[Testicular localization of extranodal multifocal non-Hodgkin lymphoma. Report of two cases, review of the literature and clinical considerations].

The aim of our study is to describe two cases of testicular localization of non- Hodgkin Lymphoma associated with the involvement of other extranodal organs, and to investigate the possible causes of this association according to the evidences found in literature. Non-Hodgkin Lymphoma is extranodal in 25% of cases. Most of the times the organs involved are stomach, bowel, skin, central nervous system. About urological localizations, the most common is testis. Very rare is to find lymphoma in kidney, prostate, urinary bladder, and ureter. Testicular lymphoma is about 5% of testis malignancies; it is more frequent in the 7th and in the 8th decade. Metastases of testicular non-Hodgkin lymphoma are described also many years later, and also in distant organs. Primary forms are usually "diffuse large B cell", a high-grade histotype; metastatic ones often show Burkitt cells. The standard therapy used for non-Hodgkin Lymphomas does not reach testis and central nervous system, so that these sites are called "Therapeutic Shrines". Therefore, in order to prevent testicular localization, it is necessary to use radiotherapy, and for nervous system prophylaxis it is necessary to administer intrathecal chemotherapy. More than one localization of non-Hodgkin lymphoma simultaneously found may indicate not only a metastatic spread, but also a multicentric origin. We describe two patients who had one testis removed because of a big mass that turned out to be a non-Hodgkin lymphoma. The first patient had been treated for a non-Hodgkin lymphoma of maxillary sinus 20 months before. The second patient showed contemporary involvement of other organs. In both cases the different localizations of non-Hodgkin lymphoma showed the same histological features and cellular immunophenotype. It is important to underline that in the former patient staging TC, repeated many times, had always been negative, but physical examination of testis had been omitted, so that sinonasal localization, assumed to be the first one, really might have been the spread of an undetected testis lymphoma. In conclusion, in case of extranodal non- Hodgkin lymphoma or any other malignancies, manual or ultrasound examination of testis should never be omitted, because standard techniques of staging (TC, RMN, PET) cannot explore this organ.

[Fournier's gangrene: our experience of 10 cases].

Fournier's gangrene, described for the first time by Alfred Jean Fournier in 1883, is a very uncommon disease. It is characterized by an acute process of cellulites and necrotizing fasciitis of the external genitalia, perineum and abdominal wall; its mortality rate is about 30-50%. We retrospectively reviewed 10 patients affected by Fournier's gangrene admitted to our Department of Urology from 1997 to 2006. At a mean follow-up of 37 months (range 0-108) 7 patients are alive and disease free, 1 patient is alive bearing the signs of the gangrene, and 2 patients died because of the disease complications. We have noted that patients' survival depends on early intervention and extremely aggressive approach. The combination of these factors with antibiotic therapy and supportive care have made this disease treatable and curable.

Priapism as a complication of heparin therapy.

One case of priapism occurred during heparin therapy for a previous surgical operation to the knee is reported. The association between heparin and priapism is often recognized; abnormal platelet aggregation could play a role in the pathogenesis of this side effect. A part from the kind of surgical treatment performed, priapism as a complication of heparin therapy might be functionally more severe than priapism due to other etiologies. Our observation would confirm this statement.

[Non-surgical treatment of urethral fistula: a suggested technic]. / Terapia non chirurgica delle fistole uretrali: proposta di tecnica.

The urethral fistulas need for recovery the traditional surgical approach. Recently are available for surgeons substances and devices particularly compatible with biological tissue and very safe. We have taken advantage of this good opportunity to treat an old and multiple fistula of the urethra in the perineum. We are completely satisfied of this, alternative method that lead the patient to recover, avoiding in the same time the risks of another surgical operation too, that is difficult and complicated.