Neoadjuvant chemotherapy for muscle-invasive bladder cancer: does variant histology matter?

PURPOSE: The most frequent histology of bladder tumors is urothelial carcinoma. Most are pure urothelial carcinomas (PUC) but up to one-third of the cases present variant histological (VH) features. The aim of this study was to evaluate the role of variant histology in neoadjuvant chemotherapy (NAC) response in patients with urothelial muscle-invasive bladder cancer. METHODS: We retrospectively analyzed data from 77 patients with bladder cancer who performed neoadjuvant chemotherapy at two institutions. RESULTS: Complete pathological response (ypT0) was higher in patients with PUC (38.5%), comparing with VH (12%). Logistic regression analysis demonstrated that variant histology is associated with an 89% lesser likelihood of tumor downstaging, with advanced clinical T stages and positive smoking history as independent predictors. The estimated mean cancer-specific survival was 68.91 months for PUC patients and 50.23 months for VH patients (log rank test, P = 0.024). Multivariate Cox regression analysis demonstrated that VH and clinical T stage were independent predictors of cancer-specific survival, indicating a worse outcome for patients with VH and advanced clinical T stages. CONCLUSIONS: There are only a few retrospective studies evaluating the clinical impact of variant histology tumors, which are mainly managed as PUC. Our results demonstrate that VH is associated with a worse likelihood of tumor downstaging after NAC and a worse cancer-specific survival in bladder cancer patients. There is a need for further studies and genetic analysis to identify the patients most likely to achieve ypT0 status and downstaging after NAC.

Schwannoma of Seminal Vesicle: A Case Report.

Seminal vesicle neoplasms are extremely rare. Schwannoma is a benign tumor of the peripherical nerve sheath composed of Schwann cells. Most of these tumors are silent and become symptomatic with compression of adjacent organs and nerves. We present a case of a 72-year-old man who presented with a several months history of predominant storage lower urinary tract symptoms and painful ejaculation. Prostate-specific antigen (PSA) was within normal ranges, and imaging documented a retrovesical nodular lesion adjacent to the right seminal vesicle with 5 cm in width. We successfully performed a robotic-assisted laparoscopic surgery to excise the lesion. Anatomopathological analysis revealed a schwannoma.

Synchronous bilateral seminoma.

OBJECTIVE: To present a case of synchronous bilateral seminoma and perform a bibliographic review about this rare presentation of testicular neoplasia, with important physical and psychological consequences. METHODS: 25-year old man with bilateral multifocal testicular neoplasias and azoospermia. We performed a bilateral inguinal radical orchiectomy, with the pathologic exam diagnosing bilateral seminoma. Adjuvant lumbar-aortic radiotherapy was initiated. More than a year after the surgery the patient is asymptomatic and without evidence of disease, although dependent of testosterone supplement. RESULTS: Germ cell testicular neoplasias are more frequent in young men between 15 and 35 years old. There is a 2-3% incidence of bilateral neoplasm, either synchronous or metachronous. Bilateral radical orchiectomy remains as standard of treatment, rendering the patient infertile and depending on exogenous androgens, which causes several psychological problems. However, a testis-sparing surgery could be performed in selected cases; our patient, having multiple bilateral neoplasias, was not eligible for this procedure. With a great incidence of carcinoma in situ on spared testicular parenchyma, scrotal radiotherapy is indicated. In spite of infertility, this treatment presents very good oncological results with androgen independence and consequent physical and psychological advantages. CONCLUSION: Bilateral orchiectomy still remains as "gold-standard" treatment for bilateral seminoma. However, there are other possibilities of treatment, such as partial orchiectomy, feasible in selected cases of small volume testicular tumours in solitary testis / bilateral tumour in men without preoperative androgen deficiency and who could be object of close clinical and imaging follow-up. This way you could avoid additional loss of quality of life, without any prejudice on oncological results.

Seminoma bilateral sincrónico. Revisión de la literatura a propósito de un caso / Synchronous bilateral seminoma

