Intraabdominal mature cystic teratoma in a 20-year-old male: A rare case.

Teratomas are the most prevalent type of germ cell tumors and usually display benign characteristics. Mature cystic teratomas consist of a varied mixture of mature tissue types that originate from squamous epithelium and skin adnexal structures. It is most commonly found in female gonads. A mature teratoma located in the abdomen of an adult male patient is exceptionally uncommon. In this case, we report a rare case of intra-abdominal mature cystic teratoma in an adult male.

Cytoplasmic Androgen Receptor, CD24 Expression and Smoking Intensity to Urothelial Carcinoma of the Bladder Invasiveness: A Cross-Sectional Study.

Purpose: To the best of our knowledge, Androgen receptor (AR) and cluster of differentiation 24 (CD24) expression in bladder urothelial carcinoma (UC) has not yet been reported in our population. The aim of this study was to evaluate the expression of both markers in UCB using immunohistochemistry. Materials and Methods: Data from 60 patients with UCB were obtained between 2009 and 2018. The samples were divided into four groups based on their smoking history. Group 1 included non-smokers, group 2 smoked <20 cigarettes/day for 30 years, group 3 smoked for 31-40 years, and group 4 smoked for > 40 years. Each group then divided into Non muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) subgroups. The smear was stained with hematoxylin and eosin (HE) - immunohistochemistry of CD24 and RA, followed by histoscore assessment. Results: The male to female smoking rates was 1.8. Based on gender, in the NMIBC group there were 85.7% men and 14.3% were women while in MIBC 74.4% men and 25.6% women. The mean age of the NMIBC and MIBC groups was 56.3 years and 54.5 years, respectively. There was no significant relationship between smoking status in group 2 (OR 0.31, CI 95% CI, p=0,39), group 3 (OR 013, CI 95% CI, p=0,05), and group 4 (OR 0.23, CI 95% CI, p=0215) to the UCB invasiveness. A significant relationship was observed between cytoplasmic AR expression and UCB invasiveness (OR 0.14[0,04; 0.47], CI 95%, p=0.001). There was no significant relationship between RA in the nucleus and UCB invasion (OR 1.09[0,18; 6.48] CI 95%, p=1000). No significant relationship was observed between CD24 expression and UCB invasiveness (OR 0.81[0,27-2,45] CI 95%, p=0712). Conclusion: Cytoplasmic AR expression is associated with UCB invasiveness. Smoking history and CD24 expression were not associated with UCB invasion.

Generalized Reddish Skin Nodules.

Diagnosis of nodular red lesions is challenging. The differential diagnosis includes dermal nevus, angioma, pyogenic granuloma, amelanotic melanoma, eccrine poroma, Kaposi's sarcoma, skin malignancy or metastasis. Erythema nodosum is one of the common consideration of the red skin nodules, however fully work up should be done to find the right diagnosis.A 60 years old female admitted to our hospital due to pain dark reddish skin nodules since one month. She had continuously high grade fever of 39 Celsius accompanied by arthralgia and fatigue since two months prior to admission and she lost 6 kg of weight in 2 months. On admission, physical examination revealed slight fever, pale conjunctiva, mild hepatosplenomegaly, tender dark red nodules 0.3 to 2 cm, firm edge, at her cheek, abdominal area and both lower extremities. No lymph nodes enlargement was noticed. Her laboratory test showed haemoglobin 9,1 g/dl, WBC 3,040/mL, PLT 149,000/mL, SGOT 48 U/L, SGPT 43 U/L, urea 12.5 mg/dL, creatinine 0.67 mg/dL. She was found to be non-reactive for HBsAg, HCV, and HIV antigens. Urine routine and microscopic examination was unremarkable.Her histopathology of left foot nodule biopsy revealed cutaneous lymphoma. The immunohistochemical (IHC) stain of CD45, CD20, and CD10 were positive, Ki67 were also positive  with >70% tumor cells, while CD3,CD56, CD30, and Granzyme were negative. Her final diagnosed was Cutaneous Diffuse large B cell lymphoma.Primary cutaneous lymphomas of B-cells occur less frequently than primary cutaneous T-cells lymphomas. Primary extra-nodal diffuse large B-Cell lymphoma (DLBCL) can be seen in up to 40% of cases. However skin involvement is less common and in a large cohort of DLBCL cases, skin involvement at presentation was seen only in 3.3% of cases.It characterized by few lesions, in general showing nodules or infiltrations of relatively fast growth and have no itching. The diagnosis is made by the immunohistochemical findings, clinicopathological correlation, and molecular pathology.  The lymphomas have different clinical behaviours despite being identical in morphological appearance. The primary lymphomas presents with local recurrence in up to 68% of the cases and with rare extra-cutaneous dissemination, with an average rate of 5-year survival varying from 89 to 96%. Cutaneous lymphoma should be always become one of considered diagnosed of skin red nodules even it is rare.

