Krukenberg Tumor in Association with Ureteral Stenosis Due to Peritoneal Carcinomatosis from Pulmonary Adenocarcinoma: A Case Report.

Krukenberg tumors from pulmonary adenocarcinoma represent an extremely rare situation; only a few cases have been reported. The aim of this paper is to report an unusual such case in which almost complete dysphagia and ureteral stenosis occurred. The 62-year-old patient was initially investigated for dysphagia and weight loss. Computed tomography showed the presence of a thoracic mass compressing the esophagus in association with a few suspect pulmonary and peritoneal nodules, one of them invading the right ureter. A biopsy was performed laparoscopically on the peritoneal nodules. The right adnexa presented an atypical aspect; right adnexectomy was also found. The histopathological and immunohistochemical studies confirmed that the primitive origin was pulmonary adenocarcinoma. Although both peritoneal carcinomatosis and ovarian metastases from pulmonary adenocarcinoma represent a very uncommon situation, this pathology should not be excluded, especially in cases presenting suspect pulmonary lesions.

Retroperitoneal Laparoscopic Radical Prostatectomy.

Introduction: Retroperitoneal Laparoscopic Radical Prostatectomy (RLRP) has been introduced in our department as the first line treatment for patients with localized prostatic cancer and life expectancy over 10 years. At the time, the surgical team had already extensive experience in minimally invasive urologic surgery. Our aim is to describe the laparoscopic technique we currently use and to analyze our oncologic and functional results. Patients and Methods: All the patients who underwent RLRP in our institution (PONDERAS ACADEMIC HOSPITAL) from January 2015 to March 2017 were included into a prospective study. The standard preoperative protocol included blood tests, prostate biopsy, pelvis MRI and bone scintigraphy, while the particular therapy was discussed and approved by the Institutional Multidisciplinary Tumor Board. In all the 45 cases, RLRP was indicated for localized prostate cancer. Results: The average patient’s age was 68 years (range 45 â€" 74 years), mean preoperative prostate specific antigen (PSAi) level was 8 ng/mL (range 3â€"15 ng/mL) and prostatic volume between 26 and 52 cc. The laparoscopic approach was completed in all 45 cases â€" no conversions to open surgery. Bilateral nerve sparing was performed in 7 cases (16%) and unilateral in 23 cases (51%). The mean operative time was 165 minutes (range 120 - 240 min), while the average blood loss was 255 mL (range 20â€"800) and two patients received blood transfusions. The mean catheterization time was 10 days (range 7â€"14 days). Positive surgical margins were observed in 8 cases (17.7%). Overall, 86% and respectively, 93% of the patients were continent during the following 3 and 6 months. 51% of the patients had erectile disfunction 6 month after the intervention. Four complications were encountered: intraoperatively - rectal injury (1 case) and postoperatively - bleeding (2 cases) and stenosis at the vesicourethral anastomosis (1 case). No mortality or late morbidity encountered. Conclusions: The radical laparoscopic prostatectomy is a safe and efficient procedure for localized prostate cancer with minimal complications and short hospitalization time, but it requires an experienced team of laparoscopic surgeons. The functional and oncological outcomes of LRP are expected to be improved as the medical team experience is extended.