogenic adenomas develop more often in adult males, and predisposing factors for their development are prior urinary system injury, infection, or malignancy, with a subset of cases developing in renal transplant patients. Herein, we present a case of a male patient in his seventies who initially presented to our institution with urinary disturbances and was subsequently diagnosed with low-grade, non-invasive urothelial carcinoma. After treatment, the patient remained disease-free for a period of seven calendar years. The current presentation was due to dysuria, and bladder endoscopy revealed a ureteral stricture and two small exophytic lesions neighboring the location of the previously treated urothelial carcinoma. Histology revealed complex papillary architecture and cystic spaces lined by a monolayer of monomorphous epithelial cells with foci of hobnail appearance. The papillary stroma consisted of edematous fibrous tissue with hyperemic blood vessels and focal infiltration by inflammatory cells. Based on the histological findings, the diagnosis of nephrogenic adenoma was established.

Quantitative Analysis of Tumor-Associated Mast Cells in Recurrent and Non-recurrent Urothelial Bladder Cancer in Stage pTa and pT1.

Background Urothelial carcinoma of the urinary bladder (UCUB) is a common malignancy in both genders with a very high recurrence rate. There has been increasing evidence for a correlation between tumor-associated mast cells (TAMC) and tumor growth and recurrence rates. In the present study, we set out to establish a link between TAMC and the clinical morphological characteristics of UCUB in stages pTa and pT1. Methodology A retrospective non-clinical approach was used, with two groups of patients with UCUB. A total of 163 patients were included, 95 in the non-recurrent group and 68 in the recurrent UCUB group. Estimation of TAMC was performed on histological slides from the initial biopsy material using Giemsa and Toluidine blue staining. The collected data were statistically analyzed using the Kaplan-Meier curve, Mann-Whitney test, receiver operating characteristic curve, and chi-square analysis. Results Statistical analysis revealed that TAMC in the tumor stroma shows a positive correlation with local recurrence, with no statistical significance to the time of recurrence. No correlation showed statistical significance with pT stage, grade, gender, and age. Conclusions The amount of TAMC in UCUB correlates positively with the rate of local recurrence. The depicted correlations are similar to those established in mammary carcinoma, some lymphoproliferative disorders, and pancreatic and prostate malignancies.

Eyelid Reconstruction with Full Thickness Skin Grafts After Carcinoma Excision.

BACKGROUND: Various techniques have been proposed for reconstruction of the eyelid anterior lamella after carcinoma excision: among these are the transposition of skin flaps, and full-thickness skin grafts or combination of these two. AIM: To present our experience in eyelid reconstruction with full-thickness skin grafts and to assess the aesthetic and functional outcomes. PATIENTS AND METHODS: The present retrospective study included 39 patients (20 males, 19 females, mean age 71 yrs) with surgically excised eyelid carcinoma, followed by reconstruction using full-thickness skin grafts. The patients were treated between 2005 and 2014. Parameters recorded were patient demographics, histological classification of malignancy, tumor localization and size, postoperative defect size. In cases of large full-thickness lower lid defect Hughes tarsoconjunctival flap was used for reconstruction of posterior lamella. Full-thickness skin grafts donor sites included upper eyelid, preauricular area and inner brachial area. We appraised the grafts viability one week after surgery and the aesthetic results - 6 months after surgery by the graft colour and lid position. RESULTS: In 95% of the cases the skin grafts were viable. The full-thickness skin graft (FTSG) failed in two patients because of subcutaneous haematoma. There were a few early postoperative complications including graft hypertrophy, graft contraction, and partial graft failure, which were managed without additional surgery. All 39 patients had normal postoperative lid function. All 39 had either good (14) or excellent (25) cosmetic results. CONCLUSIONS: Our findings suggest that full-thickness skin graft is a good choice in periocular reconstructive surgery after carcinoma excision. The surgical technique is easy to perform producing proper functional and aesthetic results.

Expression of matrix metalloproteinase-1, -9, -13, and tissue inhibitor of metalloproteinases-1 in basal cell carcinomas of the eyelid.

BACKGROUND: Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) function in the remodelling of the extracellular matrix in morphogenesis, angiogenesis, tissue repair, and tumor invasion. Elevated levels of distinct MMPs in tumor tissue are related to worse prognosis. However, no overall consistent pattern of expression in human cancer has been identified. The aim of the present study was to evaluate the expression of MMP-1, -9, -13 and TIMP-1 in tumor epithelial cells and surrounding connective tissue in primary basal cell carcinomas (BCC) of the eyelid, and to assess their role as prognostic markers for tumor recurrence. METHODS: Surgical specimens of 49 histologically proven primary BBCs of the eyelid of different histological subtypes were included. Immunohistological studies were performed using antibodies against MMP-1, MMP-9, MMP-13 and TIMP-1, and staining intensity was analyzed semi-quantitatively. RESULTS: MMP-1, -9, -13, and TIMP-1 were expressed at various intensities in epithelial tumor cells and surrounding stromal cells including fibroblasts, inflammatory cells, and vascular endothelial cells in all tumor subtypes. Staining was especially prominent at the invading edge of the BCC. A statistically significant correlation was seen between increased TIMP-1 expression in tumor and/or stromal cells with the presence of MMP-13 (p = 0.007 and p < 0.0001 respectively). Moreover, TIMP-1 expression in tumor and/or stroma was significantly associated with relapse (p = 0.012 and p = 0.042 respectively). CONCLUSION: MMP-9, MMP-13 and TIMP-1 expression may serve as a prognostic marker for early tumor invasiveness. Moreover, up-regulation of TIMP-1 in tumor and/or surrounding stromal cells may indicate an increased risk for BCC recurrence.