[Renal liposarcoma clinical and pathological aspects. Case report and literature review]. / Liposarcoma renale aspetti clinici ed anatomo-patologici. Case report e revisione della letteratura.

Sarcomas of the retroperitoneum represent 0.2% of tumors and 15% of soft tissue sarcomas. Retro-peritoneal differentiated liposarcoma must be distinguished from the connective neoplasm of kidney. The main features of these tumors are: the rapid growth, infiltration of surrounding tissue, the tendency to local relapse and very fast metastasis (60-80%). Authors report a clinical case of a patient 61 old years with occasional reflected ultrasound is performed for lumbar pain a retro peritoneal mass. CT described a retro peritoneal mass that raised medially and displaced the left kidney. The patient was subjected to removal of the mass now to his kidney capsule, which was nevertheless preserved.The histological examination showed a picture of well-differentiated liposarcoma with areas of high-grade sarcoma with malignant morphology fibrohistiocytoma-like aspects and fibromyxomatosis. The well-differentiated liposarcoma has biological behavior similar to other sarcomas with high degree of adults with high local recurrence and distant metastases in 15-20% with overall mortality at 5 years about 30%. The most significant prognostic factor is the location of the cancer and the extent and degree of differentiation did not impact on the clinical prognosis is conditioned by the difficulty of obtaining a radical surgery in spite linfoadenectomia a retro peritoneal accurate.

[Fournier's disease. Clinical case]. / La malattia di Fournier. Caso clinico.

Fournier's disease is a necrotizing fasciitis that prefers the male and which is located in the perineal area. In view of possible complications related to sepsis, systemic organ impairment and high mortality, is now considered a urological emergency. The main causes are infections of urethral and anorectal tract, immunodepression syndromes, diabetes mellitus and trauma. Infections are mixed with aerobic and anaerobic germs responsible of necrosis of tissue disorders due to the phenomena of necrotizing immunovasculitis disease. We present a case of Fournier's disease in perineal area, with gangrenosum necrotic evolution treated with antibiotic therapy, curettage of the necrotic tissue and local disinfection with saline and antiseptics solution. A total parenteral nutrition to ensure maximum perineal decontamination has been made. The extensive loss of substance scrotal was rebuilt in 25- day while the anal wound has healed spontaneously after complete surgical curettage.

[Indications and limits to endourologic procedures for endometriosis of the urinary tract]. / Indicazioni e limiti delle procedure endourologiche nell'endometriosi dell'apparato urinario.

INTRODUCTION: The incidence of Urinary tract endometriosis (UTE) ranges from 1% to 3%; bladder is the most affected organ (85% of UTE), followed by ureter (12 - 14% of UTE), for which we distinguish an intrinsic very rare form and an extrinsic variety most frequently occurring in advanced pelvic endometriosis. MATERIALS AND METHODS: From 1997 to 2010, 33 surgical procedures for urologic endometriosis were performed, involving the urinary tract, in 28 patients with mean age of 31 years (25-43). The localization of endometriosis were: 7 cases in the bladder, 2 cases in the vesicoureteral tract, and 19 cases of ureteral tract only. Of these, two cases were diagnosed with an intrinsic localization. RESULTS: Overall, we performed 3 TURB, 5 partial cystectomies (2 with open surgical approach and 3 by laparoscopy procedure), 12 laparoscopic ureterolysis and simultaneous protection of the upper urinary tract with stent, 9 cases of ureterocystoneostomy (UCNS) according to Lich-Gregoire procedure, and 3 according to Boari-Kuess procedure. Of the 12 patients who underwent ureterolysis with laparoscopic and stenting procedure, five cases required a UCNS according to Lich-Gregoire technique for persistent ureteral obstruction. CONCLUSIONS: The limits of endoscopic procedures in endometriosis of the urinary tract are correlated both to the degree of extension and the localization of the disease. It is mandatory to achieve an interdisciplinary consensus in order to ensure the disease removal and the simultaneous functional results of the upper urinary tract.

