Unusual Urologic Metastasis From Gastrointestinal Cancers: A Compilation of Case Reports and Literature Review.

Gastrointestinal cancers are highly prevalent around the world. In the metastatic setting, the most usual sites for metastases are the liver, lymph nodes, peritoneum, and lung. Urologic metastases are very rare. We report a case series of three patients with gastrointestinal tumours in different topographies (stomach, colon, and rectum) with urological metastases. In all cases, the patients were initially treated with curative intent. Two of the patients presented with bladder metastases, and the third had penile metastases in addition to pulmonary metastases. Haematuria was the most common symptom at presentation. One of the patients had a good overall survival and is still undergoing palliative intent chemotherapy. In the literature, there are few reported cases of urological metastases from gastrointestinal cancers, and that is the aim of this publication.

Phenotypic Analysis of Urothelial Exfoliated Cells in Bladder Cancer via Microfluidic Immunoassays: Sialyl-Tn as a Novel Biomarker in Liquid Biopsies.

Bladder cancer is the most common malignancy of the urinary tract, having one of the highest recurrence rates and progression from non-muscle to muscle invasive bladder cancer that commonly leads to metastasis. Cystoscopy and urine cytology are the standard procedures for its detection but have limited clinical sensitivity and specificity. Herein, a microfluidic device, the UriChip, was developed for the enrichment of urothelial exfoliated cells from fresh and frozen urine, based on deformability and size, and the cancer-associated glycan Sialyl-Tn explored as a putative bladder cancer urinary biomarker. Spiking experiments with bladder cancer cell lines showed an isolation efficiency of 53%, while clinical sample analyses revealed retention of cells with various morphologies and sizes. in situ immunoassays demonstrated significantly higher number of Sialyl-Tn-positive cells in fresh and frozen voided urine from bladder cancer patients, compared to healthy individuals. Of note, urothelial exfoliated cells from cryopreserved urine sediments were also successfully isolated by the UriChip, and found to express significantly high levels of Sialyl-Tn. Remarkably, Sialyl-Tn expression is correlated with tumor stage and grade. Overall, our findings demonstrate the potential of UriChip and Sialyl-Tn to detect urothelial bladder cancer cells in follow-up and long-term retrospective studies.

[Unclassified sex cord testis tumor]. / Tumor dos Cordões Sexuais Não Classificável do Testículo.

Unclassified sex cord testis tumor is an extremely rare tumor, especially in the adult. It is characterized histologically for a nonspecific combination of testis stromal and epithelial elements, with varying degree of differentiation. Treatment usually consists of radical orchiectomy followed by clinical and imaging surveillance. The available literature about this pathology relies almost exclusively on clinical cases. It's our aim to describe the case of a 37 years old man with an unclassified sex cord testis tumor, the first case described in Portugal, and to review the literature about this issue.

O tumor dos cordões sexuais nÉo classificável do testículo eÌ um tumor extremamente raro, particularmente na idade adulta. Caracteriza-se histologicamente pela conjugaçaÌo inespeciÌfica de elementos estromais e epiteliais do testículo, com grau de diferenciaçÉo variável. A sua abordagem consiste na orquidectomia radical, geralmente realizada antes do diagnóstico, e posterior vigil'ncia clínica e imagioloÌgica. A literatura disponível sobre esta patologia baseia-se quase exclusivamente na descriçÉo de casos clínicos. O nosso objetivo é apresentar o caso de um doente de 37 anos com um tumor dos cordões sexuais nÉo classificável do testículo, o primeiro descrito em Portugal, e fazer uma revisÉo da literatura sobre o tema.

Pararenal sclerosing PEComa.

Small renal or pararenal masses and retroperitoneum lesions are extremely difficult to diagnose. Imaging technology is a precious diagnostic tool; however, it places physicians in a difficult position since many lesions are not precisely diagnosed. Clinical and radiological findings can guide suspicion towards the diagnosis; however, in our current practice most diagnoses are based on histological findings. We aim to present a pararenal sclerosing perivascular epithelioid cell tumour (PEComa), a rare entity, whose diagnosis is only possible through invasive approaches and histological analysis. This rare lesion not only is difficult to diagnose but also has an uncertain behaviour, which is of major importance concerning its follow-up and prognosis. This case report is an attempt to add more data that will help establish criteria for diagnosis and follow-up of this rare disease.

Adrenal ganglioneuroma: a rare incidental finding.

The widespread use of imaging technology as a diagnostic tool has resulted in the identification of many previously unknown, clinically benign lesions. The current era of easy access to imaging studies places physicians in a difficult position, since many lesions are not precisely diagnosed by imaging. For example, the accurate diagnosis of non-functioning adrenal lesions remains a clinical challenge. This report describes a patient with the incidental CT finding of an uncommon adrenal ganglioneuroma. Clinical and radiological findings can guide suspicion towards this rare lesion; however, the actual diagnosis is based on histological findings. Specific characteristics of adrenal ganglioneuromas that would allow their diagnosis without invasive procedures have not been established. This case report is an attempt to add more data that will help to establish diagnostic criteria for this rare disease.

Coagulum pyelolithotomy "revisited" by laparoscopy: technique modification.

OBJECTIVE: Laparoscopic ureteropyeloplasty is a widely accepted treatment option for the obstructed ureteropelvic junction (UPJ). Although it is often a straightforward surgical procedure, there may be technical difficulties in the case of concomitant stone burden, with multiple calicial, small, mobile stones. The authors describe a modification to the classic coagulum pyelolitothomy, using a mixture based on commercially available fibrin sealant, first used in the laparoscopic era. METHODS: During a laparoscopic transperitoneal dismembered ureteropyeloplasty complemented with coagulum pyelolithotomy, the following steps are suggested: (1) Exposure of the UPJ; (2) ureter clamping with a vessel loop 2 cm distal to the UPJ (to allow pelvis filling); (3) transabdominal puncture of the pelvis with an 18-G, 20-cm needle (under laparoscopic vision) and urine aspiration; (4) recording the volume of urine aspirated; (5) preparing an equal volume of fibrin sealant (to avoid overdistention of the pelvis); (6) injecting the sealer protein solution through that needle + 1 mL of methylene blue (color the coagulum and facilitate its identification in the removal procedure); (7) insertion of another needle to inject the thrombin solution; (8) wait 5 minutes to allow coagulum cast formation; (9) circumferential excision of the UPJ; (10) coagulum removal; (11) pelvis plastic reduction (if needed) and ureter spatulation; (12) double-J stent placement; and (13) tension-free anastomosis completion. RESULTS: The procedure results in the extraction of a tenacious coagulum containing more stones than normally anticipated from the x-ray studies. CONCLUSIONS: This technique modification reduces the incidence of incomplete stone removal, when there are small, free stones lying in a large renal pelvis.