Case Report: An extremely rare occurrence of recurrent inguinal low-grade fibromyxoid sarcoma involving the scrotum.

Low-grade fibromyxoid sarcoma (LGFMS) is a rare sarcoma subtype. The most common tumor locations are the deep soft tissue of extremities or trunks. We report a rare case of recurrent LGFMS in the inguinal region involving the scrotum and both testicles. A 38-year-old male patient reported a history of multiple nodular lesions in the left inguinal region accompanied by local inflammation. The patient was submitted for local resection of the lesion at our institution, with histopathological diagnosis of LGFMS. He missed his follow-up, returning with a large bulge in the left inguinal region involving the scrotum with signs of tissue necrosis and local purulent discharge. Surgical exploration was performed and the patient underwent tumor resection in the left inguinal region and the entire scrotum, with bilateral orchiectomy, with the margins enlarged to the right inguinal region and proximal surface of the penis. Local reconstruction was performed with a left fascia lata tensor muscle flap and ipsilateral thigh coverage using partial skin graft. On microscopic examination, the tumor showed spindle cells arranged in bundles, with abundant collagen and myxoid stroma with interspersed prominent vessels. The immunohistochemical study carried out showed immunoreactivity with Ki67 (<5%), immunonegativity with desmin and S100, confirming the diagnosis of LGFMS. Postoperative recovery was good and no recurrence was seen after two years. The patient is in good health, realizing multidisciplinary outpatient follow-up and performing continuous testosterone replacement. Surgical resection with negative margins for localized disease remains the standard treatment for LGFMS.

Synchronic renal cell carcinoma associated with fibromixoid sarcoma: A rare finding.

INTRODUCTION: Renal cell carcinoma comprises over 90% of renal cancers, thus, it is the most common form of renal neoplasia. This carcinoma can often present itself in a variable fashion, ranging from incidentalomas to metastatic diseases. Furthermore, the most common metastasis associated with this type of carcinoma occurs in the lungs, bones or liver. We aim to report a case of renal cell carcinoma which presented together with a fibromixoid sarcoma. CASE PRESENTATION: A 50 year-old woman presented with hematuria, weight loss, asthenia and right lumbar pain that started 7 months prior to the consult. CT scan was performed and revealed a solid injury of 10 cm in the right kidney together with a mass in the left flank. Total right nephrectomy was promptly performed and the patient was submitted 3 months later to a tumoral resection of the abdominal wall. Histopathological findings revealed a primary renal cell carcinoma and the second, metastatic tumor was shown to be a fibromixoid sarcoma. The patient was not submitted to chemotherapy and is currently under follow-up with the surgery and oncology staffs, without showing any symptoms. DISCUSSION: Renal cell carcinoma usually presents itself together with secondary tumors on the lungs and bones. The association of this type of carcinoma with a fibromixoid sarcoma of the abdominal wall is rare and poorly reported in the literature. CONCLUSION: This case reports shows a successful treatment regarding this rare association, which can help other physicians to re-evaluate their medical conduct.

Urethral injury in penile fracture: a narrative review

ABSTRACT Objective To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. Materials and Methods We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". Results The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. Conclusion PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is mandatory and produces satisfactory results with low levels of complications.

Urethral injury in penile fracture: a narrative review.

OBJECTIVE: To present the evolution and the recent data on the etiology, diagnosis, management and outcomes of penile fracture (PF) with concomitant urethral injury. MATERIALS AND METHODS: We searched the Pubmed database between 1998 and 2019 using the following key words: "penile fracture", "fracture of penis", "trauma to penis", "rupture of corpora cavernosa", "urethral injury", "urethral rupture" and "urethral reconstruction". RESULTS: The incidence of urethral lesion in patients with PF varies by geographic region and etiology. Blood in the meatus, hematuria and voiding symptoms are highly indicative of urethral rupture. The diagnosis of PF is eminently clinical and complementary exams are not necessary. The treatment consists of urethral reconstruction and the most common complications found are urethral stenosis and urethrocutaneous fistula. CONCLUSION: PF is an uncommon urological emergency, particularly in cases with urethral involvement. Urethral injury should be suspected in the presence of suggestive clinical signs, and diagnosis is usually clinical. Urgent urethral reconstruction is man-datory and produces satisfactory results with low levels of complications.

Structural changes of dilated pelvic ureters in adults.

PURPOSE: To perform a quantitative assessment of different types of pelvic ureter tissues with chronic dilation in adults, using stereological methods. METHODS: We analyzed fragments of dilated pelvic ureters obtained from 6 patients aged between 35 and 67 years (mean, 46 years) who underwent ureteral reimplantation surgery for different reasons. The obstruction duration ranged from 27 to 180 days (mean, 93 days). The control group included fragments of normal pelvic ureters obtained during nephrectomy in 7 kidney transplant donors (age: range, 25-51 years; mean, 36 years). The volumetric density of collagen in the ureter, elastic fibers, and smooth muscle fibers was assessed. RESULTS: The volumetric density (Vv) of collagen showed no significant difference between the two groups (control: 45.3 ± 6.1; dilated: 40.8 ± 6.9; P = 0.23). A statistically significant increase in Vv of elastic fibers was observed in the dilated ureters (control: 18.4 ± 1.2; dilated: 24.6 ± 5.4; P = 0.03). A statistically significant increase in the Vv of smooth muscle fibers was observed in the dilated ureter (control: 42.0 ± 6.0; dilated: 56.2 ± 6.1; P = 0.001). CONCLUSION: The chronically dilated pelvic ureters had significantly more elastin and smooth muscle contents than the controls.