[Three cases of renal cell carcinoma with sarcomatoid differentiation]. / Tre casi di carcinoma renale con differenziazione sarcomatoide.

Renal cell carcinoma with sarcomatoid differentiation has an incidence of 4-6%. It occurs more frequently with clinical advanced presentation in relation to the greater biological aggressiveness. This variant was also found both in transplanted kidneys and in patients with von Hippel-Lindau syndrome. The authors present three cases of cancer all clinically evolving to rapidly progressive conditions. The pathologic staging was, respectively: Case 1 pT4 N0 M0 G4 case, Case 2 P G4 T3a N2 M0, Case 3 pT3a N0 M1 G4. The clinical responses related to protocols with VEGF drugs that seem to have better clinical response compared to immunotherapy are still being studied. From the pathologic point of view it is necessary, for all renal cell cancers, to search and identify the sarcomatoid components that, although poorly represented, give a negative prognosis.

[A case of chronic schistosomiasis four years after infestation]. / Caso di schistosomiasi cronica a quattro anni dalla infestazione.

Authors present a case of bilharziosis incidentally diagnosed in a patient undergoing TURB for suspected bladder cancer. The patient, who in 2005 had gone to Malaysia, had been suffering from recurrent hemorrhagic cystitis since 2007, which were treated with antibiotic therapy. In November 2009 he presented to our observation for persistent hematuria, underwent ultrasound examination, fibroscopy and TURB diagnostics for suspicious lesions. The histopathology diagnosis found granulomatous lesions with typical parasites eggs due to schistosomiasis eggs. As a consequence of that, the patient underwent medical therapy. The pathologist's role becomes nullifying not only for the diagnosis of parasitic infections but also for the exclusion or evidence of urothelial squamous neoplasia. The low incidence of this rare parasitic disease in European tourists and the presence of immigrants in our country require to spread the knowledge of these parasites and the most simple tests for early detection.

[Multilocular cystic renal cell carcinoma: our experience].

Multilocular cystic renal cell carcinoma is now recognized as an independent pattern by WHO; it is a rare malignancy with a predominantly cystic growth, characterized by very low oncologic evolution and then susceptible to conservative treatment. In the kidney cystic masses of different origin may arise, i.e. due to malformation, acquired disease or tumor. Renal neoplastic lesions may have a cystic or pseudocystic component. There are also four types of neoplasm with a predominantly cystic growth, including the multilocular cystic carcinoma, which are macroscopically very similar and impossible to differentiate through diagnostic pre-operative images. The Authors present four cases of multilocular cystic renal cell carcinoma diagnosed in the 2000-2007 period, with special reference to diagnostic difficulties and to pre- and intra-operative features of the neoplasm. In conclusion, the extemporaneous histological preoperative diagnosis of multilocular cystic renal cell carcinoma is not possible because it requires extensive sampling; furthermore, the final histological diagnosis sometimes needs particular immunohistochemical procedures to be confirmed.

[Superficial angiomyxoma of the epidiymis. Presentation of a new case and clinical considerations]. / Angiomixoma superficiale dell'epididimo. Presentazione di un nuovo caso e considerazioni cliniche.

Angiomyxomas are distinctive soft tissue tumors associated with a high risk of local recurrence but lack of metastatic potential. These tumors occur nearly exclusively in the soft tissues of the pelvis and perineum of adult women. Three types have been identified: aggressive angiomyxoma, angiomyofibroblastoma and superficial angiomyxoma. Histologically, aggressive angiomyxoma is characterized by a proliferation of spindle- or stellate-shaped cells widely separated by loose myxoid stroma in which a prominent vascular component is dispersed. Angiomyofibroblastoma shares many histological features with aggressive angiomyxoma; however, the presence of a sharply circumscribed border, and plump epithelioid tumour cells arranged in a predominantly perivascular distribution usually allow distinction from aggressive angiomyxoma. Superficial angiomyxoma can be distinguished from aggressive angiomyxoma and angiomyofibroblastoma by the multinodular growth, abundant stromal mucin, low cellularity, and lack of perivascular accentuation of stromal cells. The case of a 50-year-old-man with superficial angiomyxoma of epididymis mimicking a testicular tumor is presented. Local excision was performed. On gross inspection, this lesion was a soft bulky mass, with gelatinous appearance and not infiltrating adjacent structures. Cytologic examination of this material revealed hypocellular smears and a background of watery myxoid material. The nuclei revealed a bland chromatin pattern. This lesion was characterized by an abundant vascular component with large, thick-walled vessels. Immunohistochemically, the neoplastic cells were not positive for alpha-smooth muscle actin and desmin. The conclusion is drawn that according to a tendency of these tumors to recur locally, treatment should consist of wide surgical excision, as complete as technically possible.

