Primary Ewing's Sarcoma of the Penis: First Reported Case in the United Kingdom.

Penile cancer is generally rare, and Squamous cell cancer of the penis is the most common histological type. Sarcoma of the penis has a low incidence, but they tend to grow faster than other penile cancers. One of the rarest types of penile sarcomas is Extra-Skeletal Ewing's Sarcoma (EES). The management of such cases can be challenging, and treatment guidelines do not exist for these rare cases. We present a rare case of EES that has developed in the penis of a young patient in the United Kingdom.

It is time to think inside the (collimation) box; a quality improvement project to reduce over-scanning in CT scanning of the kidneys, ureters and bladder.

OBJECTIVE: The Royal College of Radiologists (RCR) recommend CT of the kidneys, ureters and bladder (CTKUB) as the first-line investigation for renal colic, stating that excess scan length above the upper pole of the highest kidney should not exceed 10% of the total scan length. The project aim was to determine what proportion of CTKUB scans performed at a district general hospital (DGH) were meeting this standard and explore improvement options as necessary. METHODS: A retrospective study was performed on 100 consecutive patients who attended a Radiology Department with renal colic. The number of CTKUB slices above the upper pole of the highest kidney, relative to scan length, was recorded. The DGH radiographers believed over scanning could be reduced by viewing image acquisition in real-time and manually stopping the scan at the top of the highest kidney. This was implemented and a re-audit of 50 patients was performed. RESULTS: Scan length exceeded the standard on 81% of scans (81/100). Over scanning was reduced to 14% (7/50) post-intervention. CONCLUSION: This DGH was over scanning a large proportion of patients. Manually stopping the CTKUB significantly reduced over scanning. ADVANCES IN KNOWLEDGE: A small change to CTKUB scanning technique can significantly improve adherence to RCR guidelines.

Pathological nature of renal tumors - does size matter?

INTRODUCTION: We examined the relationship between the size and nature of renal masses in term of malignant potential, histological grading, pathological staging and presence of necrosis and sarcomatoid changes. MATERIALS AND METHODS: Retrospectively, we reviewed 323 consecutive nephrectomies between 2000 and 2010. Final pathology was correlated with tumour size. The renal tumours were stratified into three groups according to the largest diameter, defined as 4 cm or smaller, greater than 4 cm to 7 cm, and greater than 7 cm. We recorded the proportion of benign tumours, tumour grade and stage, presence of necrosis and sarcomatoid change. RESULTS: Small renal masses ≤4 cm (SRMs) were more likely to be localised to the kidney (90%) and of lower histological grade (75%). The proportion of benign tumours in SRMs (15%) was higher than other two groups with the majority of benign tumours being oncocytomas. There was a statistically significant trend with greater necrosis and sarcomatoid change for the large size group. CONCLUSIONS: SRMs are likely to be low grade and organ confined with little or no adverse pathological features. There is increased likelihood of benignity in SRTs with the majority of benign tumours being oncocytomas.

CT texture analysis: a potential tool for prediction of survival in patients with metastatic clear cell carcinoma treated with sunitinib.

BACKGROUND: To assess CT texture based quantitative imaging biomarkers in the prediction of progression free survival (PFS) and overall survival (OS) in patients with clear cell renal cell carcinoma undergoing treatment with Sunitinib. METHODS: In this retrospective study, measurable lesions of 40 patients were selected based on RECIST criteria on standard contrast enhanced CT before and 2 months after treatment with Sunitinib. CT Texture analysis was performed using TexRAD research software (TexRAD Ltd, Cambridge, UK). Using a Cox regression model, correlation of texture parameters with measured time to progression and overall survival were assessed. Evaluation of combined International Metastatic Renal-Cell Carcinoma Database Consortium Model (IMDC) score with texture parameters was also performed. RESULTS: Size normalized standard deviation (nSD) alone at baseline and follow-up after treatment was a predictor of OS (Hazard ratio (HR) = 0.01 and 0.02; 95% confidence intervals (CI): 0.00 - 0.29 and 0.00 - 0.39; p = 0.01 and 0.01). Entropy following treatment and entropy change before and after treatment were both significant predictors of OS (HR = 2.68 and 87.77; 95% CI = 1.14 - 6.29 and 1.26 - 6115.69; p = 0.02 and p = 0.04). nSD was also a predictor of PFS at baseline and follow-up (HR = 0.01 and 0.01: 95% CI: 0.00 - 0.31 and 0.001 - 0.22; p = 0.01 and p = 0.003). When nSD at baseline or at follow-up was combined with IMDC, it improved the association with OS and PFS compared to IMDC alone. CONCLUSION: Size normalized standard deviation from CT at baseline and follow-up scans is correlated with OS and PFS in clear cell renal cell carcinoma treated with Sunitinib.