Primary Small Cell Neuroendocrine Tumor Within a Urethral Diverticulum.

BACKGROUND: Primary small cell neuroendocrine carcinoma of the urinary tract is a very rare cancer, accounting for fewer than 0.5% of urinary tract tumors. These are aggressive neoplasms with high rates of metastases. Urethral diverticula can be found in up to 6% of women. CASE: A 31-year-old woman presented with a clear vaginal discharge and an anterior vaginal wall mass that was thought to be a recurrent cyst. After surgical dissection, she was noted to have a urethral diverticulum with a solid nodule at the base. Final pathology showed a high-grade small cell neuroendocrine carcinoma. CONCLUSION: Malignancy in a urethral diverticulum can occur in young patients. Clinicians should be aware of this possibility when choosing to manage urethral lesions expectantly.

Societal and physician perspectives on sinonasal diagnosis and treatment.

BACKGROUND: Sinusitis is diagnosed in 31 million individuals annually and has a significant impact on health care expenditures. Otolaryngologists understand that patient expectations, health knowledge, and the use of therapeutic options by patients and primary care physicians (PCPs) vary greatly. The intent of this study was to elucidate differences in the perspectives of patients, PCPs and otolaryngologists regarding the diagnosis and treatment of sinonasal disease. METHODS: Three surveys were developed with questions targeting sinonasal infections: specifically, prevalence, diagnosis, physician prescribing patterns, treatment alternatives, and referral patterns to tertiary level physicians. Surveys were distributed to adult patients (n = 113) at general health fairs, whereas surveys for PCPs (n = 54) and otolaryngologists (n = 40) were obtained from teaching conferences and professional networking events. RESULTS: In a description of viral upper respiratory tract infections (URIs), 43% of patients attributed symptoms to allergic rhinitis, 28% to URIs, and 28% to sinus infections. Despite this, 37% of patients still expected anti-bacterial agents. In patients with acute rhinosinusitis (ARS), 44% of patients would wait <1 week to see a physician whereas 82% of otolaryngologists and 57% of PCPs felt waiting 1 week or more was appropriate. In an ambulatory care setting, 45% of PCPs would chose to treat patients with 5 days of ARS symptoms whereas 32% of otolaryngologists would treat patients (p = .22). For ARS, 70% of patients expected antibiotics. Seventy percent of PCPs stated that they would refer a patient to an otolaryngologist after a single episode of sinusitis. CONCLUSION: Patients with sinonasal symptoms confuse URIs for sinusitis and expect unnecessary treatment with antibiotics. PCPs and otolaryngologists vary regarding indications for presentation to a physician, approaches to therapy, and indications for referral to a tertiary provider in their respective practices.