Bladder pheochromocytoma: a 3-year follow-up after transurethral resection (TURB).

We report a case of a 75-year-old female with pheochromocytoma of the bladder. Clinical evaluation included ultrasonography, intravenous pyelography, CT scan, I-MIBG scintiscan. A transurethral resection was performed for a exophytic tumor of 2 cm diameter. The histological result indicated the diagnosis of bladder pheochromocytoma. Three years later the patient remains disease free. Preoperative diagnosis is established by determination of blood and urine levels of catecholamines and their metabolites is a nonspecific diagnostic tool. The sensitivity of CT scan is 82%. Iodine-methyliodobenzylguanidine (I-MIBG), used by scintiscanning, specifically accumulates in pheochromocytomas. Life-long follow-up is necessary to diagnose late recurrences.

[Renal multifocal carcinoma with adrenal gland metastasis in a patient previously treated with radical nephrectomy: what kind of therapy. Review of the literature]. / Carcinoma renale multifocale con metastasi surrenaliche multiple in paziente già sottoposto a nefrectomia radicale dell'adelfo: quale terapia? Revisione della letteratura.

A case of multiple adrenal metastases due to renal cells carcinoma, associated with a multifocal simultaneous renal cells carcinoma has been observed in a female patient previously submitted to radical contralateral nephrectomy for the same disease. In particular, stress is laid on computerized tomography scan diagnosis and surgical procedure.

[Description of a case of squamous cell carcinoma of the renal pelvis]. / Descrizione di un caso di carcinoma squamocellulare della pelvi renale.

A case of squamous cell carcinoma of renal pelvis is reported. A 73-year-old Caucasian male complained of macrohematuria. The echography and Computer Tomography scan of the abdomen and pelvis revealed a large tumor mass in the right kidney associated with lymphadenopathy. A nephrectomy of the right kidney and lymphadenectomy were performed. The isotologic examination revealed a squamous carcinoma of the renal pelvis involving the renal parenchyma and extending to the perirenal fat. The regional lymph nodes were also involved. Neoplastic invasion of inferior vena cava was found. Squamous carcinoma in situ and squamous metaplasia were noted in the urothelium adjacent to the tumor. Three months later an echography revealed a local recurrence of the disease. The patient underwent adjuvant chemotherapy. The aggressive course of the disease is in agreement with the poor prognosis of squamous carcinomas of the renal pelvis as previously reported in the literature.

[Hemorrhagic pseudocyst of the spleen]. / La pseudocisti emorragica della milza.

The authors report a rare case of haemorrhagic pseudocyst of the spleen in a 37 years old female who had always enjoyed very good health and who didn't remember any previous chest or abdominal traumas. Due to the initial refusal of the patient to undergo splenectomy, it has been possible to follow pathology progress. An echography of the cyst 6 months later, showed a maximum diameter increase of more than 2 cm and a further thinning of the cyst wall. Afterwards the patient decided to undergo the operation. The spleen showed a hollow of 10 cm of maximum diameter, with a degraded haematic content; the final histological examination confirmed the initial diagnosis of haemorrhagic pseudocyst of the spleen.

A double-blind crossover trial of atenolol, enalapril and the fixed combination of atenolol and nifedipine in mild and moderate hypertension.