Testicular Epidermoid Cyst: A Rare Case Report.

INTRODUCTION AN IMPORTANCE: Testicular epidermoid cysts (TECs) are rare benign testicular neoplasms. Recently, testicular epidermoid cysts (TECs) are listed as teratoma of prepubertal type, however it is still difficult to differentiate the epidermoid cyst from malign testicular tumor. Therefore, we would like to report testicular epidermoid cyst at our institution. CASE PRESENTATION: A 67-year-old man from Indonesia, presented with chronical painless mass of testis since one year ago. On physical examination obtained normal penile structure with descended testicles, palpable intrascrotal mass with size of 10 × 7 × 5 cm, firm consistency, immobile, without any tenderness, and no lymphadenophaty in groin. Scrotal USG showed intratesticular mass, homogenous parenchym, showed no vascularization during Doppler examination. Histopathological examination revealed the specimen of right scrotum with size of 12.5 cm × 8.5 cm × 6.1 cm with red-brownish colored, during lamellation, obtained encapsulated mass with size of 12.2 cm × 7.9 cm × 6 cm, hollowed space filled with porridge-like texture with capsule thickness of 0.1-0.3 cm. CLINICAL DISCUSSION: Epidermoid cysts are benign lesions occurring on the skin usually, however, it rarely occurs in intratesticular area. Most of the cases (60%) presented with the typical onion-ring phenomenon. Histopathological findings commonly revealed typical well-defined cyst lined by a fibrous membrane. No skin appendages are found in the cyst's lumen and no germ cell neoplasm (GCN) is present in the adjacent testicular parenchyma. CONCLUSION: All testicular masses are considered malignant until proven otherwise. It is necessary to do accurate diagnosis for the prevention of unnecessary radical orchiectomy.

Comparison of TransPerineal Prostate Biopsy Using Novel Affordable VY Probe (TPPB-VY) and TransRectal Prostate Biopsy (TRPB) in Detection of Prostate Cancer on Hypoechoic Lesions.

INTRODUCTION: Prostate cancer is one of the most commonly encountered urologic malignancy. Biopsy samples may be attained using TPPB-VY or TRPB; both of the approaches are relatively comparable in terms of accuracy. Transperineal Access System revolutionizes the methodology for obtaining prostate biopsies. But in Indonesia this device is not available and expensive, we developed VY probe mounted needle guide device. The study was aimed to compare cancer detection rate and rates of cancer detection in Grade Groups (GG) between these two approaches, particularly in prostate cancer patients. METHODS: A cross-sectional study with retrospective data from patients diagnosed with prostate cancer in Hasan Sadikin General Hospital in 2019 - 2020 was performed. Ethical approval of this study was sought from the hospital authorities (IRB number: LB.02.01/X.6.5/ 55/2020). The patient was included to the study if PSA ≥ 4 ng/ml, DRE results suggestive of prostate cancer. The diagnostic accuracy of both approaches was compared using histopathological analysis. RESULTS: There were 44 patients included in the study; 22 patients had received TRPB and 22 patients had TPPB-VY. Higher degree of cancer detection rates was found in patients receiving TPPB-VY. Patient with Prostatic adenocarcinoma were all found having hypoechoic lesion in TPPB-VY. On the other hand, half of the patient with Prostatic adenocarcinoma shown having no lesion in TRPB. Prostate cancer with hypoechoic lesion can be detected better by TPPB-VY than TRPB. Cancer detection rates on TPPB-VY were significantly higher than on TRPB for each grade group. CONCLUSION: Among patient with hypoechoic lesions, TPPB-VY led to more detectionof prostate cancer, it provides detection of all grade groups and high-grade prostate cancer, this showed a non-inferior TPPB-VY compared to TRPB. TPPB-VY should be considered as an option for all men in whom a prostate biopsy is indicated.

Penile epidermal inclusion cyst mimicking ectopic testis mass: A case report.

Epidermal inclusion cyst is a benign lesion that can originate in all parts of the human body. However, the penile location is quite rare. We reported a 24-years old man with a painless, soft, progressive-growing mass at the distal part of the penis with a history of ectopic undescended testis. Complete resection was performed, and further histopathologic study revealed an epidermal inclusion cyst of the penis. This report would like to present a rare case of a penile epidermal inclusion cyst mimicking an ectopic testis mass at our institution.

CD103+ T Lymphocyte Count Linked to the Thickness of Invasion on Acral Melanoma without E-Cadherin Involvement.

