[Stromal tumor of the ileum (GIST) at the same time as a renal carcinoma. Description of a case and review of the literature]. / Tumore stromale dell'ileo (GIST) sincrono a carcinoma renale. Descrizione di un caso e revisione della letteratura.

The gastrointestinal mesenchymal tumors from a heterogenous group that include several entities: leiomyomas, schwanomas and less differentiated tumors often referred as GIST. These neoplasm are uncommon and their clinical behaviour is most difficult to predict. We describe a malignant gastrointestinal stromal tumor of the ileum coexisting with renal cell carcinoma. The neoplasms were fixed in formaldehyde, embedded in paraffin and stained with hematoxylin-eosin. For immunohistochemical studies deparaffinized tissue sections were incubated with antibodies against vimentin, desmin, muscle specific actin, S100, CD34, GFAP, NSE and keratin. The epithelioid and spindle cells of ileal neoplasm were arranged in interlacing fascicle with occasional palisading and were positive for vimentin and CD34. Positivity for muscle specific actin was focally found. The renal neoplasm required differential diagnosis from metastatic GIST. The morphological and immunohistochemical investigations in our case were consistent with GIST coexisting with primitive renal cell carcinoma. One of the problems connected to the anatomo-clinical evaluation of GIST consist in the difficulty of making a prognosis. An almost complete review of the literature and view point on the topic has been performed. As a conclusion judging from papers regarding this argument, no clear parameters of biological behaviour exist excluding mitotic index.

[Endopyelotomy: mid- and long-term follow up]. / Endopielotomia: follow-up a medio e lungo termine.

We report our experience on 24 UPJ obstruction, that underwent endopyelotomy. The follow-up on these patients range from 12 to 72 months. The success rate, based on patient symptomatology as well as urographical and scintigraphical parameters, was 83.3%. An adequate selection of cases, with grade of hydronephrosis and crossing vessels pre-operatorial detection, would possibly show a further improvement of success rate. The antegrade transpelvic endopyelotomy adopted in the most recent cases, allows the identification of crossing vessels and the performance of a safer endopyelotomy. The average operating time was very short, while morbidity was limited to 3 cases (2 of gross haematuria and 1 urosepsis). All this shows that endopyelotomy is the first choice treatment of UPJ obstruction.

[Post-voiding contraction: evidence and characterization in other 250 urodynamic studies]. / Post-voiding contraction (PVC): evidenza e caratterizzazione in oltre 250 indagini urodinamiche.

We report our experience on PVC detection in 250 consecutive urodynamic evaluations in female patients. We emphasize the absence of evident correlations between the post-voiding contractions (PVCs) and their amplitude and the urodynamic features. We suggest a possible relation between the PVCs and two clinical features: enuresis (80% of cases associated with PVC) and mixed urinary incontinence (61.5%). Defining PVC as an improper form of detrusor instability, probably generated by a reduction of pelvic muscle tone, we underline the role performed by an urodynamic investigation defining urethral sphincter as well pelvic floor activity, this procedure being justified by the notorious interdependence between perineal and detrusorial activity.

Uptake and intracellular distribution of idarubicin in secondary cultures of normal and neoplastic urothelium.

This study analyzes the uptake and endocellular distribution of idarubicin (IDA) in normal and neoplastic urothelial secondary cultures in relation to the changes in concentration and time of exposure. The urothelial lines were isolated by Freshney's method from biopsy fragments taken from five patients with superficial bladder cancer. Pharmacological experiments were carried out on subcultures previously immunophenotypically characterized and did not exceed ten passages. The uptake and endocellular distribution of IDA was analyzed by densitometric image analysis on cells treated for 10, 20, 30 and 60 min and 2 h with scalar dosages from 10 ng/ml to 2430 ng/ml. Microscopic observations and densitometric analyzes revealed that in the cells treated with IDA, fluorescence was higher in the cytoplasm compared to the nucleus and increased with the change in dosage. Moreover, densitometric data showed that IDA uptake in the first 20 min was higher in the neoplastic cells, but after that period its behavior became heterogeneous at 30 and 60 min, while at 2 h there was an inversion of the trend. These results suggest that the in vitro cytotoxicity should be evaluated in order to verify whether the elevated uptake of IDA in the first 20 min of treatment is really correlated to a more elevated toxicity in the neoplastic cells with respect to the normal cells. This is presently under investigation.

Carcinosarcoma of penis. Case report and review of the literature.

AIMS OF THE STUDY: Carcinosarcomas (sarcomatoid carcinomas) are controversial, biphasic tumors composed of both carcinomatous and sarcomatous elements. They are uncommon and occur in numerous locations. At the time of this report only 3 cases of carcinosarcoma of penis have been reported in the literature. The aim of this article is to provide a discussion of these lesions, using informations gleaned from the pertinent literature as well as the personal experience of the authors. METHODS: The formalin-fixed paraffin-embedded tissue was stained with hematoxylin and eosin, reticulum, alcian blue and Mallory's trichrome stains. Section from selected paraffin-embedded blocks, were stained with antibodies to citokeratins, EMA, vimentin, desmin, and a actin. RESULTS: In our case the carcinomatous elements were admixed with areas of "divergent differentiation": spindle-cell and giant-cell sarcomatoid component with bone and cartilage differentiation were noted. In situ carcinoma was also detected. Immunohistochemistry showed reactivity for keratin and epithelial membrane antigen (EMA). In most of pleomorphic spindle elements. Immunoreactivity for vimentin, desmin and actin were focally found. CONCLUSIONS: The carcinosarcomas may demonstrate "divergent" differentiation into bone, cartilage or myogenous tissue, so it is possible that the cell of origin could be heterogeneous. In our case myogenous differentiation was focally found. Although the clinical data, available from the only three cases of the literature, demonstrate that the behaviour of this tumors was not different from those of squamous cell carcinoma, the authors recommended a constant careful follow-up of the patients.