Sixty-three patients with mild to moderate hypertension completed a double-blind, randomised crossover trial of atenolol 100 mg daily, enalapril 20 mg daily and the fixed combination atenolol 50 mg and nifedipine retard 20 mg (Tenif) once daily. In the three areas of efficacy that the study compared-24-hour post dose blood pressure, control of blood pressure over the dosing period with particular reference to the waking day and attenuation of systolic blood pressure on exercise-atenolol and the fixed combination demonstrated greater efficacy than enalapril.

Nifedipine blocks ACTH and cortisol release in man.

1. The present study investigated the effect of prior administration of nifedipine on AVP-induced ACTH release in seven normal volunteers. Three protocols were used: 20 mg oral nifedipine; 0.14 pressor units intramuscular (i.m.) per kg bodyweight aqueous AVP; oral nifedipine plus i.m. AVP 90 min later. Plasma ACTH and cortisol were measured at intervals for 2.5 h during each test. 2. The mean peak plasma ACTH and cortisol levels and the mean peak changes from basal in these levels were significantly lower in the nifedipine/AVP test than in the AVP alone test. The integrated area under the cortisol time curve was significantly lower for the nifedipine/AVP test than that for the AVP test alone. Nifedipine alone caused no changes in ACTH or cortisol. 3. Acute administration of oral nifedipine caused an inhibition of AVP-stimulated ACTH and cortisol release in normal humans. This effect may be due to blockade of plasma membrane calcium channels normally activated during AVP stimulation of pituitary corticotrophs.

Potentiation of fenfluramine-induced ACTH release in man by naloxone.

1. This study set out to compare the effect of the combination of fenfluramine (Fen) and naloxone (Nal) on ACTH and cortisol release with each of these agents alone in six normal volunteers. Three protocols were used: 1.5 mg/kg bodyweight oral Fen; 125 micrograms/kg bodyweight i.v. Nal; oral Fen plus i.v. Nal 135 min later. Plasma ACTH and cortisol were measured at intervals of 285 min over each test. 2. The mean peak levels and mean peak changes from basal in plasma ACTH and cortisol were significantly greater in the combination test (Fen/Nal) than in either the Fen alone or the Nal alone tests. Fen and Nal given together cause a synergistic release of ACTH and cortisol as determined by the areas under the ACTH-time and cortisol-time curves for Fen/Nal compared to the sums of Fen alone plus Nal alone curves for ACTH and cortisol. 3. We conclude that Fen and Nal acting synergistically work through different and potentiating mechanisms at the hypothalamic, central nervous system and/or pituitary levels to cause ACTH release.

Inhibition of serotonin-induced ACTH release in man by clonidine.

1. Clonidine, an alpha 2-adrenergic agonist, is thought to inhibit noradrenergic neuronal activity (NNA) in the central nervous system (CNS) by a presynaptic alpha 2-receptor mechanism. Central NNA is thought to be the primary monoaminergic stimulus to pituitary ACTH release. Fenfluramine, a serotonin releasing agent and uptake inhibitor, causes ACTH release in normal man. 2. The present study investigated the effect of clonidine on fenfluramine-induced ACTH release in six normal volunteers. Four protocols were used: 1.5 mg/kg body weight oral fenfluramine; 4.3 micrograms/kg body weight oral clonidine; oral clonidine + oral fenfluramine 1 h later; placebo clonidine. Plasma ACTH and cortisol were measured at intervals for 5 h after clonidine and for 4 h after fenfluramine. 3. The mean plasma ACTH and cortisol levels and the mean maximal changes in these levels were significantly lower during the clonidine + fenfluramine test than during fenfluramine alone. Plasma ACTH and cortisol levels were not lowered significantly more by clonidine than by placebo. 4. In conclusion, clonidine blocked the ACTH-releasing activity of fenfluramine in normal humans. This inhibition of active ACTH release may result from clonidine blockade of fenfluramine-induced activation of central NNA. Clonidine alone was no more effective than placebo in lowering plasma ACTH and cortisol.