BACKGROUND: Acral melanoma (AM) is a malignancy that originates from melanocytes, located in an anatomical area without sun exposure, aggressive, resistant to chemotherapy, and quickly metastasize. The invasion capability of tumor cells is the main factor for metastasis in malignancy. E-cadherin is a marker of tumor progressivity that has an important role in the process of invasion. The responsibility of E-cadherin in the invasion process of AM is not well known. CD103 is an immune component found in the tumor microenvironment that contributes to melanoma progression control, whereas E-cadherin is the ligand for CD103. PURPOSE: The objective of this research was to see if there was an association between E-cadherin and CD103 immunoexpression and the thickness of invasion in AM. MATERIALS AND METHODS: This is observational cross-sectional research. Formalin-fixed paraffin-embedded (FFPE) acral melanoma tissue samples were collected during 2014-2020 at the Department of Anatomic Pathology, Dr. Hasan Sadikin Hospital, Bandung. A total of 40 samples were collected, including 20 cases of invasive melanoma less than 4 mm thickness and 20 cases of invasive melanoma greater than 4 mm thickness. All samples were immunostained with E-cadherin and CD103. Chi-Square test was used to examine the association concerning E-cadherin and CD103 with the thickness of invasion, respectively. The p-value of 0.05 was chosen as the significance level. RESULTS: This study showed an insignificant association between E-cadherin immunoexpression and the thickness of invasion on AM (p = 0.4272). CD103 immunoexpression had a significant association with the thickness of invasion on AM (p = 0.0001). CONCLUSION: The findings revealed that CD103 in AM is associated with the thickness of invasion, and it may play important functions throughout the invasion process despite the uninvolvement of E-cadherin.

Pleomorphic retroperitoneal liposarcoma with kidney infiltration mimicking renal trauma.

Pleomorphic retroperitoneal liposarcoma are uncommon malignant tumor which hard to treat condition for its local aggressiveness and clinical specificity. A 84 years-old male patient complained with an abdominal mass and left flank pain without hematuria. The patient also complained of shortness of breath due to left pleural effusion. Contrast CT Scan revealed left renal hematoma with suggestive of renal trauma. Left flank exploration and tumor excision was performed to the patient. Histopathological examination showed pleomorphic retroperitoneal liposarcoma. In seventh day post-operative, the condition was fully recovered. This is an unusual presentation retroperitoneal mass. Pleomorphic retroperitoneal liposarcoma can provide atypical imaging.

High Expression of COX-2 Associated with the Depth of Invasion on Acral Melanoma by Increasing TGF-ß1.

INTRODUCTION: Acral melanoma (AM) has a poor prognosis since it is easily metastatic and resistant to chemo and immunotherapy. Cyclooxygenase-2 (COX-2) is an enzyme that plays a role in the carcinogenesis process. The increased expression of COX-2 has an impact on increasing levels of Myeloid-Derived Suppressor Cell (MDSC), which is a key regulator of immune. The increase in MDSC produces Transforming Growth Factor ß1 (TGF-ß1), which will suppress Natural Killer (NK) cells and Dendritic Cells (DC) function so that tumor cells are spared from the immune systems and are easier to invade surrounding tissues. PURPOSE: This study aimed to determine the role of COX-2 and TGF-ß1 on the depth of invasion on AM. MATERIALS AND METHODS: This study was a cross-sectional observational study on 40 paraffin blocks of AM cases during 2014-2019 in the Department of Pathology Anatomy, Faculty of Medicine, Dr. Hasan Sadikin General Hospital, Bandung. The depth of invasion of all samples was measured by dotSlide imaging software and the immunohistochemical staining of COX-2 and TGF-ß1 was performed. The association between COX-2 and TGF-ß1 expression and AM depth of invasion were analyzed using Mann Whitney. RESULTS: The result showed a significant association between COX-2 and TGF-ß1 expression and depth of invasion on AM. COX-2 expression had a significant association with TGF-ß1 expression (0.0001). Through multivariate analysis, it was found that COX-2 had the greatest association with the depth of invasion (p=0.0001). CONCLUSION: The findings showed that increasing expression of COX-2 in AM is associated with the depth of invasion by increasing TGF-ß1 and it might play important roles during the invasion process of AM.

A case report of one of the largest (9900 cm3) clear cell renal carcinoma removed in Asia.

INTRODUCTION: Giant renal cell carcinoma (volume more than 1000 cc) is a rare case. Management included surgical resection combined with targeted therapy. CASE PRESENTATION: We reported a case of giant clear cell renal carcinoma with 9.900 cm3 of total volume, that required surgical resection of the tumor. This is the largest giant clear cell RCC reported in Asia. DISCUSSION: Giant renal cell carcinoma management without targeted therapy was not optimal. Multimodal therapy was recommended for better outcome. CONCLUSION: Surgical resection of Giant RCC is challenging, for that reason targeted therapy is recommended to be the alternative regardless the outcome.