Adenosquamous carcinoma of the prostate.

We present an unusual variant of prostatic adenocarcinoma with obvious squamous differentiation. The squamous component is represented by cells that contain vesicular or hyperchromatic nuclei and large acidophilic cytoplasm. We could demonstrate immunohistochemically the presence of prostate specific antigen (PSA) and glial fibrillary acidic protein (GFAP) in these tumour cells. Either in adenocarcinomatous or malignant squamous components, the prostatic epithelial cells showed the two markers, namely PSA, GFAP, which may reflect the multidirectional differentiation of these cells from a pluripotent origin.

Cells in various benign and malignant conditions of the human prostate express different antigenic phenotypes.

Prostatic epithelium basically consists of secretory-luminal, basal and endocrine-paracrine cells. Immunohistochemical procedures are frequently used for showing the cells reflecting different differentiations. In this study, 40 prostatic tissue specimens submitted to the Department of Pathology of Inönü University, Research Hospital, between 1991 and 1996 were examined. Half of the cases were diagnosed as cancer and the other half had various benign lesions. Of the cases 22.5% (n = 9) were needle biopsy material whereas the remainder, 47.5% (n = 19), were from prostatectomy and 30% (n = 12) were transurethral resection of the prostate (TURP) specimens. High molecular weight anti-cytokeratin antibodies (HMW anti-cytokeratin) stained basal cells both in all normal prostatic tissue and benign prostatic lesions, but in the majority of cancers (70%, n = 14) negative immunoreactivity was seen. Nevertheless, in some of the cancer cases (30%, n = 6) basal cell anti-cytokeratin staining was shown. Negative immunoreactivity with HMW anti-cytokeratin is important in distinguishing between malignant and benign lesions, whereas positive staining is not every time in favour of benign lesions. With the usage of prostate specific antigen (PSA) it was seen that all of the malignant and benign prostatic lesions stained positively. Basal cells in hyperplastic glands were not stained with this stain. Irregular, and in some areas, intense (PSA) immunoreactivity is present in precancerous and malignant lesions. Endocrine cells, which are represented with Chromogranin-A (Chr-A) immunoreactivity and reflecting neuroendocrine differentiation, are present in 75% (n = 15) of benign lesions and in 50% (n = 10) of cancer cases. It was thought that the lesser number of these cells in neoplastic lesions in comparison to the non-tumoral lesions is correlated with the disorder of mechanism that regulates the cell growth. Both in neoplastic and non-tumoral tissues the prostatic epithelial cells showed the three markers, namely HMW anti-cytokeratin, PSA, and Chr-A, which may reflect the multidirectional differentiation of these cells from a pluripotent origin.

Distal hypospadias repair with meatal-based flaps on an outpatient basis.

We report the results of primary repairs that were performed on 52 consecutive patients with distal hypospadias as an outpatient procedure. A modified Mathieu repair with meatal-based vascularized flap was performed under 2.5 optical magnification using Scottring retractors, traction sutures, micro instruments and fine suture material. A total of 3 patients had complications that required reoperation (5.8%). One of these 3 complications was a urethrocutaneous fistula (1.9%). We found that the repair of distal hypospadias was successful with meatal-based flap using contemporary finer approaches and equipment.

Impalpable prostate cancer: clinicopathological features.

OBJECTIVE: To determine the clinicopathological features of impalpable prostate cancer. PATIENTS, MATERIALS AND METHODS: The numbers of T1a and T1b cancers detected in transurethral resections of the prostate (TURP) performed before and after the advent of the test for serum prostate-specific antigen (PSA) were compared and the incidence of T1 disease in specimens from 400 consecutive radical prostatectomies examined. RESULTS: The incidence of T1b disease detected at TURP decreased significantly between the periods examined, but that of T1a was unaffected. Similarly, in radical prostatectomy specimens, T1b cancers were largely replaced by T1c and impalpable T2 cancers detected by ultrasonography. CONCLUSIONS: Cancers detected incidentally at TURP tend to be small T1a tumours, possibly suitable for conservative management. T1b cancers are likely to be detected by PSA level and treated radically. T1c and impalpable T2 cancers are morphologically unlike T1b disease and justifiably belong in separate stages in the current UICC staging system.

Retroperitoneoscopic bilateral spermatic vein ligation.

An alternative method for bilateral spermatic vein ligation is presented. With a retroperitoneoscopic approach, the vascular structures are clearly identified, and damage to the intraperitoneal organs, spermatic arteries and lymphatics is minimized. We believe that the potential complications of transperitoneal laparoscopic techniques may be decreased with a retroperitoneoscopic approach.