OBJETIVO: Presentar un caso de seminoma bilateral sincrónico y realizar una revisión bibliográfica sobre una presentación poco frecuente de neoplasia testicular.MÉTODOS: Presentamos el caso de un hombre de 25 años con neoplasia testicular bilateral multifocal y azoospermia. Realizamos una orquiectomía radical inguinal bilateral, cuyo examen anatomopatológico reveló seminoma bilateral, por lo que se efectuó radioterapia lumbo-aórtica adyuvante. Más de un año después de la cirugía, se encuentra asintomático y sin evidencia de enfermedad, pero dependiente de testosterona exógena.RESULTADOS: Las neoplasias testiculares germinativas presentan una incidencia mayor en hombres entre 15 a 35 años. En el 2-3 % de los casos, se verifica neoplasia bilateral. El tratamiento recomendado es la orquiectomía radical bilateral, que ocasiona infertilidad en el paciente y dependencia de testosterona exógena. En nuestro paciente, por tener múltiples tumores bilateralmente, no existía otra opción, pero en casos seleccionados se puede efectuar orquiectomía parcial. Si es muy elevada la incidencia de carcinoma in situ en el restante parénquima, está indicada la radioterapia escrotal. A pesar de la infertilidad secundaria al tratamiento, esta opción presenta muy buenos resultados oncológicos y de no dependencia de testosterona exógena.CONCLUSIÓN: El tratamiento recomendado del seminoma bilateral sigue siendo la orquiectomía bilateral, aunque existen otras posibilidades, como la orquiectomía parcial, posible en tumores testiculares únicos, de pequeño volumen en hombres con testosterona normal y con posibilidad de vigilancia clínica y radiológica frecuente. De esta manera, se puede disminuir el impacto sobre la calidad de vida, sin alterar el resultado oncológico final(AU)

OBJECTIVE: To present a case of synchronous bilateral seminoma and perform a bibliographic review about this rare presentation of testicular neoplasia, with important physical and psychological consequences.METHODS: 25-year old man with bilateral multifocal testicular neoplasias and azoospermia. We performed a bilateral inguinal radical orchiectomy, with the pathologic exam diagnosing bilateral seminoma. Adjuvant lumbar-aortic radiotherapy was initiated. More than a year after the surgery the patient is asymptomatic and without evidence of disease, although dependent of testosterone supplement.RESULTS: Germ cell testicular neoplasias are more frequent in young men between 15 and 35 years old. There is a 2-3% incidence of bilateral neoplasm, either synchronous or metachronous. Bilateral radical orchiectomy remains as standard of treatment, rendering the patient infertile and depending on exogenous androgens, which causes several psychological problems. However, a testis-sparing surgery could be performed in selected cases; our patient, having multiple bilateral neoplasias, was not eligible for this procedure. With a great incidence of carcinoma in situ on spared testicular parenchyma, scrotal radiotherapy is indicated. In spite of infertility, this treatment presents very good oncological results with androgen independence and consequent physical and psychological advantages.CONCLUSION: Bilateral orchiectomy still remains as “gold-standard” treatment for bilateral seminoma. However, there are other possibilities of treatment, such as partial orchiectomy, feasible in selected cases of small volume testicular tumours in solitary testis / bilateral tumour in men without preoperative androgen deficiency and who could be object of close clinical and imaging follow-up. This way you could avoid additional loss of quality of life, without any prejudice on oncological results(AU)

[Surgical treatment of vesicourethral reflux in paediatric population]. / Tratamento cirúrgico do refluxo vesico-ureteral na população pediátrica.

BACKGROUND: Early diagnosis and adequate follow-up are fundamental principals for the treatment of vesicourethral reflux in children. The treatment options in these cases remain an individual choice based on multiple factors. OBJECTIVE: To determine and compare the effectiveness of two different surgical techniques (endoscopic and conventional) used on vesicourethral reflux treatment. METHODOLOGY: Cohort study, based on the clinical files of children and adolescents submitted to surgical treatment of vesicourethral reflux, between the 1st January of 2000 and 30th April 2006. The study included one year period of follow-up. Multiple variables with a presumable influence on the therapeutic option were analysed. In cases of surgical treatment, effectiveness and safety of the surgical technique where determined. RESULTS: Included 46 children and adolescents, in a total of 68 refluxive units. Thirty seven of all renal units, where submitted to endoscopic treatment: the success rate with one injection of Deflux® was 62% (IC 95% [0.46; 0.78]), increasing for 78% (IC 95% [0.65; 0.91]) when the second injection was performed. Thirty seven renal units were submitted to open surgery: Cohen procedure in 21 patients and nefrourethrectomy in two cases. Excluding the nefrourethrectomy, the classical surgery had a success rate of 97% (IC 95% [0.91; 1]). The reason between probabilities of success, considering endoscopic surgery vs. conventional surgery was 0,8 (IC 95% [0.68; 0.97]). Registered thirteen complications, most of them (85%) after conventional surgery. DISCUSSION: The high complication rates determined for conventional surgery could justify the frequent option for endoscopic surgery in small centres, despite its lower success rates. CONCLUSION: This study confirms that this therapeutic option establishes a good commitment between prophylaxis safety and classical surgery effectiveness.