A Rare Case of Prostatic Stromal Tumour of Uncertain Malignant Potential Surrounding Ejaculatory Ducts in a Patient With Concurrent Prostate Adenocarcinoma.

Stromal tumour of uncertain malignant potential (STUMP) is exceedingly rare. Diagnosis and management of STUMP present a challenge to the urologist due to the absence of specific clinical findings and its unpredictable clinical course. Thus, radical resection is often recommended. Here, we present a case of a 64-year-old male, who presented with mild obstructive voiding symptoms with a raised age-specific prostate-specific antigen (PSA) of 3.1. Magnetic resonance imaging (MRI) showed an area of suspicion, in an area thought to be the left seminal vesicle, containing a malignant lesion within it. Biopsy of this area and the prostate confirmed concurrent prostatic STUMP and Gleason 3+3=6 adenocarcinoma of the prostate, managed with robotic-assisted laparoscopic radical prostatectomy with wide local excision.

Neurovascular structure-adjacent frozen-section examination robotic-assisted radical prostatectomy: outcomes from 500 consecutive cases in the UK.

The purpose is to report the United Kingdom's largest single-centre experience of robotically assisted laparoscopic radical prostatectomies (RALP), using the neurovascular structure-adjacent frozen-section (NeuroSAFE) technique. We describe the utilisation and outcomes of this technique. This is a retrospective study from 2012 to 2019 on 520 patients undergoing NeuroSAFE RALP at our Institution. Our Institution's database was analysed for false-positive frozen-section (FS) margins as confirmed on paraffin histopathological analysis: functional outcomes of potency, continence, and biochemical recurrence (BCR). The median (range) of console time was 145 (90-300) min. In our cohort, positive FS was seen in 30.7% (160/520) of patients, with a confirmatory paraffin analysis in 91.8% of our patients' cohort (147/160). The neurovascular bundles (NVBs) that underwent secondary resection contained tumour in 26.8% (43/160) of the cases. Biochemical recurrence (BCR) was 6.7% (35/520), of which FS was positive in 40% (14/35) of those cases. There were insufficient evidence of a statistical association of urinary incontinence and positive surgical margin rates according to NS or NVB resection. NeuroSAFE enables intraoperative confirmation of the oncologic safety of a NS procedure. Patients with a positive FS on NeuroSAFE can be converted to a negative surgical margin (NSM) by ipsilateral wide resection. This spared 1 in 4 men from positive margins posterolaterally in our series. Limitations are the absence of a matched contemporary cohort of NS RALP without NeuroSAFE in our centre.

Ultrasound appearances and histological correlation of native arteriovenous fistula stenoses - A retrospective case series.

The pathophysiology of haemodialysis arteriovenous fistulae (AVF) stenoses is not fully understood. The aim of this study was to perform histology assessment of stenoses in native AVF and compare and correlate the findings between ultrasound and histology. Intimal medial thickness (IMT) was measured on ultrasound where there was measurable neointimal hyperplasia at the site of stenosis and percentage intimal thickening calculated. Ultrasound findings were then compared with histology analysis of AVF stenoses in nine patients. In this small sample, different sonographic appearances and histology were demonstrated. Ultrasound demonstrated stenoses with neointimal hyperplasia and those with no measurable neointimal hyperplasia. Percentage intimal thickening was between 0% and 100%. The histology of the de novo stenoses (where no previous radiological or surgical procedure was performed) demonstrated stenoses with neointimal hyperplasia, no neointimal hyperplasia and neointimal hyperplasia and fibrosis. The histology findings after percutaneous angioplasty (PTA) demonstrated stenoses with neointimal hyperplasia and fibrosis and a stenosis with an acute inflammatory reaction. The findings in this small sample demonstrated that AVF stenoses are not a uniform group as demonstrated by different sonographic and corresponding appearances at histology. Ultrasound appearances of neointimal hyperplasia appear to correlate with neointimal hyperplasia on histology. These findings warrant further investigation and may have implications for treatment strategies.

The neurovascular structure-adjacent frozen-section examination (NeuroSAFE) approach to nerve sparing in robot-assisted laparoscopic radical prostatectomy in a British setting - a prospective observational comparative study.