Structural changes of dilated pelvic ureters in adults

PURPOSE: To perform a quantitative assessment of different types of pelvic ureter tissues with chronic dilation in adults, using stereological methods. METHODS: We analyzed fragments of dilated pelvic ureters obtained from 6 patients aged between 35 and 67 years (mean, 46 years) who underwent ureteral reimplantation surgery for different reasons. The obstruction duration ranged from 27 to 180 days (mean, 93 days). The control group included fragments of normal pelvic ureters obtained during nephrectomy in 7 kidney transplant donors (age: range, 25-51 years; mean, 36 years). The volumetric density of collagen in the ureter, elastic fibers, and smooth muscle fibers was assessed. RESULTS: The volumetric density (Vv) of collagen showed no significant difference between the two groups (control: 45.3 ± 6.1; dilated: 40.8 ± 6.9; P = 0.23). A statistically significant increase in Vv of elastic fibers was observed in the dilated ureters (control: 18.4 ± 1.2; dilated: 24.6 ± 5.4; P = 0.03). A statistically significant increase in the Vv of smooth muscle fibers was observed in the dilated ureter (control: 42.0 ± 6.0; dilated: 56.2 ± 6.1; P = 0.001). CONCLUSION: The chronically dilated pelvic ureters had significantly more elastin and smooth muscle contents than the controls. .

Structural changes of dilated pelvic ureters in adults

To perform a quantitative assessment of different types of pelvic ureter tissues with chronic dilation in adults, using stereological methods. We analyzed fragments of dilated pelvic ureters obtained from 6 patients aged between 35 and 67 years (mean, 46 years) who underwent ureteral reimplantation surgery for different reasons. The obstruction duration ranged from 27 to 180 days (mean, 93 days). The control group included fragments of normal pelvic ureters obtained during nephrectomy in 7 kidney transplant donors (age: range, 25-51 years; mean, 36 years). The volumetric density of collagen in the ureter, elastic fibers, and smooth muscle fibers was assessed. The volumetric density (Vv) of collagen showed no significant difference between the two groups (control: 45.3 ± 6.1; dilated: 40.8 ± 6.9; P = 0.23). A statistically significant increase in Vv of elastic fibers was observed in the dilated ureters (control: 18.4 ± 1.2; dilated: 24.6 ± 5.4; P = 0.03). A statistically significant increase in the Vv of smooth muscle fibers was observed in the dilated ureter (control: 42.0 ± 6.0; dilated: 56.2 ± 6.1; P = 0.001). The chronically dilated pelvic ureters had significantly more elastin and smooth muscle contents than the controls.(AU)

Efeitos em curto prazo da radiação na densidade e na organização estrutural músculo liso e tecido conjuntivo do corpo cavernoso de ratos suplementados com L-glutamina / Short-term effects of radiation on the density and structural organization of smooth muscle and connective tissue in the corpus cavernosum of rats supplemented with L-glutamine

Objetivo - Avaliar os efeitos em curto prazo da radiação pélvica nos corpos cavernosos do pênis de ratos empregando técnicas morfológicas quantitativas e determinar se a L-glutamina (GLUT), a qual protege o tecido intestinal contra as lesões induzidas pela radiação, tem um efeito similar no pênis. Material e métodos - Grupos de ratos Wistar machos adultos receberam: (a) nenhum tratamento; (b) uma dose de radiação somente, e (c) irradiação e suplementação de glutamina na dieta. Todos os animais foram sacrificados sete dias após a irradiação. O terço médio do segmento proximal do pênis foi fixado em formalina tamponada e corado com Tricrômico de Masson para músculo liso e tecido conjuntivo e com Resorcina Fucsina de Weigert para evidenciar as fibras do sistema elástico. A quantificação das fibras musculares lisas e fibras do sistema elástico foi feita como densidade volumétrica (Vv) por meio do método estereológico. A disposição do colágeno foi avaliada pelo método de polarização com Picrosírius e as cores foram quantificadas por análise de imagens e expressas como proporção vermelho/verde. Resultados - Após a irradiação, a densidade volumétrica do músculo liso do corpo cavernoso aumentou 40,8% comparada com os controles (13.62 +- 2.96% vs 9.67 +- 2.52%; p < 0.05) e a suplementação com glutamina não reverteu este efeito. Todavia a Vv do tecido conjuntivo como um todo e das fibras elásticas no tecido cavernoso não sofreu modificações entre os grupos. Comparada com o controle, a relação vermelho/verde foi reduzida em 54,1% nos animais submetidos somente à irradiação (6.10 +- 2.69 vs 2.80 +- 1.27; p < 0.5). Novamente este efeito não foi prevenido pela suplementação com glutamina.

Data on the side effects of pelvic radiotherapy on penile tissue are mostly qualitative and long-term, and lack information on connective tissue. Here we have quantitated the short-term effects of radiation on the rat corpus cavernosum and investigated whether L-glutamine (GLUT), which protects intestinal tissue against radiation, has similar effects on the penis. Groups of adult Wistar rats received: (a) one dose of radiation; (b) radiation and GLUT supplementation; and (c) no radiation or GLUT, and were used as controls. All animals were sacrificed seven days after irradiation. Sections of the proximal penis were stained for smooth muscle, connective tissue, and elastic fibers, which were quantitated as volume fraction (Vv). Collagen organization was measured as a red/green ratio using the Picrosirius-polarization method. After radiation, smooth muscle Vv increased by 40.8% compared with controls (p<0.05), while Vv of connective tissue and elastic fibers were unchanged among the groups. The collagen red/green ratio decreased by 54.1% in irradiated animals (p<0.05). GLUT did not prevent all these changes.