Incision site metastasis: Adding insult to injury.

Incision site metastasis is a rare yet well-recognized complication of oncologic operations. We describe the case of a 60-year-old man with a large mass at the site of abdominal incision for a nephrectomy. The operation was performed for infection in an obstructed kidney, which in retrospect harbored malignancy. Percutaneous core biopsy of the mass revealed metastatic conventional renal cell carcinoma (RCC). Surgical resection was obviated by the presence of nodal disease on imaging. Palliative targeted therapy with tyrosine kinase inhibitor was initiated. RCC can not only mimic an inflammatory renal mass radiologically but also coexist with infective renal conditions. Diligent histopathological examination as a routine following nephrectomy for complicated diagnoses is imperative.

Histopathological analysis of the non - tumour parenchyma following radical nephrectomy: can it predict renal functional outcome?

ABSTRACT Introduction Radical nephrectomy (RN), a recommended treatment option for patients with Renal cell carcinoma (RCC) leads to an inevitable decline in global renal function. Pathological changes in the non-tumour parenchyma of the kidney may help predict the function of the remaining kidney. Materials and Methods Aim of this prospective, observational study was to find histopathological factors in the non-tumor renal parenchyma that could predict the decline in global renal function postoperatively and its association with co-morbidities like diabetes (DM). Data of consecutive patients undergoing RN from December-2013 to January-2015 was collected. Non-tumor parenchyma of the specimen was reported by a dedicated histopathologist. eGFR was calculated using Cockcroft-Gault formula before the surgery and at last follow up of at least 12 months. Results 73 RN specimens were analyzed. Mean follow up was 12.3 months. The mean decrease in eGFR was 22% (p=.0001). Percent decrease in eGFR did not show association with any of the histopathological parameters studied. DM was significantly associated with decrease in percent eGFR (p<0.05) and increase in arteriolar hyalinosis (p=0.004), Glomerulosclerosis (p=0.03) and Interstitial fibrosis/ Tubular atrophy (p=.0001). Maximum size of the tumor showed a negative correlation with percentage change in eGFR (p=.028). Conclusion Histological parameters in the non-tumour portion of the RN specimen may not be able to predict renal function outcome over a short follow up. However, presence of DM was associated with adverse pathological changes and significant decrease in renal function postoperatively.

Histopathological analysis of the non - tumour parenchyma following radical nephrectomy: can it predict renal functional outcome?

INTRODUCTION: Radical nephrectomy (RN), a recommended treatment option for patients with Renal cell carcinoma (RCC) leads to an inevitable decline in global renal function. Pathological changes in the non-tumour parenchyma of the kidney may help predict the function of the remaining kidney. MATERIALS AND METHODS: Aim of this prospective, observational study was to find histopathological factors in the non-tumor renal parenchyma that could predict the decline in global renal function postoperatively and its association with co-morbidities like diabetes (DM). Data of consecutive patients undergoing RN from December-2013 to January-2015 was collected. Non-tumor parenchyma of the specimen was reported by a dedicated histopathologist. eGFR was calculated using Cockcroft-Gault formula before the surgery and at last follow up of at least 12 months. RESULTS: 73 RN specimens were analyzed. Mean follow up was 12.3 months. The mean decrease in eGFR was 22% (p=.0001). Percent decrease in eGFR did not show association with any of the histopathological parameters studied. DM was significantly associated with decrease in percent eGFR (p<0.05) and increase in arteriolar hyalinosis (p=0.004), Glomerulosclerosis (p=0.03) and Interstitial fibrosis/ Tubular atrophy (p=.0001). Maximum size of the tumor showed a negative correlation with percentage change in eGFR (p=0.028). CONCLUSION: Histological parameters in the non-tumour portion of the RN specimen may not be able to predict renal function outcome over a short follow up. However, presence of DM was associated with adverse pathological changes and significant decrease in renal function postoperatively.

Extrauterine Placental Site Trophoblastic Tumor Involving the Vagina.

Very few cases of placental site trophoblastic tumor (PSTT) primarily involving extrauterine sites have been reported to date. We report a case of a 29-year-old female who presented with a vaginal nodule 9 months after delivery at an outside hospital which was initially diagnosed as a poorly differentiated squamous cell carcinoma. Subsequently she was referred to our institute, and on the basis of histology, mildly elevated serum ß-HCG level, and immunohistochemistry, PSTT was diagnosed. After the completion of chemotherapy, the vaginal nodule completely regressed and serum ß-hCG returned to baseline. Her follow-up has been unremarkable. This case highlights the importance of the fact that PSTT can be easily misdiagnosed at extrauterine sites in the absence of proper clinical, histologic, and immunohistochemical correlation.

A rare case of malignant fibrous histiocytoma/ pleomorphic undifferentiated sarcoma of the kidney.

Malignant Fibrous Histiocytoma (MFH) usually arises from the extremities with the retroperitoneum being the second most common site. We present the case report of a 58-year-old man presenting with fever and was detected to have a renal mass on evaluation. He underwent a radical nephrectomy with a preoperative diagnosis of renal cell carcinoma. But the final histopathological report was MFH. Primary renal MFH is extremely rare and is usually diagnosed on histopathology with the aid of immunohistochemistry.

Bilateral ovarian metastases from ureteric urothelial cancer: Initial case report and distinguishing role of immunohistochemistry.

Urothelial cancers of the upper tract are aggressive malignancies with a propensity for distant metastases. Transitional cell carcinoma can also develop de novo in the ovaries and differentiation between these lesions requires immunohistochemistry. We report a case of right lower ureteric urothelial carcinoma with metastases to both ovaries. To our knowledge, this is the first reported case of bilateral ovarian metastases from an upper tract primary, diagnosed with immunohistochemistry.

Monopolar versus bipolar transurethral resection of bladder tumors: a single center, parallel arm, randomized, controlled trial.

PURPOSE: We compared the safety and efficacy of bipolar transurethral resection and monopolar resection for bladder tumors. MATERIALS AND METHODS: A single center, parallel arm, randomized, controlled trial was performed from May 2011 to August 2012. All patients with suspected bladder tumors were eligible for study inclusion. Those who refused consent and those undergoing routine restaging transurethral resection of bladder tumor were excluded from analysis. The primary end point was the incidence of obturator jerk. Secondary study outcomes included the decrease in hematocrit, rates of recoagulation and transfusion, bladder perforation, decrease in sodium, resection syndrome and resection time. Pathological quality was assessed by comparing deep muscle and the degree of severe cautery artifact in the 2 arms. RESULTS: A total of 257 transurethral resections were performed during the study period. After exclusion 147 patients were randomized, including 75 in the monopolar arm and 72 in the bipolar arm. There were 6 and 4 protocol violations in the monopolar and bipolar arms, respectively. Intent to treat and per protocol analyses were performed. The incidence of obturator jerk was greater in the bipolar arm (60% vs 49.2%, p=0.27). There was no significant difference between secondary outcomes. The only significant difference was a significantly lower incidence of severe cautery artifact in the bipolar arm (25% vs 46.7%, p=0.0096). CONCLUSIONS: Bipolar transurethral resection of bladder tumor was not superior to monopolar resection with respect to obturator jerk, bladder perforation and hemostasis. There was a significantly lower incidence of severe cautery artifact after bipolar resection.