OBJECTIVES: To evaluate the neurovascular structure-adjacent frozen-section examination (NeuroSAFE) technique in a British setting in men undergoing robot-assisted laparoscopic radical prostatectomy (RALP) . PATIENTS AND METHODS: We retrospectively analysed our prospectively maintained database of patients who underwent RALP between November 2008 and February 2017. We examined preoperative pathological and functional parameters, intraoperative nerve sparing (NS), postoperative histology, as well as functional and oncological follow-up. We compared those who had a NeuroSAFE approach and those who had NS without NeuroSAFE. We also compared all the RALPs before and after the introduction of NeuroSAFE. Statistical analysis was done using the two-tailed t-test and chi-squared analysis. RESULTS: This single surgeon series included 417 RALPs, including 120 NeuroSAFEs. The NeuroSAFE cohort had a greater proportion of D'Amico high-risk disease (30.8% vs 9.6%, P < 0.001), higher Gleason scores and higher pT stage compared to the non-NeuroSAFE NS cohort. After the introduction of NeuroSAFE, more preoperatively potent men underwent bilateral NS with pT2 disease (84.6% vs 66.3%, P = 0.002) and more overall NS were performed in patients with pT3 disease (65.1% vs 36.7%, P = 0.012). Overall positive surgical margin (PSM) rates were lower in the NeuroSAFE cohort compared to those who had NS without NeuroSAFE (9.2% vs 17.8%, P = 0.04). The 12-month potency rates were also higher in the NeuroSAFE cohort for both bilateral (77.3% vs 50.9%, P = 0.009) and unilateral (70.6% vs 40%, P = 0.04) NS. Pad-free continence was also higher in the NeuroSAFE group (85.7% vs 70.9%, P = 0.019), but there was no significant difference between those who were wearing ≤1 safety pad. Although we only had short-term oncological follow-up, it did not significantly differ between the two groups. CONCLUSION: Adoption of NeuroSAFE allowed us to offer NS in higher risk patients, whilst reducing PSM rates and at the same time improving potency at 12 months.

Silsesquioxane nanocomposites as tissue implants.

BACKGROUND: Silicone implants are being used increasingly worldwide, especially in breast augmentation procedures. The most common morbidity observed is capsular contracture, which occurs in 15 percent of cases. To overcome this problem, the authors have developed a novel nanocomposite based on polyhedral oligomeric silsesquioxane-poly(carbonate-urea)urethane (POSS-PCU) for use as tissue implants. METHODS: These polymers were implanted in six healthy sheep (n = 6) for 36 months and a siloxane served as the positive control. After explantation, these polymers were extracted, as was the surrounding capsule, if any. Attenuated total reflectance Fourier transform infrared spectroscopy analysis was performed to look for signs of surface degradation on the polymers and histopathologic and electron microscopic examinations were performed to study the interaction between the biomaterial and the host environment in greater detail. RESULTS: After implantation, the authors observed minimal inflammation of the nanocomposite within the sheep model as compared with the siloxane control. Contact angle measurements and fibrinogen enzyme-linked immunosorbent assay tests were then conducted on the POSS-PCU nanocomposite to determine the reason for this behavior. The increased fibrinogen adsorption on POSS-PCU, its amphilicity, and large contact-angle hysteresis indicated that POSS-PCU inhibits inflammation by adsorbing and inactivating fibrinogen on its surface. In complete contrast, the control siloxane in the same setting demonstrated very significant inflammation and degradation, resulting in capsular formation. Naturally, there was no evidence of degradation of the nanocomposite compared with the siloxane control. CONCLUSIONS: POSS-PCU nanocomposites have enhanced interfacial biocompatibility and better biological stability as compared with conventional silicone biomaterials, thus making them safer as tissue implants.

Significance of mucin stain in differentiating benign and malignant lesions of prostate.

In an attempt to assess the significance of mucin stains in benign and malignant lesions of prostate, 200 prostatic biopsies in the department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak were studied. All the biopsies were subjected to PAS and alcian blue staining along with H&E stain. Neutral mucin (PAS positive) was more frequently observed in benign prostatic lesions (93.3%) as compared to carcinoma (36%) while acid mucin (AB positive) was found more in carcinoma prostate (68%) as compared to benign prostatic lesions (16%). The positivity for acid mucin was more in well differentiating tumour decreasing significantly in high grade malignancies. With both types of mucin, luminal positivity was slightly more as compared to cytoplasmic positivity.